Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery

Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain intensities. Further computational investigations revealed the potentialities of hybrid endoscopic procedures to induce both reduction of stomach capacity and enhancement of gastric receptors mechanical stimulation. In conclusion, biomechanics proved to be useful for the investigation of BS effects. Future exploitations of the biomechanical methods may largely improve BS reliability, efficacy and penetration rate.

Biomechanical analysis of the interaction phenomena between artificial urinary sphincter and urethral duct

Male urinary incontinence is a widespread healthcare problem, leading to a miserable quality of life. Artificial urinary sphincter (AUS) is a device inserted mostly around the urethra in adult males, which mimics the urinary sphincter by providing a closure during urinary storage and a subsequent open to permit voiding. The interaction phenomena occurring between AUS cuff and urethral duct represent a fundamental problem in the investigation of AUS reliability and durability. In this work, computational methods are exploited to deeply investigate the mechanics of interaction phenomena occurring between urethral duct and AUS device. Experimental studies are performed on urethral tissues, and structural tests are carried out on the overall urethral duct to obtain a large set of information required for mechanical properties definition. The mechanical behavior of AUS cuff is investigated using mechanical and physicochemical procedures. The cuff conformation is acquired by computed tomography techniques for the definition of the numerical model. Numerical analyses are developed to evaluate the mechanical response of urethral duct in interaction with AUS cuff, considering the lumen occlusion process for maintaining urinary continence. Finally, the investigation of the compressive stress and strain fields within urethral tissues allows the identification of device performance and reliability in correlation with surgical practice.

Mechanical properties variation and constitutive modelling of biomedical polymers after sterilization

PURPOSE

In this work, the mechanical behavior of two block copolymers for biomedical applications is studied with particular regard to the effects induced by a steam sterilization treatment that biomedical devices usually undergo in healthcare facilities. This investigation is aimed at describing the elasto-plastic behavior of the stress-strain response, determining a functional dependence between material constitutive parameters, to obtain an optimal constitutive model.

METHODS

The mechanical properties of these polymers are analyzed through uniaxial tensile tests, before and after the sterilization process. The effect of sterilization on the mechanical behavior is evaluated. The Ramberg-Osgood model is used to describe the elasto-plastic behavior of the stress-strain response.

RESULTS

Data from uniaxial tensile tests are discussed in the light of previous data on the same polymeric materials, in order to highlight the correlation between physicochemical and mechanical properties variation. The material constitutive parameters are determined and the functional dependence between them is found, thus enabling an optimal constitutive model to be obtained.

CONCLUSIONS

The effect of sterilization on the material constitutive parameters is studied, to evaluate the suitability of the model in describing the mechanical response of biomedical polymer before and after sterilization treatment. The same approach can be applied to other biomaterials, under various tensile tests, and for several processes that induce variation in mechanical properties.

Investigation of the mechanical behaviour of the plantar soft tissue during gait cycle: Experimental and numerical activities

The aim of this work is to investigate the mechanical response of the plantar soft tissue from the heel strike to the midstance, developing both experimental and numerical activities. Using force plates and motion tracking system, the dynamic and kinematic data of 10 subjects are evaluated. The average kinematics data obtained from the experimental tests are assumed as boundary and loading conditions for the computational analyses. A three-dimensional virtual solid model of the foot is developed from the analysis of Digital Imaging and Communications in Medicine images from computed tomography and magnetic resonance. Constitutive formulations that interpret the mechanical response of the biological tissues are defined. Because of the major role of plantar soft tissue in the proposed analysis, a specific visco-hyperelastic constitutive formulation is provided considering the typical features of the tissue mechanics. The three-dimensional numerical model permits to evaluate the capability of the plantar soft tissue to redistribute the deformations, especially during the midstance, and to define quantitative aspects related to the energy absorption. The numerical results highlight the stress distribution from the heel strike to the midstance. The values of stress and strain reached are more intensive during the midstance, when there is a single support of the foot.

