Passive Tissue Research Articles

Trunk stability in fatiguing frequency-dependent lifting activities

BackgroundWork-related low-back disorders (WLBDs) are one of the most frequent and costly musculoskeletal conditions. It has been showed that WLBDs may occur when intervertebral or torso equilibrium is altered by a biomechanical perturbations or neuromuscular control error. The capacity to react to such disturbances is heavily determined by the spinal stability, provided by active and passive tissues and controlled by the central nervous system. Research questionThis study aims to investigate trunk stability through the Lyapunov’s maximum exponent during repetitive liftings in relation to risk level, as well as to evaluate its ability to discriminate these risk levels. MethodsFifteen healthy volunteers performed fatiguing lifting tasks at three different frequencies corresponding to low, medium, and high risk levels according to the National Institute for Occupational Safety and Health (NIOSH) equation. We investigated changes in spinal stability during fatiguing lifting tasks at different risk levels using the maximum Lyapunov's index (λMax) computed from trunk accelerations recorded by placing three IMUs at pelvis, lower and upper spine levels. A two-way repeated-measures ANOVA was performed to determine if there was any significant effect on λMax among the three risk levels and the time (start, mid, and end of the task). Additionally, we examined the Pearson’s correlation of λMax with the trunk muscle co-activation, computed from trunk sEMG. ResultsOur findings show an increase in trunk stability with increasing risk level and as the lifting task progressed over time. A negative correlation between λMax and trunk co-activation was observed which illustrates that the increase in spinal stability could be partially attributed to increased trunk muscle co-activation. SignificanceThis study highlights the possibility of generating stability measures from kinematic data as risk assessment features in fatiguing tasks which may prove useful to detect the risk of developing work-related low back pain disorders and allow the implementation of early ergonomic interventions.

Acute effect of diagonal stretching using the posterior oblique sling system on contralateral ankle dorsiflexion.

A significant increase in the dorsiflexion range of motion (DFROM) after calf muscle stretching has been widely studied. However, it has been shown that the upper body is connected to the ankle joint by passive connective tissues. The purpose of this study was to examine the effect of upper-back stretching on the mobility of the contralateral ankle. In the supine position, DFROM in the contralateral leg was measured. In the sitting position with and without trunk rotation, DFROM was measured in both legs. In the sitting position with trunk rotation, dorsiflexion was measured only in the contralateral leg. Static diagonal stretching combining trunk rotation with slight trunk flexion was performed in the sitting position with a neutral pelvis. After stretching, DFROM in contralateral and ipsilateral legs were measured in the sitting position with a neutral pelvis. In the contralateral leg, significant differences in ΔDFROM were observed between the sitting position with trunk rotation and the supine position and between the sitting position with trunk rotation and the sitting position after stretching. In clinical settings, diagonal stretching of the unilateral posterior trunk causes a significant increase in the DFROM of the contralateral lower limb.

Passive exoskeletons alter low back load transfer mechanism

Previous studies that tested passive back-support exoskeletons focused only on active low-back tissue. Therefore, this study examines the effect from a passive back-support exoskeleton by investigating changes in the load transfer mechanism between active and passive tissue in the low back. Twelve healthy male participants performed a full range of trunk flexion–extension movements under three conditions—FREE (no exoskeleton), the backX, or the CoreBot exoskeleton—while holding 0 kg, 4 kg, and 8 kg loads. Body kinematics and electromyography were recorded. Results showed that the average muscle activity of the lumbar erector spinae (LES) was significantly reduced while wearing the exoskeletons, with a 5.9%MVC reduction with the backX and a 3.3%MVC reduction with the CoreBot. Earlier occurrence of the flexion-relaxation phenomenon induced by the trunk extension moment of exoskeletons played an important role in reducing LES muscle activity because the LES returned to a relaxed state earlier (EMG-Off: a 3.1° reduction with the backX, and a 1.8° reduction with the CoreBot; EMG-On: a 2.3° reduction with the backX, and a 1.4° reduction with the CoreBot). In addition, the maximum lumbar flexion angle (a 2.2° reduction with the backX and a 1.5° reduction with the CoreBot) showed significant decreases compared to the FREE condition, indicating that exoskeleton use can prevent low-back passive tissue from being fully activated. These results suggested the overall effects of passive back-support exoskeletons in reducing loads on both active and passive tissue in the low back.

