1
|
Xholli A, Londero AP, Scovazzi U, Cagnacci A. Elasticity of the Cervix in Relation to Uterus Position. J Clin Med 2024; 13:2572. [PMID: 38731100 PMCID: PMC11084649 DOI: 10.3390/jcm13092572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Strain elastography allows the evaluation of tissue elasticity. Background/Objectives: Tissue elasticity depends on the content and distribution of collagen fibers and is shaped by the applied tensile forces that may differ in uteri with a different angle of flexion of the corpus on the cervix. The objective was to investigate whether the angle of uterine flexion is related to cervical tissue elasticity. Methods: The anterior angle between the longitudinal axis of the uterus corpus and that of the cervix was measured in 275 non-pregnant young women by transvaginal ultrasonography and considered both as an absolute value or categorized as ≤150°, between >150° and ≤210°, and >210°. Strain elastography was used to assess tissue elasticity by placing the probe in the anterior vaginal fornix. Tissue elasticity was evaluated in the middle of the anterior cervical compartment (ACC), in the middle of the posterior cervical compartment (PCC), in the middle portion of the cervical canal (MCC), and at the internal cervical os (ICO). In a sagittal plane MCC was evaluated across the cervical canal, and ACC and PCC at a distance equal between the cervical canal and the outer anterior or posterior part of the cervix. MCC, ACC and PCC were evaluated at equal distance between the ICO and the external cervical os. Elasticity was expressed as a color score ranging from 0.1 (low elasticity) to 3 (high elasticity). Results: The angle of uterine flexion show a negative linear relation with the elasticity of the ACC (p = 0.001) and MCC (p = 0.002) and a positive relation with the elasticity of the PCC (p = 0.054). In comparison to uteri with an angle of flexion of <150°, those with an angle of flexion of >210° had lower elasticity of the ACC (p = 0.001) and MCC (p = 0.001) and higher elasticity of the PCC (p = 0.004). The ACC/PCC and PCC/MCC elasticity ratios were also significantly different (p = 0.001). Conclusions: The angle of uterine flexion is associated with changes in cervix elasticity. Retroflexion is associated with stiffer ACC and MCC and a more elastic PCC. Differences in tissue elasticity suggest structural changes of the cervix that may have implication in variate obstetric and gynecological conditions.
Collapse
Affiliation(s)
- Anjeza Xholli
- Teaching Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino of Genova, 16132 Genova, Italy; (A.X.); (U.S.)
| | - Ambrogio Pietro Londero
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genova, 16132 Genoa, Italy;
| | - Umberto Scovazzi
- Teaching Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino of Genova, 16132 Genova, Italy; (A.X.); (U.S.)
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genova, 16132 Genoa, Italy;
| | - Angelo Cagnacci
- Teaching Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino of Genova, 16132 Genova, Italy; (A.X.); (U.S.)
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DiNOGMI), University of Genova, 16132 Genoa, Italy;
| |
Collapse
|
2
|
Yoshida K. Bioengineering and the cervix: The past, current, and future for addressing preterm birth. Curr Res Physiol 2023; 6:100107. [PMID: 38107784 PMCID: PMC10724223 DOI: 10.1016/j.crphys.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023] Open
Abstract
The uterine cervix plays two important but opposing roles during pregnancy - as a mechanical barrier that maintains the fetus for nine months and as a compliant structure that dilates to allow for the delivery of a baby. In some pregnancies, however, the cervix softens and dilates prematurely, leading to preterm birth. Bioengineers have addressed and continue to address the lack of reduction in preterm birth rates by developing novel technologies to diagnose, prevent, and understand premature cervical remodeling. This article highlights these existing and emerging technologies and concludes with open areas of research related to the cervix and preterm birth that bioengineers are currently well-positioned to address.
Collapse
Affiliation(s)
- Kyoko Yoshida
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN, 55455, USA
| |
Collapse
|
3
|
Shi L, Hu L, Lee N, Fang S, Myers K. Three-Dimensional Anisotropic Hyperelastic Constitutive Model Describing the Mechanical Response of Human and Mouse Cervix. Acta Biomater 2022; 150:277-294. [PMID: 35931278 DOI: 10.1016/j.actbio.2022.07.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022]
Abstract
The mechanical function of the uterine cervix is critical for a healthy pregnancy. During pregnancy, the cervix undergoes significant softening to allow for a successful delivery. Abnormal cervical remodeling is suspected to contribute to preterm birth. Material constitutive models describing known biological shifts in pregnancy are essential to predict the mechanical integrity of the cervix. In this work, the material response of human cervical tissue under spherical indentation and uniaxial tensile tests loaded along different anatomical directions is experimentally measured. A deep-learning segmentation tool is applied to capture the tissue deformation during the uniaxial tensile tests. A 3-dimensional, equilibrium anisotropic continuous fiber constitutive model is formulated, considering collagen fiber directionality, fiber bundle dispersion, and the entropic nature of wavy cross-linked collagen molecules. Additionally, the universality of the material model is demonstrated by characterizing previously published mouse cervix mechanical data. Overall, the proposed material model captures the tension-compression asymmetric material responses and the remodeling characteristics of both human and mouse cervical tissue. The pregnant (PG) human cervix (mean locking stretch ζ=2.4, mean initial stiffness ξ=12 kPa, mean bulk modulus κ=0.26 kPa, mean dispersion b=1.0) is more compliant compared with the nonpregnant (NP) cervix (mean ζ=1.3, mean ξ=32 kPa, mean κ=1.4 kPa, mean b=1.4). Creating a validated material model, which describes the role of collagen fiber directionality, dispersion, and crosslinking, enables tissue-level biomechanical simulations to determine which material and anatomical factors drive the cervix to open prematurely. STATEMENT OF SIGNIFICANCE: In this study, we report a 3D anisotropic hyperelastic constitutive model based on Langevin statistic mechanics and successfully describe the material behavior of both human and mouse cervical tissue using this model. This model bridges the connection between the extracellular matrix (ECM) microstructure remodeling and the macro mechanical properties change of the cervix during pregnancy via microstructure-associated material parameters. This is the first model, to our knowledge, to connect the the entropic nature of wavy cross-linked collagen molecules with the mechanical behavior of the cervix. Inspired by microstructure, this model provides a foundation to understand further the relationship between abnormal cervical ECM remodeling and preterm birth. Furthermore, with a relatively simple form, the proposed model can be applied to other fibrous tissues in the future.
Collapse
Affiliation(s)
- Lei Shi
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Lingfeng Hu
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Nicole Lee
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Kristin Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA.
| |
Collapse
|
4
|
Rehbinder J, Vizet J, Park J, Ossikovski R, Vanel JC, Nazac A, Pierangelo A. Depolarization imaging for fast and non-invasive monitoring of cervical microstructure remodeling in vivo during pregnancy. Sci Rep 2022; 12:12321. [PMID: 35853917 PMCID: PMC9296502 DOI: 10.1038/s41598-022-15852-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/30/2022] [Indexed: 11/12/2022] Open
Abstract
The cervix plays a crucial role in conception, maintenance of pregnancy, and childbirth. The mechanical properties of a pregnant woman's cervix change dramatically during gestation due to a remodeling of its microstructure, necessary for delivery. However, external factors can accelerate this process and lead to prematurity, the primary cause of perinatal mortality worldwide, due to the inefficiency of existing diagnostic methods. This study shows that polarized light is a powerful tool to probe the cervical microstructure during pregnancy. A wide-field multispectral polarimetric imaging system was fabricated to explore in vivo the cervix of full-term pregnant women. The polarimetric properties of the cervix change significantly with pregnancy progression. In particular, a set of several depolarization parameters (intrinsic and extrinsic) showed a strong linear correlation with gestational age in the red part of the visible spectral range. This trend can be attributed, among other things, to a decrease in collagen density and an increase in hydration of cervical connective tissue. Wide field depolarization imaging is a very promising tool for rapid and non-invasive analysis of cervical tissue in vivo to monitor the steady progression of pregnancy, providing the practitioner with useful information to improve the detection of preterm birth.
