1
|
Lilley RL, Kabaliuk N, Reynaud A, Devananthan P, Smith N, Docherty PD. A Novel Experimental Approach for the Measurement of Vibration-Induced Changes in the Rheological Properties of Ex Vivo Ovine Brain Tissue. SENSORS (BASEL, SWITZERLAND) 2024; 24:2022. [PMID: 38610233 PMCID: PMC11014318 DOI: 10.3390/s24072022] [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: 11/30/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
Increased incidence of traumatic brain injury (TBI) imposes a growing need to understand the pathology of brain trauma. A correlation between the incidence of multiple brain traumas and rates of behavioural and cognitive deficiencies has been identified amongst people that experienced multiple TBI events. Mechanically, repetitive TBIs may affect brain tissue in a similar way to cyclic loading. Hence, the potential susceptibility of brain tissue to mechanical fatigue is of interest. Although temporal changes in ovine brain tissue viscoelasticity and biological fatigue of other tissues such as tendons and arteries have been investigated, no methodology currently exists to cyclically load ex vivo brain tissue. A novel rheology-based approach found a consistent, initial stiffening response of the brain tissue before a notable softening when subjected to a subsequential cyclic rotational shear. History dependence of the mechanical properties of brain tissue indicates susceptibility to mechanical fatigue. Results from this investigation increase understanding of the fatigue properties of brain tissue and could be used to strengthen therapy and prevention of TBI, or computational models of repetitive head injuries.
Collapse
Affiliation(s)
- Rebecca L. Lilley
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Antoine Reynaud
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- École Nationale Supérieure de Mécanique et des Microtechniques, 25000 Besançon, France
| | - Pavithran Devananthan
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Biomolecular Interaction Centre, Christchurch 8140, New Zealand
| | - Nicole Smith
- Department of Electrical Engineering, University of Canterbury, Christchurch 8140, New Zealand;
| | - Paul D. Docherty
- Department of Mechanical Engineering, University of Canterbury, Christchurch 8140, New Zealand; (R.L.L.); (N.K.); (A.R.); (P.D.)
- Institute for Technical Medicine, Furtwangen University, 78120 Villingen Schwenningen, Germany
| |
Collapse
|
2
|
Rooks TF, Baisden JL, Yoganandan N. Regional brain strain dependance on direction of head rotation. ACCIDENT; ANALYSIS AND PREVENTION 2023; 193:107301. [PMID: 37729748 DOI: 10.1016/j.aap.2023.107301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
Brain injuries in automated vehicles during crash events are likely to include mechanisms of head impact in non-standard positions and postures (i.e., occupants not facing forward in an upright position). Federal regulations currently focus on impact conditions in primary planes of motion, such as frontal or rear impacts (sagittal plane of motion) or side impact (coronal plane of motion) and do not account for out of position occupants or non-standard postures. The objective of the present study was to develop and use the anatomically accurate brain finite element model to parametrically determine the injury metrics under different vectors with head rotation. A custom developed brain finite element model with anatomical accuracy and several anatomical regions defined was used to evaluate whole-brain strain as well as regional brain strain. Cumulative Strain Damage Measure (CSDM) at a threshold of 20% strain and the 95th percentile of the maximum principal strain (MPS95) were calculated for the whole brain and each brain region under multiple rotational directions. The model was exposed to a sinusoidal angular acceleration pulse of 5000 rad per second squared (rad/s2-) over 12.5 ms. The same pulse was used in the primary axes of motion and (lateral bending, flexion, extension, axial rotation) and combined axes representing oblique flexion and oblique extension. Whole brain CSDM20 was highest for lateral bending. Whole brain MPS95 was highest for axial rotation. The rCSDM20 was more susceptible to impact direction, with several brain regions having substantial accumulation of strain for oblique flexion and lateral bending. Comparatively, rMPS95 was more consistent across all rotation directions. The present study quantified the regional brain strain response under multiple rotational vectors identifying a high amount of variability in the accumulation of strain (i.e., CSDM20) in the hypothalamus, hippocampus, and midbrain specifically. While there was a high amount of variability in the accumulation of strain for multiple regions, the maximum strain measured (i.e., MPS95) in the regions was more consistent.
