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Brascia D, Mangiameli G, Marulli G. Complex chest wall reconstruction after failure: a literature review. J Thorac Dis 2024; 16:4780-4793. [PMID: 39144326 PMCID: PMC11320226 DOI: 10.21037/jtd-23-1431] [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: 09/12/2023] [Accepted: 06/10/2024] [Indexed: 08/16/2024]
Abstract
Background and Objective Primary and secondary chest wall tumors (bone, breast, and soft tissue), congenital defects, and chest wall osteoradionecrosis often require extensive full-thickness local excisions to guarantee safe oncological margins (in cases of tumors) and complex reconstruction to provide stabilization and good biomechanical results avoiding postoperative respiratory failure. Thus, a personalized approach is required when dealing with chest wall defects, and reconstruction is planned. This review summarizes failed chest wall reconstruction procedures, identifies causes of failure, and highlights principles for complex chest wall reconstruction post-failure. Methods We performed a narrative review of the literature on PubMed, Scopus, ScienceDirect, and Google Scholar, including all the relevant studies published from 1970. Key Content and Findings The available experiences in literature are only anecdotic and no current guidelines or rules exist on this topic, also given to its rarity. Proper pre-surgical planning and a multidisciplinary team (MDT) discussion are crucial for complex cases such as infections and radiation-induced chest ulcers after previous surgical treatment. Procedures should eventually include thoracic wall debridement, necrotic tissue excision, pulse-jet lavage, prosthesis removal, and vacuum assisted closure (VAC) therapy as a bridge for chest wall re-reconstruction. Sternotomy wounds require wire and prosthesis removal, and the use of meshes or bone allografts. This review aims to summarize experiences and highlight surgical and oncologic principles for complex chest wall reconstruction after failure. Conclusions This review summarizes literature experiences to identify common key points for chest wall reconstruction after failure and to give some advice to surgeons managing this rare, challenging surgery.
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Affiliation(s)
- Debora Brascia
- Thoracic Surgery Unit, Bari University Hospital, Bari, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mangiameli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Marulli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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2
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Liang C, Jiang F, Kawaguchi D, Chen X. A Biomechanical Simulation of Forearm Flexion Using the Finite Element Approach. Bioengineering (Basel) 2023; 11:23. [PMID: 38247900 PMCID: PMC10812974 DOI: 10.3390/bioengineering11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Upper limb movement is vital in daily life. A biomechanical simulation of the forearm with consideration of the physiological characteristics of the muscles is instrumental in gaining deeper insights into the upper limb motion mechanisms. In this study, we established a finite element model of the forearm, including the radius, biceps brachii, and tendons. We simulated the motion of the forearm resulting from the contraction of the biceps brachii by using a Hill-type transversely isotropic hyperelastic muscle model. We adjusted the contraction velocity of the biceps brachii muscle in the simulation and found that a slower muscle contraction velocity facilitated forearm flexion. Then, we changed the percentage of fast-twitch fibers, the maximum muscle strength, and the neural excitation values of the biceps brachii muscle to investigate the forearm flexion of elderly individuals. Our results indicated that reduced fast-twitch fiber percentage, maximum muscle strength, and neural excitation contributed to the decline in forearm motion capability in elderly individuals. Additionally, there is a threshold for neural excitation, below which, motion capability sharply declines. Our model aids in understanding the role of the biceps brachii in forearm flexion and identifying the causes of upper limb movement disorders, which is able to provide guidance for enhancing upper limb performance.
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Affiliation(s)
| | - Fei Jiang
- Department of Mechanical Engineering, Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Tokiwadai, Ube 7558611, Yamaguchi, Japan; (C.L.); (D.K.); (X.C.)
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3
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Roth S. Thoughts and perspectives on biomechanical numerical models under impacts: Are women forgotten from research? Proc Inst Mech Eng H 2023; 237:1122-1138. [PMID: 37702375 DOI: 10.1177/09544119231195182] [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] [Indexed: 09/14/2023]
Abstract
The present paper explores a series of articles in the literature which deal with impact biomechanics of the head and thorax/abdomen segments, investigating the "sex specific properties/data" used in the studies. Statements in these studies are analyzed and point out, the use of male or female subjects for the developments of finite element models and their validation against experimental data. The present analysis raises the question about "androcentrism," and how biomechanical engineering findings and the design of the derived protecting devices are focused on male subjects.
