Novel insole design for diabetic foot ulcer management

Around the world, over 400 million people suffer from diabetes. In a chronic diabetic condition, the skin underneath the foot often becomes extremely soft and brittle, resulting in the development of foot ulcers. In literature, a plethora of footwear designs have been developed to reduce the induced stresses on a diabetic foot and to consequently prevent the incidences of foot ulcers. However, to date, no insole design exists which can handle post-ulcer diabetic foot conditions without hindering the mobility of the patients. In the current work, a novel custom insole design with arch support and ulcer isolations was tested for effective stress reduction in a diabetic foot with ulcers using finite element modeling. A full-scale model of the foot was developed with ulcers of different geometries and sizes at the heel and metatarsal regions of the foot. The stresses at the ulcer locations were quantified for standing and walking with and without the novel custom insole model. The effect of material properties of the insole on the ulcer stress reduction was quantified extensively. Also, the effectivity of a novel synthetic skin material as the insole material was tested for stress offloading at the ulcers and the rest of the foot. From the analyses, peak stress reductions were observed at the ulcers up to 91.5% due to the ulcer isolation in the novel custom insole design and the skin-like material. Specifically, the ulcer isolation feature in the insole was found to be approximately 25% more effective in peak stress reduction for commonly occurring ulcers with irregular geometry, over the tested regular circular ulcer geometry. Also, a threshold material stiffness was found for the custom insole, below which the peak stresses at the ulcers did not decrease any further. Based on this information, a working prototype of the custom insole was developed with custom ulcer isolations, which will be subjected to further testing. The results of this study would inform better custom insole designing and material selection for post-ulcer diabetic conditions, with effective stress reduction at the ulcers, and the possibilities of preventing further ulceration.

Developing nanotube junctions with arbitrary specifications

Experimentally synthesized carbon nanotube (CNTs) junctions (either single or with 2D/3D CNT network topology) are expected to have random orientation of defect sites (non-hexagonal rings) around the junction. This random and irregular nature of the junction topology and defect characteristics is expected to affect their strength and durability as well as impact the associated mesoscopic and macroscopic properties. On the contrary, theoretical and computational studies often investigate structure-property relationships of pristine and regular junctions of carbon nanostructures. In this study, we developed a computational framework to model a variety of junction structures between CNTs with arbitrary spatial (orientation and degree of overlap) and intrinsic (chirality) specifications. The developed computational model also has the ability to tune the degree of topological defects around the junction via a variety of defect annihilation approaches. Our method makes use of the primal/dual meshing concept, where the development and manipulation of the junction nodes occur using triangular meshes (primal mesh), which is eventually converted to its dual mesh (honeycomb mesh) to render a fully covalently bonded CNT junction. Here each carbon atom has 3 bonded neighbors (mimicking sp² hybridization). Under a given set of CNT orientation, overlap and chirality specifications, the approach creates a number of CNT junction configurations with varying degrees of energetic stability, offering an opportunity to investigate the effect of topological arrangement of defects around the junction on mechanical, electrical and thermal properties. In addition, it is shown via few examples that the discussed methodology can easily be extended to create multi-junction nanotube clusters, multi-wall nanotube junctions, as well as true 3D random network structures.

Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known "kneeling effect." Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.

Experimental study on tissue phantoms to understand the effect of injury and suturing on human skin mechanical properties

