Spectrum Clinical Research (India)

Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management.

&lt;p&gt;A multi-span cable stayed bridge is proposed over river Wainganga to re-establish the state highway link from Bhandara to Butibori. The location of the bridge is an important tourist and pilgrimage destination with lush green surroundings and backwaters of Gosekhurd Dam. The bridge has an overall length of 705m and deck width of 15.25m to accommodate 2 lanes of vehicular traffic and 3m+3m footpath for pedestrians. The structural arrangement of the bridge comprises 2 modules, with Module 1 of 420m and Module 2 of 280m length with span arrangements of 70m+140m+140m+70m and 70m+140m+70m respectively. The superstructure is cable stayed with RCC deck ladder type with an RCC pylon height of 30m above deck level. The pylon P3 at the center of the bridge is also proposed with Viewing Gallery 40m above deck level which is structurally independent from the main bridge. The Module 1 of the bridge is constructed by cantilever method for pylon P2 and anchored span method for pylon P1 and P3. The Module 2 of the bridge is constructed on staging. This paper discusses the design and construction aspects of the bridge along with staged construction analysis. This is one of the very few cable stayed bridges in India where all 3 methods of construction of a cable stayed superstructure are adopted in the same bridge.&lt;/p&gt;

&lt;p&gt;A multi-span cable stayed bridge is proposed over river Wainganga to re-establish the state highway link from Bhandara to Butibori. The location of the bridge is an important tourist and pilgrimage destination with lush green surroundings and backwaters of Gosekhurd Dam. The bridge has an overall length of 705m and deck width of 15.25m to accommodate 2 lanes of vehicular traffic and 3m+3m footpath for pedestrians. The structural arrangement of the bridge comprises 2 modules, with Module 1 of 420m and Module 2 of 280m length with span arrangements of 70m+140m+140m+70m and 70m+140m+70m respectively. The superstructure is cable stayed with RCC deck with an RCC pylon height of 30m above deck level. The pylon P3 at the center of the bridge is also proposed with Viewing Gallery 40m above deck level which is structurally independent from the main bridge. The Module 1 of the bridge is constructed by cantilever method for pylon P2 and anchored span method for pylon P1 and P3. The Module 2 of the bridge is constructed on staging. This presentation discusses the design and construction aspects of the bridge along with staged construction analysis. This is one of the very few cable stayed bridges in India where all 3 methods of construction of a cable stayed superstructure are adopted in the same bridge.&lt;/p&gt;

&lt;p&gt;Road Network of Himachal Pradesh, a northern state in India requires number of long span bridges across valleys and rivers due to its hilly terrain. One such bridge across river Beas at Hanogi has a total length of 119.2m. Proposed span arrangement at the location of this bridge is&lt;/p&gt;&lt;p&gt;97.2m + 22m. National Highway (NH-3) runs perpendicular to the bridge. The bridge is located in a constrained location with approach road on one side and a hillock with NH-3 at its toe on the other side. It was proposed to build an extradosed bridge of span 97.2m with pylon only on abutment A2 side and back stay cables anchored in hillock formed of rock.&lt;/p&gt;&lt;p&gt;This paper presents design aspects of the extradosed superstructure and cables, back stay anchors, Abutment A2 and staged construction analysis. The construction of the bridge is carried out by cantilever method with form traveler. This paper also covers construction methodology of the superstructure, ground Improvement and stability check at abutment A2 and Hillock where the stays are anchored.&lt;/p&gt;&lt;p&gt;This is one of the unique extradosed bridge where long span on one side is supported by cables on single pylon and back stay cables are anchored to the rock.&lt;/p&gt;

&lt;p&gt;Road Network of Himachal Pradesh, a northern state in India requires number of long span bridges across valleys and rivers due to its hilly terrain. One such bridge across river Beas at Hanogi has a total length of 119.2m. Proposed span arrangement at the location of this bridge is 97.2m + 22m. National Highway (NH-3) runs perpendicular to the bridge. The bridge is located in a constrained location with approach road on one side and a hillock with NH-3 at its toe on the other side. It was proposed to build an extradosed bridge of span 97.2m with pylon only on abutment A2 side and back stay cables anchored in hillock formed of rock.&lt;/p&gt;&lt;p&gt;This paper presents design aspects of the extradosed superstructure and cables, Back stay anchors, Abutment A2, staged construction analysis. The construction of the bridge is carried out by cantilever method with form traveller. This paper also covers construction methodology of the superstructure, ground Improvement and stability check at abutment A2 and Hillock where the stays are anchored.&lt;/p&gt;&lt;p&gt;This is one of the unique extradosed bridge where long span on one side is supported by cables on single pylon and back stay cables are anchored to the rock.&lt;/p&gt;