Collapse
Affiliation(s)
- Tyler F Rooks
- Medical College of Wisconsin, Milwaukee, WI, United States.
| | | | | |
Collapse
|
3
|
Rooks TF, Chancey VC, Baisden JL, Yoganandan N. Regional Strain Response of an Anatomically Accurate Human Finite Element Head Model Under Frontal Versus Lateral Loading. Mil Med 2023; 188:420-427. [PMID: 37948232 DOI: 10.1093/milmed/usad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because brain regions are responsible for specific functions, regional damage may cause specific, predictable symptoms. However, the existing brain injury criteria focus on whole brain response. This study developed and validated a detailed human brain computational model with sufficient fidelity to include regional components and demonstrate its feasibility to obtain region-specific brain strains under selected loading. METHODS Model development used the Simulated Injury Monitor (SIMon) model as a baseline. Each SIMon solid element was split into 8, with each shell element split into 4. Anatomical regions were identified from FreeSurfer fsaverage neuroimaging template. Material properties were obtained from literature. The model was validated against experimental intracranial pressure, brain-skull displacement, and brain strain data. Model simulations used data from laboratory experiments with a rigid arm pendulum striking a helmeted head-neck system. Data from impact tests (6 m/s) at 2 helmet sites (front and left) were used. RESULTS Model validation showed good agreement with intracranial pressure response, fair to good agreement with brain-skull displacement, and good agreement for brain strain. CORrelation Analysis scores were between 0.72 and 0.93 for both maximum principal strain (MPS) and shear strain. For frontal impacts, regional MPS was between 0.14 and 0.36 (average of left and right hemispheres). For lateral impacts, MPS was between 0.20 and 0.48 (left hemisphere) and between 0.22 and 0.51 (right hemisphere). For frontal impacts, regional cumulative strain damage measure (CSDM20) was between 0.01 and 0.87. For lateral impacts, CSDM20 was between 0.36 and 0.99 (left hemisphere) and between 0.09 and 0.93 (right hemisphere). CONCLUSIONS Recognizing that neural functions are related to anatomical structures and most model-based injury metrics focus on whole brain response, this study developed an anatomically accurate human brain model to capture regional responses. Model validation was comparable with current models. The model provided sufficient anatomical detail to describe brain regional responses under different impact conditions.
Collapse
Affiliation(s)
- Tyler F Rooks
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Valeta Carol Chancey
- Injury Biomechanics and Protection Group, U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362, USA
| | - Jamie L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| |
Collapse
|
4
|
Lee JW, Song S, Kim Y, Park SB, Han DH. Soccer's AI transformation: deep learning's analysis of soccer's pandemic research evolution. Front Psychol 2023; 14:1244404. [PMID: 37908810 PMCID: PMC10613686 DOI: 10.3389/fpsyg.2023.1244404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction This paper aims to identify and compare changes in trends and research interests in soccer articles from before and during the COVID-19 pandemic. Methods We compared research interests and trends in soccer-related journal articles published before COVID-19 (2018-2020) and during the COVID-19 pandemic (2021-2022) using Bidirectional Encoder Representations from Transformers (BERT) topic modeling. Results In both periods, we categorized the social sciences into psychology, sociology, business, and technology, with some interdisciplinary research topics identified, and we identified changes during the COVID-19 pandemic period, including a new approach to home advantage. Furthermore, Sports science and sports medicine had a vast array of subject areas and topics, but some similar themes emerged in both periods and found changes before and during COVID-19. These changes can be broadly categorized into (a) Social Sciences and Technology; (b) Performance training approaches; (c) injury part of body. With training topics being more prominent than match performance during the pandemic; and changes within injuries, with the lower limbs becoming more prominent than the head during the pandemic. Conclusion Now that the pandemic has ended, soccer environments and routines have returned to pre-pandemic levels, but the environment that have changed during the pandemic provide an opportunity for researchers and practitioners in the field of soccer to detect post-pandemic changes and identify trends and future directions for research.