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study.

Patients with chronic low back pain (CLBP) exhibit remodelling of the lumbar soft tissues such as muscle fatty infiltrations (MFI) and fibrosis of the lumbar multifidus (LuM) muscles, thickness changes of the thoracolumbar fascia (TLF) and perimuscular connective tissues (PMCT) surrounding the abdominal lateral wall muscles. Rehabilitative ultrasound imaging (RUSI) parameters such as thickness and echogenicity are sensitive to this remodelling. This experimental laboratory study aimed to explore whether these RUSI parameters (LuM echogenicity and fascia thicknesses), hereafter called dependent variables (DV) were linked to independent variables (IV) such as (1) other RUSI parameters (trunk muscle thickness and activation) and (2) physical and psychological measures. RUSI measures, as well as a clinical examination comprising physical tests and psychological questionnaires, were collected from 70 participants with LBP. The following RUSI dependent variables (RUSI-DV), measures of passive tissues were performed bilaterally: (1) LuM echogenicity (MFI/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1); (2) TLF posterior layer thickness, and (3) PMCT thickness of the fasciae between subcutaneous tissue thickness (STT) and external oblique (PMCTSTT/EO ), between external and internal oblique (PMCTEO/IO ), between IO and transversus abdominis (PMCTIO/TrA ) and between TrA and intra-abdominal content (PMCTTrA/IA ). RUSI measures of trunk muscle's function (thickness and activation), also called measures of active muscle tissues, were considered as independent variables (RUSI-IV), along with physical tests related to lumbar stability (n=6), motor control deficits (n=7), trunk muscle endurance (n=4), physical performance (n=4), lumbar posture (n=2), and range of motion (ROM) tests (n=6). Psychosocial measures included pain catastrophizing, fear-avoidance beliefs, psychological distress, illness perceptions and concepts related to adherence to a home-based exercise programme (physical activity level, self-efficacy, social support, outcome expectations). Six multivariate regression models (forward stepwise selection) were generated, using RUSI-DV measures as dependent variables and RUSI-IV/physical/psychosocial measures as independent variables (predictors). The six multivariate models included three to five predictors, explaining 63% of total LuM echogenicity variance, between 41% and 46% of trunk superficial fasciae variance (TLF, PMCTSTT/EO ) and between 28% and 37% of deeper abdominal wall fasciae variance (PMCTEO/IO , PMCTIO/TrA and PMCTTrA/IA ). These variables were from RUSI-IV (LuM thickness at rest, activation of IO and TrA), body composition (percent fat) and clinical physical examination (lumbar and pelvis flexion ROM, aberrant movements, passive and active straight-leg raise, loaded-reach test) from the biological domain, as well as from the lifestyle (physical activity level during sports), psychological (psychological distress-cognitive subscale, fear-avoidance beliefs during physical activities, self-efficacy to exercise) and social (family support to exercise) domains. Biological, psychological, social and lifestyle factors each accounted for substantial variance in RUSI-passive parameters. These findings are in keeping with a conceptual link between tissue remodelling and factors such as local and systemic inflammation. Possible explanations are discussed, in keeping with the hypothesis-generating nature of this study (exploratory). However, to impact clinical practice, further research is needed to determine if the most plausible predictors of trunk fasciae thickness and LuM fatty infiltrations have an effect on these parameters.

Qualitative and Quantitative Characteristics of the Passive Compartment Underneath the Myocardial Bridge Comprising the Blood Vessel Adventitia and the Perivascular Connective Tissue

