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Papenkort S, Borsdorf M, Kiem S, Böl M, Siebert T. Regional differences in stomach stretch during organ filling and their implications on the mechanical stress response. J Biomech 2024; 168:112107. [PMID: 38677029 DOI: 10.1016/j.jbiomech.2024.112107] [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: 11/07/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
As part of the digestive system, the stomach plays a crucial role in the health and well-being of an organism. It produces acids and performs contractions that initiate the digestive process and begin the break-up of ingested food. Therefore, its mechanical properties are of interest. This study includes a detailed investigation of strains in the porcine stomach wall during passive organ filling. In addition, the observed strains were applied to tissue samples subjected to biaxial tensile tests. The results show inhomogeneous strains during filling, which tend to be higher in the circumferential direction (antrum: 13.2%, corpus: 22.0%, fundus: 67.8%), compared to the longitudinal direction (antrum: 4.8%, corpus: 24.7%, fundus: 50.0%) at a maximum filling of 3500 ml. Consequently, the fundus region experienced the greatest strain. In the biaxial tensile experiments, the corpus region appeared to be the stiffest, reaching nominal stress values above 400 kPa in the circumferential direction, whereas the other regions only reached stress levels of below 50 kPa in both directions for the investigated stretch range. Our findings gain new insight into stomach mechanics and provide valuable data for the development and validation of computational stomach models.
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Affiliation(s)
- Stefan Papenkort
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany
| | - Mischa Borsdorf
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany
| | - Simon Kiem
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany.
| | - Markus Böl
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig, Germany
| | - Tobias Siebert
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany; Stuttgart Center for Simulation Science, University of Stuttgart, Stuttgart, Germany
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2
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Tuttle T, McClintock D, Roccabianca S. Effects of swelling and anatomical location on the viscoelastic behavior of the porcine urinary bladder wall. J Mech Behav Biomed Mater 2023; 143:105926. [PMID: 37269604 DOI: 10.1016/j.jmbbm.2023.105926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
The ability of the urinary bladder to perform its physiological function depends largely on its mechanical characteristics. Understanding the mechanics of this tissue is crucial to the development of accurate models of not just this specific organ, but of the pelvic floor overall. In this study, we tested porcine bladder to identify variations in the tissue's viscoelastic characteristics associated with anatomical locations and swelling. We investigated this relationship using a series of stress-relaxation experiments as well as a modified Maxwell-Wiechert model to aid in the interpretation of the experimental data. Our results highlight that tissue located near the neck of the bladder presents significantly different viscoelastic characteristics than the body of the organ. This supports what was previously observed and is a valuable contribution to the understanding of the location-specific properties of the bladder. We also tested the effect of swelling, revealing that the bladder's viscoelastic behavior is mostly independent of solution osmolarity in hypoosmotic solutions, but the use of a hyperosmotic solution can significantly affect its behavior. This is significant, since several urinary tract pathologies can lead to chronic inflammation and disrupt the urothelial barrier causing increased urothelial permeability, thus subjecting the bladder wall to non-physiologic osmotic challenge.
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Affiliation(s)
- Tyler Tuttle
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Dillon McClintock
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, 48823, USA.
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3
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Hu JC, Osborn SL, Sanchez PC, Xu W, Christiansen BA, Kurzrock EA. Using uniaxial tensile testing to evaluate the biomechanical properties of bladder tissue after spinal cord injury in rat model. J Biomech 2023; 152:111571. [PMID: 37027962 DOI: 10.1016/j.jbiomech.2023.111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/06/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
To investigate the biomechanical properties of rat bladder tissue after spinal cord injury (SCI) using uniaxial tensile testing. Evidence suggests the bladder wall undergoes remodeling following SCI. There is limited data describing the biomechanical properties of bladder wall after SCI. This study describes the changes in elastic and viscoelastic mechanical properties of bladder tissue using a rat model after SCI. Seventeen adult rats received mid-thoracic SCI. Basso, Beattie, and Bresnahan (BBB) locomotor testing was performed on the rats 7-14 days after injury quantifying the degree of SCI. Bladder tissue samples were collected from controls and spinal injured rats at 2- and 9-weeks post-injury. Tissue samples underwent uniaxial stress relaxation to determine instantaneous and relaxation modulus as well as monotonic load-to failure to determine Young's modulus, yield stress and strain, and ultimate stress. SCI resulted in abnormal BBB locomotor scores. Nine weeks post-injury, instantaneous modulus decreased by 71.0% (p = 0.03) compared to controls. Yield strain showed no difference at 2 weeks post-injury but increased 78% (p = 0.003) in SCI rats at 9 weeks post-injury. Compared to controls, ultimate stress decreased 46.5% (p = 0.05) at 2 weeks post-injury in SCI rats but demonstrated no difference at 9 weeks post-injury. The biomechanical properties of rat bladder wall 2 weeks after SCI showed minimal difference compared to controls. By week 9, SCI bladders had a reduction in instantaneous modulus and increased yield strain. The findings indicate biomechanical differences can be identified between control and experimental groups at 2- and 9-week intervals using uniaxial testing.