Analysis of the structural behaviour of colonic segments by inflation tests: Experimental activity and physio-mechanical model

A coupled experimental and computational approach is provided for the identification of the structural behaviour of gastrointestinal regions, accounting for both elastic and visco-elastic properties. The developed procedure is applied to characterize the mechanics of gastrointestinal samples from pig colons. Experimental data about the structural behaviour of colonic segments are provided by inflation tests. Different inflation processes are performed according to progressively increasing top pressure conditions. Each inflation test consists of an air in-flow, according to an almost constant increasing pressure rate, such as 3.5 mmHg/s, up to a prescribed top pressure, which is held constant for about 300 s to allow the development of creep phenomena. Different tests are interspersed by 600 s of rest to allow the recovery of the tissues' mechanical condition. Data from structural tests are post-processed by a physio-mechanical model in order to identify the mechanical parameters that interpret both the non-linear elastic behaviour of the sample, as the instantaneous pressure-stretch trend, and the time-dependent response, as the stretch increase during the creep processes. The parameters are identified by minimizing the discrepancy between experimental and model results. Different sets of parameters are evaluated for different specimens from different pigs. A statistical analysis is performed to evaluate the distribution of the parameters and to assess the reliability of the experimental and computational activities.

Characterization of the anisotropic mechanical behaviour of colonic tissues: experimental activity and constitutive formulation

The aim was to investigate the biomechanical behaviour of colonic tissues by a coupled experimental and numerical approach. The wall of the colon is composed of different tissue layers. Within each layer, different fibre families are distributed according to specific spatial orientations, which lead to a strongly anisotropic configuration. Accounting for the complex histology of the tissues, mechanical tests must be planned and designed to evaluate the behaviour of the colonic wall in different directions. Uni-axial tensile tests were performed on tissue specimens from 15 fresh pig colons, accounting for six different loading directions (five specimens for each loading direction). The next step of the investigation was to define an appropriate constitutive framework and develop a procedure for identification of the constitutive parameters. A specific hyperelastic formulation was developed that accounted for the multilayered conformation of the colonic wall and the fibre-reinforced configuration of the tissues. The parameters were identified by inverse analyses of the mechanical tests. The comparison of model results with experimental data, together with the evaluation of satisfaction of material thermomechanics principles, confirmed the reliability of the analysis developed. This work forms the basis for more comprehensive activities that aim to provide computational tools for the interpretation of surgical procedures that involve the gastrointestinal tract, considering the specific biomedical devices adopted.

Analysis of the biomechanical behaviour of gastrointestinal regions adopting an experimental and computational approach

An integrated experimental and computational procedure is provided for the evaluation of the biomechanical behaviour that characterizes the pressure-volume response of gastrointestinal regions. The experimental activity pertains to inflation tests performed on specific gastrointestinal conduct segments. Different inflation processes are performed according to progressively increasing volumes. Each inflation test is performed by a rapid liquid in-flaw, up to a prescribed volume, which is held constant for about 300s to allow the development of relaxation processes. The different tests are interspersed by 600s of rest to allow the recovery of the specimen mechanical condition. A physio-mechanical model is developed to interpret both the elastic behaviour of the sample, as the pressure-volume trend during the rapid liquid in-flaw, and the time-dependent response, as the pressure drop during the relaxation processes. The minimization of discrepancy between experimental data and model results entails the identification of the parameters that characterize the viscoelastic model adopted for the definition of the behaviour of the gastrointestinal regions. The reliability of the procedure is assessed by the characterization of the response of samples from rat small intestine.

Investigations on the viscoelastic behaviour of a human healthy heel pad: In vivo compression tests and numerical analysis

The aim of this study was to investigate the viscoelastic behaviour of the human heel pad by comparing the stress–relaxation curves obtained from a compression device used on an in vivo heel pad with those obtained from a three-dimensional computer-based subject-specific heel pad model subjected to external compression. The three-dimensional model was based on the anatomy revealed by magnetic resonance imaging of a 31-year-old healthy female. The calcaneal fat pad tissue was described with a viscohyperelastic model, while a fibre-reinforced hyperelastic model was formulated for the skin. All numerical analyses were performed to interpret the mechanical response of heel tissues, with loading conditions and displacement rate in agreement with experimental tests. The heel tissues showed a non-linear, viscoelastic behaviour described by characteristic hysteretic curves, stress–relaxation and viscous recovery phenomena. The reliability of the investigations was validated by the interpretation of the mechanical response of heel tissues under the application of three pistons with diameter of 15, 20 and 40 mm, at the same displacement rate of about 1.7 mm/s. The maximum and minimum relative errors were found to be less than 0.95 and 0.064, respectively.