Myocardial bridges are inborn anomalies frequently found in authopsies. Although tipically clinically silent, they are occasionally associated with severe clinical manifestations, e.g. myocardial ischemia or even sudden death. The pathophysiology and risk factors for these manifestations have not yet been completely elucidated. The connective tissue underneath the bridge has been considered as one of the factors the symptoms depend on. Thus, the aim of this research was to determine the histological characteristics of the connective tissue lying underneath the myocardial bridge and to contribute to a better understanding of the protective effects this passive compartment might have in prevention of severe clinical manifestations of myocardial bridging. The study was carried out on twenty hearts with myocardial bridges. Length of the bridge was determined using a precise electronic caliper. Sections of the myocardial bridges with the underlying connective tissue were obtained and prepared for qualitative and quantitative analysis. The connective tissue underneath the bridges was composed of adipose tissue and loose connective tissue in different ratios. The tissue underneath thin bridges was predominantly composed of adipose tissue, while loose connective tissue was the dominant component under thick bridges. The myocardial bridges had an average thickness of 0,98 ± 0.44 mm and an average length of 15,25±5,65 mm. We found a strong positive correlation between the myocardial bridge thickness and length (r = 0,860, p = 0,0001). The thickness of the passive connective tissue compartment under the myocardial bridges was 0,58±0,22 mm, and there was no correlation between this parameter and the myocardial bridge thickness (r = -0,011; p = 0,963). In the clinical evaluation of patients with these anomalies it is necessary to take into account independently the myocardial bridge thickness and length on one side and the thickness of the connective tissue lying underneath it on the other.

Targeting caveolae to pump bispecific antibody to TGF-β into diseased lungs enables ultra-low dose therapeutic efficacy.

The long-sought-after "magic bullet" in systemic therapy remains unrealized for disease targets existing inside most tissues, theoretically because vascular endothelium impedes passive tissue entry and full target engagement. We engineered the first "dual precision" bispecific antibody with one arm pair to precisely bind to lung endothelium and drive active delivery and the other to precisely block TGF-β effector function inside lung tissue. Targeting caveolae for transendothelial pumping proved essential for delivering most of the injected intravenous dose precisely into lungs within one hour and for enhancing therapeutic potency by >1000-fold in a rat pneumonitis model. Ultra-low doses (μg/kg) inhibited inflammatory cell infiltration, edema, lung tissue damage, disease biomarker expression and TGF-β signaling. The prodigious benefit of active vs passive transvascular delivery of a precision therapeutic unveils a new promising drug design, delivery and therapy paradigm ripe for expansion and clinical testing.

Manual and semi-automatic determination of elbow angle-independent parameters for a model of the biceps brachii distal tendon based on ultrasonic imaging.

Tendons consist of passive soft tissue with non linear material properties. They play a key role in force transmission from muscle to skeletal structure. The properties of tendons have been extensively examined in vitro. In this work, a non linear model of the distal biceps brachii tendon was parameterized based on measurements of myotendinous junction displacements in vivo at different load forces and elbow angles. The myotendinous junction displacement was extracted from ultrasound B-mode images within an experimental setup which also allowed for the retrieval of the exerted load forces as well as the elbow joint angles. To quantify the myotendinous junction movement based on visual features from ultrasound images, a manual and an automatic method were developed. The performance of both methods was compared. By means of exemplary data from three subjects, reliable fits of the tendon model were achieved. Further, different aspects of the non linear tendon model generated in this way could be reconciled with individual experiments from literature.

SPORTS BRA SUPPORT ALTERS METABOLIC COST AND ECONOMY PROFILES DURING TREADMILL RUNNING

1,2Alexis K. Nelson, 2Jay J. Hinton, 2Hailey B. Fong, 2Julie E. Woolfolk, 1,2Douglas W. Powell FACSM1University of Tennessee Health Science Center, 2University of Memphis Sponsor: Douglas W. Powell, FACSM The breast is a passive tissue that has been described as a wobbling mass on a rigid torso. With limited intrinsic support, female athletes are required to provide extrinsic breast support from a sports bra. Little is known about the influence of sports bra support on the bioenergetics of running. Only a single study with a small sample size has investigated sports bra support-related changes in oxygen consumption during a running task. PURPOSE: To quantify the effect of sports bra support on metabolic cost of running and running economy. METHODS: 14 female recreational runners performed a 10-minute treadmill running task at their preferred speed in each of 2 randomized sports bra support conditions: low support (LOW) and high support (HIGH), where the conditions were characterized by the athlete wearing a low or high supports bra, respectively. Indirect calorimetry was recorded for each 10-minute trial using a metabolic measurement system (Parvo Medics, Sandy, UT). Metabolic cost was calculated as the average VO2 measured across the duration of the trial while running economy was calculated as the quotient of the running distance divided by the sum of the VO2 across each 10-minute trial. A paired samples t-test was used to compare mean oxygen consumption and running economy values in the LOW and HIGH conditions. RESULTS: HIGH was associated with lower metabolic cost (L/min, p = 0.004) and improved running economy (m/L O2, p = 0.004) compared to LOW. CONCLUSIONS: Sports bra support alters the metabolic cost and economy of running. Underlying mechanisms may be related to increased pelvic and trunk rotation allowing runners to take longer strides without the burden of high breast accelerations.

