Shear Strain Index Research Articles

Relative motion between the flexor digitorum superficialis tendon and subsynovial connective tissue is time dependent.

The subsynovial connective tissue is an integral component of flexor tendon gliding in the carpal tunnel, which is strained during longitudinal tendon displacement. We tested the effects of repetition frequency and finger load on flexor tendon function throughout active finger movement. Eleven participants performed metacarpophalangeal joint flexion/extension of the long finger cyclically at three repetition frequencies (0.75, 1.00, 1.25 Hz) and two finger loads (3.5, 7 N). Relative displacement between the flexor digitorum superficialis tendon and subsynovial connective tissue was assessed as the shear-strain index with color ultrasound throughout the entire time history of finger flexion and extension. In addition, long finger joint angles were measured with electrogoniometry while flexor digitorum superficialis and extensor digitorum muscle activities were measured with fine-wire electromyography to characterize the finger movements. The shear-strain index increased with greater finger flexion (p = 0.001), representing higher relative displacement between tendon and subsynovial connective tissue; however, no changes were observed throughout finger extension. The shear-strain index also increased with higher repetition frequencies (p = 0.013) and finger loads (p = 0.029), further modulating time-dependent effects during finger flexion versus extension. Using ultrasound, we characterized the time-dependent response of the shear-strain index, in vivo, providing valuable data on flexor tendon function during active finger movement. Our results infer greater subsynovial connective tissue strain and shear during repetitive and forceful finger movements. Future research characterizing time-dependent effects in carpal tunnel syndrome patients may further elucidate the relations between subsynovial connective tissue function, damage, and carpal tunnel syndrome.

Effects of Nonlinear Soil Behavior on Kappa (κ): Observations from the KiK-Net Database

ABSTRACTSoil nonlinear behavior is often triggered in soft sedimentary deposits subjected to strong ground shaking and has led to catastrophic damage to civil infrastructure in many past earthquakes. Nonlinear behavior in soils is associated with large shear strains, increased material damping ratio, and reduced stiffness. However, most investigations of the high-frequency spectral decay parameter κ, which captures attenuation, have focused on low-intensity ground motions inducing only small shear strains. Because studies of the applicability of the κ model when larger deformations are induced are limited, this article investigates the behavior of κ (both κr per record and site-specific κ0 estimates) beyond the linear-elastic regime. About 20 stations from the Kiban–Kyoshin network database, with time-average shear-wave velocities in the upper 30 m between 213 and 626 m/s, are used in this study. We find that the classification scheme used to identify ground motions that trigger soil nonlinear behavior biases estimates of κ0 in the linear and nonlinear regimes. A hybrid method to overcome such bias is proposed considering proxies for in situ deformation (via the shear-strain index) and ground shaking intensity (via peak ground acceleration). Our findings show that soil nonlinearity affects κr and κ0 estimates, but this influence is station dependent. Most κ0 at our sites had a 5%–20% increase at the onset of soil nonlinear behavior. Velocity gradients and impedance contrasts influence the degree of soil nonlinearity and its effects on κr and κ0. Moreover, we observe that other complexities in the wave propagation phenomenon (e.g., scattering and amplifications in the high-frequency range) impose challenges to the application of the κ0 model, including the estimation of negative values of κr.

Dynamic parameters of subgrade soils prone to mud pumping considering the influence of kaolin content and the cyclic stress ratio

Rail transport industry often desires to increase the freight capacities for heavy-haul trains to transport more goods. However, this requires an increase in the axle loads, which results in the railway foundation being subjected to higher cyclic stress ratio (CSR), causing significant subgrade distress. Recent laboratory investigations indicate that addition of kaolin to low-to-medium plasticity soils can avert early softening and fluidization of the soil under increasing CSR, how the dynamic parameters such as the shear modulus (G) and the damping ratio (Dp) of soils may change consequentially to this modification needs appropriate quantification. Furthermore, while there are plenty of studies correlating shear strain and plasticity index (PI) with the dynamic properties of the soil, the role of loading parameters such as the CSR and number of cycles (N) has not been thoroughly investigated. Therefore, efforts have been made to characterise the dynamic parameters of moderately plastic silty-clay soils with varying kaolin content (cK) and loading parameters. The results indicate that as CSR exceeds a critical level, G decreases rapidly whereas Dp was found to increase abruptly in few loading cycles. The paper also shows that when G diminishes about 20% from its initial value, any further loss in shear modulus would cause soil to turn into an unstable stage where the excess pore water pressure and shear strain begins to increase rapidly. Although varying the kaolin content does not alter the PI significantly, it causes a considerable effect on the dynamic parameters of the soil. Based on the current experimental findings, empirical models are proposed to estimate dynamic parameters of subgrade soils prone to mud pumping considering loading condition under heavy haul railways.

