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Mechanical properties of extensive calcified costal cartilage: An experimental study. Heliyon 2023; 9:e13656. [PMID: 36865463 PMCID: PMC9970894 DOI: 10.1016/j.heliyon.2023.e13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Background Autologous costal cartilage is widely used as nasal augmentation or nasal reconstruction material. However, no study has focused on the mechanical difference between no calcified costal cartilage and extensive calcified costal cartilage at present. Our study aims to study the loading behavior of calcified costal cartilage under tensile and compressive stress. Method Human costal cartilage specimen was obtained from five extensive calcified costal cartilage patients and classified into four groups (group A: no calcified costal cartilage; group B: calcified costal cartilage; group C: no calcified costal cartilage after transplantation in BALB/c nude mice for half a year; group D: calcified costal cartilage after transplantation in BALB/c nude mice for half a year). Young's modulus, stress relaxation slope, and relaxation amount were analyzed through tensile and compressive tests using a material testing machine. Results We included five female patients with extensive calcified costal cartilage. Group B exhibited significantly higher Young's modulus in both the tensile and compressive tests (p < 0.05 in tensile test, p < 0.01 in compressive test), higher relaxation slope (P < 0.01) and higher relaxation amount (p < 0.05 in compression test). After transplantation, the Young's modulus of calcified and non-calcified costal cartilage decreased, except that the calcified costal cartilage increased slightly in the tensile test. The final relaxation slope and relaxation amount had increased at different degrees, but the changes did not change significantly before and after transplantation (P > 0.05). Conclusion Our results showed that the stiffness of calcified cartilage would increase 30.06% under tension and 126.31% under compression. This study may provide new insights to researchers focusing on extensive calcified costal cartilage can be used for autologous graft material.
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2
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Kang J, Tian Y, Zheng J, Lu D, Cai K, Wang L, Li D. Functional design and biomechanical evaluation of 3D printing PEEK flexible implant for chest wall reconstruction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107105. [PMID: 36108412 DOI: 10.1016/j.cmpb.2022.107105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Rigid reconstruction of chest wall defect seriously affects the postoperative respiratory owing to neglecting the functional role of natural costal cartilage. In the study, a 3D printing PEEK flexible implant was developed to restore the deformation capability during breathing motion. MATERIALS AND METHODS Bionic spring structures in different region of implant were designed by taking into consideration of the anatomical morphology and materials properties of costal cartilage. The biomechanical properties of the rigid and flexible implants under the chest compression were compared through the finite element analysis. Two kinds of chest wall implant samples were fabricated with fused deposition modeling (FDM) technology to evaluate experimentally the mechanical behaviors. Finally, the restoration ability of respiratory function from the flexible implant was investigated in vivo. RESULTS The flexible implant exhibited the similar stiffness to the natural thorax and satisfied the strength demand in the chest compression. The maximal impact force of flexible implant reached to 536 N. The fatigue failure of complete flexible implant was revealed from the initiation and propagation of interlaminar crack to the fracture in a zigzag manner. Animal experiments validated that the parameters characterizing respiratory could be recovered to the preoperative and normal state. CONCLUSIONS In the study, the flexible implant provided these advantages for perfect replication of thoracic shape, reliable safety, and great deformation capability to response respiratory movement, which given a superior treatment for chest wall reconstruction.
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Affiliation(s)
- Jianfeng Kang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Jihua Laboratory, Foshan, Guangdong, China
| | - Yucong Tian
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Jibao Zheng
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China
| | - Di Lu
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Wang
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China.
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Guangdong Xi'an Jiaotong University Academy, Guangdong, China; National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi'an Jiaotong University, Xi'an, ShaanXi, China.