Collapse
Affiliation(s)
- Jean Rehbinder
- ICube, CNRS, Université de Strasbourg, 67412, Illkirch Cedex, France
| | - Jérémy Vizet
- LPICM, CNRS, Ecole polytechnique, IP Paris, 91128, Palaiseau, France
| | - Junha Park
- LPICM, CNRS, Ecole polytechnique, IP Paris, 91128, Palaiseau, France
| | | | | | - André Nazac
- Department of Gynaecology, Iris Sud Ixelles Hospital, 1050, Ixelles, Belgium
| | - Angelo Pierangelo
- LPICM, CNRS, Ecole polytechnique, IP Paris, 91128, Palaiseau, France.
| |
Collapse
|
5
|
Zhang J, Du M, Fang JI, Lv S, Lou W, Xie Z, Chen Z, Gong X. In vivo evaluation of endometrium through dual-modality intrauterine endoscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:2554-2565. [PMID: 35774306 PMCID: PMC9203095 DOI: 10.1364/boe.453191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
Female infertilities are highly associated with poor endometrial receptivity. A receptive endometrium is generally characterized by the normal uterine cavity, intact endometrial surface, appropriate endometrial thickness, and echo pattern. Acquiring comprehensive structural information is the prerequisite of endometrium assessment, which is beyond the ability of any single-modality imaging method. In this paper, we introduce a custom-made intrauterine dual-modality (OCT/ultrasound) endoscopic imaging system and achieve in vivo imaging of rabbit uteri, for the first time to our knowledge. The endometrial features of the injured uteri in both ultrasonic and OCT images are consistent with their corresponding pathology. The quantified parameters, including uterine thickness and endometrial surface roughness, show the correlation with the endometrial injury degree but with poor performance for injury classification. The combination of these parameters was proved to assess the degrees of endometrial injury more accurately. Our work shows the potential of the dual-modality system to be translated into a clinical tool, providing multiple quantitative imaging information and helping evaluate the endometrial receptivity and diagnose infertility.
Collapse
Affiliation(s)
- Jinke Zhang
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Equal contribution
| | - Meng Du
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang 421001, China
- Equal contribution
| | - JInghui Fang
- Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Equal contribution
| | - Shengmiao Lv
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wenjin Lou
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhihua Xie
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Zhiyi Chen
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang 421001, China
- Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaojing Gong
- Research Center for Biomedical Optics and Molecular Imaging, Shenzhen Key Laboratory for Molecular Imaging, Guangdong Provincial Key Laboratory of Biomedical Optical Imaging Technology, CAS Key Laboratory of Health Informatics, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| |
Collapse
|
6
|
Fang S, McLean J, Shi L, Vink JSY, Hendon CP, Myers KM. Anisotropic Mechanical Properties of the Human Uterus Measured by Spherical Indentation. Ann Biomed Eng 2021; 49:1923-1942. [PMID: 33880632 DOI: 10.1007/s10439-021-02769-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
The mechanical function of the uterus is critical for a successful pregnancy. During gestation, uterine tissue grows and stretches to many times its size to accommodate the growing fetus, and it is hypothesized the magnitude of uterine tissue stretch triggers the onset of contractions. To establish rigorous mechanical testing protocols for the human uterus in hopes of predicting tissue stretch during pregnancy, this study measures the anisotropic mechanical properties of the human uterus using optical coherence tomography (OCT), instrumented spherical indentation, and video extensometry. In this work, we perform spherical indentation and digital image correlation to obtain the tissue's force and deformation response to a ramp-hold loading regimen. We translate previously reported fiber architecture, measured via optical coherence tomography, into a constitutive fiber composite material model to describe the equilibrium material behavior during indentation. We use an inverse finite element method integrated with a genetic algorithm (GA) to fit the material model to our experimental data. We report the mechanical properties of human uterine specimens taken across different anatomical locations and layers from one non-pregnant (NP) and one pregnant (PG) patient; both patients had pathological uterine tissue. Compared to NP uterine tissue, PG tissue has a more dispersed fiber distribution and equivalent stiffness material parameters. In both PG and NP uterine tissue, the mechanical properties differ significantly between anatomical locations.
Collapse
Affiliation(s)
- Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - James McLean
- Department of Electrical Engineering, Columbia University, New York, NY, 10027, USA
| | - Lei Shi
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Joy-Sarah Y Vink
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Christine P Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, 10027, USA
| | - Kristin M Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA.
| |
Collapse
|
7
|
Yan Y, Basij M, Garg A, Varrey A, Alhousseini A, Hsu R, Hernandez-Andrade E, Romero R, Hassan SS, Mehrmohammadi M. Spectroscopic photoacoustic imaging of cervical tissue composition in excised human samples. PLoS One 2021; 16:e0247385. [PMID: 33657136 PMCID: PMC7928441 DOI: 10.1371/journal.pone.0247385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/06/2021] [Indexed: 02/04/2023] Open
Abstract
Objective Cervical remodeling is an important component in determining the pathway of parturition; therefore, assessing changes in cervical tissue composition may provide information about the cervix’s status beyond the measurement of cervical length. Photoacoustic imaging is a non-invasive ultrasound-based technology that captures acoustic signals emitted by tissue components in response to laser pulses. This optical information allows for the determination of the collagen-to-water ratio (CWR). The purpose of this study was to compare the CWR evaluated by using spectroscopic photoacoustic (sPA) imaging in cervical samples obtained from pregnant and non-pregnant women. Methods This cross-sectional study comprised cervical biopsies obtained at the time of hysterectomy (n = 8) and at the scheduled cesarean delivery in pregnant women at term who were not in labor (n = 8). The cervical CWR was analyzed using a fiber-optic light-delivery system integrated to an ultrasound probe. The photoacoustic signals were acquired within the range of wavelengths that cover the peak absorption of collagen and water. Differences in the CWR between cervical samples from pregnant and non-pregnant women were analyzed. Hematoxylin and eosin and Sirius Red stains were used to compare the collagen content of cervical samples in these two groups. Results Eight cervix samples were obtained after hysterectomy, four from women ≤41 years of age and four from women ≥43 years of age; all cervical samples (n = 8) from pregnant women were obtained after 37 weeks of gestation at the time of cesarean section. The average CWR in cervical tissue samples from pregnant women was 18.7% (SD 7.5%), while in samples from non-pregnant women, it was 55.0% (SD 20.3%). There was a significantly higher CWR in the non-pregnant group compared to the pregnant group with a p-value <0.001. A subgroup analysis that compared the CWR in cervical samples from pregnant women and non-pregnant women ≤41 years of age (mean 46.3%, SD 23.1%) also showed a significantly higher CWR (p <0.01). Lower collagen content in the pregnancy group was confirmed by histological analysis, which revealed the loss of tissue composition, increased water content, and collagen degradation. Conclusion The proposed bimodal ultrasound and sPA imaging system can provide information on the biochemical composition of cervical tissue in pregnant and non-pregnant women. Photoacoustic imaging showed a higher collagen content in cervical samples from non-pregnant women as compared to those from pregnant women, which matched with the histological analysis. This novel imaging method envisions a new potential for a sensitive diagnostic tool in the evaluation of cervical tissue composition.