Ultrasound examination predicts 6-month progression in carpal tunnel syndrome patients.

Carpal tunnel syndrome (CTS) is a peripheral neuropathy resulting from chronic median nerve compression. Chronic compression leads to neurological changes that are quantified through nerve conduction studies (NCS). Although NCS represents the gold standard in CTS assessment, they provide limited prognostic value. Several studies have identified ultrasound as a tool in diagnosing and potentially predicting the progression of CTS in patients. The purpose of this study was to evaluate the predictive value of ultrasound examination in CTS patients. Twenty patients recruited at their first visit with the neurologist completed two NCS and ultrasound examinations approximately 6 months apart. Ultrasound examination consisted of B-mode, pulse-wave Doppler and colour Doppler ultrasound videos and images to quantify median nerve cross-sectional area, intraneural blood flow velocity in three wrist postures (15° flexion, neutral, and 30° extension), and displacement of the flexor digitorum superficialis (FDS) tendon and the adjacent subsynovial connective tissue (SSCT) of the middle finger during repetitive finger flexion-extension cycles. A questionnaire was administered to assess the work-relatedness of CTS. Linear regression analyses revealed that intraneural blood flow velocity (R2 = 0.36, p = .03), assessed in wrist flexion, and relative FDS-SSCT displacement (R2 = 0.27, p = .04) and shear strain index (R2 = 0.28, p = .04) were significant predictors of nerve sensory and motor changes at 6 months. Results suggest the possibility of using a battery of ultrasound measures as viable markers to predict median nerve functional changes within 6 months.

Study of the Relationship Between Ultrasound Strain Indices and Cognitive Decline for Vulnerable Carotid Plaque.

A relationship between ultrasound strain indices in carotid plaque to cognitive domains of executive and language function are studied in 42 symptomatic and 34 asymptomatic patients. The mean and standard deviation of the percentage stenosis were 72.10 ± 15.19 and 77.41 ± 11.20 for symptomatic and asymptomatic patients respectively. Pearson's correlation between axial, lateral and shear strain indices versus executive and language composite scores was performed.. A significant inverse correlation for both executive and language function for symptomatic patients to strain indices was found. On the other hand, for asymptomatic patients only executive function was inversely correlated with the corresponding strain indices. Our hypothesis that microemboli from vulnerable plaque and possible 'silent strokes' may be responsible for decline in executive function for both symptomatic and asymptomatic patients'. Strokes and transient ischemic attacks may be responsible for further cognitive decline in language function for symptomatic patients.

Carotid Plaque Strain Indices Were Correlated With Cognitive Performance in a Cohort With Advanced Atherosclerosis, and Traditional Doppler Measures Showed no Association.

Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid plaque strain indices (CPSIs), have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, the MCA pulsatility index (PI), and CPSIs would be associated with poorer cognitive performance in individuals with advanced atherosclerosis. Neurocognitive testing, carotid ultrasound imaging, transcranial Doppler imaging, and carotid strain imaging were performed on 40 patients scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the surgical-side maximum peak systolic velocity (PSV; from the bulb, proximal, mid, or distal ICA), mean MCA velocity and PI, and maximum CPSIs (axial, lateral, and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age-adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuospatial construction, and mental flexibility. Participants had a median age of 71.0 (interquartile range, 9.75) years; 26 were male (65%), and 14 were female (35%). Traditional Doppler parameters, PSV, mean MCA velocity, and MCA PI did not predict cognitive performance (all P > .05). Maximum CPSIs were significantly associated with cognitive performance (P < .05). Traditional velocity measurements of the maximum bulb-ICA PSV, mean MCA velocity, and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease; however, maximum CPSIs were associated with cognitive performance. These findings suggest that cognition may be associated with unstable plaque rather than blood flow.