Skin injuries are the most common type of injuries occurring in day-to-day life. A skin injury usually manifests itself in the form of a wound or a cut. While a shallow wound may heal by itself within a short time, deep wounds require surgical interventions such as suturing for timely healing. To date, suturing practices are based on a surgeon's experience and may vary widely from one situation to another. Understanding the mechanics of wound closure and suturing of the skin is crucial to improve clinical suturing practices and also to plan automated robotic surgeries. In the literature, phenomenological two-dimensional computational skin models have been developed to study the mechanics of wound closure. Additionally, the effect of skin pre-stress (due to the natural tension of the skin) on wound closure mechanics has been studied. However, in most of these analyses, idealistic two-dimensional skin geometries, materials and loads have been assumed, which are far from reality, and would clearly generate inaccurate quantitative results. In this work, for the first time, a biofidelic human skin tissue phantom was developed using a two-part silicone material. A wound was created on the phantom material and sutures were placed to close the wound. Uniaxial mechanical tests were carried out on the phantom specimens to study the effect of varying wound size, quantity, suture and pre-stress on the mechanical behavior of human skin. Also, the average mechanical behavior of the human skin surrogate was characterized using hyperelastic material models, in the presence of a wound and sutures. To date, such a robust experimental study on the effect of injury and sutures on human skin mechanics has not been attempted. The results of this novel investigation will provide important guidelines for surgical planning and validation of results from computational models in the future.

A biofidelic computational model of the female pelvic system to understand effect of bladder fill and progressive vaginal tissue stiffening due to prolapse on anterior vaginal wall

Treatment of anterior vaginal prolapse (AVP), suffered by over 500,000 women in the USA, is a challenge in urogynecology because of the poorly understood mechanics of AVP. Recently, computational modeling combined with finite element method has been used to model AVP through the study of pelvic floor muscle and connective tissue impairments on the anterior vaginal wall (AVW). Also, the effects of pelvic organ displacements on the AVW were studied numerically. In our current work, an MRI-based full-scale biofidelic computational model of the female pelvic system composed of the urinary bladder, vaginal canal, and the uterus was developed, and a novel finite element method framework was employed to simulate vaginal tissue stiffening and also bladder filling due to expansion for the first time. A mesh convergence study was conducted to choose a computationally efficient mesh, and a non-linear hyperelastic Yeoh's material model was adopted for the study. The AVW displacements, mechanical stresses, and strains were estimated at varying degrees of bladder fills and vaginal tissue stiffening. Both bladder filling and vaginal stiffening were found to increase the stress concentration on the AVW with varying trends, which have been discussed in detail in the paper. To our knowledge, this study is the first to estimate the individual and combined effects of bladder filling and vaginal tissue stiffening due to prolapse on the AVW. Copyright © 2016 John Wiley & Sons, Ltd.

Relative Effects of Fluid Oscillations and Nutrient Transport in the In Vitro Growth of Valvular Tissues

Engineered valvular tissues are cultured dynamically, and involve specimen movement. We previously demonstrated that oscillatory shear stresses (OSS) under combined steady flow and specimen cyclic flexure (flex-flow) promote tissue formation. However, localized efficiency of specimen mass transport is also important in the context of cell viability within the growing tissues. Here, we investigated the delivery of two essential species for cell survival, glucose and oxygen, to 3-dimensional (3D) engineered valvular tissues. We applied a convective-diffusive model to characterize glucose and oxygen mass transport with and without valve-like specimen flexural movement. We found the mass transport effects for glucose and oxygen to be negligible for scaffold porosities typically present during in vitro experiments and non-essential unless the porosity was unusually low (<40%). For more typical scaffold porosities (75%) however, we found negligible variation in the specimen mass fraction of glucose and oxygen in both non-moving and moving constructs (p > 0.05). Based on this result, we conducted an experiment using bone marrow stem cell (BMSC)-seeded scaffolds under Pulsatile flow-alone states to permit OSS without any specimen movement. BMSC-seeded specimen collagen from the pulsatile flow and flex-flow environments were subsequently found to be comparable (p > 0.05) and exhibited some gene expression similarities. We conclude that a critical magnitude of fluid-induced, OSS created by either pulsatile flow or flex-flow conditions, particularly when the oscillations are physiologically-relevant, is the direct, principal stimulus that promotes engineered valvular tissues and its phenotype, whereas mass transport benefits derived from specimen movement are minimal.

