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Sjöstrand S, Evertsson M, Atile E, Andersson R, Svensson I, Cinthio M, Jansson T. Displacement Patterns in Magnetomotive Ultrasound Explored by Finite Element Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:333-345. [PMID: 34802840 DOI: 10.1016/j.ultrasmedbio.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Magnetomotive ultrasound is an emerging technique that enables detection of magnetic nanoparticles. This has implications for ultrasound molecular imaging, and potentially addresses clinical needs regarding determination of metastatic infiltration of the lymphatic system. Contrast is achieved by a time-varying magnetic field that sets nanoparticle-laden regions in motion. This motion is governed by vector-valued mechanical and magnetic forces. Understanding how these forces contribute to observed displacement patterns is important for the interpretation of magnetomotive ultrasound images. Previous studies have captured motion adjacent to nanoparticle-laden regions that was attributed to diamagnetism. While diamagnetism could give rise to a force, it cannot fully account for the observed displacements in magnetomotive ultrasound. To isolate explanatory variables of the observed displacements, a finite element model is set up. Using this model, we explore potential causes of the unexplained motion by comparing numerical models with earlier experimental findings. The simulations reveal motion outside particle-laden regions that could be attributed to mechanical coupling and the principle of mass conservation. These factors produced a motion that counterbalanced the time-varying magnetic excitation, and whose extent and distribution was affected by boundary conditions as well as compressibility and stiffness of the surroundings. Our findings emphasize the importance of accounting for the vector-valued magnetic force in magnetomotive ultrasound imaging. In an axisymmetric geometry, that force can be represented by a simple scalar expression, an oversimplification that rapidly becomes inaccurate with distance from the symmetry axis. Additionally, it results in an underestimation of the vertical force component by up to 30%. We therefore recommend using the full vector-valued force to capture the magnetic interaction. This study enhances our understanding of how forces govern magnetic nanoparticle displacement in tissue, contributing to accurate analysis and interpretation of magnetomotive ultrasound imaging.
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Knaus KR, Handsfield GG, Blemker SS. A 3D model of the soleus reveals effects of aponeuroses morphology and material properties on complex muscle fascicle behavior. J Biomech 2022; 130:110877. [PMID: 34896789 PMCID: PMC8841064 DOI: 10.1016/j.jbiomech.2021.110877] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023]
Abstract
The soleus is an important plantarflexor muscle with complex fascicle and connective tissue arrangement. In this study we created an image-based finite element model representing the 3D structure of the soleus muscle and its aponeurosis connective tissue, including distinct fascicle architecture of the posterior and anterior compartments. The model was used to simulate passive and active soleus lengthening during ankle motion to predict tissue displacements and fascicle architecture changes. Both the model's initial architecture and changes incurred during passive lengthening were consistent with prior in vivo data from diffusion tensor imaging. Model predictions of active lengthening were consistent with axial plane muscle displacements that we measured in eight subjects' lower legs using cine DENSE (Displacement Encoding with Stimulated Echoes) MRI during eccentric dorsiflexion. Regional strains were variable and nonuniform in the model, but average fascicle strains were similar between the compartments for both passive (anterior: 0.18 ± 0.06, posterior: 0.19 ± 0.05) and active (anterior: 0.12 ± 0.05, posterior: 0.13 ± 0.06) lengthening and were two- to three-times greater than muscle belly strain (0.06). We used additional model simulations to investigate the effects of aponeurosis material properties on muscle deformation, by independently varying the longitudinal or transverse stiffness of the posterior or anterior aponeurosis. Results of model variations elucidate how properties of soleus aponeuroses contribute to fascicle architecture changes. Greater longitudinal stiffness of posterior compared to anterior aponeurosis promoted more uniform spatial distribution of muscle tissue deformation. Reduced transverse stiffness in both aponeuroses resulted in larger differences between passive and active soleus lengthening.
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Arduino A, Pettenuzzo S, Berardo A, Salomoni VA, Majorana C, Carniel EL. A Continuum-Tensegrity Computational Model for Chondrocyte Biomechanics in AFM Indentation and Micropipette Aspiration. Ann Biomed Eng 2022; 50:1911-1922. [PMID: 35879583 PMCID: PMC9794536 DOI: 10.1007/s10439-022-03011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022]
Abstract
Mechanical stimuli are fundamental in the development of organs and tissues, their growth, regeneration or disease. They influence the biochemical signals produced by the cells, and, consequently, the development and spreading of a disease. Moreover, tumour cells are usually characterized by a decrease in the cell mechanical properties that may be directly linked to their metastatic potential. Thus, recently, the experimental and computational study of cell biomechanics is facing a growing interest. Various experimental approaches have been implemented to describe the passive response of cells; however, cell variability and complex experimental procedures may affect the obtained mechanical properties. For this reason, in-silico computational models have been developed through the years, to overcome such limitations, while proposing valuable tools to understand cell mechanical behaviour. This being the case, we propose a combined continuous-tensegrity finite element (FE) model to analyse the mechanical response of a cell and its subcomponents, observing how every part contributes to the overall mechanical behaviour. We modelled both Atomic Force Microscopy (AFM) indentation and micropipette aspiration techniques, as common mechanical tests for cells and elucidated also the role of cell cytoplasm and cytoskeleton in the global cell mechanical response.