Abstract WMP47: Traditional Doppler Measures Do Not predict Cognition in a Cohort With Advanced Atherosclerosis

Introduction: Traditional Doppler measures have been used to predict cognitive performance in patients with carotid atherosclerosis. Novel measures, such as carotid strain indices (CSI) have shown associations with cognitive performance. We hypothesized that lower mean middle cerebral artery (MCA) velocities, higher bulb-internal carotid artery (ICA) velocities, MCA pulsatility index (PI) and CSI would be associated with poorer cognitive performance in individuals with advanced atherosclerosis. Methods: Neurocognitive testing, carotid ultrasound, transcranial Doppler and CSI were performed on 40 subjects scheduled for carotid endarterectomy. Kendall tau correlations were used to examine relationships between cognitive tests and the maximum peak systolic velocity (PSV) (from bulb, proximal, mid or distal ICA), mean MCA velocity and PI (on surgical side) and CSI (maximum axial, lateral and shear strain indices used to characterize plaque deformations with arterial pulsation). Cognitive measures included age adjusted indices of verbal fluency, verbal and visual learning/memory, psychomotor speed, auditory attention/working memory, visuoconstruction, and mental flexibility. Results: Participants were median age 71.0 (IQR 9.75) years, 26 male (65%) and 14 female (35%). Median stenosis was 70.00 (IQR 10.00) percent. Traditional Doppler parameters, PSV, mean MCA velocity and MCA PI did not predict cognitive performance (p values all &gt;0.05). Maximum strain values were significantly associated with cognitive performance (p&lt;0.05). Table . Conclusions: Traditional velocity measurements of maximum bulb-ICA PSV, mean MCA velocity and PI were not associated with cognitive performance in patients with advanced atherosclerotic disease, however maximum strain indices were associated with cognitive performance. Findings suggest that cognition may be associated with unstable plaque (plaques at greater risk for rupture) rather than blood flow.

Evaluation of soil-structure interaction effects from system identification of structures subject to forced vibration tests

We describe procedures to evaluate the dynamic properties of test structures subject to forced vibration testing. We seek modal vibration periods and damping ratios corresponding to the actual flexible-based response of the structure (incorporating the effects of compliance in the soil medium supporting the foundation) and similar attributes for a fixed-base condition in which only the flexibility of the structure is represented. Our approach consists of using suitable input and output time series with conventional parametric system identification procedures, and as such extends previously developed procedures for use with earthquake recordings. We verify the proposed approach and demonstrate its application using data from two test structures supported on shallow foundations that have been used in forced vibration tests and that have recorded earthquakes. The structures were tested with and without braces to modify their stiffness and were deployed at two sites with different soil conditions. We analyze the results to evaluate experimental period lengthening ratios and foundation damping. The results show (1) strong increases in period lengthening and foundation damping with the wave parameter (dimensionless ratio of structure-to-soil stiffness), (2) compatibility between modal properties from forced vibration testing and earthquake excitation, (3) soil nonlinearity increases period lengthening and modifies foundation damping in a manner that can be reasonably captured in predictive models using equivalent-linear soil properties compatible with a proposed shear strain index.

Seismic performance investigation of high CFRDs subjected to mainshock-aftershock sequences

In this paper, 24 as-recorded mainshock-aftershock seismic sequences are selected to analyse the seismic performance of a 200-m-high concrete face rockfill dam (CFRD) subjected to mainshock-aftershock seismic sequences by a series of elastic-plastic analyses, based on three damage measures (DMs), displacement, shear strain and damage index (DI). The dynamic responses of CFRD subjected to single mainshocks and single aftershocks are also obtained for comparison. Evidently, CFRD will experience additional damage or destruction while experiencing an aftershock, which cannot be ignored in the corresponding seismic design codes.