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Papenkort S, Borsdorf M, Böl M, Siebert T. A geometry model of the porcine stomach featuring mucosa and muscle layer thicknesses. J Mech Behav Biomed Mater 2023; 142:105801. [PMID: 37068433 DOI: 10.1016/j.jmbbm.2023.105801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
The stomach is a vital organ responsible for food storage, digestion, and transport. Stomach diseases are of great economic and medical importance and require a large number of bariatric surgeries every year. To improve medical interventions, in silico modeling of the gastrointestinal tract has gained popularity in recent years to study stomach functioning. Because of the great structural and nutritional similarity between the porcine and human stomach, the porcine stomach is a suitable surrogate for the development and validation of gastric models. This study presents a realistic 3D geometry model of the porcine stomach based on a photogrammetric reconstruction of a real organ. Layer thicknesses of the stomach wall's mucosa and tunica muscularis were determined by more than 1900 manual measurements at different locations. Layer thickness distributions show mean mucosal and muscle thicknesses of 2.29 ± 0.45 mm and 2.83 ± 0.99 mm, respectively. In general, layer thicknesses increase from fundus (mucosa: 1.82 ± 0.19 mm, muscle layer: 2.59 ± 0.32 mm) to antrum (mucosa: 2.69 ± 0.31 mm, muscle layer: 3.73 ± 1.05 mm). The analysis of stomach asymmetry with respect to an idealized symmetrical stomach model, an approach often used in the literature, revealed volumetric deviations of 45%, 15%, and 92% for the antrum, corpus, and fundus, respectively. The present work also suggests an algorithm for the computation of longitudinal and circumferential directions at local points. These directions are useful for the implementation of material anisotropy. In addition, we present data on the passive pressure-volume relationship of the organ and perform an exemplary finite-element simulation, where we demonstrate the applicability of the model. We encourage others to utilize the geometry model featuring profound asymmetry for future model-based investigations on stomach functioning.
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5
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Monteiro-Reis S, Ferreira JPS, Pires RA, Lobo J, Carvalho JA, Reis RL, Jorge RN, Jerónimo C. Bladder Wall Stiffness after Cystectomy in Bladder Cancer Patients: A Preliminary Study. Cancers (Basel) 2023; 15:cancers15020359. [PMID: 36672309 PMCID: PMC9856862 DOI: 10.3390/cancers15020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/08/2023] Open
Abstract
Bladder cancer (BlCa), specifically urothelial carcinomas, is a heterogeneous disease that derives from the urothelial lining. Two main classes of BlCa are acknowledged: the non-muscle invasive BlCa and the muscle-invasive BlCa; the latter constituting an aggressive disease which invades locally and metastasizes systemically. Distinguishing the specific microenvironment that cancer cells experience between mucosa and muscularis propria layers can help elucidate how these cells acquire invasive capacities. In this work, we propose to measure the micromechanical properties of both mucosa and muscularis propria layers of the bladder wall of BlCa patients, using atomic force microscopy (AFM). To do that, two cross-sections of both the macroscopically normal urinary bladder wall and the bladder wall adjacent to the tumor were collected and immediately frozen, prior to AFM samples analysis. The respective "twin" formalin-fixed paraffin-embedded tissue fragments were processed and later evaluated for histopathological examination. H&E staining suggested that tumors promoted the development of muscle-like structures in the mucosa surrounding the neoplastic region. The average Young's modulus (cell stiffness) in tumor-adjacent specimens was significantly higher in the muscularis propria than in the mucosa. Similarly, the tumor-free specimens had significantly higher Young's moduli in the muscularis propria than in the urothelium. Young's moduli were higher in all layers of tumor-adjacent tissues when compared with tumor-free samples. Here we provide insights into the stiffness of the bladder wall layers, and we show that the presence of tumor in the surrounding mucosa leads to an alteration of its smooth muscle content. The quantitative assessment of stiffness range here presented provides essential data for future research on BlCa and for understanding how the biomechanical stimuli can modulate cancer cells' capacity to invade through the different bladder layers.