Collapse
Affiliation(s)
- Jea Woog Lee
- Intelligent Information Processing Lab, Chung-Ang University, Seoul, Republic of Korea
| | - Sangmin Song
- Department of Artificial Intelligence, Chung-Ang University, Seoul, Republic of Korea
| | - YoungBin Kim
- Graduate School of Advanced Imaging Science, Multimedia and Film, Chung-Ang University, Seoul, Republic of Korea
| | - Seung-Bo Park
- Graduate School of Sports Medicine, CHA University, Seongnam-si, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Seoul, Republic of Korea
| |
Collapse
|
5
|
Terpsma R, Carlsen RW, Szalkowski R, Malave S, Fawzi AL, Franck C, Hovey C. Head Impact Modeling to Support a Rotational Combat Helmet Drop Test. Mil Med 2023; 188:e745-e752. [PMID: 34508268 DOI: 10.1093/milmed/usab374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 08/30/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The Advanced Combat Helmet (ACH) military specification (mil-spec) provides blunt impact acceleration criteria that must be met before use by the U.S. warfighter. The specification, which requires a helmeted magnesium Department of Transportation (DOT) headform to be dropped onto a steel hemispherical target, results in a translational headform impact response. Relative to translations, rotations of the head generate higher brain tissue strains. Excessive strain has been implicated as a mechanical stimulus leading to traumatic brain injury (TBI). We hypothesized that the linear constrained drop test method of the ACH specification underreports the potential for TBI. MATERIALS AND METHODS To establish a baseline of translational acceleration time histories, we conducted linear constrained drop tests based on the ACH specification and then performed simulations of the same to verify agreement between experiment and simulation. We then produced a high-fidelity human head digital twin and verified that biological tissue responses matched experimental results. Next, we altered the ACH experimental configuration to use a helmeted Hybrid III headform, a freefall cradle, and an inclined anvil target. This new, modified configuration allowed both a translational and a rotational headform response. We applied this experimental rotation response to the skull of our human digital twin and compared brain deformation relative to the translational baseline. RESULTS The modified configuration produced brain strains that were 4.3 times the brain strains from the linear constrained configuration. CONCLUSIONS We provide a scientific basis to motivate revision of the ACH mil-spec to include a rotational component, which would enhance the test's relevance to TBI arising from severe head impacts.
Collapse
Affiliation(s)
- Ryan Terpsma
- Terminal Ballistics Technology Department 5421, Sandia National Laboratories, Albuquerque, NM 87185, USA
| | - Rika Wright Carlsen
- Department of Engineering, Robert Morris University, Moon Township, PA 15108, USA
| | | | | | - Alice Lux Fawzi
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - Christian Franck
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Chad Hovey
- Terminal Ballistics Technology Department 5421, Sandia National Laboratories, Albuquerque, NM 87185, USA
| |
Collapse
|
6
|
Wang LM, Goodman MB, Kuhl E. Image-based axon model highlights heterogeneity in initiation of damage. Biophys J 2023; 122:9-19. [PMID: 36461640 PMCID: PMC9822833 DOI: 10.1016/j.bpj.2022.11.2946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/29/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Head injury simulations predict the occurrence of traumatic brain injury by placing a threshold on the calculated strains for axon tracts within the brain. However, a current roadblock to accurate injury prediction is the selection of an appropriate axon damage threshold. While several computational studies have used models of the axon cytoskeleton to investigate damage initiation, these models all employ an idealized, homogeneous axonal geometry. This homogeneous geometry with regularly spaced microtubules, evenly distributed throughout the model, overestimates axon strength because, in reality, the axon cytoskeleton is heterogeneous. In the heterogeneous cytoskeleton, the weakest cross section determines the initiation of failure, but these weak spots are not present in a homogeneous model. Addressing one source of heterogeneity in the axon cytoskeleton, we present a new semiautomated image analysis pipeline for using serial-section transmission electron micrographs to reconstruct the microtubule geometry of an axon. The image analysis procedure locates microtubules within the images, traces them throughout the image stack, and reconstructs the microtubule structure as a finite element mesh. We demonstrate the image analysis approach using a C. elegans touch receptor neuron due to the availability of high-quality serial-section transmission electron micrograph data sets. The results of the analysis highlight the heterogeneity of the microtubule structure in the spatial variation of both microtubule number and length. Simulations comparing this image-based geometry with homogeneous geometries show that structural heterogeneity in the image-based model creates significant spatial variation in deformation. The homogeneous geometries, on the other hand, deform more uniformly. Since no single homogeneous model can replicate the mechanical behavior of the image-based model, our results argue that heterogeneity in axon microtubule geometry should be considered in determining accurate axon failure thresholds.