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Affiliation(s)
- Sebastien Roth
- Laboratoire Interdisciplinaire Carnot de Bourgogne, site Université de Technologie de Belfort-Montbéliard (UTBM), UMR CNRS 6303/Univ. Bourgogne Franche-Comte (UBFC), Belfort, France
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4
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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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Bordoni B, Walkowski S, Escher A, Ducoux B. The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine. Complement Med Res 2021; 29:74-82. [PMID: 34237723 DOI: 10.1159/000517507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient's homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator's hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.
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Affiliation(s)
- Bruno Bordoni
- Department of Cardiology, Foundation Don Carlo Gnocchi IRCCS, Institute of Hospitalization and Care with Scientific Address, Milan, Italy
| | - Stevan Walkowski
- Osteopathic Manipulative Medicine, Heritage College of Osteopathic Medicine-Dublin, Dublin, Ohio, USA
| | - Allan Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Bruno Ducoux
- Osteopathy, Formation Recherche Ostéopathie Prévention (FROP), Bordeaux, France
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6
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3D Digital Adaptive Thorax Modelling of Peoples with Spinal Disabilities: Applications for Performance Clothing Design. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Peoples with spinal disability face a huge problem in the design and development of ergonomically fitted and comfortable clothing. Various research studies on the design and developments of functional clothing for scoliosis patients consider their morphological shapes. However, developing appropriate models of the complicated and deformed anatomical shape of the patient in 3D digitization technologies makes it possible to design a comfortable and fitted garment. The current paper proposes a method for developing a fully parametric 3D adaptive model of the thorax of a patient suffering from scoliosis. The model is designed from the spine and follows the deformation of the spine to adapt the thorax skeleton according to the temporal evolution of the spinal column deformation. The integration of the model of the thorax, adjusted to the patient’s data, enables the chain of acquisition, processing, and global model to be validated. The fit of the model could be improved for the different bones and it is possible to modify the angles of the spine to see the evolution of the disease. The developed model greatly helps to further detect anthropometric points from certain bone parts of the skeleton to design a basic bodice adapted to the patient’s evolving morphology.
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Clark AR, Burrowes KS, Tawhai MH. Integrative Computational Models of Lung Structure-Function Interactions. Compr Physiol 2021; 11:1501-1530. [PMID: 33577123 DOI: 10.1002/cphy.c200011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Anatomically based integrative models of the lung and their interaction with other key components of the respiratory system provide unique capabilities for investigating both normal and abnormal lung function. There is substantial regional variability in both structure and function within the normal lung, yet it remains capable of relatively efficient gas exchange by providing close matching of air delivery (ventilation) and blood delivery (perfusion) to regions of gas exchange tissue from the scale of the whole organ to the smallest continuous gas exchange units. This is despite remarkably different mechanisms of air and blood delivery, different fluid properties, and unique scale-dependent anatomical structures through which the blood and air are transported. This inherent heterogeneity can be exacerbated in the presence of disease or when the body is under stress. Current computational power and data availability allow for the construction of sophisticated data-driven integrative models that can mimic respiratory system structure, function, and response to intervention. Computational models do not have the same technical and ethical issues that can limit experimental studies and biomedical imaging, and if they are solidly grounded in physiology and physics they facilitate investigation of the underlying interaction between mechanisms that determine respiratory function and dysfunction, and to estimate otherwise difficult-to-access measures. © 2021 American Physiological Society. Compr Physiol 11:1501-1530, 2021.
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Affiliation(s)
- Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kelly S Burrowes
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn H Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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8
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Marcucci L, Reggiani C. Increase of resting muscle stiffness, a less considered component of age-related skeletal muscle impairment. Eur J Transl Myol 2020. [DOI: 10.4081/ejtm.2020.8982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Elderly people perform more slowly movements of everyday life as rising from a chair, walking, and climbing stairs. This is in the first place due to the loss of muscle contractile force which is even more pronounced than the loss of muscle mass. In addition, a secondary, but not negligible, component is the rigidity or increased stiffness which requires greater effort to produce the same movement and limits the range of motion of the joints. In this short review, we discuss the possible determinants of the limitations of joint mobility in healthy elderly, starting with the age-dependent alterations of the articular structure and focusing on the increased stiffness of the skeletal muscles. Thereafter, the possible mechanisms of the increased stiffness of the muscle-tendon complex are considered, among them changes in the muscle fibers, alterations of the connective components (extracellular matrix or ECM, aponeurosis, fascia and tendon) and remodeling of the neural pattern of muscle activation with increased of antagonist co-activation.