Collapse
Affiliation(s)
- Yan Yan
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Alpana Garg
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Aneesha Varrey
- Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Ali Alhousseini
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan, United States of America
| | - Richard Hsu
- Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, United States of America
| | - Edgar Hernandez-Andrade
- Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, Texas, United States of America
| | - Roberto Romero
- Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
- Detroit Medical Center, Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, United States of America
| | - Sonia S. Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Office of Women’s Health, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, Michigan, United States of America
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
- * E-mail:
| |
Collapse
|
8
|
Chatterjee A, Saghian R, Dorogin A, Cahill LS, Sled JG, Lye S, Shynlova O. Combination of histochemical analyses and micro-MRI reveals regional changes of the murine cervix in preparation for labor. Sci Rep 2021; 11:4903. [PMID: 33649420 PMCID: PMC7921561 DOI: 10.1038/s41598-021-84036-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
The cervix is responsible for maintaining pregnancy, and its timely remodeling is essential for the proper delivery of a baby. Cervical insufficiency, or "weakness", may lead to preterm birth, which causes infant morbidities and mortalities worldwide. We used a mouse model of pregnancy and term labor, to examine the cervical structure by histology (Masson Trichome and Picrosirius Red staining), immunohistochemistry (Hyaluronic Acid Binding Protein/HABP), and ex-vivo MRI (T2-weighted and diffusion tensor imaging), focusing on two regions of the cervix (i.e., endocervix and ectocervix). Our results show that mouse endocervix has a higher proportion of smooth muscle cells and collagen fibers per area, with more compact tissue structure, than the ectocervix. With advanced gestation, endocervical changes, indicative of impending delivery, are manifested in fewer smooth muscle cells, expansion of the extracellular space, and lower presence of collagen fibers. MRI detected three distinctive zones in pregnant mouse endocervix: (1) inner collagenous layer, (2) middle circular muscular layer, and (3) outer longitudinal muscular layer. Diffusion MRI images detected changes in tissue organization as gestation progressed suggesting the potential application of this technique to non-invasively monitor cervical changes that precede the onset of labor in women at risk for preterm delivery.
Collapse
Affiliation(s)
- Antara Chatterjee
- Physiology, University of Toronto, Toronto, Canada
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Rojan Saghian
- Medical Biophysics, University of Toronto, Toronto, Canada
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Canada
| | - Anna Dorogin
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Lindsay S Cahill
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Canada
| | - John G Sled
- Medical Biophysics, University of Toronto, Toronto, Canada
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Canada
- Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Stephen Lye
- Physiology, University of Toronto, Toronto, Canada
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
- Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Oksana Shynlova
- Physiology, University of Toronto, Toronto, Canada.
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.
- Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
| |
Collapse
|
9
|
Qi W, Zhao P, Sun Z, Ma X, Wang H, Wu W, Wen Z, Kisrieva-Ware Z, Woodard PK, Wang Q, McKinstry RC, Cahill AG, Wang Y. Magnetic resonance diffusion tensor imaging of cervical microstructure in normal early and late pregnancy in vivo. Am J Obstet Gynecol 2021; 224:101.e1-101.e11. [PMID: 32668204 DOI: 10.1016/j.ajog.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/06/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical remodeling is an important aspect of birth timing. Before cervical ripening, the collagen fibers are arranged in a closely interweaved network, but during ripening, the fibers become disorganized and the cervix becomes more hydrated. To quantitatively measure cervical remodeling, we need a noninvasive method to monitor changes in cervical collagen fiber organization and hydration in vivo. OBJECTIVE To use diffusion tensor imaging to image and quantify the spatial and temporal differences in cervical microstructure between normal early and late pregnancies. STUDY DESIGN After institutional review board approval and consent, a group of healthy women in early pregnancy (22 patients at 12-14 weeks' gestation) and a group in late pregnancy (27 patients at 36-38 weeks' gestation) underwent magnetic resonance imaging on a Siemens MAGNETOM Vida 3 Tesla unit. Diffusion tensor imaging of the cervix in the axial plane was performed with a two-dimensional single-shot echo planar imaging diffusion-weighted sequence. In early and late pregnancy groups, the differences of the diffusion tensor imaging measures were compared between the subglandular zone and the outer stroma regions of the cervix. In addition, the diffusion tensor imaging measures were compared between the early and late pregnancy groups. Finally, for the late pregnancy group, the diffusion tensor imaging measures were compared between the primipara and multipara groups. RESULTS Diffusion tensor imaging measures of microstructure significantly differed between the subglandular zone and outer stroma regions of the cervix in both early and late pregnancies. In the subglandular zone, fractional anisotropy was lower in the late pregnancy group than in the early pregnancy group (0.37 [0.34-0.42] vs 0.50 [0.43-0.58]; P<.0005), suggesting increased collagen fiber disorganization in this zone. In addition, mean diffusivity was higher in the late pregnancy group than in the early pregnancy group (1.84 [1.73-2.02] mm2/sec×10-3 vs 1.56 [1.42-1.69] mm2/sec×10-3; P=.001), suggesting increased hydration in the subglandular zone. In the outer stroma, neither fractional anisotropy (0.44 [0.40-0.50] vs 0.41 [0.37-0.43]; P=.095) nor mean diffusivity (2.09 [1.92-2.25] mm2/sec×10-3 vs 2.12 [2.04-2.24] mm2/sec×10-3; P=.269) significantly differed between early pregnancy and late pregnancy, suggesting insignificant temporal microstructural changes in this cervical zone. Diffusion tensor imaging measures did not significantly differ between cervixes from primiparous and multiparous women in late pregnancy. CONCLUSION This in vivo study demonstrates that diffusion tensor imaging can noninvasively quantify the microstructural differences in collagen fiber organization and hydration in cervical subregions between early pregnancy and late pregnancy.
Collapse
|
10
|
McLean JP, Fang S, Gallos G, Myers KM, Hendon CP. Three-dimensional collagen fiber mapping and tractography of human uterine tissue using OCT. BIOMEDICAL OPTICS EXPRESS 2020; 11:5518-5541. [PMID: 33149968 PMCID: PMC7587264 DOI: 10.1364/boe.397041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 05/10/2023]
Abstract
Automatic quantification and visualization of 3-D collagen fiber architecture using Optical Coherence Tomography (OCT) has previously relied on polarization information and/or prior knowledge of tissue-specific fiber architecture. This study explores image processing, enhancement, segmentation, and detection algorithms to map 3-D collagen fiber architecture from OCT images alone. 3-D fiber mapping, histogram analysis, and 3-D tractography revealed fiber groupings and macro-organization previously unseen in uterine tissue samples. We applied our method on centimeter-scale mosaic OCT volumes of uterine tissue blocks from pregnant and non-pregnant specimens revealing a complex, patient-specific network of fibrous collagen and myocyte bundles.
Collapse
Affiliation(s)
- James P. McLean
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Shuyang Fang
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - George Gallos
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kristin M. Myers
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| |
Collapse
|
11
|
Lye TH, Marboe CC, Hendon CP. Imaging of subendocardial adipose tissue and fiber orientation distributions in the human left atrium using optical coherence tomography. J Cardiovasc Electrophysiol 2019; 30:2950-2959. [PMID: 31661178 PMCID: PMC6916589 DOI: 10.1111/jce.14255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Background Optical coherence tomography (OCT) has the potential to provide real‐time imaging guidance for atrial fibrillation ablation, with promising results for lesion monitoring. OCT can also offer high‐resolution imaging of tissue composition, but there is insufficient cardiac OCT data to inform the use of OCT to reveal important tissue architecture of the human left atrium. Thus, the objective of this study was to define OCT imaging data throughout the human left atrium, focusing on the distribution of adipose tissue and fiber orientation as seen from the endocardium. Methods and Results Human hearts (n = 7) were acquired for imaging the left atrium with OCT. A spectral‐domain OCT system with 1325 nm center wavelength, 6.5 μm axial resolution, 15 μm lateral resolution, and a maximum imaging depth of 2.51 mm in the air was used. Large‐scale OCT image maps of human left atrial tissue were developed, with adipose thickness and fiber orientation extracted from the imaging data. OCT imaging showed scattered distributions of adipose tissue around the septal and pulmonary vein regions, up to a depth of about 0.43 mm from the endocardial surface. The total volume of adipose tissue detected by OCT over one left atrium ranged from 1.42 to 28.74 mm3. Limited fiber orientation information primarily around the pulmonary veins and the septum could be identified. Conclusion OCT imaging could provide adjunctive information on the distribution of subendocardial adipose tissue, particularly around thin areas around the pulmonary veins and septal regions. Variations in OCT‐detected tissue composition could potentially assist ablation guidance.