36. Assessment of static spine stability and relative implications of trunk muscles, thoracolumbar fascia and intra-abdominal pressure

<h3>BACKGROUND CONTEXT</h3> The spine is an inherently unstable structure due to the numerous degrees of freedom it possesses. Yet, its static spinal stability is believed to be maintained by the actions of muscle activations combined with their intramuscular pressure (IMP), intra-abdominal pressure (IAP) generated by the abdominal muscles, and the passive engagement of the thoracolumbar fascia (TLF). Nonetheless, previous studies provide little information about the relative contribution of these tissues. <h3>PURPOSE</h3> The purpose of this research was to leverage a novel, validated and fully representative finite elements (FE) model of the spine to explore the relative actions of spinal muscles, TLF, IMP and IAP, as well as their collective efforts to achieve equilibrium static spinal stability. <h3>STUDY DESIGN/SETTING</h3> A novel, validated and comprehensive FE spine model was previously developed by the authors, which was applied to the current study. The model put forth includes accurate continuum models of all thoracic and lumbar vertebral bodies (VBs), intervertebral discs (IVDs), major spine muscles inclusive of their IMP (modelled as fluid-structure continuum), TLF tissue and a model of the IAP (modeled strategy like IMP). <h3>METHODS</h3> Equilibrium static stability was assessed as the ability of select tissues to restore the spine's initial position after an external perturbation is applied. For this reason, a previously validated spinal perturbation of 350N flexion force was applied at the first thoracic vertebra. Case studies including each tissue on its own, as well as combinations, were investigated. For each scenario, in-planar lumbar VBs final displacements, after tissue activations and applying the perturbation, were recorded in efforts of quantifying equilibrium static stability. Muscle activation was based on validated EMG muscle forces while IAP was introduced as an increasing pressure of 67 mmHg (9 kPa) maximum value in an abdominal cavity. <h3>RESULTS</h3> With the upright spine position being the initial stable position, the application of the 350N perturbation on the model inclusive of only the VBs and IVDs was identified as the most unstable position. Thereafter, activating the IAP, muscles, and TLF contributed individually to 24%, 53.8%, and 77% equilibrium static stabilities, respectively. Furthermore, combined tissues stability results fell between 60% and 93%, with 93% being the result of all tissues activated together to their maximum physiological capability. Another worthwhile finding was the approximately 46% drop in IMP developed by spinal muscles on the passive engagement of the TLF, suggesting its role in stabilizing and preventing excessive muscles pressurization. <h3>CONCLUSIONS</h3> This research concluded that the included muscles, combined with their IMP, IAP and TLF, are major spine stabilizers, contributing to 93% of the spine's equilibrium static stability, as defined in this paper. The TLF in particular, one of the strongest passive tissues in the back, showed to be capable of storing excessive loads, potentially as a protective measure. This was supported by the observed resultant forces at the TLF-VBs connection points, which summed up to around 244N acting opposite to applied perturbation. Lastly, results of this study may assist to better understand the notion of equilibrium static spinal stability as literature and previous studies are still pressing for more representative spine models able to assess other modes of stability. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Size-tunable PEG-grafted copolymers as a polymeric nanoruler for passive targeting muscle tissues.

Muscle-targeted drug delivery is a major challenge in nanomedicine. The extravasation of nanomedicines (or nanoparticles) from the bloodstream into muscle tissues is hindered by the continuous endothelium, the so-called blood-muscle barrier. This study aimed to evaluate the optimal size of macromolecular drugs for extravasation (or passive targeting) into muscle tissues. We constructed a size-tunable polymeric delivery platform as a polymeric nanoruler by grafting poly(ethylene glycol)s (PEGs) onto the poly(aspartic acid) (PAsp) backbone. A series of PEG-grafted copolymers (gPEGs) with a narrow size distribution between 11 and 32nm in hydrodynamic diameter (DH) were prepared by changing the molecular weight of the PEGs. Biodistribution analyses revealed that accumulation amounts of gPEGs in the muscle tissues of normal mice tended to decrease above their size of ~15nm (or~11nm for the heart). The gPEGs accumulated in the skeletal muscles of Duchenne muscular dystrophy model mice (mdx mice) at a 2-3-fold higher level than in the skeletal muscles of normal mice. At the same time, there was a reduced accumulation of gPEGs in the spleen and liver. Intravital confocal laser scanning microscopy and immunohistochemical analysis showed extravasation and locally enhanced accumulation of gPEGs in the skeletal muscle of mdx mice. This study outlined the pivotal role of macromolecular drug size in muscle-targeted drug delivery and demonstrated the enhanced permeability of 11-32nm-sized macromolecular drugs in mdx mice.