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Affiliation(s)
- Sara Monteiro-Reis
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
| | - João P. S. Ferreira
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto (FEUP), 4200-465 Porto, Portugal
| | - Ricardo A. Pires
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - João Lobo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
| | - João A. Carvalho
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Department of Urology, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
| | - Rui L. Reis
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4805-017 Guimarães, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Braga/Guimarães, Portugal
| | - Renato Natal Jorge
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto (FEUP), 4200-465 Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto Comprehensive Cancer Centre (Porto.CCC), 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
- Correspondence: or ; Tel.: +351-225084000
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6
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Frara N, Barbe MF, Giaddui D, Braverman AS, Amin M, Yu D, Ruggieri MR. Dog and human bladders have different neurogenic and nicotinic responses in inner versus outer detrusor muscle layers. Am J Physiol Regul Integr Comp Physiol 2022; 323:R589-R600. [PMID: 36062901 PMCID: PMC9722258 DOI: 10.1152/ajpregu.00084.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 01/02/2023]
Abstract
The aim of this study was to investigate layer and species variations in detrusor muscle strip responses to myogenic, neurogenic, and nicotinic, and muscarinic receptor stimulations. Strips from bladders of 9 dogs and 6 human organ transplant donors were dissected from inner and outer longitudinal muscle layers, at least 1 cm above urethral orifices. Strips were mounted in muscle baths and maximal responses to neurogenic stimulation using electrical field stimulation (EFS) and myogenic stimulation using potassium chloride (KCl, 120 mM) determined. After washing and re-equilibration was completed, responses to nicotinic receptor agonist epibatidine (10 μM) were determined followed by responses to EFS and muscarinic receptor agonist bethanechol (30 μM) in continued presence of epibatidine. Thereafter, strips and full-thickness bladder sections from four additional dogs and three human donors were examined for axonal density and intramural ganglia. In dog bladders, contractions to KCl, epibatidine, and bethanechol were 1.5- to 2-fold higher in the inner longitudinal muscle layer, whereas contractions to EFS were 1.5-fold higher in the outer (both pre- and post-epibatidine). Human bladders showed 1.2-fold greater contractions to epibatidine in the inner layer and to EFS in the outer, yet no layer differences to KCl or bethanechol were noted. In both species, axonal density was 2- to 2.5-fold greater in the outer layer. Dogs had more intramural ganglia in the adventitia/serosa layer, compared with more internal layers and to humans. These findings indicate several layer-dependent differences in receptor expression or distribution, and neurogenic responses in dog and human detrusor muscles, and myogenic/muscarinic differences between dog versus humans.
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Affiliation(s)
- Nagat Frara
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mary F Barbe
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Dania Giaddui
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alan S Braverman
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mamta Amin
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Daohai Yu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Michael R Ruggieri
- Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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7
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Cheng F, Watton PN, Pederzani G, Kurobe M, Takaoka EI, Chapple C, Birder L, Yoshimura N, Robertson AM. A constrained mixture-micturition-growth (CMMG) model of the urinary bladder: Application to partial bladder outlet obstruction (BOO). J Mech Behav Biomed Mater 2022; 134:105337. [PMID: 35863296 PMCID: PMC9835014 DOI: 10.1016/j.jmbbm.2022.105337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/13/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023]
Abstract
We present a constrained mixture-micturition-growth (CMMG) model for the bladder. It simulates bladder mechanics, voiding function (micturition) and tissue adaptations in response to altered biomechanical conditions. The CMMG model is calibrated with both in vivo and in vitro data from healthy male rat urinary bladders (cystometry, bioimaging of wall structure, mechanical testing) and applied to simulate the growth and remodeling (G&R) response to partial bladder outlet obstruction (BOO). The bladder wall is represented as a multi-layered, anisotropic, nonlinear constrained mixture. A short time scale micturition component of the CMMG model accounts for the active and passive mechanics of voiding. Over a second, longer time scale, G&R algorithms for the evolution of both cellular and extracellular constituents act to maintain/restore bladder (homeostatic) functionality. The CMMG model is applied to a spherical membrane model of the BOO bladder utilizing temporal data from an experimental male rodent model to parameterize and then verify the model. Consistent with the experimental studies of BOO, the model predicts: an initial loss of voiding capacity followed by hypertrophy of SMC to restore voiding function; bladder enlargement; collagen remodeling to maintain its role as a protective sheath; and increased voiding duration with lower average flow rate. This CMMG model enables a mechanistic approach for investigating the bladder's structure-function relationship and its adaption in pathological conditions. While the approach is illustrated with a conceptual spherical bladder model, it provides the basis for application of the CMMG model to anatomical geometries. Such a mechanistic approach has promise as an in silico tool for the rational development of new surgical and pharmacological treatments for bladder diseases such as BOO.