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Zhou E, Huang H, Zhao Y, Wang L, Fan Y. The effects of titanium mesh cage size on the biomechanical responses of cervical spine after anterior cervical corpectomy and fusion: A finite element study. Clin Biomech (Bristol, Avon) 2022; 91:105547. [PMID: 34923190 DOI: 10.1016/j.clinbiomech.2021.105547] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Due to the lack of sufficient studies focusing on titanium mesh cage size, there exists a puzzle among surgeons about how to determine the optimal size of cage to provide surgical segments an adequate distraction. METHODS The biomechanical responses of cervical spine after the implantation of cages with different heights and trimmed angles were analyzed using the finite element method. Twenty Anterior Cervical Corpectomy and Fusion models, of which the surgical segment was C5, were developed corresponding to the combinations of 4-different-heights and 5-different-trimmed angle cages. Biomechanical parameters were calculated under simulated physiological load of cervical spine. A rating scale was designed to assess the biomechanical performances of titanium mesh cages with different heights and trimmed angles comprehensively, assisting to select the most appropriate combination of cage height and trimmed angle. FINDINGS It was indicated that in the single-level Anterior Cervical Corpectomy and Fusion at C5 segment, a cage with a height fitting with the space between C4 and C6 as well as a trimmed angle 2° lower than the sagittal angle of C4 inferior endplate would provide adequate biomechanical environment for cervical spine to resist cage subsidence and reduce the impact to adjacent segments. INTERPRETATION The biomechanical responses of cervical spine are affected significantly by the height and trimmed angles of titanium mesh cage. The results of this study would provide quantitative guidance for surgeons to determine the optimal height and trimmed angle of titanium mesh cage for a specific patient in order to achieve favorable clinical outcomes.
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Bori E, Armaroli F, Innocenti B. Biomechanical analysis of femoral stems in hinged total knee arthroplasty in physiological and osteoporotic bone. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106499. [PMID: 34763174 DOI: 10.1016/j.cmpb.2021.106499] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Adequate fixation is a requisite for hinged Total Knee Arthroplasty (TKA): consequently, several stem solutions are currently available. However, there are no evidence-based biomechanical guidelines for surgeons to determine the appropriate stem length and whether to use cemented or press-fit fixation. The objective of this study is therefore to compare, using a validated finite-element model, bone stresses and implant micromotions in different configurations. METHODS The 3D bone geometries were obtained from CT-scans reconstruction and the 3D model components of an Endo-Model Rotating Hinge (WALDEMAR LINK GmbH & Co. KG, Hamburg, Germany) were generated from industrial designs provided by the manufacturer. Sixteen configurations were investigated considering four stem lengths (50, 95, 120, 160 mm), cemented and press-fit fixation and physiological and osteoporotic bone properties. A further configuration without stem was analyzed as control. Average Von-Mises stresses, risk of fracture and micromotions were extracted in several regions of interest at 0° and 90° of flexion, under physiological load conditions. RESULTS Generally, longer stems guarantee better fixation compared to short ones; however, they induce higher stress-shielding effect in the distal region of the femur (even greater for press-fit stems, with values up to 38.5% greater than cemented ones). The cemented configurations, especially in case of 50 mm and 95 mm lengths, induce lower micromotions (down to 16% lower) compared to their respective press-fit configurations. The osteoporotic RF values were greater than the physiological ones (up to 20.5%), but always below the bone limit of fracture. CONCLUSIONS According to this study, when surgeons need to select a femoral stem in a hinged TKA aiming to proper stability and bone stress, the preferable option would be short cemented stems.
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徐 崇, 唐 彬, 曾 夕, 黄 思, 马 骏. [Three-Dimensional Nonlinear Finite Element Modeling and Analysis of Concomitant Atlanto-Occipital Fusion and Atlantoaxial Joint Dislocation]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:121-126. [PMID: 35048611 PMCID: PMC10408867 DOI: 10.12182/20220160203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To establish, with finite element technology, a three-dimensional nonlinear finite element model of the normal occipital bone, atlas and axis and a three-dimensional nonlinear finite element model of concomitant atlanto-occipital fusion and atlantoaxial dislocation, providing a biomechanical method for clinical research on the upper cervical spine. METHODS Finite element analysis was conducted with the CT data of a 27-year-old male volunteer, and a three-dimensional nonlinear finite element model, i.e., the normal model, of the normal occipital bone, atlas and axis was established accordingly. Finite element analysis was conducted with the CT data of a 35-year-old male patient with concomitant atlanto-occipital fusion and atlantoaxial dislocation. Then, the ideal state of a simple ligament rupture under high load was generated by computer simulation, and a three-dimensional nonlinear finite element model of concomitant atlanto-occipital fusion and atlantoaxial dislocation was established, i.e., the atlanto-occipital fusion with atlantoaxial dislocation model. For both models, a vertical upward torque of 1.5 N·m was applied on the upper surface of the occipital bone. Through comparative analysis of the two models under stress, the data of the range of motion (ROM) for flexion, extension, lateral bending, and rotation were examined. In addition, stress and deformation analysis with 1.5 N·m torque load was conducted to validate the effectiveness of the two three-dimensional nonlinear finite element models established in the study. RESULTS When the normal model established in the study was under 1.5 N·m torque load, it exhibited a maximum ROM for each unit of flexion, extension, and the ROM approximated the experimental measurement results of human mechanics, confirming the validity of the simulation. The stress and deformation results of the model were consistent with the basic principles of mechanics. The moment-angular displacement of the model showed obvious nonlinear characteristics. Compared with the normal model, the atlanto-occipital fusion with atlantoaxial dislocation model showed reduced ROM of the atlanto-occipital joint under a torque of 1.5 N·m, while the ROM of the C1-C2 joint for the four conditions of flexion, posterior extention, lateral bending, and rotation under load, with the exception of rotating motion, was greatly increased compared with that of the normal model, which was in line with the actual clinical performance of the patient. CONCLUSION The atlanto-occipital fusion with atlantoaxial dislocation model and the three-dimensional nonlinear finite element model of the normal occipital bone, atlas and axis were successfully established by finite element technology. The models had valid simulation and reliable kinematic characteristics, and could be used as a reliable tool to simulate clinical diseases.