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3
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Gradischar A, Lebschy C, Krach W, Krall M, Fediuk M, Gieringer A, Smolle-Jüttner F, Hammer N, Beyer B, Smolle J, Schäfer U. Measurement of global mechanical properties of human thorax Part 1: Costal cartilage. J Biomech 2022; 142:111242. [DOI: 10.1016/j.jbiomech.2022.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
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4
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Huang Y, Holcombe SA, Zhou Q, Wang SC, Tang J, Nie B. A GAN based approach for inferring progression trajectories of costal cartilage calcification from cross-sectional data at image level. Comput Biol Med 2022; 146:105647. [PMID: 35617729 DOI: 10.1016/j.compbiomed.2022.105647] [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: 01/24/2022] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Costal cartilage calcification (CCC) increases with age and presents differently for men and women. In individuals, however, the cross-sectional studies that show such trends do not reveal the geometric trajectories through which calcification might accumulate across a lifetime. Generative adversarial networks have the potential to reveal such trajectories from cross-sectional data by learning population trends and synthesizing individualized images at progressive levels of calcification. METHODS Chest wall mid-surface CT images with normalized cartilage morphologies were produced for 379 subjects aged 6 to 90, and labeled by sex and calcification severity. A conditional GAN with added loss terms to favor one-way accumulation of CCC was trained using organized image batches. GAN performance was assessed by comparing the distributions of images between the training and synthetic groups. RESULTS Synthetic images generated from a common seed for a given sex and at successive calcification severity levels showed incremental and regional growth of calcification sites. CCC patterns for synthetic male and female images matched known sex-based differences, and individual CCC growth in synthetic images was consistent with previously observed population trends. These trends in the synthetic images were also quantified by structural similarity scores. Synthetic images generated from different input seeds further showed individual variance in specific regions and trajectories of CCC accumulation. CONCLUSION This study inferred individual progression of CCC accumulation from uncalcified to severely calcified using cross-sectional image data. This information can inform computational models of the changing chest wall biomechanics with age, and the GAN-based technique shows potential for inferring longitudinal data from population trends in other clinical areas.
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Affiliation(s)
- Yuan Huang
- State Key Laboratory of Automotive Safety and Energy, Tsinghua University, China; International Center for Automotive Medicine (ICAM), University of Michigan, USA.
| | - Sven A Holcombe
- International Center for Automotive Medicine (ICAM), University of Michigan, USA.
| | - Qing Zhou
- State Key Laboratory of Automotive Safety and Energy, Tsinghua University, China.
| | - Stewart C Wang
- International Center for Automotive Medicine (ICAM), University of Michigan, USA.
| | - Jisi Tang
- State Key Laboratory of Automotive Safety and Energy, Tsinghua University, China.
| | - Bingbing Nie
- State Key Laboratory of Automotive Safety and Energy, Tsinghua University, China.
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5
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Rujira-Arporn T, Sriswadpong P, Jirawatnotai S. The diagnostic accuracy of hand-held ultrasonography in evaluation of costal cartilage calcification for grafting in rhinoplasty: A cadaveric study. J Plast Reconstr Aesthet Surg 2022; 75:3462-3468. [PMID: 35659735 DOI: 10.1016/j.bjps.2022.04.065] [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: 09/14/2021] [Revised: 12/15/2021] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Autologous costal cartilage graft (ACC) is considered a gold standard in complex rhinoplasty. Costal cartilage calcification remains a problematic issue, causing not only difficulties during the harvesting, carving, and fixation procedures but also worsening the long-term outcome with resorption. PURPOSE This study aims to establish diagnostic accuracy of hand-held ultrasonography in not only detecting the degree and pattern of costal cartilage calcification but also assessing its ability to predict the volume of the harvestable cartilage graft. METHODS The study was performed on 50 fresh cadavers with an age range between 17 and 80 years (mean 53.4 ± 16.2 years). An ultrasonographic examination of the costal cartilage of 5th, 6th, and 7th ribs of both hemithoraces was performed. The presence of calcification of the cartilages and the pattern, length, width, cross-sectional area, and depth of calcification were observed and recorded. These results were compared against direct visualization and measurement via surgical dissection. RESULTS Hand-held ultrasonography has a sensitivity of 94% and a specificity of 96% in detecting calcification with 96% positive predictive value and 93% negative predictive value. The positive likelihood ratio was 20.81 and the negative likelihood ratio was 0.06. Overall, the modality has demonstrated the ability to determine dimensions of the costal cartilage to within millimeters. The pattern of calcification was also correctly predicted in all 300 specimens. CONCLUSION Hand-held ultrasonography is an affordable and accessible choice of demonstrating the presence and pattern of calcification as well as the general dimensions of the harvestable rib cartilage.
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Affiliation(s)
- Thitithip Rujira-Arporn
- Plastic and Reconstructive Surgery, Lerdsin Hospital, 190 Silom Road, Bangrak 10500, Bangkok, Thailand
| | - Papat Sriswadpong
- Plastic and Reconstructive Surgery, Lerdsin Hospital, 190 Silom Road, Bangrak 10500, Bangkok, Thailand
| | - Supasid Jirawatnotai
- Plastic and Reconstructive Surgery, Lerdsin Hospital, 190 Silom Road, Bangrak 10500, Bangkok, Thailand.