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Affiliation(s)
- Fangzhou Cheng
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
| | - Paul N Watton
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States; Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.
| | - Giulia Pederzani
- Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Masahiro Kurobe
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Ei-Ichiro Takaoka
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Chris Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Lori Birder
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Medicine, University of Pittsburgh, United States
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
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8
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Trostorf R, Morales Orcajo E, Pötzke A, Siebert T, Böl M. A pilot study on active and passive ex vivo characterisation of the urinary bladder and its impact on three-dimensional modelling. J Mech Behav Biomed Mater 2022; 133:105347. [DOI: 10.1016/j.jmbbm.2022.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
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9
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Rosen DP, Larson NB, Alizad A, Fatemi M. Non-invasive measurement of the internal pressure of a pressurized biological compartment using Lamb waves. IEEE Trans Biomed Eng 2021; 69:1860-1869. [PMID: 34807817 DOI: 10.1109/tbme.2021.3129652] [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] [Indexed: 11/05/2022]
Abstract
In this study, we propose a mechanical analysis for estimating the internal pressure of a finitely deformed spherical compartment from Lamb wave measurements. The proposed analysis produces a dispersion relation associating Lamb wave speed with pressure using limited material parameters (only a strain stiffening term). The analysis was validated on ultrasound bladder vibrometry (UBV) experiments collected from 9 ex vivo porcine bladders before and after formalin cross-linking. Estimated pressures were compared with pressures measured directly by a pressure transducer. The proposed analysis proved broadly effective at estimating pressure from UBV based Lamb wave without calibration as demonstrated by the observed concordance between estimated and measured pressures (Lins CCC = 0.82 (0.66-0.91). Theoretical limitations and potential refinements to improve the accuracy and generality of the approach are discussed.
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10
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A Data-Driven Memory-Dependent Modeling Framework for Anomalous Rheology: Application to Urinary Bladder Tissue. FRACTAL AND FRACTIONAL 2021. [DOI: 10.3390/fractalfract5040223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We introduce a data-driven fractional modeling framework for complex materials, and particularly bio-tissues. From multi-step relaxation experiments of distinct anatomical locations of porcine urinary bladder, we identify an anomalous relaxation character, with two power-law-like behaviors for short/long long times, and nonlinearity for strains greater than 25%. The first component of our framework is an existence study, to determine admissible fractional viscoelastic models that qualitatively describe linear relaxation. After the linear viscoelastic model is selected, the second stage adds large-strain effects to the framework through a fractional quasi-linear viscoelastic approach for the nonlinear elastic response of the bio-tissue of interest. From single-step relaxation data of the urinary bladder, a fractional Maxwell model captures both short/long-term behaviors with two fractional orders, being the most suitable model for small strains at the first stage. For the second stage, multi-step relaxation data under large strains were employed to calibrate a four-parameter fractional quasi-linear viscoelastic model, that combines a Scott-Blair relaxation function and an exponential instantaneous stress response, to describe the elastin/collagen phases of bladder rheology. Our obtained results demonstrate that the employed fractional quasi-linear model, with a single fractional order in the range α = 0.25–0.30, is suitable for the porcine urinary bladder, producing errors below 2% without need for recalibration over subsequent applied strains. We conclude that fractional models are attractive tools to capture the bladder tissue behavior under small-to-large strains and multiple time scales, therefore being potential alternatives to describe multiple stages of bladder functionality.
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11
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Tuttle TG, Morhardt DR, Poli AA, Park JM, Arruda EM, Roccabianca S. Investigation of Fiber-Driven Mechanical Behavior of Human and Porcine Bladder Tissue Tested Under Identical Conditions. J Biomech Eng 2021; 143:111007. [PMID: 34159357 DOI: 10.1115/1.4051525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Indexed: 11/08/2022]
Abstract
The urinary bladder is a highly dynamic organ that undergoes large deformations several times per day. Mechanical characteristics of the tissue are crucial in determining the function and dysfunction of the organ. Yet, literature reporting on the mechanical properties of human bladder tissue is scarce and, at times, contradictory. In this study, we focused on mechanically testing tissue from both human and pig bladders using identical protocols to validate the use of pigs as a model for the human bladder. Furthermore, we tested the effect of two treatments on tissue mechanical properties. Namely, elastase to digest elastin fibers, and oxybutynin to reduce smooth muscle cell spasticity. Additionally, mechanical properties based on the anatomical direction of testing were evaluated. We implemented two different material models to aid in the interpretation of the experimental results. We found that human tissue behaves similarly to pig tissue at high deformations (collagen-dominated behavior) while we detected differences between the species at low deformations (amorphous matrix-dominated behavior). Our results also suggest that elastin could play a role in determining the behavior of the fiber network. Finally, we confirmed the anisotropy of the tissue, which reached higher stresses in the transverse direction when compared to the longitudinal direction.