Collapse
Affiliation(s)
- Lucy M Wang
- Department of Mechanical Engineering, Stanford University, Stanford, California.
| | - Miriam B Goodman
- Department of Molecular and Cellular Physiology, Stanford University, Stanford, California
| | - Ellen Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, California
| |
Collapse
|
7
|
Ji S, Ghajari M, Mao H, Kraft RH, Hajiaghamemar M, Panzer MB, Willinger R, Gilchrist MD, Kleiven S, Stitzel JD. Use of Brain Biomechanical Models for Monitoring Impact Exposure in Contact Sports. Ann Biomed Eng 2022; 50:1389-1408. [PMID: 35867314 PMCID: PMC9652195 DOI: 10.1007/s10439-022-02999-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
Head acceleration measurement sensors are now widely deployed in the field to monitor head kinematic exposure in contact sports. The wealth of impact kinematics data provides valuable, yet challenging, opportunities to study the biomechanical basis of mild traumatic brain injury (mTBI) and subconcussive kinematic exposure. Head impact kinematics are translated into brain mechanical responses through physics-based computational simulations using validated brain models to study the mechanisms of injury. First, this article reviews representative legacy and contemporary brain biomechanical models primarily used for blunt impact simulation. Then, it summarizes perspectives regarding the development and validation of these models, and discusses how simulation results can be interpreted to facilitate injury risk assessment and head acceleration exposure monitoring in the context of contact sports. Recommendations and consensus statements are presented on the use of validated brain models in conjunction with kinematic sensor data to understand the biomechanics of mTBI and subconcussion. Mainly, there is general consensus that validated brain models have strong potential to improve injury prediction and interpretation of subconcussive kinematic exposure over global head kinematics alone. Nevertheless, a major roadblock to this capability is the lack of sufficient data encompassing different sports, sex, age and other factors. The authors recommend further integration of sensor data and simulations with modern data science techniques to generate large datasets of exposures and predicted brain responses along with associated clinical findings. These efforts are anticipated to help better understand the biomechanical basis of mTBI and improve the effectiveness in monitoring kinematic exposure in contact sports for risk and injury mitigation purposes.
Collapse
Affiliation(s)
- Songbai Ji
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA.
| | - Mazdak Ghajari
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, ON, N6A 5B9, Canada
| | - Reuben H Kraft
- Department of Mechanical and Nuclear Engineering, Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Marzieh Hajiaghamemar
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Matthew B Panzer
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Remy Willinger
- University of Strasbourg, IMFS-CNRS, 2 rue Boussingault, 67000, Strasbourg, France
| | - Michael D Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Hälsovägen 11C, 141 57, Huddinge, Sweden
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
8
|
American Football Helmet Effectiveness Against a Strain-Based Concussion Mechanism. Ann Biomed Eng 2022; 50:1498-1509. [PMID: 35816264 DOI: 10.1007/s10439-022-03005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/30/2022] [Indexed: 12/23/2022]
Abstract
Brain strain is increasingly being used in helmet design and safety performance evaluation as it is generally considered as the primary mechanism of concussion. In this study, we investigate whether different helmet designs can meaningfully alter brain strains using two commonly used metrics, peak maximum principal strain (MPS) of the whole brain and cumulative strain damage measure (CSDM). A convolutional neural network (CNN) that instantly produces detailed brain strains is first tested for accuracy for helmeted head impacts. Based on N = 144 impacts in 12 impact conditions from three random and representative helmet models, we conclude that the CNN is sufficiently accurate for helmet testing applications, for elementwise MPS (success rate of 98.6%), whole-brain peak MPS and CSDM (coefficient of determination of 0.977 and 0.980, with root mean squared error of 0.015 and 0.029, respectively). We then apply the technique to 23 football helmet models (N = 1104 impacts) to reproduce elementwise MPS. Assuming a concussion would occur when peak MPS or CSDM exceeds a threshold, we sweep their thresholds across the value ranges to evaluate the number of predicted hypothetical concussions that different helmets sustain across the impact conditions. Relative to the 12 impact conditions tested, we find that the "best" and "worst" helmets differ by an average of 22.5% in terms of predicted concussions, ranging from 0 to 42% (the latter achieved at the threshold value of 0.28 for peak MPS and 0.4 for CSDM, respectively). Such a large variation among helmets in strain-based concussion predictions demonstrate that helmet designs can still be optimized in a clinically meaningful way. The robustness and accuracy of the CNN tool also suggest its potential for routine use for helmet design and safety performance evaluation in the future. The CNN is freely available online at https://github.com/Jilab-biomechanics/CNN-brain-strains .