Collapse
Affiliation(s)
- Theresa H Lye
- Department of Electrical Engineering, Columbia University, New York, NY
| | - Charles C Marboe
- Department of Pathology, Columbia University Medical Center, New York, NY
| | | |
Collapse
|
12
|
Li W, Narice BF, Anumba DO, Matcher SJ. Polarization-sensitive optical coherence tomography with a conical beam scan for the investigation of birefringence and collagen alignment in the human cervix. BIOMEDICAL OPTICS EXPRESS 2019; 10:4190-4206. [PMID: 31453004 PMCID: PMC6701558 DOI: 10.1364/boe.10.004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 05/19/2023]
Abstract
By measuring the phase retardance of a cervical extracellular matrix, our in-house polarization-sensitive optical coherence tomography (PS-OCT) was shown to be capable of (1) mapping the distribution of collagen fibers in the non-gravid cervix, (2) accurately determining birefringence, and (3) measuring the distinctive depolarization of the cervical tissue. A conical beam scan strategy was also employed to explore the 3D orientation of the collagen fibers in the cervix by interrogating the samples with an incident light at 45° and successive azimuthal rotations of 0-360°. Our results confirmed previous observations by X-ray diffraction, suggesting that in the non-gravid human cervix collagen fibers adjacent to the endocervical canal and in the outermost areas tend to arrange in a longitudinal fashion whereas in the middle area they are oriented circumferentially. PS-OCT can assess the microstructure of the human cervical collagen in vitro and holds the potential to help us better understand cervical remodeling prior to birth pending the development of an in vivo probe.
Collapse
Affiliation(s)
- Wei Li
- Biophotonics Group, Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, S3 7HQ, UK
- Co-first authors with equal contribution
| | - Brenda F. Narice
- Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2SF, UK
- Co-first authors with equal contribution
| | - Dilly O. Anumba
- Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2SF, UK
| | - Stephen J. Matcher
- Biophotonics Group, Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, S3 7HQ, UK
| |
Collapse
|
13
|
Ji X, Yao X, Klenner A, Gan Y, Gaeta AL, Hendon CP, Lipson M. Chip-based frequency comb sources for optical coherence tomography. OPTICS EXPRESS 2019; 27:19896-19905. [PMID: 31503744 DOI: 10.1364/oe.27.019896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/15/2019] [Indexed: 06/10/2023]
Abstract
Optical coherence tomography (OCT) is a powerful interferometric imaging technique widely used in medical fields such as ophthalmology, cardiology and dermatology. Superluminescent diodes (SLDs) are widely used as light sources in OCT. Recently integrated chip-based frequency combs have been demonstrated in numerous platforms and the possibility of using these broadband chip-scale combs for OCT has been raised extensively over the past few years. However, the use of these chip-based frequency combs as light sources for OCT requires bandwidth and power compatibility with current OCT systems and have not been shown to date. Here we generate frequency combs based on chip-scale lithographically-defined microresonators and demonstrate its capability as a novel light source for OCT. The combs are designed with a small spectral line spacing of 0.21 nm which ensure imaging range comparable to commercial system and operated at non-phase locked regime which provide conversion efficiency of 30%. The comb source is shown to be compatible with a standard commercial spectral domain (SD) OCT system and enables imaging of human tissue with image quality comparable to the one achieved with tabletop commercial sources. The comb source also provides a path towards fully integrated OCT systems.
Collapse
|
14
|
Park SY, Singh-Moon RP, Wan EY, Hendon CP. Towards real-time multispectral endoscopic imaging for cardiac lesion quality assessment. BIOMEDICAL OPTICS EXPRESS 2019; 10:2829-2846. [PMID: 31259054 PMCID: PMC6583339 DOI: 10.1364/boe.10.002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 05/08/2023]
Abstract
Atrial fibrillation (Afib) can lead to life threatening conditions such as heart failure and stroke. During Afib treatment, clinicians aim to repress unusual electrical activity by electrically isolating the pulmonary veins (PV) from the left atrium (LA) using radiofrequency ablation. However, current clinical tools are limited in reliably assessing transmurality of the ablation lesions and detecting the presence of gaps within ablation lines, which can warrant repeat procedures. In this study, we developed an endoscopic multispectral reflectance imaging (eMSI) system for enhanced discrimination of tissue treatment at the PV junction. The system enables direct visualization of cardiac lesions through an endoscope at acquisition rates up to 25 Hz. Five narrowband, high-power LEDs were used to illuminate the sample (450, 530, 625, 810 and 940nm) and combinatory parameters were calculated based on their relative reflectance. A stitching algorithm was employed to generate large field-of-view, multispectral mosaics of the ablated PV junction from individual eMSI images. A total of 79 lesions from 15 swine hearts were imaged, ex vivo. Statistical analysis of the acquired five spectral data sets and ratiometric maps revealed significant differences between transmural lesions, non-transmural lesions around the venoatrial junctions, unablated posterior wall of left atrium tissue, and pulmonary vein (p < 0.0001). A pixel-based quadratic discriminant analysis classifier was applied to distinguish four tissue types: PV, untreated LA, non-transmural and transmural lesions. We demonstrate tissue type classification accuracies of 80.2% and 92.1% for non-transmural and transmural lesions, and 95.0% and 92.8% for PV and untreated LA sites, respectively. These findings showcase the potential of eMSI for lesion validation and may help to improve AFib treatment efficacy.
Collapse
Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| | - Rajinder P. Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| | - Elaine Y. Wan
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| |
Collapse
|
15
|
McLean JP, Gan Y, Lye TH, Qu D, Lu HH, Hendon CP. High-speed collagen fiber modeling and orientation quantification for optical coherence tomography imaging. OPTICS EXPRESS 2019; 27:14457-14471. [PMID: 31163895 PMCID: PMC6825605 DOI: 10.1364/oe.27.014457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 05/03/2023]
Abstract
Quantifying collagen fiber architecture has clinical and scientific relevance across a variety of tissue types and adds functionality to otherwise largely qualitative imaging modalities. Optical coherence tomography (OCT) is uniquely suited for this task due to its ability to capture the collagen microstructure over larger fields of view than traditional microscopy. Existing image processing techniques for quantifying fiber architecture, while accurate and effective, are very slow for processing large datasets and tend to lack structural specificity. We describe here a computationally efficient method for quantifying and visualizing collagen fiber organization. The algorithm is demonstrated on swine atria, bovine anterior cruciate ligament, and human cervical tissue samples. Additionally, we show an improved performance for images with crimped fiber textures and low signal to noise when compared to similar methods.
Collapse
Affiliation(s)
- James P. McLean
- Electrical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| | - Yu Gan
- Electrical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| | - Theresa H. Lye
- Electrical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| | - Dovina Qu
- Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| | - Helen H. Lu
- Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| | - Christine P. Hendon
- Electrical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 1300 West 120th Street, New York, NY 10025,
USA
| |
Collapse
|
16
|
Tissue-Specific Optical Mapping Models of Swine Atria Informed by Optical Coherence Tomography. Biophys J 2019; 114:1477-1489. [PMID: 29590604 PMCID: PMC5883619 DOI: 10.1016/j.bpj.2018.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Computational models and experimental optical mapping of cardiac electrophysiology serve as powerful tools to investigate the underlying mechanisms of arrhythmias. Modeling can also aid the interpretation of optical mapping signals, which may have different characteristics with respect to the underlying electrophysiological signals they represent. However, despite the prevalence of atrial arrhythmias such as atrial fibrillation, models of optical electrical mapping incorporating realistic structure of the atria are lacking. Therefore, we developed image-based models of atrial tissue using structural information extracted from optical coherence tomography (OCT), which can provide volumetric tissue characteristics in high resolution. OCT volumetric data of four swine atrial tissue samples were used to develop models incorporating tissue geometry, tissue-specific myofiber orientation, and ablation lesion regions. We demonstrated the use of these models through electrophysiology and photon scattering simulations. Changes in transmural electrical conduction were observed with the inclusion of OCT-derived, depth-resolved fiber orientation. Additionally, the amplitude of optical mapping signals were not found to correspond with lesion transmurality because of lesion geometry and electrical propagation occurring beyond excitation light penetration. This work established a framework for the development of tissue-specific models of atrial tissue derived from OCT imaging data, which can be useful in future investigations of electrophysiology and optical mapping signals with respect to realistic atrial tissue structure.