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Affiliation(s)
- Tyler G Tuttle
- Mechanical Engineering Department, Michigan State University, 474 S. Shaw Lane, East Lansing, MI 48824
| | - Duncan R Morhardt
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Andrea A Poli
- Mechanical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - John M Park
- Department of Urology, Michigan Medicine, 1500 E. Medical Drive, Ann Arbor, MI 48019
| | - Ellen M Arruda
- Mechanical Engineering Department, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Sara Roccabianca
- Mechanical Engineering Department, Michigan State University, 474 S. Shaw Lane, East Lansing, MI 48824
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12
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Nagaraja S, Leichsenring K, Ambati M, De Lorenzis L, Böl M. On a phase-field approach to model fracture of small intestine walls. Acta Biomater 2021; 130:317-331. [PMID: 34119714 DOI: 10.1016/j.actbio.2021.06.002] [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: 03/02/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
We address anisotropic elasticity and fracture in small intestine walls (SIWs) with both experimental and computational methods. Uniaxial tension experiments are performed on porcine SIW samples with varying alignments and quantify their nonlinear elastic anisotropic behavior. Fracture experiments on notched SIW strips reveal a high sensitivity of the crack propagation direction and the failure stress on the tissue orientation. From a modeling point of view, the observed anisotropic elastic response is studied with a continuum mechanical model stemming from a strain energy density with a neo-Hookean component and an anisotropic component with four families of fibers. Fracture is addressed with the phase-field approach, featuring two-fold anisotropy in the fracture toughness. Elastic and fracture model parameters are calibrated based on the experimental data, using the maximum and minimum limits of the experimental stress-stretch data set. A very good agreement between experimental data and computational results is obtained, the role of anisotropy being effectively captured by the proposed model in both the elastic and the fracture behavior. STATEMENT OF SIGNIFICANCE: This article reports a comprehensive experimental data set on the mechanical failure behavior of small intestinal tissue, and presents the corresponding protocols for preparing and testing the samples. On the one hand, the results of this study contribute to the understanding of small intestine mechanics and thus to understanding of load transfer mechanisms inside the tissue. On the other hand, these results are used as input for a phase-field modelling approach, presented in this article. The presented model can reproduce the mechanical failure behavior of the small intestine in an excellent way and is thus a promising tool for the future mechanical description of diseased small intestinal tissue.
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13
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Borsdorf M, Böl M, Siebert T. Influence of layer separation on the determination of stomach smooth muscle properties. Pflugers Arch 2021; 473:911-920. [PMID: 33900446 PMCID: PMC8164583 DOI: 10.1007/s00424-021-02568-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 01/29/2023]
Abstract
Uniaxial tensile experiments are a standard method to determine the contractile properties of smooth muscles. Smooth muscle strips from organs of the urogenital and gastrointestinal tract contain multiple muscle layers with different muscle fiber orientations, which are frequently not separated for the experiments. During strip activation, these muscle fibers contract in deviant orientations from the force-measuring axis, affecting the biomechanical characteristics of the tissue strips. This study aimed to investigate the influence of muscle layer separation on the determination of smooth muscle properties. Smooth muscle strips, consisting of longitudinal and circumferential muscle layers (whole-muscle strips [WMS]), and smooth muscle strips, consisting of only the circumferential muscle layer (separated layer strips [SLS]), have been prepared from the fundus of the porcine stomach. Strips were mounted with muscle fibers of the circumferential layer inline with the force-measuring axis of the uniaxial testing setup. The force-length (FLR) and force-velocity relationships (FVR) were determined through a series of isometric and isotonic contractions, respectively. Muscle layer separation revealed no changes in the FLR. However, the SLS exhibited a higher maximal shortening velocity and a lower curvature factor than WMS. During WMS activation, the transversally oriented muscle fibers of the longitudinal layer shortened, resulting in a narrowing of this layer. Expecting volume constancy of muscle tissue, this narrowing leads to a lengthening of the longitudinal layer, which counteracted the shortening of the circumferential layer during isotonic contractions. Consequently, the shortening velocities of the WMS were decreased significantly. This effect was stronger at high shortening velocities.