Divergence Between Nonlinear and Equivalent-Linear 1D Site Response Analyses for Different V S Realizations of Typical Clay Sites

Surface ground motions can be obtained via various methods of analysis such as equivalent-linear (EL) and nonlinear (NL) one-dimensional numerical simulations. Selection of analysis method would be a challenging issue due to difficulty of input data preparation. The uncertainty inherent in soil parameters and shear wave velocity has significant impact on the soil surface hazard analysis through amplification function. In the present study, realizations of two clay sites in Shiraz city, southern Iran, along with three hypothetical sites are selected to examine the divergence between EL and NL ground response analyses. Two constitutive models, namely modified hyperbolic Kondner–Zelasko (MKZ) and general quadratic/hyperbolic (GQ/H), are implemented in site response analyses of synthetic profiles generated for reference profiles. The GQ/H model requires user-defined shear strength to simulate soil behavior. Two approaches of shear strength estimation are utilized in the current study. Several issues related to site response analysis are investigated such as effect of shear strength estimation method, input ground-motion intensity, and soil condition on the divergence between EL and NL spectral accelerations. The obtained EL/NL spectral response ratios are presented as a function of either shear strain index or oscillator period for the abovementioned issues. Moreover, 20% difference thresholds of the shear strain index are computed and compared with those from previous researches.

Noninvasive characterization of carotid plaque strain

ObjectiveCurrent risk stratification of internal carotid artery plaques based on diameter-reducing percentage stenosis may be unreliable because ischemic stroke results from plaque disruption with atheroembolization. Biomechanical forces acting on the plaque may render it vulnerable to rupture. The feasibility of ultrasound-based quantification of plaque displacement and strain induced by hemodynamic forces and their relationship to high-risk plaques have not been determined. We studied the feasibility and reliability of carotid plaque strain measurement from clinical B-mode ultrasound images and the relationship of strain to high-risk plaque morphology. MethodsWe analyzed carotid ultrasound B-mode cine loops obtained in patients with asymptomatic ≥50% stenosis during routine clinical scanning. Optical flow methods were used to quantify plaque motion and shear strain during the cardiac cycle. The magnitude (maximum absolute shear strain rate [MASSR]) and variability (entropy of shear strain rate [ESSR] and variance of shear strain rate [VSSR]) of strain were combined into a composite shear strain index (SSI), which was assessed for interscan repeatability and correlated with plaque echolucency. ResultsNineteen patients (mean age, 70 years) constituting 36 plaques underwent imaging; 37% of patients (n = 7) showed high strain (SSI ≥0.5; MASSR, 2.2; ESSR, 39.7; VSSR, 0.03) in their plaques; the remaining clustered into a low-strain group (SSI <0.5; MASSR, 0.58; ESSR, 21.2; VSSR, 0.002). The area of echolucent morphology was greater in high-strain plaques vs low-strain plaques (28% vs 17%; P = .018). Strain measurements showed low variability on Bland-Altman plots with cluster assignment agreement of 76% on repeated scanning. Two patients developed a stroke during 2 years of follow-up; both demonstrated high SSI (≥0.5) at baseline. ConclusionsCarotid plaque strain is reliably computed from routine B-mode imaging using clinical ultrasound machines. High plaque strain correlates with known high-risk echolucent morphology. Strain measurement can complement identification of patients at high risk for plaque disruption and stroke.

Relative Differences between Nonlinear and Equivalent-Linear 1-D Site Response Analyses

This study investigates the conditions for which one-dimensional (1-D) nonlinear (NL) site response analysis results are distinct from equivalent-linear (EL) results and provides guidance for predicting when differences are large enough to be of practical significance. Relative differences in spectral accelerations and Fourier amplitudes computed from NL and EL analyses are assessed for a range of site conditions and for suites of input motions appropriate for active crustal and stable continental regions. Among several considered parameters, EL/NL differences are most clearly dependent on shear strain index ( I γ), defined as the ratio of input motion peak velocity to time-averaged shear-wave velocity in the top 30 m of the soil profile. For small I γ (generally under 0.03%), EL and NL results are practically identical, whereas at larger strains, differences can be significant for frequencies &gt;0.3 Hz. Frequency-dependent I γ values are recommended for conditions above which NL analyses are preferred to EL.