Endometriosis is a benign gynecological condition characterized by increased growth, inflammation, invasion, and angiogenesis, partly regulated by a class of enzymes called matrix metalloproteinases (MMPs). The importance of a few MMPs, e.g., MMP-9, -3, and -7 has been studied in endometriosis progression. Although MMP-13 plays an essential role in bone regeneration and cancer, no report has been found on the part of MMP-13 and endometriosis progression. We found the upregulation of MMP-13 expression and activity in patients having endometriosis in the eastern Indian population. In addition, the -77A/G polymorphism of the MMP13 promoter (rs: 2252070) is associated with regulating transcription and subsequent susceptibility to disease. In eastern Indian case-control groups, the effect of the -77A/G single-nucleotide polymorphism on MMP13 promoter activity and its relationship with endometriosis susceptibility was studied. The AG genotype was shown to be more predisposed to endometriosis risk than the GG genotype (p:0.02; odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.10-2.49), also AG genotype was more frequent in late-stage patients compared to early-stage (p: 0.03, OR: 2.0, 95% CI: 1.09-3.66). Furthermore, the MMP13 gene levels were greater in AA compared to GG individuals. Additionally, MMP13 promoter-reporter experiments in cultured endometrial epithelial cells and in silico analyses both demonstrated increased transcriptional activity near the G to A transition under basal/IL-1β -induced/c-FOS overexpressed condition. Overall, c-FOS tighter binding to the A allele-carrying promoter enhances MMP13 transcription, which is further amplified by IL-1β due to increased c-FOS phosphorylation, promoting MMP-13 production and endometriosis risk.

To study clinical, surgical characteristics and the relationship between endometriosis lesion types and conception rate after surgery in infertile women with endometriosis. A prospective, multicenter cohort of 204 women (age 20-35years) with endometriosis was followed up post-surgery between November 2017 and February 2020 at three tertiary-care hospitals. Based on the severity of endometriosis lesion type, deep infiltrating endometriosis (DIE) (81/204, 39.7%) was the most common lesion; followed by ovarian endometriosis (OMA) (64/204, 31.4%), and superficial peritoneal endometriosis (SUP) (59/204, 28.9%). Endometriosis patients had a single lesion type (94/204, 46.1%), two lesion types (77/204, 37.7%), or three lesion types (33/204, 16.2%) with significant differences between regions (P<0.001). Around 40% (37/95) of obese women had SUP (P=0.003) whereas 78% (14/18) of underweight women had DIE (P<0.001). Significant differences in mean Endometriosis Fertility Index scores between endometriosis lesion types and patients with one, two, and three types of lesions were observed (P<0.001). The majority (22/32, 68.8%) of the women conceived naturally after the surgery. Half (16/32; 50%) of the women with a single lesion type conceived after the surgery; of which most (13/16, 81.2%) had SUP, followed by OMA (2/16, 12.5%), and DIE (1/16, 6.3%). Women with SUP and only one type of endometriotic lesion were more likely to conceive post-surgery.

Plants and fungi are a vital part of healthcare. Over 80% of the global population rely on traditional medicine, much of which is based on plant remedies. Traditional Chinese medicine alone uses over 5,000 plant species.&#x0D; There is a healing quality in nature, which has been known for centuries, be it taking time to smell the roses, meditating on a mountain, lying in a wildflower field, strolling by a meandering stream, or hiking in ancient redwood groves. Hippocrates, the father of modern medicine, recognized this powerful attribute in his humbling statement:&#x0D; Nature cures—not the physician. Hippocrates

Endometriosis is characterized by the ectopic development of the endometrium which relies on angiogenesis. Although studies have identified the involvement of different matrix metalloproteinases (MMPs) in endometriosis, no study has yet investigated the role of MMP-2 in endometriosis-associated angiogenesis. The present study aims to understand the regulation of MMP-2 activity in endothelial cells and on angiogenesis during progression of ovarian endometriosis. Histological and biochemical data showed increased expressions of vascular endothelial growth factor (VEGF), VEGF receptor-2, cycloxygenase (COX)-2, von Willebrand factor along with angiogenesis during endometriosis progression. Women with endometriosis showed decreased MMP-2 activity in eutopic endometrium as compared to women without endometriosis. However, ectopic ovarian endometrioma showed significantly elevated MMP-2 activity with disease severity. In addition, increased MT1MMP and decreased tissue inhibitors of metalloproteinases (TIMP)-2 expressions were found in the late stages of endometriosis indicating more MMP-2 activation with disease progression. In vitro study using human endothelial cells showed that prostaglandin E2 (PGE2) significantly increased MMP-2 activity as well as tube formation. Inhibition of COX-2 and/or phosphorylated AKT suppressed MMP-2 activity and endothelial tube formation suggesting involvement of PGE2 in regulation of MMP-2 activity during angiogenesis. Moreover, specific inhibition of MMP-2 by chemical inhibitor significantly reduced cellular migration, invasion and tube formation. In ovo assay showed decreased angiogenic branching upon MMP-2 inhibition. Furthermore, a significant reduction of lesion numbers was observed upon inhibition of MMP-2 and COX-2 in mouse model of endometriosis. In conclusion, our study establishes the involvement of MMP-2 activity via COX-2-PGE2-pAKT axis in promoting angiogenesis during endometriosis progression.