Adjacent segments biomechanics following lumbar fusion surgery: a musculoskeletal finite element model study.

This study exploits a novel musculoskeletal finite element (MS-FE) spine model to evaluate the post-fusion (L4-L5) alterations in adjacent segment kinetics. Unlike the existing MS models with idealized representation of spinal joints, this model predicts stress/strain distributions in all passive tissues while organically coupled to a MS model. This generic (in terms of musculature and material properties) model uses population-based in vivo vertebral sagittal rotations, gravity loads, and an optimization algorithm to calculate muscle forces. Simulations represent individuals with an intact L4-L5, a preoperative severely degenerated L4-L5 (by reducing the disc height by ~ 60% and removing the nucleus incompressibility), and a postoperative fused L4-L5 segment with either a fixed or an altered lumbopelvic rhythm with respect to the intact condition (based on clinical observations). Changes in spine kinematics and back muscle cross-sectional areas (due to intraoperative injuries) are considered based on in vivo data while simulating three activities in upright/flexed postures. Postoperative changes in some adjacent segment kinetics were found considerable (i.e., larger than 25%) that depended on the postoperative lumbopelvic kinematics and preoperative L4-L5 disc condition. Postoperative alterations in adjacent disc shear, facet/ligament forces, and annulus stresses/strains were greater (> 25%) than those found in intradiscal pressure and compression (< 25%). Kinetics of the lower (L5-S1) and upper (L3-L4) adjacent segments were altered to different degrees. Alterations in segmental rotations mainly affected adjacent disc shear forces, facet/ligament forces, and annulus/collagen fibers stresses/strains. An altered lumbopelvic rhythm (increased pelvis rotation) tends to mitigate some of these surgically induced changes.

Greater Breast Support Alters Trunk and Knee Joint Biomechanics Commonly Associated With Anterior Cruciate Ligament Injury.

ObjectiveThe female breast is a passive tissue with little intrinsic support. Therefore, women rely on external breast support (sports bras) to control breast motion during athletic tasks. Research has demonstrated that lower levels of breast support are associated with altered trunk and pelvis movement patterns during running, a common athletic task. However, no previous study has identified the effect of sports bra support on movement patterns during other athletic tasks including landing. Therefore, the purpose of this study was to examine the effects of breast support on trunk and knee joint biomechanics in female collegiate athletes during a double-leg landing task.MethodsFourteen female collegiate athletes completed five double-leg landing trials in each of three different sports bra conditions: no support, low support, and high support. A 10-camera motion capture system (250 Hz, Qualisys, Goteburg, Sweden) and two force platforms (1,250 Hz, AMTI, Watertown, MA, USA) were used to collect three-dimensional kinematics and ground reaction forces simultaneously. Visual 3D was used to calculate trunk segment and knee joint angles and moments. Custom software (MATLAB 2021a) was used to determine discrete values of dependent variables including vertical breast displacement, knee joint and trunk segment angles at initial contact and 100 ms post-initial contact, and peak knee joint moments. A repeated measures analysis of covariance with post-hoc paired samples t-tests were used to evaluate the effect of breast support on landing biomechanics.ResultsIncreasing levels of breast support were associated with reductions in peak knee flexion (Right: p = 0.008; Left: p = 0.029) and peak knee valgus angles (Right: p = 0.011; Left: p = 0.003) as well as reductions in peak knee valgus moments (Right: p = 0.033; Left: p = 0.013). There were no changes in peak knee extension moments (Right: p = 0.216; Left: p = 0.261). Increasing levels of breast support were associated with greater trunk flexion angles at initial contact (p = 0.024) and greater peak trunk flexion angles (p = 0.002).ConclusionsLower levels of breast support are associated with knee joint and trunk biomechanical profiles suggested to increase ACL injury risk.