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Jafarzadeh E, Soheilifard R, Ehsani-Seresht A. Design optimization procedure for an orthopedic insole having a continuously variable stiffness/shape to reduce the plantar pressure in the foot of a diabetic patient. Med Eng Phys 2021; 98:44-49. [PMID: 34848037 DOI: 10.1016/j.medengphy.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022]
Abstract
Foot ulcers and lower-limb amputations are among the major problems in diabetic patients. Orthopedic insoles can reduce the risk of diabetic foot ulcers in patients through pressure redistribution on the bottom of the foot. The purpose of this study was to propose an optimization method to design the dedicated insoles for diabetic patients in order to decrease the maximum plantar pressure. At first, a three-dimensional finite element model of bones, ligaments and soft tissue of a diabetic patient's foot was created using CT scan images. Then, the foot plantar pressure was calculated by means of a finite element software. Next, the stiffness and shape of a simple flat insole were separately modified to reduce the maximum foot plantar pressure. The optimization method resulted in a dedicated insole design with a continuously variable stiffness/shape within its area that creates a smooth pressure distribution for the patient comfort. The results showed a 40% reduction in the maximum foot pressure, which we attribute to the modification of insole stiffness. In addition, the optimal shape of the proposed insole decreased the maximum plantar pressure by 25% compared to the flat insole.
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Sadeghian SM, Shapiro FD, Shefelbine SJ. Computational model of endochondral ossification: Simulating growth of a long bone. Bone 2021; 153:116132. [PMID: 34329814 DOI: 10.1016/j.bone.2021.116132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/04/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022]
Abstract
Mechanical loading is a crucial factor in joint and bone development. Using a computational model, we investigated the role of mechanics on cartilage growth rate, ossification of the secondary center, formation of the growth plate, and overall bone shape. A computational algorithm was developed and implemented into finite element models to simulate the endochondral ossification for symmetric and asymmetric motion in a generic diarthrodial joint. Under asymmetric loading condition the secondary center ossifies asymmetrically leaning toward the external load and results in tilted growth plate. Also the mechanics seems to have greater influence in the early onset of the ossification of the secondary center rather than later progression of the center. While previous models have simulated select stages of skeletal development, our model can simulate growth and ossification during the entirety of post-natal development. Such computational models of skeletal development may provide insight into specific loading conditions that cause bone and joint deformities, and the required timing for rehabilitative repair.
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Rajaveni SP, Nair IS, Brindha K, Elango L. Finite element modelling to assess the submarine groundwater discharge in an over exploited multilayered coastal aquifer. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:67456-67471. [PMID: 34254236 DOI: 10.1007/s11356-021-15219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
A three-dimensional variable-density finite element model was developed to quantify the impact of groundwater over use on submarine groundwater discharge (SGD). The model was applied to the Arani-Korttalaiyar river basin, north of Chennai, India. This region has an upper unconfined and lower semi-confined aquifer extending up to 30 km inland from the coast and beyond this distance; the two aquifers merge and become a single unconfined aquifer. The model simulated that during the period from 2000 to 2012, the flux of seawater to the aquifer has increased from 17,000 to 24,500 m3/day due to over-exploitation of groundwater from the semi-confined aquifer. Where as in the unconfined aquifer, SGD has been taking place. Scenarios showing the impact of newly constructed managed aquifer recharge structures, 10% additional increase in rainfall recharge, and termination of pumping from five well-fields on the groundwater conditions in the area were studied. The model predicted a SGD of 85,243 m3/day from the unconfined aquifer and 22,414 m3/day from the semi-confined aquifer by the end of 2030. By adopting managed aquifer recharge methods, seawater intrusion (rate of 4,408 m3/day) can be reduced and SGD (rate of 22,414 m3/day) increased. The rate of SGD increase and the movement of seawater to aquifer can be completely prevented in the semi-confined aquifer by adopting these management options by 2030. Findings from this study have enhanced the understanding of SGD and water budget, which can be used by decision-makers for the sustainable management of groundwater resources in coastal aquifers.