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Affiliation(s)
- Mischa Borsdorf
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany.
| | - Markus Böl
- Institute of Mechanics and Adaptronics, Department of Mechanical Engineering, Braunschweig University of Technology, Braunschweig, Germany
| | - Tobias Siebert
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
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14
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Predicting muscle tissue response from calibrated component models and histology-based finite element models. J Mech Behav Biomed Mater 2021; 117:104375. [PMID: 33578299 DOI: 10.1016/j.jmbbm.2021.104375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Skeletal muscle is an anisotropic soft biological tissue composed of muscle fibres embedded in a structurally complex, hierarchically organised extracellular matrix. In a recent work (Kuravi et al., 2021) we have developed 3D finite element models from series of histological sections. Moreover, based on decellularisation of fresh tissue samples, a novel set of experimental data on the direction dependent mechanical properties of collagenous ECM was established (Kohn et al., 2021). Together with existing information on the material properties of single muscle fibres, the combination of these techniques allows computing predictions of the composite tissue response. To this end, an inverse finite element procedure is proposed in the present work to calibrate a constitutive model of the extracellular matrix, and supplementary biaxial tensile tests on fresh and decellularised tissues are performed for model validation. The results of this rigorously predictive and thus unforgiving strategy suggest that the prediction of the tissue response from the individual characteristics of muscle cells and decellularised tissue is only possible within clear limits. While orders of magnitude are well matched, and the qualitative behaviour in a wide range of load cases is largely captured, the existing deviations point at potentially missing components of the model and highlight the incomplete experimental information in bottom-up multiscale approaches to model skeletal muscle tissue.
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Trostorf R, Morales-Orcajo E, Siebert T, Böl M. Location- and layer-dependent biomechanical and microstructural characterisation of the porcine urinary bladder wall. J Mech Behav Biomed Mater 2020; 115:104275. [PMID: 33360487 DOI: 10.1016/j.jmbbm.2020.104275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/04/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
The knowledge of the mechanical properties of the urinary bladder wall helps to explain its storage and micturition functions in health and disease studies; however, these properties largely remain unknown, especially with regard to its layer-specific characteristics and microstructure. Consequently, this study entails the assessment of the layer-specific differences in the mechanical properties and microstructure of the bladder wall, especially during loading. Accordingly, ninety-two (n=92) samples of porcine urinary bladder walls were mechanically and histologically analysed. Generally, the bladder wall and different tissue layers exhibit a non-linear stress-stretch relationship. In this study, the load transfer mechanisms were not only associated with the wavy structure of muscular and mucosal layers, but also with the entire bladder wall microstructure. Contextually, an interplay between the mucosal and muscular layers could be identified. Therefore, depending on the region and direction, the mucosal layer exhibited a stiffer mechanical response to equi-biaxial loading than that offered by the muscular layer when deformed to stretch levels higher than λ=1.6 to λ=2.2. For smaller stretches, the mucosal layer evinces no significant mechanical reaction, while the muscular layer bears the load. Owing to the orientation of its muscle fibres, the muscular layer shows an increased degree of anisotropy compared to the mucosal layer. Furthermore, the general incompressibility assumption is analysed for different layers by measuring the change in thickness during loading, which indicated a small volume loss.
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Affiliation(s)
- Robin Trostorf
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Enrique Morales-Orcajo
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Tobias Siebert
- Institute of Sport and Motion Science, University of Stuttgart, Stuttgart D-70569, Germany
| | - Markus Böl
- Institute of Mechanics and Adaptronics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
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16
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Poletajew S, Ilczuk T, Krajewski W, Niemczyk G, Cyran A, Białek Ł, Radziszewski P, Górnicka B, Kryst P. Bladder perforation during transurethral resection of bladder tumour is not a result of a deficient structure of the bladder wall. World J Surg Oncol 2020; 18:216. [PMID: 32814580 PMCID: PMC7439624 DOI: 10.1186/s12957-020-01992-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/06/2020] [Indexed: 01/05/2023] Open
Abstract
Background Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if the bladder wall structure affects the risk of bladder perforation during TUR. Methods Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled in this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in the bladder submucosa and the presence of degenerative changes in the urothelium. Results Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. The immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From a clinical point of view, ultrastructural analysis by electron microscopy showed a higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32). Conclusions Bladder perforation during TUR is not a result of a deficient structure of the bladder wall. Based on available evidence, the surgical technique seems to play the most important role in its prevention.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809, Warsaw, Poland.