Self-Balanced Near-Field Microwave Radiometer for Passive Tissue Thermometry

Medical microwave radiometry is a near-field passive thermometry technique that requires highly sensitive and stable receiver to gather and process the ultra-low power thermal radiation from biological tissues (−174 dBm/Hz). The noise measurements are susceptible to radio frequency interference (RFI) and influenced by variations in power reflection between the near-field antenna and radiometer input ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\rho $ </tex-math></inline-formula> ), instrument electronic noise ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {T}_{ \boldsymbol {rec}}$ </tex-math></inline-formula> ), amplifier noise ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {T}_{ \boldsymbol {A}}$ </tex-math></inline-formula> ), and system gain ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {G}$ </tex-math></inline-formula> ). Design of a self-balanced dual frequency band Dicke radiometer is reported in this work with real time calibration to eliminate the influence of <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\rho $ </tex-math></inline-formula> , <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">${ \boldsymbol {T}}_{ \boldsymbol {rec}}, \boldsymbol {T}_{ \boldsymbol {A}}$ </tex-math></inline-formula> and gain ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {G}$ </tex-math></inline-formula> ) on the unknown source temperature ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\boldsymbol {T}_{ \boldsymbol {S}}$ </tex-math></inline-formula> ). The radiometer is designed for operation over 1.2-1.5 GHz (low frequency/LF) and 2.8-3.1 GHz (high frequency/HF) for deep and superficial tissue temperature measurements, respectively. The radiometer measurements are characterized using matched load and ultra-wideband spiral antenna using tissue mimicking phantoms. The linearity of source temperature measurements for the matched load is close to 1 with root mean square error of 0.22 and 0.37 °C in LF and HF bands, respectively. Radiometer noise measurements using UWB antenna in tissue mimicking phantom confirm stable measurements and immunity to ambient RFI.

Embedded Computational Heart Model for External Ventricular Assist Device Investigations

PurposeExternal cardiac assist devices are based on a promising and simple concept for treating heart failure, but they are surprisingly difficult to design. Thus, a structured approach combining experiments with computer-based optimization is essential. The latter provides the motivation for the work presented in this paper.MethodsWe present a computational modeling framework for realistic representation of the heart’s tissue structure, electrophysiology and actuation. The passive heart tissue is described by a nonlinear anisotropic material law, considering fiber and sheetlet directions. For muscle contraction, an orthotropic active-strain model is employed, initiated by a periodically propagating electrical potential. The model allows for boundary conditions at the epicardium accounting for external assist devices, and it is coupled to a circulation network providing appropriate pressure boundary conditions inside the ventricles.ResultsSimulated results from an unsupported healthy and a pathological heart model are presented and reproduce accurate deformations compared to phenomenological measurements. Moreover, cardiac output and ventricular pressure signals are in good agreement too. By investigating the impact of applying an exemplary external actuation to the pathological heart model, it shows that cardiac patches can restore a healthy blood flow.ConclusionWe demonstrate that the devised computational modeling framework is capable of predicting characteristic trends (e.g. apex shortening, wall thickening and apex twisting) of a healthy heart, and that it can be used to study pathological hearts and external activation thereof.

Société de Biomécanique Young Investigator Award 2021: Numerical investigation of the time-dependent stress–strain mechanical behaviour of skeletal muscle tissue in the context of pressure ulcer prevention

BackgroundPressure-induced tissue strain is one major pathway for Pressure Ulcer development and, especially, Deep Tissue Injury. Biomechanical investigation of the time-dependent stress–strain mechanical behaviour of skeletal muscle tissue is therefore essential. In the literature, a viscoelastic formulation is generally assumed for the experimental characterization of skeletal muscles, with the limitation that the underlying physical mechanisms that give rise to the time dependent stress–strain behaviour are not known. The objective of this study is to explore the capability of poroelasticity to reproduce the apparent viscoelastic behaviour of passive muscle tissue under confined compression. MethodsExperimental stress-relaxation response of 31 cylindrical porcine samples tested under fast and slow confined compression by Vaidya and collaborators were used. An axisymmetric Finite Element model was developed in ABAQUS and, for each sample a one-to-one inverse analysis was performed to calibrate the specimen-specific constitutive parameters, namely, the drained Young's modulus, the void ratio, hydraulic permeability, the Poisson's ratio, the solid grain's and fluid's bulk moduli. FindingsThe peak stress and consolidation were recovered for most of the samples (N=25) by the poroelastic model (normalised root-mean-square error ≤0.03 for fast and slow confined compression conditions). InterpretationThe strength of the proposed model is its fewer number of variables (N=6 for the proposed poroelastic model versus N=18 for the viscohyperelastic model proposed by Vaidya and collaborators). The incorporation of poroelasticity to clinical models of Pessure Ulcer formation could lead to more precise and mechanistic explorations of soft tissue injury risk factors.