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9
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Marcucci L, Reggiani C. Increase of resting muscle stiffness, a less considered component of age-related skeletal muscle impairment. Eur J Transl Myol 2020; 30:8982. [PMID: 32782762 PMCID: PMC7385684 DOI: 10.4081/ejtm.2019.8982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
Elderly people perform more slowly movements of everyday life as rising from a chair, walking, and climbing stairs. This is in the first place due to the loss of muscle contractile force which is even more pronounced than the loss of muscle mass. In addition, a secondary, but not negligible, component is the rigidity or increased stiffness which requires greater effort to produce the same movement and limits the range of motion of the joints. In this short review, we discuss the possible determinants of the limitations of joint mobility in healthy elderly, starting with the age-dependent alterations of the articular structure and focusing on the increased stiffness of the skeletal muscles. Thereafter, the possible mechanisms of the increased stiffness of the muscle-tendon complex are considered, among them changes in the muscle fibers, alterations of the connective tissue components, i.e., extracellular matrix (ECM), aponeurosis, tendon and fascia, and remodeling of the neural pattern of muscle activation that increases antagonist co-activation.
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Affiliation(s)
- Lorenzo Marcucci
- Department of Biomedical Sciences, Padova University, Padova, Italy.,Center for Mechanics of Biological Materials, Padova University, Padova, Italy.,Center for Biosystems Dynamics Research, RIKEN, Suita, Osaka, 565-0874, Japan
| | - Carlo Reggiani
- Department of Biomedical Sciences, Padova University, Padova, Italy.,Center for Mechanics of Biological Materials, Padova University, Padova, Italy.,Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
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10
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Bito T, Suzuki Y, Kajiwara Y, Zeidan H, Harada K, Shimoura K, Tatsumi M, Nakai K, Nishida Y, Yoshimi S, Kawabe R, Yokota J, Yamashiro C, Tsuboyama T, Aoyama T. Effects of deep thermotherapy on chest wall mobility of healthy elderly women. Electromagn Biol Med 2020; 39:123-128. [PMID: 32131642 DOI: 10.1080/15368378.2020.1737803] [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] [Indexed: 10/24/2022]
Abstract
Chest wall mobility decreases with age in community-dwelling women aged 65 years or older. Thermotherapy is used to improve soft-tissue extensibility. However, its effects on chest wall mobility are unclear. This study aimed to examine the effect of thermotherapy on chest wall mobility in healthy elderly women. Twenty-eight elderly women participated in this study. Chest wall mobility at three levels (axillary, xiphoid, and tenth rib), respiratory function (forced vital capacity and forced expiratory volume), and tissue temperature (skin temperature (ST)) and deep temperature (DT) with 10 mm and 20 mm depth from the skin (10 mm DT and 20 mm DT)) were measured before and after 15 minutes of thermotherapy. The subjects randomly received one of the three interventions (capacitive and resistive electric transfer (CRet), hot pack (HP), and sham CRet (sham)). Chest wall mobility at all levels significantly increased after CRet intervention. Hot pack significantly increased tenth rib excursion; it also significantly increased ST, 10 mm DT, and 20 mm DT, whereas CRet significantly increased 10 mm DT and 20 mm DT. There were significant differences between CRet, HP, and sham in ST, 10 mm DT, and 20 mm DT. Furthermore, 20 mm DT had increased more in CRet than in HP. CRet improved chest wall mobility at all levels and HP improved at the tenth rib level. This implies that CRet can be one of the approaches to improve chest wall mobility.
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Affiliation(s)
- Tsubasa Bito
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,Kobe Century Memorial Hospital, Hyogo-ku, Kobe, Japan
| | - Yusuke Suzuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Yuu Kajiwara
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Hala Zeidan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Keiko Harada
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Kanako Shimoura
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Masataka Tatsumi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Kengo Nakai
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Yuichi Nishida
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Soyoka Yoshimi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Rika Kawabe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Junpei Yokota
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Chiaki Yamashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.,School of Health Sciences, Bukkyo University, Nakagyo-ku, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan
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11
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Marcucci L, Bondì M, Randazzo G, Reggiani C, Natali AN, Pavan PG. Fibre and extracellular matrix contributions to passive forces in human skeletal muscles: An experimental based constitutive law for numerical modelling of the passive element in the classical Hill-type three element model. PLoS One 2019; 14:e0224232. [PMID: 31689322 PMCID: PMC6830811 DOI: 10.1371/journal.pone.0224232] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/08/2019] [Indexed: 01/30/2023] Open
Abstract
The forces that allow body movement can be divided into active (generated by sarcomeric contractile proteins) and passive (sustained by intra-sarcomeric proteins, fibre cytoskeleton and extracellular matrix (ECM)). These are needed to transmit the active forces to the tendon and the skeleton. However, the relative contribution of the intra- and extra- sarcomeric components in transmitting the passive forces is still under debate. There is limited data in the literature about human muscle and so it is difficult to make predictions using multiscale models, imposing a purely phenomenological description for passive forces. In this paper, we apply a method for the experimental characterization of the passive properties of fibres and ECM to human biopsy and propose their clear separation in a Finite Element Model. Experimental data were collected on human single muscle fibres and bundles, taken from vastus lateralis muscle of elderly subjects. Both were progressively elongated to obtain two stress-strain curves which were fitted to exponential equations. The mechanical properties of the extracellular passive components in a bundle of fibres were deduced by the subtraction of the passive tension observed in single fibres from the passive tension observed in the bundle itself. Our results showed that modulus and tensile load bearing capability of ECM are higher than those of fibres and defined their quantitative characterization that can be used in macroscopic models to study their role in the transmission of forces in physiological and pathophysiological conditions.
