Non-linear micromechanics of soft tissues

Multimodal and multiscale characterization reveals how tendon structure and mechanical response are altered by reduced loading

Tendons are collagen-based connective tissues where the composition, structure and mechanics respond and adapt to the local mechanical environment. Adaptation to prolonged inactivity can result in stiffer tendons that are more prone to injury. However, the complex relation between reduced loading, structure, and mechanical performance is still not fully understood. This study combines mechanical testing with high-resolution synchrotron X-ray imaging, scattering techniques and histology to elucidate how reduced loading affects the structural properties and mechanical response of rat Achilles tendons on multiple length scales. The results show that reduced in vivo loading leads to more crimped and less organized fibers and this structural inhomogeneity could be the reason for the altered mechanical response. Unloading also seems to change the fibril response, possibly by altering the strain partitioning between hierarchical levels, and to reduce cell density. This study elucidates the relation between in vivo loading, the Achilles tendon nano-, meso‑structure and mechanical response. The results provide fundamental insights into the mechanoregulatory mechanisms guiding the intricate biomechanics, tissue structural organization, and performance of complex collagen-based tissues. STATEMENT OF SIGNIFICANCE: Achilles tendon properties allow a dynamic interaction between muscles and tendon and influence force transmission during locomotion. Lack of physiological loading can have dramatic effects on tendon structure and mechanical properties. We have combined the use of cutting-edge high-resolution synchrotron techniques with mechanical testing to show how reduced loading affects the tendon on multiple hierarchical levels (from nanoscale up to whole organ) clarifying the relation between structural changes and mechanical performance. Our findings set the first step to address a significant healthcare challenge, such as the design of tailored rehabilitations that take into consideration structural changes after tendon immobilization.

Microscale characterisation of the time-dependent mechanical behaviour of brain white matter

Brain mechanics is a topic of deep interest because of the significant role of mechanical cues in both brain function and form. Specifically, capturing the heterogeneous and anisotropic behaviour of cerebral white matter (WM) is extremely challenging and yet the data on WM at a spatial resolution relevant to tissue components are sparse. To investigate the time-dependent mechanical behaviour of WM, and its dependence on local microstructural features when subjected to small deformations, we conducted atomic force microscopy (AFM) stress relaxation experiments on corpus callosum (CC), corona radiata (CR) and fornix (FO) of fresh ovine brain. Our experimental results show a dependency of the tissue mechanical response on axons orientation, with e.g. the stiffness of perpendicular and parallel samples is different in all three regions of WM whereas the relaxation behaviour is different for the CC and FO regions. An inverse modelling approach was adopted to extract Prony series parameters of the tissue components, i.e. axons and extra cellular matrix with its accessory cells, from experimental data. Using a bottom-up approach, we developed analytical and FEA estimates that are in good agreement with our experimental results. Our systematic characterisation of sheep brain WM using a combination of AFM experiments and micromechanical models provide a significant contribution for predicting localised time-dependent mechanics of brain tissue. This information can lead to more accurate computational simulations, therefore aiding the development of surgical robotic solutions for drug delivery and accurate tissue mimics, as well as the determination of criteria for tissue injury and predict brain development and disease progression.

An Injectable Meta-Biomaterial: From Design and Simulation to In Vivo Shaping and Tissue Induction

A novel type of injectable biomaterial with an elastic softening transition is described. The material enables in vivo shaping, followed by induction of 3D stable vascularized tissue. The synthesis of the injectable meta-biomaterial is instructed by extensive numerical simulation as a suspension of irregularly fragmented, highly porous sponge-like microgels. The irregular particle shape dramatically enhances yield strain for in vivo stability against deformation. Porosity of the particles, along with friction between internal surfaces, provides the elastic softening transition. This emergent metamaterial property enables the material to reversibly change stiffness during deformation, allowing native tissue properties to be matched over a wide range of deformation amplitudes. After subcutaneous injection in mice, predetermined shapes can be sculpted manually. The 3D shape is maintained during excellent host tissue integration, with induction of vascular connective tissue that persists to the end of one-year follow-up. The geometrical design is compatible with many hydrogel materials, including cell-adhesion motives for cell transplantation. The injectable meta-biomaterial therefore provides new perspectives in soft tissue engineering and regenerative medicine.