The effect of body warming on respiratory system stress recovery in the rat

The mechanical characteristics of respiratory system tissues include visco-elastic behaviour. In particular, after mechanical unloading, i.e., a reduction in respiratory system volume, the lower stress achieved slowly increases, approaching higher constant value, due to visco-elastic stress recovery. We performed experiments in which constant deflation flow arrest was applied in rats to study the successive pressure-time course, which defines the visco-elastic stress recovery. To investigate the possible effects of temperature changes, measurements were performed at two body temperatures, 36.6 ± 0.3 and 39.0 ± 0.1 °C. We found that stress recovery is reduced by increasing body temperature. Pressure-time curves after deflation arrest were fitted by specific mathematical model, and a good agreement was found. Model parameters exhibited significant changes with body temperature variations, suggesting that temperaturedependent micro-structural rearrangement phenomena in the tissues of alveolar wall were involved in the stress recovery decrement with body temperature increase. Thus, visco-elastic phenomena in respiratory system tissues of mammals exhibit temperature dependence. The stress recovery changes with body temperature suggest that expiration is expected to be easier in condition of physiological body temperature than in the case of increased temperature.

Biomechanical behaviour of heel pad tissue experimental testing, constitutive formulation, and numerical modelling

This paper deals with the constitutive formulation of heel pad tissue and presents a procedure for identifying constitutive parameters using experimental data, with the aim of developing a computational approach for investigating the actual biomechanical response. The preliminary definition of constitutive parameters was developed using a visco-hyperelastic formulation, considering experimental data from in vitro compression tests on specimens of fat pad tissue and data from in vivo tests to identify the actual trend of tissue stiffness. The discrepancy between model results and experimental data was evaluated on the basis of a specific cost function, adopting a stochastic/deterministic procedure. The parameter evaluation was upgraded by considering experimental tests performed on the fat pad tissues of a cadaveric foot using in situ indentation tests at 0.01 and 350 mm/s strain rates. The constitutive formulation was implemented in a numerical model. The comparison of data from in situ tests and numerical results led to an optimal domain of parameters based on an admissible discrepancy criterion. Numerical results evaluated for different sets of parameters inside the domain are reported and compared with experimental data for a reliability evaluation of the proposed procedure.

Modelling of mandible bone properties in the numerical analysis of oral implant biomechanics

The biomechanical efficiency of oral implants is deeply influenced by mechanical properties of cortical and trabecular bone in the jaw and, in particular, in the peri-implant region. When the mechanical response of the implant-bone system is analysed by means of numerical models, the effective mechanical properties of bone and the possible change as a function of spatial position must be carefully considered. The procedure presented provides for the attribution of the mechanical properties of bone, considered as anisotropic elastic material, as a function of the spatial position making use of Fourier series and polynomial functions. The procedure is implemented in a general purpose finite element software, adopted to develop biomechanical analyses of prosthetic systems. This procedure allows for an accurate representation of bone tissue properties. Results pertaining to the analysis of commercial oral implants show the potential of the method adopted.

Investigation of viscoelastoplastic response of bone tissue in oral implants press fit process

According to the standard surgical protocols, the press fit is obtained inserting an implant in a drilled hole that is provided with a lower diameter. In this way, it is induced a relevant strain state in the peri-implant bone that favors the primary stability of the implant. Experimental evaluation of this phenomenon is very difficult and does not offer a complete set of information. A numerical analysis is adopted to describe the mechanical phenomena occurring in the peri-implant tissue. At this purpose, suitable constitutive models are adopted for the bone tissue for the evaluation of plastic and viscous effects caused by the real strain field induced. Specific numerical procedures are developed to model the press fit action of an implant against the surrounding bone tissue and the subsequent viscoelastoplastic effects determined. The results of the numerical analysis make it possible to estimate the deformation caused by the insertion of the implant and the evolutionary trend after insertion by considering the inelastic time-dependent behavior of bone tissue in peri-implant region. According to the viscous characteristic of the bone tissue, the numerical analyses show a stress relaxation in the order of 30% around the implant.

A Visco-Hyperelastic-Damage Constitutive Model for the Analysis of the Biomechanical Response of the Periodontal Ligament