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Affiliation(s)
- Lorenzo Marcucci
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Michela Bondì
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giulia Randazzo
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
- Kinesiology Research Center, Garibaldijeva, Koper, Slovenia
| | - Arturo N. Natali
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Piero G. Pavan
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Corso Stati Uniti 4, Padova, Italy
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12
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Shih KS, Truong TA, Hsu CC, Hou SM. Biomechanical investigation of different surgical strategies for the treatment of rib fractures using a three-dimensional human respiratory model. ACTA ACUST UNITED AC 2019; 64:93-102. [PMID: 29095691 DOI: 10.1515/bmt-2017-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/09/2017] [Indexed: 01/17/2023]
Abstract
Rib fracture is a common injury and can result in pain during respiration. Conservative treatment of rib fracture is applied via mechanical ventilation. However, ventilator-associated complications frequently occur. Surgical fixation is another approach to treat rib fractures. Unfortunately, this surgical treatment is still not completely defined. Past studies have evaluated the biomechanics of the rib cage during respiration using a finite element method, but only intact conditions were modelled. Thus, the purpose of this study was to develop a realistic numerical model of the human rib cage and to analyse the biomechanical performance of intact, injured and treated rib cages. Three-dimensional finite element models of the human rib cage were developed. Respiratory movement of the human rib cage was simulated to evaluate the strengths and limitations of different scenarios. The results show that a realistic human respiratory movement can be simulated and the predicted results were closely related to previous study (correlation coefficient>0.92). Fixation of two fractured ribs significantly decreased the fixation index (191%) compared to the injured model. This fixation may provide adequate fixation stability as well as reveal lower bone stress and implant stress compared with the fixation of three or more fractured ribs.
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Affiliation(s)
- Kao-Shang Shih
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC.,College of Medicine, Fu Jen Catholic University, Taipei 242, Taiwan, ROC
| | - Thanh An Truong
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan, ROC
| | - Ching-Chi Hsu
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Rd., Taipei 106, Taiwan, ROC
| | - Sheng-Mou Hou
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC
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13
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Yang C, Dong-Hai Z, Ling-Ying L, Yong-Hui Y, Yang W, Li-Wei Z, Rui-Guo H, Jia-Ke C. Simulation of blast lung injury induced by shock waves of five distances based on finite element modeling of a three-dimensional rat. Sci Rep 2019; 9:3440. [PMID: 30837628 PMCID: PMC6401050 DOI: 10.1038/s41598-019-40176-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Blast lung injury (BLI) caused by both military and civilian explosions has become the main cause of death for blast injury patients. By building three-dimensional (3D) models of rat explosion regions, we simulated the surface pressure of the skin and lung. The pressure distributions were performed at 5 distances from the detonation center to the center of the rat. When the distances were 40 cm, 50 cm, 60 cm, 70 cm and 80 cm, the maximum pressure of the body surface were 634.77kPa, 362.46kPa, 248.11kPa, 182.13kPa and 109.29kPa and the surfaces lung pressure ranges were 928–2916 Pa, 733–2254 Pa, 488–1236 Pa, 357–1189 Pa and 314–992 Pa. After setting 6 virtual points placed on the surface of each lung lobe model, simulated pressure measurement and corresponding pathological autopsies were then conducted to validate the accuracy of the modeling. For the both sides of the lung, when the distance were 40 cm, 50 cm and 60 cm, the Pearson’s values showed strong correlations. When the distances were 70 cm and 80 cm, the Pearson’s values showed weak linear correlations. This computational simulation provided dynamic anatomy as well as functional and biomechanical information.