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Mechanism of transverse fracture of the skull base caused by blunt force to the mandible. Leg Med (Tokyo) 2021; 54:101996. [PMID: 34864482 DOI: 10.1016/j.legalmed.2021.101996] [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: 08/30/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Transverse fracture of the skull base is common both in the crushing of temporal regions of the skull and in the case of force acting on one temporal region. However, the mechanism of transverse skull base fracture caused by maxillofacial force has not been fully clarified. To provide an injury identification basis for forensic pathologists and clinicians, this paper combines accident reconstruction and finite element analysis methods to study the injury mechanism of an incomplete transverse fracture of skull base after the injured individual's mandible was subjected to violence in a traffic accident. The results show that after the injured individual's mandible was subjected to violence, forces in the direction of the left mandibular fossa and the right mandibular fossa were generated, creating the component forces. The combination of the two forces can produce a crushing effect toward the center of the skull base, as if the left and right temporal regions are being crushed, and the stress is concentrated at the joint of the mandible, the middle cranial fossa and the hypophyseal fossa. When the stress exceeds a certain limit, it will cause a transverse fracture of the skull base.
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Blank JL, Thelen DG, Allen MS, Roth JD. Sensitivity of the shear wave speed-stress relationship to soft tissue material properties and fiber alignment. J Mech Behav Biomed Mater 2021; 125:104964. [PMID: 34800889 PMCID: PMC8666097 DOI: 10.1016/j.jmbbm.2021.104964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/26/2021] [Accepted: 11/06/2021] [Indexed: 01/03/2023]
Abstract
The use of shear wave propagation to noninvasively measure material properties and loading in tendons and ligaments is a growing area of interest in biomechanics. Prior models and experiments suggest that shear wave speed primarily depends on the apparent shear modulus (i.e., shear modulus accounting for contributions from all constituents) at low loads, and then increases with axial stress when axially loaded. However, differences in the magnitudes of shear wave speeds between ligaments and tendons, which have different substructures, suggest that the tissue's composition and fiber alignment may also affect shear wave propagation. Accordingly, the objectives of this study were to (1) characterize changes in the apparent shear modulus induced by variations in constitutive properties and fiber alignment, and (2) determine the sensitivity of the shear wave speed-stress relationship to variations in constitutive properties and fiber alignment. To enable systematic variations of both constitutive properties and fiber alignment, we developed a finite element model that represented an isotropic ground matrix with an embedded fiber distribution. Using this model, we performed dynamic simulations of shear wave propagation at axial strains from 0% to 10%. We characterized the shear wave speed-stress relationship using a simple linear regression between shear wave speed squared and axial stress, which is based on an analytical relationship derived from a tensioned beam model. We found that predicted shear wave speeds were both in-range with shear wave speeds in previous in vivo and ex vivo studies, and strongly correlated with the axial stress (R2 = 0.99). The slope of the squared shear wave speed-axial stress relationship was highly sensitive to changes in tissue density. Both the intercept of this relationship and the apparent shear modulus were sensitive to both the shear modulus of the ground matrix and the stiffness of the fibers' toe-region when the fibers were less well-aligned to the loading direction. We also determined that the tensioned beam model overpredicted the axial tissue stress with increasing load when the model had less well-aligned fibers. This indicates that the shear wave speed increases likely in response to a load-dependent increase in the apparent shear modulus. Our findings suggest that researchers may need to consider both the material and structural properties (i.e., fiber alignment) of tendon and ligament when measuring shear wave speeds in pathological tissues or tissues with less well-aligned fibers.
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Liu T, Ead M, Cruz SDV, Jomha N, Adeeb S, El-Rich M, Duke K, Westover L. Polycarbonate-urethane coating can significantly improve talus implant contact characteristics. J Mech Behav Biomed Mater 2021; 125:104936. [PMID: 34749205 DOI: 10.1016/j.jmbbm.2021.104936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022]
Abstract
Talus implants can be utilized in cases of talus avascular necrosis and has been regarded as a promising treatment method. However, existing implants are made of stiff materials that directly oppose natural cartilage. The risk of long-term cartilage wear and bone fracture from the interaction between the cartilage and stiff implant surfaces has been documented in post-hemiarthroplasty of the hip, knee and ankle joints. The aim is to explore the effects of adding a layer of compliant material (polycarbonate-urethane; PCU) over a stiff material (cobalt chromium) in talus implants. To do so, we obtained initial ankle geometry from four cadaveric subjects in neutral standing to create the finite element models. We simulated seven models for each subject: three different types of talus implants, each coated with and without PCU, and a biological model. In total, we constructed 28 finite element models. By comparing the contact characteristics of the implant models with their respective biological model counterparts, our results showed that PCU coated implants have comparable contact area and contact pressure to the biological models, whereas stiff material implants without the PCU coating all have relatively higher contact pressure and smaller contact areas. These results confirmed that adding a layer of compliant material coating reduces the contact pressure and increases the contact area which in turn reduces the risk of cartilage wear and bone fracture. The results also suggest that there can be clinical benefits of adding a layer of compliant material coating on existing stiff material implants, and can provide valuable information towards the design of more biofidelic implants in the future.