Personalised 3D Assessment of Trochanteric Soft Tissues Improves HIP Fracture Classification Accuracy

Passive soft tissues surrounding the trochanteric region attenuate fall impact forces and thereby control hip fracture risk. The degree of attenuation is related to Soft Tissue Thickness (STT). STT at the neutral hip impact orientation, estimated using a regression relation in body mass index (BMI), was previously shown to influence the current absolute risk of hip fracture (ARF0) and its fracture classification accuracy. The present study investigates whether fracture classification using ARF0 improves when STT is determined from the subject’s Computed-Tomography (CT) scans (i.e. personalised) in an orientation-specific (i.e. 3D) manner. STT is calculated as the shortest distance along any impact orientation between a semi-automatically segmented femur surface and an automatically segmented soft tissue/air boundary. For any subject, STT along any of the 33 impact orientations analysed always exceeds the value estimated using BMI. Accuracy of fracture classification using ARF0 improves when using personalised 3D STT estimates (AUC = 0.87) instead of the BMI-based STT estimate (AUC = 0.85). The improvement is smaller (AUC = 0.86) when orientation-specificity of CT-based STT is suppressed and is nil when personalisation is suppressed instead. Thus, fracture classification using ARF0 improves when CT is used to personalise STT estimates and improves further when, in addition, the estimates are orientation specific.

Nterlimb Asymmetry of Vertical Ground Reaction Force as a Risk Factor for Re-injury and Knee Osteoarthritis Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

Background: Anterior cruciate ligament (ACL) reconstruction is performed as the gold standard of care for patients with ACL rupture. ACL reconstruction provides successful clinical outcomes, however, it cannot repair faulty lower limb mechanics. The loading asymmetry between right and left limbs during movement is often used to measure the effectiveness of surgical interventions and the potential risks of re-injury. Objectives: This study aims to evaluate the interlimb asymmetry of vertical ground reaction in patients with ACL reconstruction. Methods: An online search was done in the following databases: Science Direct, Scopus, PubMed, and Google Scholar. Then, studies from 2000 to 2022 were extracted. Selected articles were screened in a 4-step process according to the inclusion and exclusion criteria. Two researchers evaluated the methodological quality of the articles with the modified Downs and Black checklist. Finally, studies were classified into 3 categories: low (&lt; 40%), medium (40% - 69%), and high quality (≥ 70%). Results: Finally, 9 studies were selected for the systematic review. The average methodological quality was 68.33% (range 54% - 80%), which shows the medium quality of the studies. A total of 4 articles had high methodological quality and 5 articles had medium quality. The results of 8 studies reported asymmetric vertical ground reaction force after ACL reconstruction. Only 1 study reported no significant difference in the asymmetrical vertical ground reaction force. Conclusion: Patients undergoing ACL reconstruction have knee flexion limitation and decreased quadriceps muscle strength. Eventually, this mechanism of energy absorption by the active tissue decreases, and mainly the shock absorption by the passive tissue increases. As a result, this mechanism leads to ACL re-injury and tibiofemoral joint cartilage damage.