| | - Tomasz Ilczuk
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Grzegorz Niemczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Cyran
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Białek
- First Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809, Warsaw, Poland
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TAMURA ATSUTAKA, YANO WATARU, YOSHIMURA DAICHI, NISHIKAWA SOICHIRO. MECHANICAL CHARACTERIZATION OF SPINAL DURA USING A PD-CONTROLLED BIAXIAL TENSILE TESTER. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, we developed an equi-load biaxial tensile tester and applied it to a series of mechanical tests using specimens obtained from the porcine spinal dura mater. The dural sample exhibited a nonlinear and anisotropic behavior as it was more deformable in the longitudinal direction rather than in the circumferential direction at lower strains; i.e., mechanical response of the longitudinal direction was significantly compliant in the Toe region compared to that of the circumferential direction under 1:1 biaxial stretching. However, we have not observed a significant difference with respect to the resultant strain and Young’s modulus between the longitudinal and circumferential directions at higher strains or in the Linear region. Our results also indicated that the upper thoracic region (T1) was relatively compliant compared to the lumbar region (L), where the failure load was almost equal between them because the dural thickness of T1 was five-fold greater than that of L; i.e., spinal dura mater became stiffer and stronger at further distances from the brain. This shows structural effectiveness and may be preferable to mechanically protect the vulnerable spinal cord from externally applied impact loads.
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Affiliation(s)
- ATSUTAKA TAMURA
- Department of Mechanical and Aerospace Engineering, Graduate School of Engineering, Tottori University, 4-101 Koyama-Minami, Tottori 680-8552, Japan
| | - WATARU YANO
- Department of Mechanical Engineering, Graduate School of Sustainability Science, Tottori University, 4-101 Koyama-Minami, Tottori 680-8552, Japan
| | - DAICHI YOSHIMURA
- Mechanical and Physical Engineering, Tottori University, 4-101 Koyama-Minami, Tottori 680-8552, Japan
| | - SOICHIRO NISHIKAWA
- Mechanical and Physical Engineering, Tottori University, 4-101 Koyama-Minami, Tottori 680-8552, Japan
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18
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Bauer M, Morales-Orcajo E, Klemm L, Seydewitz R, Fiebach V, Siebert T, Böl M. Biomechanical and microstructural characterisation of the porcine stomach wall: Location- and layer-dependent investigations. Acta Biomater 2020; 102:83-99. [PMID: 31760221 DOI: 10.1016/j.actbio.2019.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
The mechanical properties of the stomach wall help to explain its function of storing, mixing, and emptying in health and disease. However, much remains unknown about its mechanical properties, especially regarding regional heterogeneities and wall microstructure. Consequently, the present study aimed to assess regional differences in the mechanical properties and microstructure of the stomach wall. In general, the stomach wall and the different tissue layers exhibited a nonlinear stress-stretch relationship. Regional differences were found in the mechanical response and the microstructure. The highest stresses of the entire stomach wall in longitudinal direction were found in the corpus (201.5 kPa), where food is ground followed by the antrum (73.1 kPa) and the fundus (26.6 kPa). In contrast, the maximum stresses in circumferential direction were 39.7 kPa, 26.2 kPa, and 15.7 kPa for the antrum, fundus, and corpus, respectively. Independent of the fibre orientation and with respect to the biaxial loading direction, partially clear anisotropic responses were detected in the intact wall and the muscular layer. In contrast, the innermost mucosal layer featured isotropic mechanical characteristics. Pronounced layers of circumferential and longitudinal muscle fibres were found in the fundus only, whereas corpus and antrum contained almost exclusively circumferential orientated muscle fibres. This specific stomach structure mirrors functional differences in the fundus as well as corpus and antrum. Within this study, the load transfer mechanisms, connected with these wavy layers but also in total with the stomach wall's microstructure, are discussed. STATEMENT OF SIGNIFICANCE: This article examines for the first time the layer-specific mechanical and histological properties of the stomach wall attending to the location of the sample. Moreover, both mechanical behaviour and microstructure were explicitly match identifying the heterogeneous characteristics of the stomach. On the one hand, the results of this study contribute to the understanding of stomach mechanics and thus to their functional understanding of stomach motility. On the other hand, they are relevant to the fields of constitutive formulation of stomach tissue, whole stomach mechanics, and stomach-derived scaffolds i.e., tissue-engineering grafts.