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Porter DL, Bradshaw AJ, Nielsen RH, Newell P, Dentinger BTM, Naleway SE. The melanized layer of Armillaria ostoyae rhizomorphs: Its protective role and functions. J Mech Behav Biomed Mater 2021; 125:104934. [PMID: 34773913 DOI: 10.1016/j.jmbbm.2021.104934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Armillaria ostoyae (Romagn.) Herink is a highly pathogenic fungus that uses exploratory, cordlike structures called rhizomorphs to seek out new sources of nutrition, posing a parasitic threat to natural stands of trees, orchards, and vineyards. Rhizomorphs are notoriously difficult to destroy, and this resilience is due in large part to a melanized layer that protects the rhizomorph. While this structure has been previously observed, its structural and chemical defenses are yet to be discerned. Research was conducted on both lab-cultured and wild-harvested rhizomorph samples. While both environments produce rhizomorphs, only the wild-harvested rhizomorphs produced the melanized layer, allowing for direct investigation of its structure and properties. Imaging, chemical analysis, mechanical testing, and finite element modeling were used to understand the defense mechanisms provided by the melanized layer. Imaging showed a porous outer layer in both types of rhizomorphs, though the pores were smaller in the harvested melanized layer. This melanized layer contained calcium, which provides chemical defense against both human and natural control methods, but was absent from cultured samples. Nanoindentation resulted in a larger variance of hardness values for cultured rhizomorphs than for wild-harvested. Finite element analysis proved that the smaller pore structure of the melanized porous layer had the best balance between maximum deformation and resulting permanent deformation. These results allow for a better understanding of the defenses of this pathogenic fungus, which may lead to better control methods.
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Singh G, Gupta S, Chanda A. Biomechanical modelling of diabetic foot ulcers: A computational study. J Biomech 2021; 127:110699. [PMID: 34425420 DOI: 10.1016/j.jbiomech.2021.110699] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 01/13/2023]
Abstract
Diabetic foot problems are widespread globally, resulting in substantial medical, economic, and social challenges for patients and their families. Among diabetic complications, foot ulceration is the most frequent outcome and is more probable to be of neuropathic origin. To date, a plethora of studies has focused on diabetic foot and ulcer prevention. However, limited studies have investigated the biomechanics of diabetic foot post ulceration. In this work, extensive biomechanical modelling of diabetic foot ulcers was attempted. A full-scale foot model was developed using measurements from a human subject, and ulcers of differing sizes and depths were modelled at different plantar sites numerically. Also, the foot model was computationally modified to study the effect of flat foot conditions on the same diabetic ulcers. Standing condition was simulated, and the induced stresses were investigated at the plantar region. The maximum stresses were observed to be similar for all ulcer sizes and depths at the lateral midfoot region of the normal foot. However, the maximum stresses were reported in the lateral heel region for the flat foot, which varied significantly with size and depth. Such results present important information on the foot condition post ulceration and may help identify possibilities of further ulceration in the diabetic foot. These novel findings are anticipated to be indispensable for the development of suitable interventions (e.g., custom orthotics) for diabetic foot ulcer management.
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Zhang X, Wang H, Hao Z. A numerical bone regeneration model incorporating angiogenesis, considering oxygen-induced secretion of vascular endothelial growth factor and vascular remodeling. J Biomech 2021; 127:110656. [PMID: 34416529 DOI: 10.1016/j.jbiomech.2021.110656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/06/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
Angiogenesis is considered playing an important role in bone regeneration. Studies have shown that angiogenesis is affected by biological factors, oxygen tension, and blood flow. In this paper, we propose a bone regeneration model with angiogenesis based on the theories of mechanobiology regulation, vascular network modeling, oxygen-induced secretion of vascular endothelial growth factor (VEGF), and vascular remodeling. The results showed that this model can describe the distribution and concentration of vascular endothelial growth factor induced by oxygen tension during bone regeneration, the growth and remodeling of vascular tissue under the influence of vascular endothelial growth factor and mechanical loading, and the correspondence between vascular tissue and bone regeneration.
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Gujar AN, Shivamurthy PG, Sabrish S. Effect of 125-150 Hz Vibrational Frequency Electric Toothbrush on Teeth and Supporting Structures: A Finite Element Method Study. J Contemp Dent Pract 2021; 22:1150-1159. [PMID: 35197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM AND OBJECTIVE The aim of this finite element method (FEM) study was to assess the safety of 125-150 Hz vibrational frequency electric toothbrush on teeth and associated structures. MATERIALS AND METHODS A three-dimensional (3D) geometric model of entire skull having maxilla, mandible, and their dentitions was created using a computed tomography (CT) image of a healthy male patient. Linear static analysis was carried out by applying 15 g of force on anterior part of maxilla and mandible from labial and lingual sides each to calculate the primary displacement (sagittal, vertical, and transversal) and principal stress levels generated on the maxillary and mandibular dentition, on the maxilla and mandible and on the whole skull. RESULTS A force of 15 g applied to maxillary anterior teeth from labial side caused a mean deflection of 0.003 mm and stress of 0.004 MPa on the teeth and supporting structures. A force of 15 g applied to maxillary anterior teeth from palatal side caused a mean deflection of 0.017 mm and stress of 0.017 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from labial side caused a mean deflection of 0.078 mm and stress of 0.051 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from lingual side caused a mean deflection of 0.077 mm and stress of 0.051 MPa on the teeth and supporting structures. CONCLUSION For the applied loads and boundary conditions, very small or negligible amount of stresses were observed in maxilla, mandible, and their dentitions. The vibrational frequency of 150 Hz producing 15 g of force did not produce any harmful effects on maxilla, mandible, and their dentitions. Hence, 125-150 Hz of vibrational frequency can be considered optimum. CLINICAL SIGNIFICANCE An electric toothbrush using the vibration of 125-150 Hz produces negligible stress on teeth and associated structures.