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Affiliation(s)
- Chang Yang
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Zhang Dong-Hai
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Liu Ling-Ying
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Yu Yong-Hui
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Wu Yang
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Zang Li-Wei
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Han Rui-Guo
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Chai Jia-Ke
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China.
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Zhang G, Chen X, Ohgi J, Jiang F, Sugiura S, Hisada T. Effect of intercostal muscle contraction on rib motion in humans studied by finite element analysis. J Appl Physiol (1985) 2018; 125:1165-1170. [PMID: 30048203 DOI: 10.1152/japplphysiol.00995.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effect of intercostal muscle contraction on generating rib motion has been investigated for a long time and is still controversial in physiology. This may be because of the complicated structure of the rib cage, making direct prediction of the relationship between intercostal muscle force and rib movement impossible. Finite element analysis is a useful tool that is good at solving complex structural mechanic problems. In this study, we individually activated the intercostal muscle groups from the dorsal to ventral portions and obtained five different rib motions classified based on rib moving directions. We found that the ribs cannot only rigidly rotate around the spinal joint but also be deformed, particularly around the relatively soft costal cartilages, where the moment of muscle force for the rigid rotation is small. Although the intercostal muscles near the costal cartilages cannot generate a large moment to rotate the ribs, the muscles may still have a potential to deform the costal cartilages and contribute to the expansion and contraction of the rib cage based on the force-length relationship. Our results also indicated that this potential is matched well with the special shape of the costal cartilages, which become progressively oblique in the caudal direction. Compared with the traditional explanation of rib motion, by additionally considering the effect from the tissue deformation, we found that the special structure of the ventral portion of the human rib cage could be of mechanical benefit to the intercostal muscles, generating inspiratory and expiratory rib motions. NEW & NOTEWORTHY Compared with the traditional explanation of rib motion, additionally considering the effect from tissue deformation helps us understand the special structure of the ventral portion of the human rib cage, such that the costal cartilages progressively become oblique and the costochondral junction angles gradually change into nearly right angles from the upper to lower ribs, which could be of mechanical benefit to the intercostal muscles in the ventral portion, generating inspiratory and expiratory rib motions.
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Affiliation(s)
- Guangzhi Zhang
- Research Center of Computational Mechanics , Tokyo , Japan
| | - Xian Chen
- Department of Mechanical Engineering, Yamaguchi University , Ube , Japan
| | - Junji Ohgi
- Department of Mechanical Engineering, Yamaguchi University , Ube , Japan
| | - Fei Jiang
- Department of Mechanical Engineering, Yamaguchi University , Ube , Japan
| | - Seiryo Sugiura
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Kashiwa, Japan
| | - Toshiaki Hisada
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Kashiwa, Japan
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de Cesare N, Trevisan C, Maghin E, Piccoli M, Pavan PG. A finite element analysis of diaphragmatic hernia repair on an animal model. J Mech Behav Biomed Mater 2018; 86:33-42. [PMID: 29933200 DOI: 10.1016/j.jmbbm.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/15/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
The diaphragm is a mammalian skeletal muscle that plays a fundamental role in the process of respiration. Alteration of its mechanical properties due to a diaphragmatic hernia contributes towards compromising its respiratory functions, leading to the need for surgical intervention to restore the physiological conditions by means of implants. This study aims to assess via numerical modeling biomechanical differences between a diaphragm in healthy conditions and a herniated diaphragm surgically repaired with a polymeric implant, in a mouse model. Finite Element models of healthy and repaired diaphragms are developed from diagnostic images and anatomical samples. The mechanical response of the diaphragmatic tendon is described by assuming an isotropic hyperelastic model. A similar constitutive model is used to define the mechanical behavior of the polymeric implant, while the muscular tissue is modeled by means of a three-element Hill's model, specifically adapted to mouse muscle fibers. The Finite Element Analysis is addressed to simulate diaphragmatic contraction in the eupnea condition, allowing the evaluation of diaphragm deformation in healthy and herniated-repaired conditions. The polymeric implant reduces diaphragm excursion compared to healthy conditions. This explains the possible alteration in the mechanical functionality of the repaired diaphragm. Looking to the surgical treatment of diaphragmatic hernia in human neonatal subjects, this study suggests the implementation of alternative approaches based on the use of biological implants.
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Affiliation(s)
- N de Cesare
- Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - C Trevisan
- Department of Woman's and Child's Health, University of Padova, Italy; Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - E Maghin
- Department of Woman's and Child's Health, University of Padova, Italy; Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - M Piccoli
- Tissue Engineering Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy; Department of Biomedical Sciences, University of Padova, Italy
| | - P G Pavan
- Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy.
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