Collapse
|
9
|
Basinas I, McElvenny DM, Pearce N, Gallo V, Cherrie JW. A Systematic Review of Head Impacts and Acceleration Associated with Soccer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095488. [PMID: 35564889 PMCID: PMC9100160 DOI: 10.3390/ijerph19095488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Epidemiological studies of the neurological health of former professional soccer players are being undertaken to identify whether heading the ball is a risk factor for disease or premature death. A quantitative estimate of exposure to repeated sub-concussive head impacts would provide an opportunity to investigate possible exposure-response relationships. However, it is unclear how to formulate an appropriate exposure metric within the context of epidemiological studies. We have carried out a systematic review of the scientific literature to identify the factors that determine the magnitude of head impact acceleration during experiments and from observations during playing or training for soccer, up to the end of November 2021. Data were extracted from 33 experimental and 27 observational studies from male and female amateur players including both adults and children. There was a high correlation between peak linear and angular accelerations in the observational studies (p < 0.001) although the correlation was lower for the experimental data. We chose to rely on an analysis of maximum or peak linear acceleration for this review. Differences in measurement methodology were identified as important determinants of measured acceleration, and we concluded that only data from accelerometers fixed to the head provided reliable information about the magnitude of head acceleration from soccer-related impacts. Exposures differed between men and women and between children and adults, with women on average experiencing higher acceleration but less frequent impacts. Playing position appears to have some influence on the number of heading impacts but less so on the magnitude of the head acceleration. Head-to-head collisions result in high levels of exposure and thus probably risk causing a concussion. We concluded, in the absence of evidence to the contrary, that estimates of the cumulative number of heading impacts over a playing career should be used as the main exposure metric in epidemiological studies of professional players.
Collapse
Affiliation(s)
- Ioannis Basinas
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Damien M. McElvenny
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Division of Population Health, Health Services Research & Primary Care, Centre for Occupational and Environmental Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Valentina Gallo
- Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands;
| | - John W. Cherrie
- Institute of Occupational Medicine, Research Avenue North, Edinburgh EH14 4AP, UK; (I.B.); (D.M.M.)
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh EH14 4AS, UK
- Correspondence:
| |
Collapse
|
10
|
Wu S, Zhao W, Ji S. Real-time dynamic simulation for highly accurate spatiotemporal brain deformation from impact. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2022; 394:114913. [PMID: 35572209 PMCID: PMC9097909 DOI: 10.1016/j.cma.2022.114913] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Real-time dynamic simulation remains a significant challenge for spatiotemporal data of high dimension and resolution. In this study, we establish a transformer neural network (TNN) originally developed for natural language processing and a separate convolutional neural network (CNN) to estimate five-dimensional (5D) spatiotemporal brain-skull relative displacement resulting from impact (isotropic spatial resolution of 4 mm with temporal resolution of 1 ms). Sequential training is applied to train (N = 5184 samples) the two neural networks for estimating the complete 5D displacement across a temporal duration of 60 ms. We find that TNN slightly but consistently outperforms CNN in accuracy for both displacement and the resulting voxel-wise four-dimensional (4D) maximum principal strain (e.g., root mean squared error (RMSE) of ~1.0% vs. ~1.6%, with coefficient of determination, R 2 >0.99 vs. >0.98, respectively, and normalized RMSE (NRMSE) at peak displacement of 2%-3%, based on an independent testing dataset; N = 314). Their accuracies are similar for a range of real-world impacts drawn from various published sources (dummy, helmet, football, soccer, and car crash; average RMSE/NRMSE of ~0.3 mm/~4%-5% and average R 2 of ~0.98 at peak displacement). Sequential training is effective for allowing instantaneous estimation of 5D displacement with high accuracy, although TNN poses a heavier computational burden in training. This work enables efficient characterization of the intrinsically dynamic brain strain in impact critical for downstream multiscale axonal injury model simulation. This is also the first application of TNN in biomechanics, which offers important insight into how real-time dynamic simulations can be achieved across diverse engineering fields.