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Identifying Factors Associated with Head Impact Kinematics and Brain Strain in High School American Football via Instrumented Mouthguards. Ann Biomed Eng 2021; 49:2814-2826. [PMID: 34549342 PMCID: PMC8906650 DOI: 10.1007/s10439-021-02853-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/13/2021] [Indexed: 01/04/2023]
Abstract
Repeated head impact exposure and concussions are common in American football. Identifying the factors associated with high magnitude impacts aids in informing sport policy changes, improvements to protective equipment, and better understanding of the brain's response to mechanical loading. Recently, the Stanford Instrumented Mouthguard (MiG2.0) has seen several improvements in its accuracy in measuring head kinematics and its ability to correctly differentiate between true head impact events and false positives. Using this device, the present study sought to identify factors (e.g., player position, helmet model, direction of head acceleration, etc.) that are associated with head impact kinematics and brain strain in high school American football athletes. 116 athletes were monitored over a total of 888 athlete exposures. 602 total impacts were captured and verified by the MiG2.0's validated impact detection algorithm. Peak values of linear acceleration, angular velocity, and angular acceleration were obtained from the mouthguard kinematics. The kinematics were also entered into a previously developed finite element model of the human brain to compute the 95th percentile maximum principal strain. Overall, impacts were (mean ± SD) 34.0 ± 24.3 g for peak linear acceleration, 22.2 ± 15.4 rad/s for peak angular velocity, 2979.4 ± 3030.4 rad/s2 for peak angular acceleration, and 0.262 ± 0.241 for 95th percentile maximum principal strain. Statistical analyses revealed that impacts resulting in Forward head accelerations had higher magnitudes of peak kinematics and brain strain than Lateral or Rearward impacts and that athletes in skill positions sustained impacts of greater magnitude than athletes in line positions. 95th percentile maximum principal strain was significantly lower in the observed cohort of high school football athletes than previous reports of collegiate football athletes. No differences in impact magnitude were observed in athletes with or without previous concussion history, in athletes wearing different helmet models, or in junior varsity or varsity athletes. This study presents novel information on head acceleration events and their resulting brain strain in high school American football from our advanced, validated method of measuring head kinematics via instrumented mouthguard technology.
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Xiao S, Li L, Yao J, Wang L, Li K, Yang C, Wang C, Fan Y. Microcracks on the Rat Root Surface Induced by Orthodontic Force, Crack Extension Simulation, and Proteomics Study. Ann Biomed Eng 2021; 49:2228-2242. [PMID: 33686616 DOI: 10.1007/s10439-021-02733-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
Root resorption is a common complication during orthodontic treatment. Microcracks occur on the root surface after an orthodontic force is applied and may be related to the root resorption caused by the orthodontic process. However, the mechanisms underlying root resorption induced by microcracks remain unclear. In this study, a rat orthodontic model was used to investigate the biological mechanisms of root resorption caused by microcracks. First, the first molar was loaded with 0.5-N orthodontic force for 7 days, and microcracks were observed on the root apex surface using a scanning electron microscope. Second, to describe the mechanical principle resulting in microcracks, a finite element model of rat orthodontics was established, which showed that a maximum stress on the root apex can cause microcrack extension. Third, after 7 days of loading in vivo, histological observation revealed that root resorption occurred in the stress concentration area and cementoclasts appeared in the resorption cavity. Finally, proteomics analysis of the root apex area, excluding the periodontal ligament, revealed that the NOX2, Aifm1, and MAPK signaling pathways were involved in the root resorption process. Microcrack extension on the root surface increases calcium ion concentrations, alters the proteins related to root resorption, and promotes cementoclast formation.
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Li XF, Lv ZD, Yin HL, Song XX. Impact of adjacent pre-existing disc degeneration status on its biomechanics after single-level anterior cervical interbody fusion. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106355. [PMID: 34418812 DOI: 10.1016/j.cmpb.2021.106355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Mechanics and biology may be interconnected and amplify each other during disc degeneration. It remains unknown the influence of pre-existing disc degeneration and its impact on adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF). This study aimed to discuss the necessity of including degenerated adjacent segments in single-level ACDF surgery from a biomechanical view. METHODS A poroelastic C2-T1 finite element model was created and validated. A C5-C6 ACDF model was developed based on this normal model. Moderate C4-C5 disc degeneration was created by appropriately modifying the morphology and tissue material properties in this fusion model. Degenerative morphology was modeled based on Thompson's grading system and Walraevens's scoring system for cervical spine, including disc height, whole disc area, nucleus pulposus (NP) area, endplate sclerosis and curvature. Stresses in disc and endplate and loads in facet joint were computed under moment loads in the fusion models with normal and pre-existing degenerative disc condition. RESULTS As for the adjacent disc, the stress values in degenerative condition were 7.41%, 5% and 5.26% larger than that in normal situation during extension, axial rotation and lateral bending motion, respectively. The disc stress changes mainly stemmed from annulus fibrosus (AF) tissue, but not NP. In the endplate, stress values of degeneration status were 4.17, 4.35 and 6.06% larger than that of normal condition under axial rotation, lateral bending and extension. The facet load magnitudes of pre-existing degeneration were 11.28, 11.57, 11.78 and 11.42% greater than that of normal condition in flexion, extension, axial rotation and lateral bending motion. CONCLUSION Pre-existing degenerated disc experience increased biomechanical changes in adjacent segment after single-level ACDF. It may pose a long-term cumulative problem related to biomechanics in cervical spine after fusion. Before surgery, surgeons should be careful about selecting the fusion level.