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6
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Suazo M, Herrero J, Fortuny G, Puigjaner D, López JM. Biomechanical response of human rib cage to cardiopulmonary resuscitation maneuvers: Effects of the compression location. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3585. [PMID: 35188706 PMCID: PMC9285513 DOI: 10.1002/cnm.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
The biomechanical response of a human rib cage to cardiopulmonary resuscitation maneuvers was investigated by means of finite element simulations. We analyzed the effect of the location where the force was applied on the achieved compression depths and stress levels experienced by the breastbone and ribs. For compression locations on the breastbone, a caudal shift of the application area toward the breastbone tip resulted in a 17% reduction of the force required to achieve a target 5 cm compression depth. We found that the use of compression regions located on the costal cartilages would involve higher risk of rib fractures.
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Affiliation(s)
- Mario Suazo
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
- Departamento de Matemática AplicadaEscuela de Matemática y Ciencias de la Computación, UNAH–VSTegucigalpaHonduras
| | - Joan Herrero
- Departament d’ Enginyeria QuímicaUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Gerard Fortuny
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Dolors Puigjaner
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Josep M. López
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
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7
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Anisotropic and age-dependent elastic material behavior of the human costal cartilage. Sci Rep 2021; 11:13618. [PMID: 34193931 PMCID: PMC8245550 DOI: 10.1038/s41598-021-93176-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Compared to articular cartilage, the biomechanical properties of costal cartilage have not yet been extensively explored. The research presented addresses this problem by studying for the first time the anisotropic elastic behavior of human costal cartilage. Samples were taken from 12 male and female cadavers and unconfined compression and indentation tests were performed in mediolateral and dorsoventral direction to determine Young’s Moduli EC for compression and Ei5%, Ei10% and Eimax at 5%, 10% and maximum strain for indentation. Furthermore, the crack direction of the unconfined compression samples was determined and histological samples of the cartilage tissue were examined with the picrosirius-polarization staining method. The tests revealed mean Young’s Moduli of EC = 32.9 ± 17.9 MPa (N = 10), Ei5% = 11.1 ± 5.6 MPa (N = 12), Ei10% = 13.3 ± 6.3 MPa (N = 12) and Eimax = 14.6 ± 6.6 MPa (N = 12). We found that the Young’s Moduli in the indentation test are clearly anisotropic with significant higher results in the mediolateral direction (all P = 0.002). In addition, a dependence of the crack direction of the compressed specimens on the load orientation was observed. Those findings were supported by the orientation of the structure of the collagen fibers determined in the histological examination. Also, a significant age-related elastic behavior of human costal cartilage could be shown with the unconfined compression test (P = 0.009) and the indentation test (P = 0.004), but no sex effect could be detected. Those results are helpful in the field of autologous grafts for rhinoplastic surgery and for the refinement of material parameters in Finite Element models e.g., for accident analyses with traumatic impact on the thorax.
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8
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Brady L, Stender CJ, Wang YN, Schade GR, Maxwell AD, Wessells H, Ledoux WR. Mechanical characterization of fibrotic and mineralized tissue in Peyronie's disease. Int J Impot Res 2021; 34:477-486. [PMID: 34035467 DOI: 10.1038/s41443-021-00439-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022]
Abstract
Peyronie's disease affects penile mechanics, but published research lacks biomechanical characterization of affected tunica albuginea. This work aims to establish mechanical testing methodology and characterize pathological tissue mechanics of Peyronie's disease. Tunica albuginea was obtained from patients (n = 5) undergoing reconstructive surgery for Peyronie's disease, sectioned into test specimens (n = 12), stored frozen at -20 °C, and imaged with micro-computed tomography (µCT). A tensile testing protocol was developed based on similar soft tissues. Correlation of mechanical summary variables (force, displacement, stiffness, work, Young's modulus, ultimate tensile stress, strain at ultimate tensile stress, and toughness) and µCT features were assessed with linear regression. Specimens empirically grouped into hard or soft stress-strain behavior were compared using a Student's t-test. Surface strain and failure patterns were described qualitatively. Specimens displayed high inter- and intra-subject variability. Mineralization volume was not correlated with mechanical parameters. Empirically hard tissue had higher ultimate tensile stress. Failure mechanisms and strain patterns differed between mineralized and non-mineralized specimens. Size, shape, and quantity of mineralization may be more important in determining Peyronie's disease plaque behavior than presence of mineralization alone, and single summary variables like modulus may not fully describe mechanical behavior.