Collapse
Affiliation(s)
- Shaoju Wu
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States of America
| | - Wei Zhao
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States of America
| | - Songbai Ji
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States of America
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States of America
- Correspondence to: Department of Biomedical Engineering, Worcester Polytechnic Institute, 60 Prescott Street, Worcester, MA 01506, USA., (S. Ji)
| |
Collapse
|
11
|
Head Impact Kinematics and Brain Deformation in Paired Opposing Youth Football Players. J Appl Biomech 2022; 38:136-147. [PMID: 35483702 DOI: 10.1123/jab.2021-0098] [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: 03/18/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
Head impact exposure is often quantified using peak resultant kinematics. While kinematics describes the inertial response of the brain to impact, they do not fully capture the dynamic brain response. Strain, a measure of the tissue-level response of the brain, may be a better predictor of injury. In this study, kinematic and strain metrics were compared to contact characteristics in youth football. Players on 2 opposing teams were instrumented with head impact sensors to record impact kinematics. Video was collected to identify contact scenarios involving opposing instrumented players (ie, paired contact scenarios) and code contact characteristics (eg, player role, impact location). A previously validated, high-resolution brain finite element model, the atlas-based brain model, was used to simulate head impacts and calculate strain metrics. Fifty-two paired contact scenarios (n = 105 impacts) were evaluated. Lighter players tended to have greater biomechanical metrics compared to heavier players. Impacts to the top of the helmet were associated with lower strain metrics. Overall, strain was better correlated with rotational kinematics, suggesting these metrics may be better predictors of the tissue-level brain response than linear kinematics. Understanding the effect of contact characteristics on brain strain will inform future efforts to improve sport safety.
Collapse
|
12
|
Miller LE, Urban JE, Espeland MA, Walkup MP, Holcomb JM, Davenport EM, Powers AK, Whitlow CT, Maldjian JA, Stitzel JD. Cumulative strain-based metrics for predicting subconcussive head impact exposure-related imaging changes in a cohort of American youth football players. J Neurosurg Pediatr 2022; 29:387-396. [PMID: 35061991 PMCID: PMC9404368 DOI: 10.3171/2021.10.peds21355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Youth football athletes are exposed to repetitive subconcussive head impacts during normal participation in the sport, and there is increasing concern about the long-term effects of these impacts. The objective of the current study was to determine if strain-based cumulative exposure measures are superior to kinematic-based exposure measures for predicting imaging changes in the brain. METHODS This prospective, longitudinal cohort study was conducted from 2012 to 2017 and assessed youth, male football athletes. Kinematic data were collected at all practices and games from enrolled athletes participating in local youth football organizations in Winston-Salem, North Carolina, and were used to calculate multiple risk-weighted cumulative exposure (RWE) kinematic metrics and 36 strain-based exposure metrics. Pre- and postseason imaging was performed at Wake Forest School of Medicine, and diffusion tensor imaging (DTI) measures, including fractional anisotropy (FA), and its components (CL, CP, and CS), and mean diffusivity (MD), were investigated. Included participants were youth football players ranging in age from 9 to 13 years. Exclusion criteria included any history of previous neurological illness, psychiatric illness, brain tumor, concussion within the past 6 months, and/or contraindication to MRI. RESULTS A total of 95 male athletes (mean age 11.9 years [SD 1.0 years]) participated between 2012 and 2017, with some participating for multiple seasons, resulting in 116 unique athlete-seasons. Regression analysis revealed statistically significant linear relationships between the FA, linear coefficient (CL), and spherical coefficient (CS) and all strain exposure measures, and well as the planar coefficient (CP) and 8 strain measures. For the kinematic exposure measures, there were statistically significant relationships between FA and RWE linear (RWEL) and RWE combined probability (RWECP) as well as CS and RWEL. According to area under the receiver operating characteristic (ROC) curve (AUC) analysis, the best-performing metrics were all strain measures, and included metrics based on tensile, compressive, and shear strain. CONCLUSIONS Using ROC curves and AUC analysis, all exposure metrics were ranked in order of performance, and the results demonstrated that all the strain-based metrics performed better than any of the kinematic metrics, indicating that strain-based metrics are better discriminators of imaging changes than kinematic-based measures. Studies relating the biomechanics of head impacts with brain imaging and cognitive function may allow equipment designers, care providers, and organizations to prevent, identify, and treat injuries in order to make football a safer activity.