Morphology and molecular phylogeny of Macrobrachium snpurii, a new species of the genus Macrobrachium Bate, 1868 from Kerala, India

Macrobrachium snpurii sp. nov., collected from the Karamana River, in the lower reaches of Western Ghats, is described and illustrated. DNA barcoding using Cytochrome B gene sequences has elucidated the taxonomic status of the new species and the NJ tree reveals that M. snpurii sp. nov., is phylogenetically close to M. idella idella. However, morphometric and meristic features of the species share certain characters with M. idella idella, M. patheinense and M. tratense, while it diverges remarkably from these three species in distinctive diagnostic characters: rostral formula 12-14/4 with 2 postorbital teeth; carapace smooth with distal end of rostrum directed upwards; chelae with 2 proximal denticles both in the movable and immovable fingers. A wide gap present in the distal part of the chelae, when fingers are closed. Movable finger, longer than the immovable and distal end of fingers inwardly hook-like; palm more pigmented than fingers and telson extends beyond the level of the outer lateral spine of uropodal exopod. A pair of plumose setae is present between the inner pair of movable spines of telson.

Macrobrachium indianum (Decapoda: Palaemonidae), a new species of hill stream prawn from Pambar River, Kerala, India

Macrobrachium indianum new species is described from the Pambar River, Kerala, S. India. The species shares certain characters with M. gurudeve Jayachandran & Raji, 2004, M. bombayense Almelker & Sankolli, 2006 and M. kulkarnii Almelker & Sankolli, 2006, while it differs remarkably from these three species in distinctive diagnostic characters: rostral formula 7-8/3-4 with 1 postorbital teeth, one tooth above orbit; carapace smooth with distal end of rostrum directed downwards; cephalothorax longer than rostrum; in second chelate leg, proximal cutting edge of movable finger with two weak denticles, one weak denticle in immovable finger, carpus longer than merus, merus shorter than propodus and longer than ischium; dactylus the shortest podomere. Five thick and a few thin reddish brown bands of chromatophores are seen on carapace. Pigmentation is found mid and ventro-laterally on abdominal segments, pereiopods have chromatophores at the distal part of podomeres.

Description, DNA barcode and phylogeny of a new species, Macrobrachium abrahami (Decapoda: Palaemonidae) from Kerala, India

Macrobrachium abrahami, new species is described from Vamanapuram River, Kerala, South India. DNA bar-coding using Cytochrome B gene sequences has elucidated the taxonomic status of the new species and the ML tree reveals that M. abrahami sp. nov., is phylogenetically close to M. prabhakarani, but morphologically more similar to M. scabriculum. However, the species shares certain morphological characters with M. scabriculum, M. prabhakarani and M. lanatum, but differs remarkably from these three species in distinctive diagnostic characters: rostrum moderately long, convex, distal end directed upwards, rostral formula 12-15/2-3 with 5-6 postorbital teeth, and carapace glabrous. In larger second chelate leg, fingers stout, pubescence restricted to their base; proximal half of cutting edge with fifteen denticles. In smaller second chelate leg, cutting edge of both fingers carry six small denticles situated proximally, distal one comparatively larger. Delicate setae are seen throughout the palm. A row of dark chromatophores is present along the posterio-dorsal margin of uropodal exopods and endopods, close to the base of uropodal setae. The thickness of each band of the row is almost equal to the thickness of uropodal setae.

Distribution of Added Iron in Milk of Cows and Buffaloes and its Effect on Oxidized Flavor Development

Association of added ferrous and ferric forms of iron in raw and pasteurized cow and buffalo milk is discussed in connection with its effect on oxidative deterioration of milk. Association of iron with sulfhydryls is shown to accelerate oxidized flavor development. Heat treatment or a suitable reducing agent capable of rendering the metal to the reduced state appears to promote the catalytic activity of added iron in milk. Buffalo milk does not differ from cow milk in its resistance to iron-induced oxidative deterioration.