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Affiliation(s)
- Lynda Brady
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Christina J Stender
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Yak-Nam Wang
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - George R Schade
- Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Adam D Maxwell
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA, USA.,Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hunter Wessells
- Department of Urology, School of Medicine, University of Washington, Seattle, WA, USA
| | - William R Ledoux
- VA RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA, USA. .,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA. .,Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
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9
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Heveran CM, Schurman CA, Acevedo C, Livingston EW, Howe D, Schaible EG, Hunt HB, Rauff A, Donnelly E, Carpenter RD, Levi M, Lau AG, Bateman TA, Alliston T, King KB, Ferguson VL. Chronic kidney disease and aging differentially diminish bone material and microarchitecture in C57Bl/6 mice. Bone 2019; 127:91-103. [PMID: 31055118 PMCID: PMC6760860 DOI: 10.1016/j.bone.2019.04.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/15/2019] [Accepted: 04/26/2019] [Indexed: 12/31/2022]
Abstract
Chronic kidney disease (CKD) is a common disease of aging and increases fracture risk over advanced age alone. Aging and CKD differently impair bone turnover and mineralization. We thus hypothesize that the loss of bone quality would be greatest with the combination of advanced age and CKD. We evaluated bone from young adult (6 mo.), middle-age (18 mo.), and old (24 mo.) male C57Bl/6 mice three months following either 5/6th nephrectomy, to induce CKD, or Sham procedures. CKD exacerbated losses of cortical and trabecular microarchitecture associated with aging. Aging and CKD each resulted in thinner, more porous cortices and fewer and thinner trabeculae. Bone material quality was also reduced with CKD, and these changes to bone material were distinct from those due to age. Aging reduced whole-bone flexural strength and modulus, micrometer-scale nanoindentation modulus, and nanometer-scale tissue and collagen strain (small-angle x-ray scattering [SAXS]. By contrast, CKD reduced work to fracture and variation in bone tissue modulus and composition (Raman spectroscopy), and increased percent collagen strain. The increased collagen strain burden was associated with loss of toughness in CKD. In addition, osteocyte lacunae became smaller, sparser, and more disordered with age for Sham mice, yet these age-related changes were not clearly observed in CKD. However, for CKD, larger lacunae positively correlated with increased serum phosphate levels, suggesting that osteocytes play a role in systemic mineral homeostasis. This work demonstrates that CKD reduces bone quality, including microarchitecture and bone material properties, and that loss of bone quality with age is compounded by CKD. These findings may help reconcile why bone mass does not consistently predict fracture in the CKD population, as well as why older individuals with CKD are at high risk of fragility.
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Affiliation(s)
- Chelsea M Heveran
- Department of Mechanical Engineering, University of Colorado, Boulder, CO, United States of America
| | - Charles A Schurman
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, United States of America
| | - Claire Acevedo
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, United States of America
| | - Eric W Livingston
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, United States of America
| | - Danielle Howe
- Department of Biomedical Engineering, The College of New Jersey, Ewing, NJ, United States of America
| | - Eric G Schaible
- Advanced Light Source, Lawrence Berkeley National Laboratory, Berkeley, CA, United States of America
| | - Heather B Hunt
- Department of Materials Science & Engineering, Cornell University, Ithaca, NY, United States of America
| | - Adam Rauff
- Department of Bioengineering, University of Colorado, Denver, CO, United States of America
| | - Eve Donnelly
- Department of Materials Science & Engineering, Cornell University, Ithaca, NY, United States of America
| | - R Dana Carpenter
- Department of Mechanical Engineering, University of Colorado, Denver, CO, United States of America
| | - Moshe Levi
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C., United States of America
| | - Anthony G Lau
- Department of Biomedical Engineering, The College of New Jersey, Ewing, NJ, United States of America
| | - Ted A Bateman
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, United States of America
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, United States of America
| | - Karen B King
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Virginia L Ferguson
- Department of Mechanical Engineering, University of Colorado, Boulder, CO, United States of America.
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10
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Gao Y, Gao J, Li H, Du D, Jin D, Zheng M, Zhang C. Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques. Ther Adv Musculoskelet Dis 2019; 11:1759720X19877131. [PMID: 31579403 PMCID: PMC6759717 DOI: 10.1177/1759720x19877131] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023] Open
Abstract
It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.