Collapse
|
17
|
Lye TH, Iyer V, Marboe CC, Hendon CP. Mapping the human pulmonary venoatrial junction with optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2019; 10:434-448. [PMID: 30800491 PMCID: PMC6377904 DOI: 10.1364/boe.10.000434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 05/24/2023]
Abstract
Imaging guidance provided by optical coherence tomography (OCT) could improve the outcomes of atrial fibrillation (AF) ablation by providing detailed structural information of the pulmonary veins, which are critical targets during ablation. In this study, stitched volumetric OCT images of venoatrial junctions from post-mortem human hearts were acquired and compared to histology. Image features corresponding to venous media and myocardial sleeves, as well as fiber orientation and fibrosis, were identified and found to vary between veins. Imaging of detailed tissue architecture could improve understanding of the AF structural substrate within the pulmonary veins and assist the guidance of ablation procedures.
Collapse
Affiliation(s)
- Theresa H. Lye
- Columbia University, 500 W 120th Street, New York, NY 10027, USA
| | - Vivek Iyer
- Columbia University Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Charles C. Marboe
- Columbia University Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | | |
Collapse
|
18
|
Chue-Sang J, Holness N, Gonzalez M, Greaves J, Saytashev I, Stoff S, Gandjbakhche A, Chernomordik VV, Burkett G, Ramella-Roman JC. Use of Mueller matrix colposcopy in the characterization of cervical collagen anisotropy. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-9. [PMID: 30088376 PMCID: PMC8357193 DOI: 10.1117/1.jbo.23.12.121605] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/23/2018] [Indexed: 05/18/2023]
Abstract
Annually, about 15 million preterm infants are born in the world. Of these, due to complications resulting from their premature birth, about 1 million would die before the age of five. Since the high incidence of preterm birth (PTB) is partially due to the lack of effective diagnostic modalities, methodologies are needed to determine risk of PTB. We propose a noninvasive tool based on polarized light imaging aimed at measuring the organization of collagen in the cervix. Cervical collagen has been shown to remodel with the approach of parturition. We used a full-field Mueller matrix polarimetric colposcope to assess and compare cervical collagen content and structure in nonpregnant and pregnant women in vivo. Local collagen directional azimuth was used and a total of eight cervices were imaged.
Collapse
Affiliation(s)
- Joseph Chue-Sang
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Nola Holness
- Florida International University, Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, United States
| | - Mariacarla Gonzalez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Joan Greaves
- Jackson Memorial Hospital, Holtz Children’s Hospital, Miami, Florida, United States
| | - Ilyas Saytashev
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
| | - Susan Stoff
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Viktor V. Chernomordik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Gene Burkett
- University of Miami, Leonard Miller School of Medicine, Department of Obstetrics and Gynecology, Miami, Florida, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
- Address all correspondence to: Jessica C. Ramella-Roman, E-mail:
| |
Collapse
|
19
|
Torquato BGS, Oliveira MS, Juliano GR, Aguiar LS, Juliano GR, Silveira LMD, Espíndula AP, Oliveira LF, Cavellani CL, Oliveira FAD, Teixeira VDPA, Ferraz MLF. Analysis of the collagen fibers on autopsied patients’ uterus with the Acquired Immunodeficiency Syndrome. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to compare the percentage of collagen fibers in the autopsied women’s uterine body and cervix with and without the Acquired Immunodeficiency Syndrome (Aids). Methods: 30 autopsied women’s medical files were selected from 1988 to 2013. 30 fragments of the uterine body and 30 cervix were collected and then divided into two groups, 15 with Aids and 15 without, The quantification of the collagen fibers of the uterine body and cervix was performed on slides stained with picrosirius, using the KS-300® system. Results: the percentage of collagen fibers was lower for cervix (U=336544; p=0.001) and higher for the uterine body (U=308726,5; p=0.004) in the retroviral group when compared to the group without the disease. The percentage was higher for cervix than the uterine body in the group with Aids (t=0,4793; p=0.0031). the same result was found in the group without Aids (t=2,397; p=0.0637). Conclusions: the increase in the percentage of collagen fibers in the uterine body of women with Aids’ indicates an immune response for viral infection and reveals a failure in keeping the infection restricted to the cervix. The interpretation of the histochemical and morphometric parameters can be useful in the diagnosis associated to HIV infection, contributing for clinical improvement and life expectancy.
Collapse
|
20
|
Nallasamy S, Akins M, Tetreault B, Luby-Phelps K, Mahendroo M. Distinct reorganization of collagen architecture in lipopolysaccharide-mediated premature cervical remodeling. Biol Reprod 2018; 98:63-74. [PMID: 29161343 PMCID: PMC5803761 DOI: 10.1093/biolre/iox155] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
Previous work has identified divergent mechanisms by which cervical remodeling is achieved in preterm birth (PTB) induced by hormone withdrawal (mifepristone) or lipopolysaccharide (LPS). Our current study aims to document how collagen architecture is modified to achieve premature cervical remodeling in mice treated with LPS as a model of infection-induced inflammation. Cervices were collected on gestation day (d) 15 from mice with premature cervical ripening induced by LPS and compared to d15 and d18 controls as well as a hormone withdrawal PTB model. Second harmonic generation (SHG) and electron microscopy were utilized for visualization of collagen morphology and ultrastructure. LPS-mediated premature cervical ripening is characterized by unique structural changes in collagen fiber morphology. LPS treatment increased the interfibrillar spacing of collagen fibrils. A preferential disruption of collagen fiber architecture in the subepithelial region compared to midstroma region was evidenced by increased pores lacking collagen signal in SHG images in the LPS-treated mice. Coinciding with this alteration, the infiltration of neutrophils was concentrated in the subepithelial stromal region as compared to midstromal region implicating the potential role of immune cells to extracellular matrix reorganization in inflammation-induced preterm cervical ripening. The current study demonstrates a preferential disorganization of collagen interfibrillar spacing and collagen fiber structure in LPS-mediated ripening.
Collapse
Affiliation(s)
- Shanmugasundaram Nallasamy
- Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Meredith Akins
- Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Breanna Tetreault
- Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kate Luby-Phelps
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mala Mahendroo
- Department of Obstetrics and Gynecology and Green Center for Reproductive Biology Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
21
|
Nott JP, Pervolaraki E, Benson AP, Bonney EA, Pickering JD, Wilkinson N, Simpson N. Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study. BJOG 2017; 125:812-818. [PMID: 29226548 DOI: 10.1111/1471-0528.15002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the microarchitecture of the cervix using high-resolution diffusion tensor (DT) magnetic resonance imaging (MRI). DESIGN Cross-sectional study. SETTING Leeds, UK. SAMPLE Women undergoing hysterectomy for benign pathology. METHODS Ex-vivo DT-MRI measurements were obtained using a 9.4-T Bruker nuclear magnetic resonance (NMR) spectrometer on seven fixed human cervices obtained at hysterectomy. A deterministic fibre-tracking algorithm was used to indirectly visualise underlying fibre organisation. Inter-regional differences in tissue structure were sought using quantitative measurements of diffusion. MAIN OUTCOME MEASURE The identification of an occlusive structure in the region corresponding to the internal cervical os. RESULTS Fibre tracking demonstrated two regions: an outer circular and inner longitudinal layer. The total circumferential tract volume (TV) was greatest in the proximal region of the cervix (TV: proximal, 271 ± 198 mm3 ; middle, 186 ± 119 mm3 ; distal, 38 ± 36 mm3 ). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements were significantly different between regions in all samples (P < 0.0005), indicating greater tract density and organisation towards the internal os. CONCLUSION Fibre tracking infers a system of dense, well-defined, encircling fibres in the proximal region of the cervix, corresponding to the location of the internal os. These findings may provide evidence of specific anatomic microarchitecture within the cervix able to resist intrauterine forces associated with pregnancy. TWEETABLE ABSTRACT Diffusion-tensor MRI derived tractography identified well-defined encircling fibres at the internal os.