On the management of maternal pushing during the second stage of labor: a biomechanical study considering passive tissue fatigue damage accumulation

During the second stage of labor, the maternal pelvic floor muscles undergo repetitive stretch loading as uterine contractions and strenuous maternal pushes combined to expel the fetus, and it is not uncommon that these muscles sustain a partial or complete rupture. It has recently been demonstrated that soft tissues, including the anterior cruciate ligament and connective tissue in sheep pelvic floor muscle, can accumulate damage under repetitive physiological (submaximal) loads. It is well known to material scientists that this damage accumulation can not only decrease tissue resistance to stretch but also result in a partial or complete structural failure. Thus, we wondered whether certain maternal pushing patterns (in terms of frequency and duration of each push) could increase the risk of excessive damage accumulation in the pelvic floor tissue, thereby inadvertently contributing to the development of pelvic floor muscle injury. This study aimed to determine which labor management practices (spontaneous vs directed pushing) are less prone to accumulate damage in the pelvic floor muscles during the second stage of labor and find the optimum approach in terms of minimizing the risk of pelvic floor muscle injury. We developed a biomechanical model for the expulsive phase of the second stage of labor that includes the ability to measure the damage accumulation because of repetitive physiological submaximal loads. We performed 4 simulations of the second stage of labor, reflecting a directed pushing technique and 3 alternatives for spontaneous pushing. The finite element model predicted that the origin of the pubovisceral muscle accumulates the most damage and so it is the most likely place for a tear to develop. This result was independent of the pushing pattern. Performing 3 maternal pushes per contraction, with each push lasting 5 seconds, caused less damage and seemed the best approach. The directed pushing technique (3 pushes per contraction, with each push lasting 10 seconds) did not reduce the duration of the second stage of labor and caused higher damage accumulation. The frequency and duration of the maternal pushes influenced the damage accumulation in the passive tissues of the pelvic floor muscles, indicating that it can influence the prevalence of pelvic floor muscle injuries. Our results suggested that the maternal pushes should not last longer than 5 seconds and that the duration of active pushing is a better measurement than the total duration of the second stage of labor. Hopefully, this research will help to shed new light on the best practices needed to improve the experience of labor for women.

Fat Is Consistently Present within the Plantar Muscular Space of the Human Foot-An Anatomical Study.

Background and Objectives: The foot comprises of active contractile and passive connective tissue components, which help maintain stability and facilitate movement during gait. The role of age- or pathology-related degeneration and the presence of fat within muscles in foot function and pain remains unclear. The existence of fat has to date not been quantified or compared between individuals according to age, sex, side or subregion. Materials and Methods: 18 cadaveric feet (mean age 79 years) were sectioned sagittally and photographed bilaterally. Fat in the plantar muscular space of the foot (PMSF) was quantified through the previously validated manual fat quantification method, which involved observing photographs of each section and identifying regions using OsiriX. Fat volume and percentage was calculated using a modified Cavalieri’s method. Results: All feet had fat located within the PMSF, averaging 25.8% (range, 16.5–39.4%) of the total PMSF volume. The presence of fat was further confirmed with plastination and confocal microscopy. Conclusions: These findings suggest that fat within the PMSF is a consistent but highly variable finding in elderly cohorts. Fat within the foot muscles may need to be considered a norm when comparing healthy and non-healthy subjects, and for therapeutic interventions to the foot. Further work is required to understand in detail the morphological and mechanical presence of fat in the foot, and compare these findings with pathological cohorts, such as sarcopenia. Additionally, future work should investigate if fat may compensate for the degeneration of the intrinsic muscles of the foot, with implications for both the use of orthotics and pain management.

Role of smooth muscle activation in the static and dynamic mechanical characterization of human aortas

Experimental data and a suitable material model for human aortas with smooth muscle activation are not available in the literature despite the need for developing advanced grafts; the present study closes this gap. Mechanical characterization of human descending thoracic aortas was performed with and without vascular smooth muscle (VSM) activation. Specimens were taken from 13 heart-beating donors. The aortic segments were cooled in Belzer UW solution during transport and tested within a few hours after explantation. VSM activation was achieved through the use of potassium depolarization and noradrenaline as vasoactive agents. In addition to isometric activation experiments, the quasistatic passive and active stress-strain curves were obtained for circumferential and longitudinal strips of the aortic material. This characterization made it possible to create an original mechanical model of the active aortic material that accurately fits the experimental data. The dynamic mechanical characterization was executed using cyclic strain at different frequencies of physiological interest. An initial prestretch, which corresponded to the physiological conditions, was applied before cyclic loading. Dynamic tests made it possible to identify the differences in the viscoelastic behavior of the passive and active tissue. This work illustrates the importance of VSM activation for the static and dynamic mechanical response of human aortas. Most importantly, this study provides material data and a material model for the development of a future generation of active aortic grafts that mimic natural behavior and help regulate blood pressure.