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Affiliation(s)
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Centre for Orthopaedic Translational Research, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Hengyuan Li
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Dajiang Du
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Dongxu Jin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Minghao Zheng
- Centre for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Changqing Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
- Institute of Microsurgery on Extremities, Shanghai 200233, China
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11
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A Decade's Experience: A Sound Framework as the Foundation to Nasal Reconstruction. J Craniofac Surg 2019; 29:2032-2037. [PMID: 29927821 DOI: 10.1097/scs.0000000000004695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of nasal reconstruction surgery is to restore normal nasal shape and function, and its success begins with creating a stable framework. In this article the authors discuss the most advantageous materials for building such a framework and how to design this element to achieve better and more durable outcomes. This is a retrospective study including patients who underwent nasal reconstruction in our rhinoplasty and nasal reconstruction center at a tertiary referral hospital between 2006 and 2016. Data included patient characteristics, defect location, the reason for defect, use of supporting structure, flap, lining, and complications were recorded. The minimum postoperative follow-up was at least 6 months after the last operation. This study included 455 patients. Nasal defects treated most commonly involved zone 2 and an average defect of 4.2 subunits. Expanded forehead flap for cover with costal cartilage as a framework and turn-over flap combined with distal end of the flap for lining was the most common reconstruction method used in this study. The complication rate was 4.39% and nearly half of these complications were related to usage of an expander during reconstruction. Regardless of flap used, the supporting structure was the most critical element for the 3-dimensional shape of the reconstructed nose. As 1 of the 3 elements of nasal reconstruction, framework deserves adequate attention during such reconstruction.
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12
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Holcombe SA, Wang SC, Grotberg JB. The effect of age and demographics on rib shape. J Anat 2017; 231:229-247. [PMID: 28612467 DOI: 10.1111/joa.12632] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/22/2022] Open
Abstract
Elderly populations have a higher risk of rib fractures and other associated thoracic injuries than younger adults, and the changes in body morphology that occur with age are a potential cause of this increased risk. Rib centroidal path geometry for 20 627 ribs was extracted from computed tomography (CT) scans of 1042 live adult subjects, then fitted to a six-parameter mathematical model that accurately characterizes rib size and shape, and a three-parameter model of rib orientation within the body. Multivariable regression characterized the independent effect of age, height, weight, and sex on the rib shape and orientation across the adult population, and statistically significant effects were seen from all demographic factors (P < 0.0001). This study reports a novel aging effect whereby both the rib end-to-end separation and rib aspect ratio are seen to increase with age, producing elongated and flatter overall rib shapes in elderly populations, with age alone explaining up to 20% of population variability in the aspect ratio of mid-level ribs. Age was not strongly associated with overall rib arc length, indicating that age effects were related to shape change rather than overall bone length. The rib shape effect was found to be more strongly and directly associated with age than previously documented age-related changes in rib angulation. Other demographic results showed height and sex being most strongly associated with rib size, and weight most strongly associated with rib pump-handle angle. Results from the study provide a statistical model for building rib shapes typical of any given demographic by age, height, weight, and sex, and can be used to help build population-specific computational models of the thoracic rib cage. Furthermore, results also quantify normal population ranges for rib shape parameters which can be used to improve the assessment and treatment of rib skeletal deformity and disease.
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Affiliation(s)
- Sven A Holcombe
- Department of Biomechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,International Center for Automotive Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stewart C Wang
- International Center for Automotive Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James B Grotberg
- Department of Biomechanical Engineering, University of Michigan, Ann Arbor, MI, USA
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Volokh KY, Aboudi J. Aneurysm strength can decrease under calcification. J Mech Behav Biomed Mater 2015; 57:164-74. [PMID: 26717251 DOI: 10.1016/j.jmbbm.2015.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 12/18/2022]
Abstract
Aneurysms are abnormal dilatations of vessels in the vascular system that are prone to rupture. Prediction of the aneurysm rupture is a challenging and unsolved problem. Various factors can lead to the aneurysm rupture and, in the present study, we examine the effect of calcification on the aneurysm strength by using micromechanical modeling. The calcified tissue is considered as a composite material in which hard calcium particles are embedded in a hyperelastic soft matrix. Three experimentally calibrated constitutive models incorporating a failure description are used for the matrix representation. Two constitutive models describe the aneurysmal arterial wall and the third one - the intraluminal thrombus. The stiffness and strength of the calcified tissue are simulated in uniaxial tension under the varying amount of calcification, i.e. the relative volume of the hard inclusion within the periodic unit cell. In addition, the triaxiality of the stress state, which can be a trigger for the cavitation instability, is tracked. Results of the micromechanical simulation show an increase of the stiffness and a possible decrease of the strength of the calcified tissue as compared to the non-calcified one. The obtained results suggest that calcification (i.e. the presence of hard particles) can significantly affect the stiffness and strength of soft tissue. The development of refined experimental techniques that will allow for the accurate quantitative assessment of calcification is desirable.
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Affiliation(s)
| | - Jacob Aboudi
- Faculty of Engineering, Tel Aviv University, Israel.
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