Collapse
Affiliation(s)
- J P Nott
- Division of Women's and Children's Health, University of Leeds, Leeds, UK
| | - E Pervolaraki
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - A P Benson
- School of Biomedical Sciences, University of Leeds, Leeds, UK.,Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - E A Bonney
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J D Pickering
- Division of Anatomy, School of Medicine, University of Leeds, Leeds, UK
| | - N Wilkinson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nab Simpson
- Division of Women's and Children's Health, University of Leeds, Leeds, UK
| |
Collapse
|
22
|
Westervelt AR, Fernandez M, House M, Vink J, Nhan-Chang CL, Wapner R, Myers KM. A Parameterized Ultrasound-Based Finite Element Analysis of the Mechanical Environment of Pregnancy. J Biomech Eng 2017; 139:2612939. [PMID: 28303276 DOI: 10.1115/1.4036259] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Indexed: 11/08/2022]
Abstract
Preterm birth is the leading cause of childhood mortality and can lead to health risks in survivors. The mechanical functions of the uterus, fetal membranes, and cervix have dynamic roles to protect the fetus during gestation. To understand their mechanical function and relation to preterm birth, we built a three-dimensional parameterized finite element model of pregnancy. This model is generated by an automated procedure that is informed by maternal ultrasound measurements. A baseline model at 25 weeks of gestation was characterized, and to visualize the impact of cervical structural parameters on tissue stretch, we evaluated the model sensitivity to (1) anterior uterocervical angle, (2) cervical length, (3) posterior cervical offset, and (4) cervical stiffness. We found that cervical tissue stretching is minimal when the cervical canal is aligned with the longitudinal uterine axis, and a softer cervix is more sensitive to changes in the geometric variables tested.
Collapse
Affiliation(s)
- Andrea R Westervelt
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 e-mail:
| | - Michael Fernandez
- Department of Mechanical Engineering, Columbia University, New York, NY 10027 e-mail:
| | - Michael House
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111 e-mail:
| | - Joy Vink
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032 e-mail:
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032 e-mail:
| | - Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032 e-mail:
| | - Kristin M Myers
- Mem. ASME Department of Mechanical Engineering, Columbia University, New York, NY 10027 e-mail:
| |
Collapse
|
23
|
Stanziano A, Caringella AM, Cantatore C, Trojano G, Caroppo E, D’Amato G. Evaluation of the cervix tissue homogeneity by ultrasound elastography in infertile women for the prediction of embryo transfer ease: a diagnostic accuracy study. Reprod Biol Endocrinol 2017; 15:64. [PMID: 28806905 PMCID: PMC5557509 DOI: 10.1186/s12958-017-0283-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/03/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ultrasound elastography is a non-invasive medical imaging technique able to quantitatively characterize the stiffness of a given tissue. It has been shown to predict the risk for cervical insufficiency and preterm delivery, and to allow differentiation of malignancy from normal tissue. The present study sought to evaluate whether cervical tissue dishomogeneity, as assessed by cervical ultrasound elastography, may predict the embryo transfer (ET) ease in infertile women undergoing IVF/ICSI. METHODS We evaluated 154 infertile patients with no history of previous ET or intrauterine insemination. Cervical stiffness was evaluated in six regions of interest (ROI), compared two by two to obtain strain ratio (SR) values. Since a SR value of 1 was suggestive of tissue homogeneity, we computed 1-SR/SR-1 values to obtain a measure of the degree of cervical tissue dishomogeneity that we named "dishomogeneity index" (DI). Ultrasound-guided ET was performed by an expert operator blinded to the results of cervical elastography. The prediction ability of elastography on ET ease was evaluated by binary logistic regression, and the predictive accuracy of the independent variables was quantified with area under the curve (AUC) estimates derived from receiver operating characteristic (ROC) curve. RESULTS ET resulted to be easy in 99 out of 154 patients (64,2%), difficult in 54 patients (35%), and impossible in one. DI values in cervical medial lips region correctly classified 86.9% of patients, according to binary logistic regression, with a sensitivity of 81.4% and a specificity of 89,9%, positive likelihood ratio (LR) 8.07 and negative LR of 0.21. A DI cut-off value of 0.29 predicted a difficulty of ET with a sensitivity of 88,9% and a specificity of 85%. CONCLUSIONS Cervical ultrasound elastography, by allowing the identification of cervical tissue dishomogeneity, may be of help in predicting the ET ease in infertile women candidates to IVF/ICSI.
Collapse
Affiliation(s)
- Antonio Stanziano
- Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano (Ba), Italy
| | - Anna Maria Caringella
- Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano (Ba), Italy
| | - Clementina Cantatore
- Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano (Ba), Italy
| | - Giuseppe Trojano
- 0000 0001 0120 3326grid.7644.1University of Bari, Obstetrics and Gynecology, 70100 BARI (Ba), Italy
| | - Ettore Caroppo
- Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano (Ba), Italy
| | - Giuseppe D’Amato
- Asl Bari, DPT Maternal and Child Health, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano (Ba), Italy
| |
Collapse
|
24
|
Chue-Sang J, Bai Y, Stoff S, Gonzalez M, Holness N, Gomes J, Jung R, Gandjbakhche A, Chernomordik VV, Ramella-Roman JC. Use of Mueller matrix polarimetry and optical coherence tomography in the characterization of cervical collagen anisotropy. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-9. [PMID: 28853246 PMCID: PMC5997002 DOI: 10.1117/1.jbo.22.8.086010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/24/2017] [Indexed: 05/20/2023]
Abstract
Preterm birth (PTB) presents a serious medical health concern throughout the world. There is a high incidence of PTB in both developed and developing countries ranging from 11% to 15%, respectively. Recent research has shown that cervical collagen orientation and distribution changes during pregnancy may be useful in predicting PTB. Polarization imaging is an effective means to measure optical anisotropy in birefringent materials, such as the cervix's extracellular matrix. Noninvasive, full-field Mueller matrix polarimetry (MMP) imaging methodologies, and optical coherence tomography (OCT) imaging were used to assess cervical collagen content and structure in nonpregnant porcine cervices. We demonstrate that the highly ordered structure of the nonpregnant porcine cervix can be observed with MMP. Furthermore, when utilized ex vivo, OCT and MMP yield very similar results with a mean error of 3.46% between the two modalities.
Collapse
Affiliation(s)
- Joseph Chue-Sang
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Yuqiang Bai
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Susan Stoff
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Mariacarla Gonzalez
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Nola Holness
- Florida International University, Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida, United States
| | - Jefferson Gomes
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Ranu Jung
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
| | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Viktor V. Chernomordik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, United States
| | - Jessica C. Ramella-Roman
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
- Address all correspondence to: Jessica C. Ramella-Roman, E-mail:
| |
Collapse
|
25
|
Myers KM, Elad D. Biomechanics of the human uterus. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2017; 9. [PMID: 28498625 DOI: 10.1002/wsbm.1388] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/15/2022]
Abstract
The appropriate biomechanical function of the uterus is required for the execution of human reproduction. These functions range from aiding the transport of the embryo to the implantation site, to remodeling its tissue walls to host the placenta, to protecting the fetus during gestation, to contracting forcefully for a safe parturition and postpartum, to remodeling back to its nonpregnant condition to renew the cycle of menstruation. To serve these remarkably diverse functions, the uterus is optimally geared with evolving and contractile muscle and tissue layers that are cued by chemical, hormonal, electrical, and mechanical signals. The relationship between these highly active biological signaling mechanisms and uterine biomechanical function is not completely understood for normal reproductive processes and pathological conditions such as adenomyosis, endometriosis, infertility and preterm labor. Animal studies have illuminated the rich structural function of the uterus, particularly in pregnancy. In humans, medical imaging techniques in ultrasound and magnetic resonance have been combined with computational engineering techniques to characterize the uterus in vivo, and advanced experimental techniques have explored uterine function using ex vivo tissue samples. The collective evidence presented in this review gives an overall perspective on uterine biomechanics related to both its nonpregnant and pregnant function, highlighting open research topics in the field. Additionally, uterine disease and infertility are discussed in the context of tissue injury and repair processes and the role of computational modeling in uncovering etiologies of disease. WIREs Syst Biol Med 2017, 9:e1388. doi: 10.1002/wsbm.1388 For further resources related to this article, please visit the WIREs website.