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Böl M, Iyer R, Dittmann J, Garcés-Schröder M, Dietzel A. Investigating the passive mechanical behaviour of skeletal muscle fibres: Micromechanical experiments and Bayesian hierarchical modelling. Acta Biomater 2019; 92:277-289. [PMID: 31077887 DOI: 10.1016/j.actbio.2019.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
Characterisation of the skeletal muscle's passive properties is a challenging task since its structure is dominated by a highly complex and hierarchical arrangement of fibrous components at different scales. The present work focuses on the micromechanical characterisation of skeletal muscle fibres, which consist of myofibrils, by realising three different deformation states, namely, axial tension, axial compression, and transversal compression. To the best of the authors' knowledge, the present study provides a novel comprehensive data set representing of different deformation states. These data allow for a better understanding of muscle fibre load transfer mechanisms and can be used for meaningful modelling approaches. As the present study shows, axial tension and compression experiments reveal a strong tension-compression asymmetry at fibre level. In comparison to the tissue level, this asymmetric behaviour is more pronounced at the fibre scale, elucidating the load transfer mechanism in muscle tissue and aiding in the development of future modelling strategies. Further, a Bayesian hierarchical modelling approach was used to consider the experimental fluctuations in a parameter identification scheme, leading to more comprehensive parameter distributions that reflect the entire observed experimental uncertainty. STATEMENT OF SIGNIFICANCE: This article examines for the first time the mechanical properties of skeletal muscle fibres under axial tension, axial compression, and transversal compression, leading to a highly comprehensive data set. Moreover, a Bayesian hierarchical modelling concept is presented to identify model parameters in a broad way. The results of the deformation states allow a new and comprehensive understanding of muscle fibres' load transfer mechanisms; one example is the effect of tension-compression asymmetry. On the one hand, the results of this study contribute to the understanding of muscle mechanics and thus to the muscle's functional understanding during daily activity. On the other hand, they are relevant in the fields of skeletal muscle multiscale, constitutive modelling.
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Affiliation(s)
- Markus Böl
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
| | - Rahul Iyer
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Johannes Dittmann
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Mayra Garcés-Schröder
- Institute of Micro Technology, Technische Universität Braunschweig, Braunschweig D-38124, Germany
| | - Andreas Dietzel
- Institute of Micro Technology, Technische Universität Braunschweig, Braunschweig D-38124, Germany
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21
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Borsdorf M, Tomalka A, Stutzig N, Morales-Orcajo E, Böl M, Siebert T. Locational and Directional Dependencies of Smooth Muscle Properties in Pig Urinary Bladder. Front Physiol 2019; 10:63. [PMID: 30787883 PMCID: PMC6372509 DOI: 10.3389/fphys.2019.00063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
The urinary bladder is a distensible hollow muscular organ, which allows huge changes in size during absorption, storage and micturition. Pathological alterations of biomechanical properties can lead to bladder dysfunction and loss in quality of life. To understand and treat bladder diseases, the mechanisms of the healthy urinary bladder need to be determined. Thus, a series of studies focused on the detrusor muscle, a layer of urinary bladder made of smooth muscle fibers arranged in longitudinal and circumferential orientation. However, little is known about whether its active muscle properties differ depending on location and direction. This study aimed to investigate the porcine bladder for heterogeneous (six different locations) and anisotropic (longitudinal vs. circumferential) contractile properties including the force-length-(FLR) and force-velocity-relationship (FVR). Therefore, smooth muscle tissue strips with longitudinal and circumferential direction have been prepared from different bladder locations (apex dorsal, apex ventral, body dorsal, body ventral, trigone dorsal, trigone ventral). FLR and FVR have been determined by a series of isometric and isotonic contractions. Additionally, histological analyses were conducted to determine smooth muscle content and fiber orientation. Mechanical and histological examinations were carried out on 94 and 36 samples, respectively. The results showed that maximum active stress (pact ) of the bladder strips was higher in the longitudinal compared to the circumferential direction. This is in line with our histological investigation showing a higher smooth muscle content in the bladder strips in the longitudinal direction. However, normalization of maximum strip force by the cross-sectional area (CSA) of smooth muscle fibers yielded similar smooth muscle maximum stresses (165.4 ± 29.6 kPa), independent of strip direction. Active muscle properties (FLR, FVR) showed no locational differences. The trigone exhibited higher passive stress (ppass ) than the body. Moreover, the bladder exhibited greater ppass in the longitudinal than circumferential direction which might be attributed to its microstructure (more longitudinal arrangement of muscle fibers). This study provides a valuable dataset for the development of constitutive computational models of the healthy urinary bladder. These models are relevant from a medical standpoint, as they contribute to the basic understanding of the function of the bladder in health and disease.
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Affiliation(s)
- Mischa Borsdorf
- Institute for Sport and Exercise Science, Department of Movement and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - André Tomalka
- Institute for Sport and Exercise Science, Department of Movement and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Norman Stutzig
- Institute for Sport and Exercise Science, Department of Movement and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Enrique Morales-Orcajo
- Institute of Solid Mechanics, Department of Mechanical Engineering, Technical University of Braunschweig, Braunschweig, Germany
| | - Markus Böl
- Institute of Solid Mechanics, Department of Mechanical Engineering, Technical University of Braunschweig, Braunschweig, Germany
| | - Tobias Siebert
- Institute for Sport and Exercise Science, Department of Movement and Exercise Science, University of Stuttgart, Stuttgart, Germany
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