Collapse
Affiliation(s)
- Logan E. Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem,School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston-Salem
| | - Jillian E. Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem,School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston-Salem
| | - Mark A. Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem
| | - Michael P. Walkup
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem
| | - James M. Holcomb
- Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas
| | | | - Alexander K. Powers
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem,Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem
| | - Christopher T. Whitlow
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem,Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A. Maldjian
- Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem,School of Biomedical Engineering and Sciences, Virginia Tech–Wake Forest University, Winston-Salem
| |
Collapse
|
13
|
Liu Y, Lu Y, Shao Y, Wu Y, He J, Wu C. Mechanism of the traumatic brain injury induced by blast wave using the energy assessment method. Med Eng Phys 2022; 101:103767. [DOI: 10.1016/j.medengphy.2022.103767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/20/2022] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
|
14
|
|
15
|
Monroe DC, DuBois SL, Rhea CK, Duffy DM. Age-Related Trajectories of Brain Structure–Function Coupling in Female Roller Derby Athletes. Brain Sci 2021; 12:brainsci12010022. [PMID: 35053766 PMCID: PMC8774127 DOI: 10.3390/brainsci12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
Contact and collision sports are believed to accelerate brain aging. Postmortem studies of the human brain have implicated tau deposition in and around the perivascular space as a biomarker of an as yet poorly understood neurodegenerative process. Relatively little is known about the effects that collision sport participation has on the age-related trajectories of macroscale brain structure and function, particularly in female athletes. Diffusion MRI and resting-state functional MRI were obtained from female collision sport athletes (n = 19 roller derby (RD) players; 23–45 years old) and female control participants (n = 14; 20–49 years old) to quantify structural coupling (SC) and decoupling (SD). The novel and interesting finding is that RD athletes, but not controls, exhibited increasing SC with age in two association networks: the frontoparietal network, important for cognitive control, and default-mode network, a task-negative network (permuted p = 0.0006). Age-related increases in SC were also observed in sensorimotor networks (RD, controls) and age-related increases in SD were observed in association networks (controls) (permuted p ≤ 0.0001). These distinct patterns suggest that competing in RD results in compressed neuronal timescales in critical networks as a function of age and encourages the broader study of female athlete brains across the lifespan.
Collapse
Affiliation(s)
- Derek C. Monroe
- Correspondence: ; Tel.: +1-336-334-5347; Fax: +1-336-334-3238
| | | | | | | |
Collapse
|
16
|
Filben TM, Pritchard NS, Miller LE, Miles CM, Urban JE, Stitzel JD. Header biomechanics in youth and collegiate female soccer. J Biomech 2021; 128:110782. [PMID: 34656012 DOI: 10.1016/j.jbiomech.2021.110782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Concerns about the effects of intentional heading in soccer have led to regulatory restrictions on headers for youth players. However, there is limited data describing how header exposure varies across age levels, and few studies have attempted to compare head impact exposure across different levels of play with the same sensor. Additionally, little is known about the biomechanical response of the brain to header impacts. The objective of this study was to evaluate head kinematics and the resulting tissue-level brain strain associated with intentional headers among youth and collegiate female soccer players. Six youth and 13 collegiate participants were instrumented with custom mouthpiece-based sensors measuring six-degree-of-freedom head kinematics of headers during practices and games. Kinematics of film-verified headers were used to drive impact simulations with a detailed brain finite element model to estimate tissue-level strain. Linear and rotational head kinematics and strain metrics, specifically 95th percentile maximum principal strain (ε1,95) and the area under the cumulative strain damage measure curve (VSM1), were compared across levels of play (i.e., youth vs. collegiate) while adjusting for session type and ball delivery method. A total of 483 headers (n = 227 youth, n = 256 collegiate) were analyzed. Level of play was significantly associated with linear acceleration, rotational acceleration, rotational velocity, ε1,95, and VSM1. Headers performed by collegiate players had significantly greater mean head kinematics and strain metrics compared to those performed by youth players (all p < .001). Targeted interventions aiming to reduce head impact magnitude in soccer should consider factors associated with the level of play.
Collapse
Affiliation(s)
- Tanner M Filben
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA.
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
17
|
Relationship Between Time-Weighted Head Impact Exposure on Directional Changes in Diffusion Imaging in Youth Football Players. Ann Biomed Eng 2021; 49:2852-2862. [PMID: 34549344 PMCID: PMC8978207 DOI: 10.1007/s10439-021-02862-4] [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: 07/26/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023]
Abstract
Approximately 3.5 million youth and adolescents in the US play football, a sport with one of the highest rates of concussion. Repeated subconcussive head impact exposure (HIE) may lead to negative neurological sequelae. To understand HIE as an independent predictive variable, quantitative cumulative kinematic metrics have been developed to capture the volume (i.e., number), severity (i.e., magnitude), and frequency (i.e., time-weighting by the interval between head impacts). In this study, time-weighted cumulative HIE metrics were compared with directional changes in diffusion tensor imaging (DTI) metrics. Changes in DTI conducted on a per-season, per-player basis were assessed as a dependent variable. Directional changes were defined separately as increases and decreases in the number of abnormal voxels relative to non-contact sport controls. Biomechanical and imaging data from 117 athletes (average age 11.9 ± 1.0 years) enrolled in this study was analyzed. Cumulative HIE metrics were more strongly correlated with increases in abnormal voxels than decreases in abnormal voxels. Additionally, across DTI sub-measures, increases and decreases in mean diffusivity (MD) had the strongest relationships with HIE metrics (increases in MD: average R2 = 0.1753, average p = 0.0002; decreases in MD: average R2 = 0.0997, average p = 0.0073). This encourages further investigation into the physiological phenomena represented by directional changes.