In Vitro Evaluation of Biomaterials for Vocal Fold Injection: A Systematic Review

Vocal fold injection is a preferred treatment in glottic insufficiency because it is relatively quick and cost-saving. However, researchers have yet to discover the ideal biomaterial with properties suitable for human vocal fold application. The current systematic review employing PRISMA guidelines summarizes and discusses the available evidence related to outcome measures used to characterize novel biomaterials in the development phase. The literature search of related articles published within January 2010 to March 2021 was conducted using Scopus, Web of Science (WoS), Google Scholar and PubMed databases. The search identified 6240 potentially relevant records, which were screened and appraised to include 15 relevant articles based on the inclusion and exclusion criteria. The current study highlights that the characterization methods were inconsistent throughout the different studies. While rheologic outcome measures (viscosity, elasticity and shear) were most widely utilized, there appear to be no target or reference values. Outcome measures such as cellular response and biodegradation should be prioritized as they could mitigate the clinical drawbacks of currently available biomaterials. The review suggests future studies to prioritize characterization of the viscoelasticity (to improve voice outcomes), inflammatory response (to reduce side effects) and biodegradation (to improve longevity) profiles of newly developed biomaterials.

Validation of markerless strain-field optical tracking approach for soft tissue mechanical assessment

Strain measurement during tissue deformation is crucial to elucidate relationships between mechanical loading and functional changes in biological tissues. When combined with specified loading conditions, assessment of strain fields can be used to craft models that accurately represent the mechanical behavior of soft tissue. Inhomogeneities in strain fields may be indicative of normal or pathological inhomogeneities in mechanical properties. In this study, we present the validation of a modified Demons registration algorithm for non-contact, marker-less strain measurement of tissue undergoing uniaxial loading. We validate the algorithm on a synthetic dataset composed of artificial deformation fields applied to a speckle image, as well as images of aortic sections of varying perceptual quality. Initial results indicate that Demons outperforms recent Optical Flow and Digital Image Correlation methods in terms of accuracy and robustness to low image quality, with similar runtimes. Demons achieves at least 8% lower maximal deviation from ground truth on 50% biaxial and shear strain applied to aortic images. To illustrate utility, we quantified strain fields of multiple human aortic specimens undergoing uniaxial tensile testing, noting the formation of strain concentrations in areas of rupture. The modified Demons algorithm captured a large range of strains (up to 50%) and provided spatially resolved strain fields that could be useful in the assessment of soft tissue pathologies.

Locations of optimally matched Gabor atoms from ultrasound RF echoes for inter-scatterer spacing estimation

BACKGROUND AND OBJECTIVE

The resolvable scatterer spacing related to biological tissue microstructures is a quantitative signature used for the disease diagnosis and tissue classification. In the present study, a method by locating optimally matched Gabor atoms (LOMGA) from ultrasound RF echo signals is proposed to improve the inter-scatterer spacing (ISS) estimation.

METHOD

A series of Gabor atoms are obtained from the signals with a matching pursuit algorithm. Then, the optimum atoms highly correlated with the coherent components are automatically selected according to the second-order difference of the reconstructed signal-to-residue ratio. The distances between the locations of adjacent atoms are applied to estimate the ISSs. In the simulation experiments, four regular degrees of the scatterer distributions are modeled with the Gamma distribution. One hundred sets of ultrasound RF echo signals are simulated based on the regular and diffuse scatterer distributions, and then combined to generate signals with preset coherent-to-diffuse ratios (CDRs). The accuracy performance of the LOMGA method is compared with that based on wavelet transform (WT) algorithm. In the microwave ablation experiments, the ultrasound RF echo signals of the region of interest (ROI) are collected from the normal and coagulated porcine liver tissues. The means and standard deviations of the LOMGA-based ISSs are compared with the WT-based results.

RESULTS

The results based on simulated signals with CDRs from 10 dB to -10 dB demonstrate that the proposed method improves the estimation accuracies of the mean ISSs by 5.10%, 9.00%, 19.80%, and 23.82%, and reduces the mean standard deviations by 27.20%, 22.50%, 11.50%, and 4.49% more than the WT method for the four regularities, respectively. The performance of the LOMGA method is also verified with the ultrasound RF echo signals from ex vivo porcine liver tissues in microwave ablation experiments.

CONCLUSIONS

It is concluded that the LOMGA method can provide more accurate and stable ISS estimation, which improves the performance of the tissue characterization with ISS-based quantitative ultrasound.

Comparison of strength and depth cut with scalpel on porcine gingival tissues

The composition of the gums confers some physical characteristics that make it resistant to mechanical stimulation.  The objective of the study was to compare the difference of the utilized forces when performing cuts in the anterior and posterior sections of porcine gingival tissue, measuring the depth of the tissue. A comparative descriptive study was performed with a non-probability convenience sampling, sectioned pig mandibles were used. The experimental trials were performed with an EZ-S SHIMADZU texture analyzer. All of the samples were submitted to a vertical shear force, thus identified the force level used to perform the incision and its depth. the necessary force to perform a cut in porcine gingival tissue was evaluated, comparing the posterior section (39.3571 Newton and 2.160 mm)  and  with the anterior ( 37.8424 newton and 1.747 mm), just as the depth of said cut, showing a statistical difference on the depth, (p=0.022 p< 0.59); regarding the force, no statistically significant difference was found. In the analyzed samples where the shear force in the posterior and anterior section were compared, no difference was found in both groups; as for the cut depth, this was greater in the posterior section than in the anterior.