The periodontal ligament (PDL), as other soft biological tissues, shows a strongly non-linear and time-dependent mechanical response and can undergo large strains under physiological loads. Therefore, the characterization of the mechanical behavior of soft tissues entails the definition of constitutive models capable of accounting for geometric and material non-linearity. The microstructural arrangement determines specific anisotropic properties. A hyperelastic anisotropic formulation is adopted as the basis for the development of constitutive models for the PDL and properly arranged for investigating the viscous and damage phenomena as well to interpret significant aspects pertaining to ordinary and degenerative conditions. Visco-hyperelastic models are used to analyze the time-dependent mechanical response, while elasto-damage models account for the stiffness and strength decrease that can develop under significant loading or degenerative conditions. Experimental testing points out that damage response is affected by the strain rate associated with loading, showing a decrease in the damage limits as the strain rate increases. These phenomena can be investigated by means of a model capable of accounting for damage phenomena in relation to viscous effects. The visco-hyperelastic-damage model developed is defined on the basis of a Helmholtz free energy function depending on the strain-damage history. In particular, a specific damage criterion is formulated in order to evaluate the influence of the strain rate on damage. The model can be implemented in a general purpose finite element code. The accuracy of the formulation is evaluated by using results of experimental tests performed on animal model, accounting for different strain rates and for strain states capable of inducing damage phenomena. The comparison shows a good agreement between numerical results and experimental data.

Interaction phenomena between oral implants and bone tissue in single and multiple implant frames under occlusal loads and misfit conditions: A numerical approach

An investigation is carried out on the effects induced in bone tissue surrounding oral implants placed in the premolar region of a mandible by using a numerical approach. In particular, a single implant and a multiple implant frame under loading are considered. The effects of accuracy in the coupling of the connecting bar and implants are evaluated. The mechanical response of the bone-oral implant system, depending on the different mechanical properties assumed for the peri-implant bone tissue during the evolutionary trend of osseointegration, is studied. A further task regard to the comparison of the mechanical state induced in the bone depending on the loading conditions considered. Effects of physiological occlusal loads are compared with ones given by framework defects arising from the specific manufacturing process, such as misfit between the implants and the connecting bar. The investigation offers the basis for an integrated clinical and biomechanical evaluation of the effects induced on peri-implant bone, depending on bone properties, implant system configuration, and the actions induced. Analyses performed show that stress states induced by the investigated type of misfit are comparable to those arising from the application of physiological loading conditions.

Experimental–numerical analysis of minipig's multi-rooted teeth

The paper pertains to the analysis of the biomechanical behaviour of the periodontal ligament (PDL) by using a combined experimental and numerical approach. Experimental analysis provides information about a two-rooted pig premolar tooth in its socket with regard to morphological configuration and deformational response. The numerical analysis developed for the present investigation adopts a specific anisotropic hyperelastic formulation, accounting for tissue structural arrangement. The parameters to be adopted for the PDL constitutive model are evaluated with reference to data deducted from experimental in vitro tests on different specimens taken from literature. According to morphometric data relieved, solid models are provided as basis for the development of numerical models that adopt the constitutive formulation proposed. A reciprocal validation of experimental and numerical data allows for the evaluation of reliability of results obtained. The work is intended as preliminary investigation to study the correlation between mechanical status of PDL and induction to cellular activity in orthodontic treatments.

Anisotropic elasto-damage constitutive model for the biomechanical analysis of tendons

The aim of this work is to investigate the instantaneous mechanical response of tendons by the use of an anisotropic elasto-damage constitutive model. This study addresses the analysis of the mechanical behaviour of healthy tendons during physiological loading and to degeneration phenomena. These are correlated with aging or traumatic events such as chronic or acute overloading during sporting activities. Histo-morphometric considerations suggest the adoption of a transversally isotropic constitutive model that describes the anisotropy of the material. The non-linearity of its overall mechanical response is taken into account by using a hyperelastic approach and also evaluates softening behaviour related to damage phenomena. The values of the parameters adopted within the analytical model are estimated both for human tendons previously subjected to cyclical loading and for specimens not subjected to cyclical loading. The results obtained by adopting this analytical model are compared with the experimental data in order to evaluate the capability of the model to describe the mechanical response of the tissue.

A Transversally Isotropic Elasto-damage Constitutive Model for the Periodontal Ligament

A numerical formulation of an elasto-damage constitutive model was developed and implemented in a finite element software to investigate the biomechanical response of the periodontal ligament (PDL). The mathematical framework accounts for the description of large strains, anisotropy and inelastic phenomena. The anisotropic mechanical response is caused by the spatial orientation of the sub-structures of the tissue, such as collagen fibres. Inelastic behaviour, induced by high level strains, is modelled by means of damage models. In vitro experimental testing on PDL samples from pigs was performed to obtain tensile stress-strain curves. A finite element analysis is presented in order to define a general numerical approach. A comparison of numerical and experimental data is provided in order to show the reliability and effectiveness of the formulation assumed.