Classification of Symptomatic and Asymptomatic Patients with and without Cognitive Decline Using Non-invasive Carotid Plaque Strain Indices as Biomarkers

Vascular cognitive decline may be caused by micro-emboli generated by carotid plaque instability. We previously found that maximum strain indices in carotid plaque were significantly correlated with cognitive function. In the work described here, we examined these associations with a larger sample size, as well as evaluated the performance of these maximum strain indices in predicting cognitive impairment. Ultrasound-based strain imaging and cognition assessment were conducted on 75 human patients. Patients underwent one of two standardized cognitive test batteries, either the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) or the National Institute of Neurologic Disorder and Stroke–Canadian Stroke Network (NINDS-CSN) Vascular Cognitive Impairment Harmonization Standards (60 min). Scores were standardized within each battery to allow these data to be combined across all participants. Radiofrequency signals for ultrasound strain imaging were acquired on the carotid arteries using either a Siemens Antares with a VFX 13-5 linear array transducer or a Siemens S2000 with an 18 L6 linear array transducer. The same hierarchical block-matching motion tracking algorithm developed in our laboratory was used to estimate accumulated axial, lateral, and shear strain indices in carotid plaque, with inclusion of adventitia regardless of the ultrasound system and transducer used. Associations between cognitive z-scores and maximum strain indices were examined using Pearson's correlation coefficients. Maximum strain indices were also employed to predict cognitive impairment using receiver operating characteristic analysis. All correlations between maximum strain indices and total cognition were statistically significant (p < 0.05), indicating that these indices have good utility in predicting cognitive impairment. Maximum lateral strain indices provided an area under the curve of 0.85 for symptomatic patients and 0.68 for asymptomatic patients. Our results indicate the important relationship of maximum strain indices to cognitive function and the feasibility of using maximum strain indices to predict cognitive decline with inclusion of the adventitia layer into the segmentation of plaque.

Improved Correlation of Strain Indices with Cognitive Dysfunction with Inclusion of Adventitial Layer with Carotid Plaque.

Plaque instability may lead to chronic embolization, which in turn may contribute to progressive cognitive decline. Accumulated strain tensor indices over a cardiac cycle within a pulsating carotid plaque may be viable biomarkers for the diagnosis of plaque instability. Using plaque-only carotid artery segmentations, we recently demonstrated that impaired cognitive function correlated significantly with maximum axial and lateral strain indices within a localized region of interest in plaque. Inclusion of the adventitial layer focuses our strain or instability measures on the vessel wall-plaque interface hypothesized to be a region with increased shearing forces and measureable instability. A hierarchical block-matching motion tracking algorithm developed in our laboratory was used to estimate accumulated axial, lateral, and shear strain distribution in plaques identified with the plaque-with-adventitia segmentation. Correlations of strain indices to the Repeatable Battery for the Assessment of Neuropsychological Status Total score were performed and compared with previous results. Overall, correlation coefficients (r) and significance (p) values improved for axial, lateral, and shear strain indices. Shear strain indices, however, demonstrated the largest improvement. The Pearson correlation coefficients for maximum shear strain and cognition improved from the previous plaque-only analyses of -0.432 and -0.345 to -0.795 and -0.717 with the plaque-with-adventitia segmentation for the symptomatic group and for all patients combined, respectively. Our results demonstrate the advantage of including adventitia for ultrasound carotid strain imaging providing improved association to parameters assessing cognitive impairment in patients. This supports theories of the importance of the vessel wall plaque interface in the pathophysiology of embolic disease.