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Indahlastari A, Albizu A, Kraft JN, O'Shea A, Nissim NR, Dunn AL, Carballo D, Gordon MP, Taank S, Kahn AT, Hernandez C, Zucker WM, Woods AJ. Individualized tDCS modeling predicts functional connectivity changes within the working memory network in older adults. Brain Stimul 2021; 14:1205-1215. [PMID: 34371212 PMCID: PMC8892686 DOI: 10.1016/j.brs.2021.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Working memory decline has been associated with normal aging. The frontal brain structure responsible for this decline is primarily located in the prefrontal cortex (PFC). Our previous neuroimaging study demonstrated a significant change in functional connectivity between the left dorsolateral PFC (DLPFC) and left ventrolateral PFC (VLPFC) when applying 2 mA tDCS in MRI scanner during an N-Back task. These regions were part of the working memory network. The present study is the first study that utilizes individualized finite element models derived from older adults' MRI to predict significant changes of functional connectivity observed from an acute tDCS application. METHODS Individualized head models from 15 healthy older adults (mean age = 71.3 years) were constructed to create current density maps. Each head model was segmented into 11 tissue types: white matter, gray matter, CSF, muscle, blood vessels, fat, eyes, air, skin, cancellous, and cortical bone. Electrodes were segmented from T1-weighted images and added to the models. Computed median and maximum current density values in the left DLPFC and left VLPFC regions of interest (ROIs) were correlated with beta values as functional connectivity metrics measured in different timepoint (baseline, during stimulation) and stimulation condition (active and sham). MAIN RESULTS Positive significant correlations (R2 = 0.523 for max J, R2 = 0.367 for median J, p < 0.05) were found between the beta values and computed current densities in the left DLPFC ROIs for active stimulation, but no significant correlation was found during sham stimulation. We found no significant correlation between connectivity and current densities computed in the left VLPFC for both active and sham stimulation. CONCLUSIONS The amount of current within the left DLPFC ROIs was found positively correlated with changes in functional connectivity between left DLPFC and left VLPFC during active 2 mA stimulation. Future work may include expansion of number of participants to further test the accuracy of tDCS models used to predict tDCS-induced functional connectivity changes within the working memory network.
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Lim J, Dobrev I, Röösli C, Stenfelt S, Kim N. Development of a finite element model of a human head including auditory periphery for understanding of bone-conducted hearing. Hear Res 2021; 421:108337. [PMID: 34470714 DOI: 10.1016/j.heares.2021.108337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 01/18/2023]
Abstract
A three-dimensional finite-element (FE) model of a human head including the auditory periphery was developed to obtain a better understanding of bone-conducted (BC) hearing. The model was validated by comparison of cochlear and head responses in both air-conducted (AC) and BC hearing with experimental data. Specifically, the FE model provided the cochlear responses such as basilar membrane velocity and intracochlear pressure corresponding to BC stimulations applied to the mastoid or the conventional bone-anchored-hearing-aid (BAHA) positions. This is a strength of the model because it is difficult to obtain the cochlear responses from experiments corresponding to the BC stimulation applied at a specific position on the head surface. In addition, there have been few studies based on an FE model that can calculate the head and cochlear responses simultaneously from a BC stimulation. Moreover, in this study, the intracochlear sound pressure at multi-positions along the BM length was calculated and used to clarify the effect of stimulating force direction on the cochlear and promontory velocities in BC hearing. Also, the relationship between BC and AC stimulation and the basilar membrane velocity in the FE model was used to calculate the stimulation level at hearing thresholds which has been investigated only by psychoacoustical methods.
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Du R, Fang L, Peng W, Yang R, Nie S, Xiao H, Gong J, Dai Y, Deng J. Wave front aberrations induced from biomechanical effects after customized myopic laser refractive surgery in finite element model. Int Ophthalmol 2021; 42:81-94. [PMID: 34392473 DOI: 10.1007/s10792-021-02003-9] [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: 12/08/2020] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A customized myopic refractive surgery was simulated by establishing a finite element model of the human eye, after which we studied the wave front aberrations induced by biomechanical effects and ablation profile after wave front-guided LASIK surgery. METHODS Thirty myopia patients (i.e., 60 eyes) without other eye diseases were selected. Their ages, preoperative spherical equivalent, astigmatism, and wave front aberration were then obtained, in addition to the mean spherical equivalent error range - 4 to - 8D. Afterward, wave front-guided customized LASIK surgery was simulated by establishing a finite element eye model, followed by the analysis of the wave front aberrations induced by the surface displacement from corneal biomechanical effects, as well as customized ablation profile. Finally, the preoperative and induced aberrations were statistically analyzed. RESULTS Comatic aberrations were the main wave front abnormality induced by biomechanical effects, and the wave front aberrations induced by the ablation profile mainly included coma and secondary coma, as well as sphere and secondary-sphere aberrations. Overall, the total high-order aberrations (tHOAs), total coma (C31), and sphere ([Formula: see text]) increased after wave front-guided customized LASIK surgery. According to our correlation analyses, coma, sphere, and tHOAs were significantly correlated with decentration. Additionally, the material parameters of ocular tissue were found to affect the postoperative wave front aberrations. When the material parameters of the sclera remained constant but those of cornea increased, the induced wave front aberrations were reduced. CONCLUSION All biomechanical effects of cornea and ablation profile had significant effects on postoperative wave front aberrations after customized LASIK refractive surgery; however, the effects of the ablation profile were more notorious. Additionally, the characteristics of biomechanical materials have influence on the clinical correction effect.