Collapse
Affiliation(s)
- Kristin M Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - David Elad
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel.,Department of Biomedical Engineering, Columbia University, New York, NY, USA
| |
Collapse
|
26
|
Qu D, Chuang PJ, Prateepchinda S, Balasubramanian PS, Yao X, Doty SB, Hendon CP, Lu HH. Micro- and Ultrastructural Characterization of Age-Related Changes at the Anterior Cruciate Ligament-to-Bone Insertion. ACS Biomater Sci Eng 2016; 3:2806-2814. [PMID: 33418704 DOI: 10.1021/acsbiomaterials.6b00602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There remains a lack of understanding of the structural changes that occur across the complex, multitissue anterior cruciate ligament (ACL)-to-bone insertion as a function of aging. The objective of this study is to provide a multiscale comparison of matrix properties across the skeletally immature and mature ACL-to-bone insertion. Using complementary imaging methods, micro- and ultrastructural analysis of the insertion revealed that collagen fiber orientation at the interface changes with age, though the degree of collagen organization is maintained over time. These changes are accompanied by a decrease in collagen fibril density and are likely driven by physiological loading. Mineral crystal structure and crystallinity are conserved over time, despite regional differences in crystallinity between the interface and bone. This suggests that mineral chemistry is established early in development and underscores its important functional role. Collectively, these findings provide new insights into interface development and set critical design benchmarks for integrative soft tissue repair.
Collapse
Affiliation(s)
- Dovina Qu
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, 351 Engineering Terrace, MC 8904, New York, New York 10027, United States
| | - Philip J Chuang
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, 351 Engineering Terrace, MC 8904, New York, New York 10027, United States
| | - Sagaw Prateepchinda
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, 351 Engineering Terrace, MC 8904, New York, New York 10027, United States
| | - Priya S Balasubramanian
- Structure-Function Imaging Laboratory, Department of Electrical Engineering, Columbia University, 500 W. 120th Street, 1300 S. W. Mudd Building, MC 4712, New York, New York 10027, United States
| | - Xinwen Yao
- Structure-Function Imaging Laboratory, Department of Electrical Engineering, Columbia University, 500 W. 120th Street, 1300 S. W. Mudd Building, MC 4712, New York, New York 10027, United States
| | - Stephen B Doty
- Analytical Microscopy Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, United States
| | - Christine P Hendon
- Structure-Function Imaging Laboratory, Department of Electrical Engineering, Columbia University, 500 W. 120th Street, 1300 S. W. Mudd Building, MC 4712, New York, New York 10027, United States
| | - Helen H Lu
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, 351 Engineering Terrace, MC 8904, New York, New York 10027, United States
| |
Collapse
|
27
|
Yao W, Gan Y, Myers KM, Vink JY, Wapner RJ, Hendon CP. Collagen Fiber Orientation and Dispersion in the Upper Cervix of Non-Pregnant and Pregnant Women. PLoS One 2016; 11:e0166709. [PMID: 27898677 PMCID: PMC5127549 DOI: 10.1371/journal.pone.0166709] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/02/2016] [Indexed: 11/18/2022] Open
Abstract
The structural integrity of the cervix in pregnancy is necessary for carrying a pregnancy until term, and the organization of human cervical tissue collagen likely plays an important role in the tissue's structural function. Collagen fibers in the cervical extracellular matrix exhibit preferential directionality, and this collagen network ultrastructure is hypothesized to reorient and remodel during cervical softening and dilation at time of parturition. Within the cervix, the upper half is substantially loaded during pregnancy and is where the premature funneling starts to happen. To characterize the cervical collagen ultrastructure for the upper half of the human cervix, we imaged whole axial tissue slices from non-pregnant and pregnant women undergoing hysterectomy or cesarean hysterectomy respectively using optical coherence tomography (OCT) and implemented a pixel-wise fiber orientation tracking method to measure the distribution of fiber orientation. The collagen fiber orientation maps show that there are two radial zones and the preferential fiber direction is circumferential in a dominant outer radial zone. The OCT data also reveal that there are two anatomic regions with distinct fiber orientation and dispersion properties. These regions are labeled: Region 1-the posterior and anterior quadrants in the outer radial zone and Region 2-the left and right quadrants in the outer radial zone and all quadrants in the inner radial zone. When comparing samples from nulliparous vs multiparous women, no differences in these fiber properties were noted. Pregnant tissue samples exhibit an overall higher fiber dispersion and more heterogeneous fiber properties within the sample than non-pregnant tissue. Collectively, these OCT data suggest that collagen fiber dispersion and directionality may play a role in cervical remodeling during pregnancy, where distinct remodeling properties exist according to anatomical quadrant.
Collapse
Affiliation(s)
- Wang Yao
- Department of Mechanical Engineering, Columbia University, New York, NY, United States of America
| | - Yu Gan
- Department of Electrical Engineering, Columbia University, New York, NY, United States of America
| | - Kristin M. Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, United States of America
| | - Joy Y. Vink
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, United States of America
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, United States of America
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, United States of America
- * E-mail:
| |
Collapse
|
28
|
Yoshida K, Mahendroo M, Vink J, Wapner R, Myers K. Material properties of mouse cervical tissue in normal gestation. Acta Biomater 2016; 36:195-209. [PMID: 26961804 DOI: 10.1016/j.actbio.2016.03.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/09/2016] [Accepted: 03/01/2016] [Indexed: 01/04/2023]
Abstract
UNLABELLED An appropriately timed cervical remodeling process is critical for a healthy delivery, yet little is known about the material property changes of the cervix in pregnancy because obtaining human tissue samples is difficult. Rodent models offer advantages including accurately timed pregnant tissues and genetically altered models. Determining the material properties of the mouse cervix, however, is challenging because of its small size and complex geometry. The aim of this study is to quantify cervical material property changes in a normal mouse pregnancy using a microstructurally-inspired porous fiber composite model. We mechanically test intact, whole, gestation-timed mouse cervix by pulling apart tensioned sutures through its inner canal. To interpret our mechanical testing results, we conduct an inverse finite element analysis, taking into account the combined loading state of the thick-walled cylindrical tissue. We fit the material model to previous osmotic swelling data and load-deformation data from this study using a nonlinear optimization scheme, and validate the model by predicting a separate set of deformation data. Overall, the proposed porous fiber composite model captures the mechanical behavior of the mouse cervix in large deformation. The evolution of cervical material parameters indicates that in a normal mouse pregnancy, the cervix begins to soften between day 6 and day 12 of a 19-day gestation period. The material parameter associated with the collagen fiber stiffness decreases from 3.4MPa at gestation day 6 to 9.7e-4MPa at gestation day 18, while the ground substance stiffness decreases from 2.6e-1MPa to 7.0e-4MPa. STATEMENT OF SIGNIFICANCE Accelerated cervical remodeling can lead to extremely premature births. Little is known, however, about the material property changes of the cervix in pregnancy because pregnant human tissue samples are limited. Rodent models overcome this limitation and provide access to gestation-timed samples. Measuring the material property changes of the mouse cervix in pregnancy is challenging due to its small size and complex geometry. Here, we establish a combined experimental and modeling framework. We use this framework to determine the cervical material property changes throughout a normal mouse pregnancy. We present our experimental methods for mechanically testing whole, intact cervical tissue samples. We fit a porous fiber composite material model to the mechanical data and show that the mouse cervix begins to soften between day 6 and day 12 of a 19-day gestation period.
Collapse
|
29
|
Nott JP, Bonney EA, Pickering JD, Simpson NA. The structure and function of the cervix during pregnancy. TRANSLATIONAL RESEARCH IN ANATOMY 2016. [DOI: 10.1016/j.tria.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
30
|
Banerjee S, Chatterjee S, Anura A, Chakrabarty J, Pal M, Ghosh B, Paul RR, Sheet D, Chatterjee J. Global spectral and local molecular connects for optical coherence tomography features to classify oral lesions towards unravelling quantitative imaging biomarkers. RSC Adv 2016. [DOI: 10.1039/c5ra24117k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The biopsy based diagnosis of oral precancers like leukoplakia (OLK) and submucous fibrosis (OSF) as well as squamous cell carcinoma (OSCC) suffers from observer specific variability.