Collapse
|
18
|
Liu Y, Domel AG, Cecchi NJ, Rice E, Callan AA, Raymond SJ, Zhou Z, Zhan X, Li Y, Zeineh MM, Grant GA, Camarillo DB. Time Window of Head Impact Kinematics Measurement for Calculation of Brain Strain and Strain Rate in American Football. Ann Biomed Eng 2021; 49:2791-2804. [PMID: 34231091 DOI: 10.1007/s10439-021-02821-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023]
Abstract
Wearable devices have been shown to effectively measure the head's movement during impacts in sports like American football. When a head impact occurs, the device is triggered to collect and save the kinematic measurements during a predefined time window. Then, based on the collected kinematics, finite element (FE) head models can calculate brain strain and strain rate, which are used to evaluate the risk of mild traumatic brain injury. To find a time window that can provide a sufficient duration of kinematics for FE analysis, we investigated 118 on-field video-confirmed football head impacts collected by the Stanford Instrumented Mouthguard. The simulation results based on the kinematics truncated to a shorter time window were compared with the original to determine the minimum time window needed for football. Because the individual differences in brain geometry influence these calculations, we included six representative brain geometries and found that larger brains need a longer time window of kinematics for accurate calculation. Among the different sizes of brains, a pre-trigger time of 40 ms and a post-trigger time of 70 ms were found to yield calculations of brain strain and strain rate that were not significantly different from calculations using the original 200 ms time window recorded by the mouthguard. Therefore, approximately 110 ms is recommended for complete modeling of impacts for football.
Collapse
Affiliation(s)
- Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA.
| | - August G Domel
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Nicholas J Cecchi
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Eli Rice
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, 94305, USA
| | - Ashlyn A Callan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Samuel J Raymond
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Zhou Zhou
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Xianghao Zhan
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Yiheng Li
- Department of Biomedical Informatics, Stanford University, Stanford, CA, 94305, USA
| | - Michael M Zeineh
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
- Department of Neurology, Stanford University, Stanford, CA, 94305, USA
| | - David B Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, 94305, USA
| |
Collapse
|
19
|
Toward subject-specific evaluation: methods of evaluating finite element brain models using experimental high-rate rotational brain motion. Biomech Model Mechanobiol 2021; 20:2301-2317. [PMID: 34432184 DOI: 10.1007/s10237-021-01508-7] [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: 08/16/2020] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Computational models of the brain have become the gold standard in biomechanics to understand, predict, and mitigate traumatic brain injuries. Many models have been created and evaluated with limited experimental data and without accounting for subject-specific morphometry of the specimens in the dataset. Recent advancements in the measurement of brain motion using sonomicrometry allow for a comprehensive evaluation of brain model biofidelity using a high-rate, rotational brain motion dataset. In this study, four methods were used to determine the best technique to compare nodal displacement to experimental brain motion, including a new morphing method to match subject-specific inner skull geometry. Three finite element brain models were evaluated in this study: the isotropic GHBMC and SIMon models, as well as an anisotropic model with explicitly embedded axons (UVA-EAM). Using a weighted cross-correlation score (between 0 and 1), the anisotropic model yielded the highest average scores across specimens and loading conditions ranging from 0.53 to 0.63, followed by the isotropic GHBMC with average scores ranging from 0.46 to 0.58, and then the SIMon model with average scores ranging from 0.36 to 0.51. The choice of comparison method did not significantly affect the cross-correlation score, and differences of global strain up to 0.1 were found for the morphed geometry relative to baseline models. The morphed or scaled geometry is recommended when evaluating computational brain models to capture the subject-specific skull geometry of the experimental specimens.
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Kianoosh Ghazi
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 60 Prescott Street, Worcester, MA, 01605, USA
| | - Shaoju Wu
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 60 Prescott Street, Worcester, MA, 01605, USA
| | - Wei Zhao
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 60 Prescott Street, Worcester, MA, 01605, USA
| | - Songbai Ji
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 60 Prescott Street, Worcester, MA, 01605, USA. .,Department of Mechanical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, 01609, USA.
| |
Collapse
|