Mathematical Modeling and Virtual Reality Simulation of Surgical Tool Interactions With Soft Tissue: A Review and Prospective

This is an informed assessment of the state of the art and an extensive inventory of modeling approaches and methods for soft tissue/medical cutting tool interaction and of the associated medical processes and phenomena. Modeling and simulation through numerical, theoretical, computational, experimental, and other methods was discussed in comprehensive review sections each of which is concluded with a plausible prospective discussion biased toward the development of so-called virtual reality (VR) simulator environments. The finalized prospective section reflects on the future demands in the area of soft tissue cutting modeling and simulation mostly from a conceptual angle with emphasis on VR development requirements including real-time VR simulator response, cost-effective “close-to-reality” VR implementations, and other demands. The review sections that serve as the basis for the suggested prospective needs are categorized based on: (1) Major VR simulator applications including virtual surgery education, training, operation planning, intraoperative simulation, image-guided surgery, etc. and VR simulator types, e.g., generic, patient-specific and surgery-specific and (2) Available numerical, theoretical, and computational methods in terms of robustness, time effectiveness, computational cost, error control, and accuracy of modeling of certain types of virtual surgical interventions and their experimental validation, geared toward ethically driven artificial “phantom” tissue-based approaches. Digital data processing methods used in modeling of various feedback modalities in VR environments are also discussed.

Recent advances in studying single bacteria and biofilm mechanics

Bacterial biofilms correspond to surface-associated bacterial communities embedded in hydrogel-like matrix, in which high cell density, reduced diffusion and physico-chemical heterogeneity play a protective role and induce novel behaviors. In this review, we present recent advances on the understanding of how bacterial mechanical properties, from single cell to high-cell density community, determine biofilm tri-dimensional growth and eventual dispersion and we attempt to draw a parallel between these properties and the mechanical properties of other well-studied hydrogels and living systems.

Role of virtual simulation in surgical training

The comparison of the developments obtained by training for aviation with the ones obtained by training for surgery highlights the efforts that are still required to define shared and validated training curricula for surgeons. This work focuses on robotic assisted surgery and the related training systems to analyze the current approaches to surgery training based on virtual environments. Limits of current simulation technology are highlighted and the systems currently on the market are compared in terms of their mechanical design and characteristics of the virtual environments offered. In particular the analysis focuses on the level of realism, both graphical and physical, and on the set of training tasks proposed. Some multimedia material is proposed to support the analysis and to highlight the differences between the simulations and the approach to training. From this analysis it is clear that, although there are several training systems on the market, some of them with a lot of scientific literature proving their validity, there is no consensus about the tasks to include in a training curriculum or the level of realism required to virtual environments to be useful.

A validated 3D microstructure-based constitutive model of coronary artery adventitia

A structure-based model that accurately predicts micro- or macromechanical behavior of blood vessels is necessary to understand vascular physiology. Based on recently measured microstructural data, we propose a three-dimensional microstructural model of coronary adventitia that incorporates the elastin and collagen distributions throughout the wall. The role of ground substance was found to be negligible under physiological axial stretch λz = 1.3, based on enzyme degradation of glycosaminoglycans in swine coronary adventitia (n = 5). The thick collagen bundles of outer adventitia (n = 4) were found to be undulated and unengaged at physiological loads, whereas the inner adventitia consisted of multiple sublayers of entangled fibers that bear the majority of load at higher pressures. The microstructural model was validated against biaxial (inflation and extension) experiments of coronary adventitia (n = 5). The model accurately predicted the nonlinear responses of the adventitia, even at high axial force (axial stretch ratio λz = 1.5). The model also enabled a reliable estimation of material parameters of individual fibers that were physically reasonable. A sensitivity analysis was performed to assess the effect of using mean values of the distributions for fiber orientation and waviness as opposed to the full distributions. The simplified mean analysis affects the fiber stress-strain relation, resulting in incorrect estimation of mechanical parameters, which underscores the need for measurements of fiber distribution for a rigorous analysis of fiber mechanics. The validated structure-based model of coronary adventitia provides a deeper understanding of vascular mechanics in health and can be extended to disease conditions.