Collapse
Affiliation(s)
- Satarupa Banerjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | - Swarnadip Chatterjee
- Advanced Technology Development Centre
- Indian Institute of Technology
- Kharagpur
- India
| | - Anji Anura
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | | | - Mousumi Pal
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Bhaskar Ghosh
- Department of ENT & Head Neck Surgery
- Medical College
- Kolkata
- India
| | - Ranjan Rashmi Paul
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Debdoot Sheet
- Department of Electrical Engineering
- Indian Institute of Technology
- Kharagpur
- India
| | - Jyotirmoy Chatterjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| |
Collapse
|
31
|
A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth. J Med Life 2016; 9:342-347. [PMID: 27928435 PMCID: PMC5141391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of cervical incompetence is low and the best prophylactic option is progesterone administration.
Collapse
|
32
|
Myers KM, Feltovich H, Mazza E, Vink J, Bajka M, Wapner RJ, Hall TJ, House M. The mechanical role of the cervix in pregnancy. J Biomech 2015; 48:1511-23. [PMID: 25841293 PMCID: PMC4459908 DOI: 10.1016/j.jbiomech.2015.02.065] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 02/28/2015] [Indexed: 01/10/2023]
Abstract
Appropriate mechanical function of the uterine cervix is critical for maintaining a pregnancy to term so that the fetus can develop fully. At the end of pregnancy, however, the cervix must allow delivery, which requires it to markedly soften, shorten and dilate. There are multiple pathways to spontaneous preterm birth, the leading global cause of death in children less than 5 years old, but all culminate in premature cervical change, because that is the last step in the final common pathway to delivery. The mechanisms underlying premature cervical change in pregnancy are poorly understood, and therefore current clinical protocols to assess preterm birth risk are limited to surrogate markers of mechanical function, such as sonographically measured cervical length. This is what motivates us to study the cervix, for which we propose investigating clinical cervical function in parallel with a quantitative engineering evaluation of its structural function. We aspire to develop a common translational language, as well as generate a rigorous integrated clinical-engineering framework for assessing cervical mechanical function at the cellular to organ level. In this review, we embark on that challenge by describing the current landscape of clinical, biochemical, and engineering concepts associated with the mechanical function of the cervix during pregnancy. Our goal is to use this common platform to inspire novel approaches to delineate normal and abnormal cervical function in pregnancy.
Collapse
Affiliation(s)
- Kristin M Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
| | - Helen Feltovich
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Provo, UT, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Edoardo Mazza
- Department of Mechanical and Process Engineering, ETH Zurich, & EMPA Dübendorf, Switzerland
| | - Joy Vink
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY USA
| | - Michael Bajka
- Department of Obstetrics and Gynecology, University Hospital of Zurich, Switzerland
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY USA
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Michael House
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
33
|
Fernandez M, House M, Jambawalikar S, Zork N, Vink J, Wapner R, Myers K. Investigating the mechanical function of the cervix during pregnancy using finite element models derived from high-resolution 3D MRI. Comput Methods Biomech Biomed Engin 2015; 19:404-17. [PMID: 25970655 PMCID: PMC4644115 DOI: 10.1080/10255842.2015.1033163] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Preterm birth is a strong contributor to perinatal mortality, and preterm infants that survive are at risk for long-term morbidities. During most of pregnancy, appropriate mechanical function of the cervix is required to maintain the developing fetus in utero. Premature cervical softening and subsequent cervical shortening are hypothesized to cause preterm birth. Presently, there is a lack of understanding of the structural and material factors that influence the mechanical function of the cervix during pregnancy. In this study we build finite element models of the pregnant uterus, cervix, and fetal membrane based on magnetic resonance imagining data in order to examine the mechanical function of the cervix under the physiologic loading conditions of pregnancy. We calculate the mechanical loading state of the cervix for two pregnant patients: 22 weeks gestational age with a normal cervical length and 28 weeks with a short cervix. We investigate the influence of (1) anatomical geometry, (2) cervical material properties, and (3) fetal membrane material properties, including its adhesion properties, on the mechanical loading state of the cervix under physiologically relevant intrauterine pressures. Our study demonstrates that membrane-uterus interaction, cervical material modeling, and membrane mechanical properties are factors that must be deliberately and carefully handled in order to construct a high quality mechanical simulation of pregnancy.
Collapse
Affiliation(s)
- M. Fernandez
- Columbia University, Department of Mechanical Engineering, 500 W 120 Street, New York, NY, USA
| | - M. House
- Tufts Medical Center, Department of Obstetrics and Gynecology, 800 Washington Street #360, Boston, MA, USA
| | - S. Jambawalikar
- Columbia University Medical Center, Department of Radiology, 622 West 168 Street, PB-1-301, New York, NY, USA
| | - N. Zork
- Columbia University Medical Center, Department of Radiology, 622 West 168 Street, PB-1-301, New York, NY, USA
| | - J. Vink
- Columbia University Medical Center, Department of Radiology, 622 West 168 Street, PB-1-301, New York, NY, USA
| | - R. Wapner
- Columbia University Medical Center, Department of Radiology, 622 West 168 Street, PB-1-301, New York, NY, USA
| | - K. Myers
- Columbia University, Department of Mechanical Engineering, 500 W 120 Street, New York, NY, USA
| |
Collapse
|
34
|
Myers KM, Hendon CP, Gan Y, Yao W, Yoshida K, Fernandez M, Vink J, Wapner RJ. A continuous fiber distribution material model for human cervical tissue. J Biomech 2015; 48:1533-40. [PMID: 25817474 DOI: 10.1016/j.jbiomech.2015.02.060] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
Abstract
The uterine cervix during pregnancy is the vital mechanical barrier which resists compressive and tensile loads generated from a growing fetus. Premature cervical remodeling and softening is hypothesized to result in the shortening of the cervix, which is known to increase a woman׳s risk of preterm birth. To understand the role of cervical material properties in preventing preterm birth, we derive a cervical material model based on previous mechanical, biochemical and histological experiments conducted on nonpregnant and pregnant human hysterectomy cervical tissue samples. In this study we present a three-dimensional fiber composite model that captures the equilibrium material behavior of the tissue in tension and compression. Cervical tissue is modeled as a fibrous composite material, where a single family of preferentially aligned and continuously distributed collagen fibers are embedded in a compressible neo-Hookean ground substance. The total stress in the collagen solid network is calculated by integrating the fiber stresses. The shape of the fiber distribution is described by an ellipsoid where semi-principal axis lengths are fit to optical coherence tomography measurements. The composite material model is fit to averaged mechanical testing data from uni-axial compression and tension experiments, and averaged material parameters are reported for nonpregnant and term pregnant human cervical tissue. The model is then evaluated by investigating the stress and strain state of a uniform thick-walled cylinder under a compressive stress with collagen fibers preferentially aligned in the circumferential direction. This material modeling framework for the equilibrium behavior of human cervical tissue serves as a basis to determine the role of preferentially-aligned cervical collagen fibers in preventing cervical deformation during pregnancy.
Collapse
Affiliation(s)
- Kristin M Myers
- Department of Mechanical Engineering, Columbia University School of Engineering and Applied Science, 500 W. 120th Street, Mudd 220, New York, NY 10027, USA.
| | - Christine P Hendon
- Department of Electrical Engineering, Columbia University School of Engineering and Applied Science, New York, NY, USA
| | - Yu Gan
- Department of Electrical Engineering, Columbia University School of Engineering and Applied Science, New York, NY, USA
| | - Wang Yao
- Department of Mechanical Engineering, Columbia University School of Engineering and Applied Science, 500 W. 120th Street, Mudd 220, New York, NY 10027, USA
| | - Kyoko Yoshida
- Department of Mechanical Engineering, Columbia University School of Engineering and Applied Science, 500 W. 120th Street, Mudd 220, New York, NY 10027, USA
| | - Michael Fernandez
- Department of Mechanical Engineering, Columbia University School of Engineering and Applied Science, 500 W. 120th Street, Mudd 220, New York, NY 10027, USA
| | - Joy Vink
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|