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Ghazi K, Wu S, Zhao W, Ji S. Effective Head Impact Kinematics to Preserve Brain Strain. Ann Biomed Eng 2021; 49:2777-2790. [PMID: 34341899 DOI: 10.1007/s10439-021-02840-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
Conventional kinematics-based brain injury metrics often approximate peak maximum principal strain (MPS) of the whole brain but ignore the anatomical location of occurrence. In this study, we develop effective impact kinematics consisting of peak rotational velocity and the associated rotational axis to preserve not only peak MPS but also spatially detailed MPS. A pre-computed brain response atlas (pcBRA) serves as a common reference. A training dataset (N = 3069) is used to develop a convolutional neural network (CNN) to automate impact simplification. When preserving peak MPS alone, the CNN-estimated effective peak rotational velocity achieves a coefficient of determination ([Formula: see text]) of ~ 0.96 relative to the directly identified counterpart, far outperforming nominal peak velocity from the resultant profiles ([Formula: see text] of ~ 0.34). Impacts from a subset of data (N = 1900) are also successfully matched with pcBRA idealized impacts based on elementwise MPS, where their regression slope and Pearson correlation coefficient do not deviate from 1.0 (when identical) by more than 0.1. The CNN-estimated effective peak rotation velocity and rotational axis are sufficiently accurate for ~ 73.5% of the impacts. This is not possible for the nominal peak velocity or any other conventional injury metric. The performance may be further improved by expanding the pcBRA to include deceleration and focusing on region-wise strains. This study establishes a new avenue to reduce an arbitrary head impact into an idealized but actual "impact mode" characterized by triplets of basic kinematic variables. They retain specific physical interpretations of head impact and may be an advancement over state-of-the-art kinematics-based scalar metrics for more effective impact comparison in the future.
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Bola M, Simões JA, Ramos A. Finite element modelling and experimental validation of a total implanted shoulder joint. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106158. [PMID: 34022497 DOI: 10.1016/j.cmpb.2021.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
Background Replicating a total shoulder arthroplasty in laboratory is a difficult task due to complex geometry of the structures and degrees of freedom of the joint. Implanted joint shoulders have been investigated using numerical tools, but models developed lack of experimental validation. The objective of this study was to develop a finite element model that replicated correctly an experimental simulator of an implanted joint shoulder based on the comparison of measured and calculated strains. The methods used include a non-cemented Anatomical Comprehensive© Total Shoulder System that was implanted in 4th generation composite bones. The finite element model designed replicates adequately the experimental model. Both models included the most important muscles of shoulder abduction and the same boundary conditions (loads, fixation, and interface conditions). Strain gauge rosettes were used to measure strain responses on the shoulder in 90° abduction. The results of linear regression analysis between numerical and experimental results present a high correlation coefficient of 0.945 and a root-mean-square-error of 35 µε, suggesting adequate agreement between the experimental and the numerical models. Small strains were obtained and changes in load distribution from posterior to anterior region were observed. As conclusion we can say that the experiments allowed good replication of the finite element model, and the use of strain gauges is suitable for numerical-experimental validation of bone joints.
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How different the scoliotic curves are? Stud Health Technol Inform 2021. [PMID: 34190060 DOI: 10.3233/shti210434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
The pathomechanism of spinal deformity development in adolescent idiopathic scoliosis (AIS) has been related to the sagittal curvature of the spine. It is not known how the variations in the sagittal profile relates to the coronal deformity patterns in AIS. A total of 70 Lenke 1 and 50 Lenke 5 AIS patients were included retrospectively. A finite element (FE) model was developed for each spine where the sagittal spinal curvatures were modeled as 2D S shaped elastic rods. Transverse plane deformation patterns of these rods under physiological loading were determined and clustered based on their similarities. The patients' characteristics, including the Lenke type, and the spinal measurements in these deformation pattern clusters were statistically compared. Three different axial deformation patterns were determined from the FE simulations of the 120 sagittal curves. Two axial groups were looped shaped in opposing directions (Group I and III) and one was lemniscate shaped (Group II). 94% of the patients in Groups I and II were Lenke 1 and 100% of Group III was Lenke 5. The position of the sagittal inflection point moved downward from Group I-III resulting in significantly different ratio of the arc lengths above and below the sagittal inflection points for Groups I, II and III (0.49±0.59, 1.15±0.44, and 3.22±1.8). A classification of idiopathic scoliosis, based on the biomechanics of S-shaped flexible rods deformation could distinguish between different coronal curve types. The geometrical parameters of the sagittal profiles in the axial deformation pattern groups were significantly different.
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