Multi-scale Modeling of the Cardiovascular System: Disease Development, Progression, and Clinical Intervention

Cardiovascular diseases (CVDs) are the leading cause of death in the western world. With the current development of clinical diagnostics to more accurately measure the extent and specifics of CVDs, a laudable goal is a better understanding of the structure-function relation in the cardiovascular system. Much of this fundamental understanding comes from the development and study of models that integrate biology, medicine, imaging, and biomechanics. Information from these models provides guidance for developing diagnostics, and implementation of these diagnostics to the clinical setting, in turn, provides data for refining the models. In this review, we introduce multi-scale and multi-physical models for understanding disease development, progression, and designing clinical interventions. We begin with multi-scale models of cardiac electrophysiology and mechanics for diagnosis, clinical decision support, personalized and precision medicine in cardiology with examples in arrhythmia and heart failure. We then introduce computational models of vasculature mechanics and associated mechanical forces for understanding vascular disease progression, designing clinical interventions, and elucidating mechanisms that underlie diverse vascular conditions. We conclude with a discussion of barriers that must be overcome to provide enhanced insights, predictions, and decisions in pre-clinical and clinical applications.

Evaluation of Biaxial Mechanical Properties of Aortic Media Based on the Lamellar Microstructure

Evaluation of the mechanical properties of arterial wall components is necessary for establishing a precise mechanical model applicable in various physiological and pathological conditions, such as remodeling. In this contribution, a new approach for the evaluation of the mechanical properties of aortic media accounting for the lamellar structure is proposed. We assumed aortic media to be composed of two sets of concentric layers, namely sheets of elastin (Layer I) and interstitial layers composed of mostly collagen bundles, fine elastic fibers and smooth muscle cells (Layer II). Biaxial mechanical tests were carried out on human thoracic aortic samples, and histological staining was performed to distinguish wall lamellae for determining the dimensions of the layers. A neo-Hookean strain energy function (SEF) for Layer I and a four-parameter exponential SEF for Layer II were allocated. Nonlinear regression was used to find the material parameters of the proposed microstructural model based on experimental data. The non-linear behavior of media layers confirmed the higher contribution of elastic tissue in lower strains and the gradual engagement of collagen fibers. The resulting model determines the nonlinear anisotropic behavior of aortic media through the lamellar microstructure and can be assistive in the study of wall remodeling due to alterations in lamellar structure during pathological conditions and aging.

Biaxial deformation of collagen and elastin fibers in coronary adventitia

The microstructural deformation-mechanical loading relation of the blood vessel wall is essential for understanding the overall mechanical behavior of vascular tissue in health and disease. We employed simultaneous mechanical loading-imaging to quantify in situ deformation of individual collagen and elastin fibers on unstained fresh porcine coronary adventitia under a combination of vessel inflation and axial extension loading. Specifically, the specimens were imaged under biaxial loads to study microscopic deformation-loading behavior of fibers in conjunction with morphometric measurements at the zero-stress state. Collagen fibers largely orientate in the longitudinal direction, while elastin fibers have major orientation parallel to collagen, but with additional orientation angles in each sublayer of the adventitia. With an increase of biaxial load, collagen fibers were uniformly stretched to the loading direction, while elastin fibers gradually formed a network in sublayers, which strongly depended on the initial arrangement. The waviness of collagen decreased more rapidly at a circumferential stretch ratio of λθ = 1.0 than at λθ = 1.5, while most collagen became straightened at λθ = 1.8. These microscopic deformations imply that the longitudinally stiffer adventitia is a direct result of initial fiber alignment, and the overall mechanical behavior of the tissue is highly dependent on the corresponding microscopic deformation of fibers. The microstructural deformation-loading relation will serve as a foundation for micromechanical models of the vessel wall.

Microstructural constitutive model of active coronary media

Although vascular smooth muscle cells (VSMCs) are pivotal in physiology and pathology, there is a lack of detailed morphological data on these cells. The objective of this study was to determine dimensions (width and length) and orientation of swine coronary VSMCs and to develop a microstructural constitutive model of active media. The dimensions, spatial aspect ratio and orientation angle of VSMCs measured at zero-stress state were found to follow continuous normal (or bimodal normal) distributions. The VSMCs aligned off circumferential direction of blood vessels with symmetrical polar angles 18.7° ± 10.9°, and the local VSMC deformation was affine with tissue-level deformation. A microstructure-based active constitutive model was developed to predict the biaxial vasoactivity of coronary media, based on experimental measurements of geometrical and deformation features of VSMCs. The results revealed that the axial active response of blood vessels is associated with multi-axial contraction as well as oblique VSMC arrangement. The present morphological database is essential for developing accurate structural models and is seminal for understanding the biomechanics of muscular vessels.