Pathological changes in the subsynovial connective tissue increase with self-reported carpal tunnel syndrome symptoms

BackgroundFibrosis and thickening of the subysnovial connective tissue are the most common pathological findings in carpal tunnel syndrome. The relationship between subsynovial connective tissue characteristics and self-reported carpal tunnel syndrome symptoms was assessed. MethodsSymptoms were characterized using the Boston Carpal Tunnel Questionnaire and Katz hand diagram in twenty-two participants (11 with symptoms, 11 with no symptoms). Using ultrasound, the thickness of the subsynovial connective tissue was measured using a thickness ratio (subsynovial thickness/tendon thickness) and gliding function was assessed using a shear strain index ((Displacementtendon−Displacementsubsynovial)/Displacementtendonx 100). For gliding function, participants performed 10 repeated flexion–extension cycles of the middle finger at a rate of one cycle per second. FindingsParticipants with symptoms had a 38.5% greater thickness ratio and 39.2% greater shear strain index compared to participants without symptoms (p<0.05). InterpretationUltrasound detected differences the SSCT in symptomatic group that was characterized by low self-reported symptom severity scores. This study found ultrasound useful for measuring structural and functional changes in the SSCT that could provide insight in the early pathophysiology associated with carpal tunnel syndrome symptoms.

An integrated system for the segmentation of atherosclerotic carotid plaque ultrasound video

The robust border identification of atherosclerotic carotid plaque, the corresponding degree of stenosis of the common carotid artery (CCA), and also the characteristics of the arterial wall, including plaque size, composition, and elasticity, have significant clinical relevance for the assessment of future cardiovascular events. To facilitate the follow-up and analysis of the carotid stenosis in serial clinical investigations, we propose and evaluate an integrated system for the segmentation of atherosclerotic carotid plaque in ultrasound videos of the CCA based on video frame normalization, speckle reduction filtering, M-mode state-based identification, parametric active contours, and snake segmentation. Initially, the cardiac cycle in each video is identified and the video M-mode is generated, thus identifying systolic and diastolic states. The video is then segmented for a time period of at least one full cardiac cycle. The algorithm is initialized in the first video frame of the cardiac cycle, with human assistance if needed, and the moving atherosclerotic plaque borders are tracked and segmented in the subsequent frames. Two different initialization methods are investigated in which initial contours are estimated every 20 video frames. In the first initialization method, the initial snake contour is estimated using morphology operators; in the second initialization method, the Chan-Vese active contour model is used. The performance of the algorithm is evaluated on 43 real CCA digitized videos from B-mode longitudinal ultrasound segments and is compared with the manual segmentations of an expert, available every 20 frames in a time span of 3 to 5 s, covering, in general, 2 cardiac cycles. The segmentation results were very satisfactory, according to the expert objective evaluation, for the two different methods investigated, with true-negative fractions (TNF-specificity) of 83.7 ± 7.6% and 84.3 ± 7.5%; true-positive fractions (TPF-sensitivity) of 85.42 ± 8.1% and 86.1 ± 8.0%; and between the ground truth and the proposed segmentation method, kappa indices (KI) of 84.6% and 85.3% and overlap indices of 74.7% and 75.4%. The segmentation contours were also used to compute the cardiac state identification and radial, longitudinal, and shear strain indices for the CCA wall and plaque between the asymptomatic and symptomatic groups were investigated. The results of this study show that the integrated system investigated in this study can be successfully used for the automated video segmentation of the CCA plaque in ultrasound videos.

Predictive model for normalized shear modulus of cohesive soils

Evaluating dynamic properties of geomaterials is an essential step for solving geotechnical earthquake engineering problems. The shear stiffness-reduction curves of soils are commonly presented in normalized form and have many applications in equivalent-linear and nonlinear dynamic analyses. In this study, a radial basis function (RBF) neural network model was developed to predict normalized shear modulus of cohesive soils. The most important factors that affect this parameter include effective confining pressure, shear strain, and plasticity index. The comprehensive database used for the development of the model was obtained from previously published experimental results. Validation of the model performance was carried out by using centrifuge tests results. A parametric analysis was then performed to evaluate sensitivity of the proposed model to variations of the influencing parameters. The results indicate that the neural network model could provide predictions more accurate than those obtained by the previous models. ARTICLE INFO

Correlation of cognitive function with ultrasound strain indices in carotid plaque.

Instability in carotid vulnerable plaque can generate cerebral micro-emboli, which may be related to both stroke and eventual cognitive abnormality. Strain imaging to detect plaque vulnerability based on regions with large strain fluctuations, with arterial pulsation, may be able to determine the risk of cognitive impairment. Plaque instability may be characterized by increased strain variations over a cardiac cycle. Radiofrequency signals for ultrasound strain imaging were acquired from the carotid arteries of 24 human patients using a Siemens Antares with a VFX 13-5 linear array transducer. These patients underwent standardized cognitive assessment (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]). Plaque regions were segmented by a radiologist at end-diastole using the Medical Imaging Interaction Toolkit. A hierarchical block-matching motion tracking algorithm was used to estimate the cumulated axial, lateral and shear strains within the imaging plane. The maximum, minimum and peak-to-peak strain indices in the plaque computed from the mean cumulated strain over a small region of interest in the plaque with large deformations were obtained. The maximum and peak-to-peak mean cumulated strain indices over the entire plaque region were also computed. All strain indices were then correlated with RBANS Total performance. Overall cognitive performance (RBANS Total) was negatively associated with values of the maximum strain and the peak-to-peak for axial and lateral strains, respectively. There was no significant correlation between the RBANS Total score and shear strain and strain indices averaged over the entire identified plaque for this group of patients. However, correlation of maximum lateral strain was higher for symptomatic patients (r=-0.650, p=0.006) than for asymptomatic patients (r=-0.115, p=0.803). On the other hand, correlation of maximum axial strain averaged over the entire plaque region was significantly higher for asymptomatic patients (r=-0.817, p=0.016) than for symptomatic patients (r=-0.224, p=0.402). The results reveal a direct relationship between the maximum axial and lateral strain indices in carotid plaque and cognitive impairment.

Repetitive differential finger motion increases shear strain between the flexor tendon and subsynovial connective tissue

Non-inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) are characteristic in carpal tunnel syndrome (CTS) patients. These pathological changes have been linked to repetitive hand tasks that create shear forces between the flexor tendons and SSCT. We measured the relative motion of the flexor digitorum superficialis tendon and SSCT during two repetitive finger tasks using color Doppler ultrasound. Twelve participants performed flexion-extension cycles for 30 min with the long finger alone (differential movement) and with all four fingers together (concurrent movement). Shear strain index (SSI, a relative measure of excursion in flexion and extension) and maximum velocity ratio (MVR, the ratio of SSCT versus tendon during flexion and extension) were used to represent shear. A linear effect of exertion time was significant and corresponded with larger tendon shear in differential motion. The flexion SSI increased 20.4% from the first to the 30th minute, while MVR decreased 8.9% in flexion and 8.7% in extension. No significant changes were found during concurrent motion. These results suggest that exposure to repetitive differential finger tasks may increase the risk of shear injury in the carpal tunnel.

The effect of wrist position on the relative motion of tendon, nerve, and subsynovial connective tissue within the carpal tunnel in a human cadaver model

The purpose of this study was to measure the effect of wrist position on the relative motion of the middle finger flexor digitorum superficialis (FDS) tendon, subsynovial connective tissue (SSCT), median nerve, and flexor retinaculum during simulated active finger motion. The relative motion of each tissue was measured by fluoroscopy in 10 human cadavers. Measurements were obtained for wrist positions of neutral (0 degree extension), 30 and 60 degrees of flexion, and 30 and 60 degrees of extension. The shear strain index (SSI) was defined as the difference in motion between two tissues (tendon, SSCT, or nerve) divided by tendon excursion, expressed as a percentage. The motion of the tendon, SSCT, and nerve in the 60 degree flexed position was significantly less than the motion in all other wrist positions (p < 0.001). The SSI at 60 degrees of flexion for tendon-SSCT and tendon-nerve were significantly increased compared with all other positions (p < 0.001). Because the SSCT and tendon are physically connected, a decrease in SSCT motion relative to the tendon would increase the shear strain on the SSCT with tendon motion. Thus, this result suggests that the SSCT may be predisposed to shear injury from activity done in 60 degrees of wrist flexion.