Sustained Mechanical Loading Research Articles

Enhancing pressure ulcer prevention through optimized design of a multi-cellular foam mattress

Sustained mechanical loading on skeletal muscle tissue can lead to degeneration and cell damage over time, resulting in the development of pressure ulcers, particularly in hospital mattresses or for wheelchair-bound users. The primary risk factors for this damage are tissue ischemia caused by pressure in the contact area and tissue compressive strain. In this study, a multi-cell, multi-material foam mattress for the upper comfort layer was developed, with the aim of simultaneously minimizing soft tissue compressive strain and maximum surface pressure on the human buttocks zone. The levels of these factors were estimated using the finite element method (FEM). A multi-objective optimization (MOO) approach was employed, coupling the non-dominated sorting genetic algorithm (NSGA-II) with FEM. This algorithm helped determine the required compressive strength and the optimal cell configurations to achieve the desired outcomes. The majority of the optimal solutions exhibited contact pressures (Cpresss) below the recommended threshold to avoid local tissue ischemia. The optimized cellular material configurations resulted in soft tissue compressive strain of 12% and Cpress of 3.4 kPa, indicating longer safety times for supine support on the foam mattress without the need for repositioning. The optimization process utilized 5 softer foam materials out of the 9 firmness levels tested to achieve these results. The proposed multi-cell, multi-material foam mattress model shows promise for the prevention of pressure sores, as suggested by the optimization findings.

Experimental study on the residual strength of butt adhesive joints subjected to systematic creep damage

AbstractUsing adhesively bonded joints is an effective strategy for achieving lightweight designs. However, understanding the long‐term performance of these bonded joints remains a critical concern. Creep is a time‐dependent phenomenon induced by sustained mechanical loads, which can lead to viscous strain in adhesive materials. This strain has the potential to cause cracking in bonded structures over time. This study aims to investigate the creep and post‐creep behaviors of adhesively bonded aluminum joints, focusing on two crucial parameters: creep load level and creep duration. Butt adhesive joint (BAJ) specimens were fabricated and exposed to varying creep loads and times. Subsequently, quasi‐static tensile tests were conducted to assess the residual mechanical properties. The results indicated that higher creep loads resulted in increased creep deformations at constant creep durations. Furthermore, a downward trend was observed in the residual tensile mechanical properties of BAJ specimens following creep. Specifically, higher creep load levels and longer times led to more pronounced reductions in joint strength, strain, and stiffness. These reductions in joint mechanical properties were corroborated through joint fracture surface analysis. Additionally, mathematical models were developed using response surface methodology (RSM) to predict the experimental joint residual mechanical properties under different creep loads and times.Highlights Investigation of creep and post‐creep behaviors in adhesive joints. Higher creep load levels result in greater joint permanent deformations. Impact of higher creep load levels and durations on joint failure strength. Decreasing in the joint deformability and stiffness after creep.

Residual strength and time to failure of bonded wooden lap joints at high temperatures and superimposed constant loading

ABSTRACT The study focused on the effect of high temperatures on wooden bond lines of single lap tensile shear specimens according to EN 302-1 made from beech wood at superimposed sustained mechanical loading. The quasi-duration of load (DOL) tests encompassed temperature levels of 160–232°C with specimens loaded at 30% of their mean shear strength at ambient temperature for 40 min. The investigations comprised one phenol resorcinol formaldehyde (PRF), two melamine urea formaldehyde (MUF) and three one-component polyurethane (1C-PUR) adhesives as well as solid wood reference specimens. Complementary ramp load tests were performed with specimens heated in unloaded state up to 250°C. The investigations revealed three highly differentiated adhesive DOL behaviours although showing a well comparable pure temperature-bound strength reduction effect at 200°C. PRF and one MUF showed little to no additional influence of applied load, while for two 1C-PUR brands a drastic impact on survival times and residual strength was revealed. One MUF and a special 1C-PUR forwarded results between both extremes. The investigations provide evidence that the assessment of the temperature behaviour of structural adhesives can be biased when relying exclusively on ramp load tests with specimens heated in unloaded state, and thus necessitates a superimposed load as present in realistic fire scenarios.

An evaluation of the effects of localised skin cooling on microvascular, inflammatory, structural, and perceptual responses to sustained mechanical loading of the sacrum: A study protocol.

This study protocol aims to investigate how localised cooling influences the skin's microvascular, inflammatory, structural, and perceptual tolerance to sustained mechanical loading at the sacrum, evaluating factors such as morphology, physiology, and perceptual responses. The protocol will be tested on individuals of different age, sex, skin tone and clinical status, using a repeated-measure design with three participants cohorts: i) young healthy (n = 35); ii) older healthy (n = 35); iii) spinal cord injured (SCI, n = 35). Participants will complete three testing sessions during which their sacrum will be mechanically loaded (60 mmHg; 45 min) and unloaded (20 min) with a custom-built thermal probe, causing pressure-induced ischemia and post-occlusive reactive hyperaemia. Testing sessions will differ by the probe's temperature, which will be set to either 38°C (no cooling), 24°C (mild cooling), or 16°C (strong cooling). We will measure skin blood flow (via Laser Doppler Flowmetry; 40 Hz); pro- and anti-inflammatory biomarkers in skin sebum (Sebutape); structural skin properties (Optical Coherence Tomography); and ratings of thermal sensation, comfort, and acceptance (Likert Scales); throughout the loading and unloading phases. Changes in post-occlusive reactive hyperaemia will be considered as the primary outcome and data will be analysed for the independent and interactive effects of stimuli's temperature and of participant group on within- and between-subject mean differences (and 95% Confidence Intervals) in peak hyperaemia, by means of a 2-way mixed model ANOVA (or Friedman). Regression models will also be developed to assess the relationship between absolute cooling temperatures and peak hyperaemia. Secondary outcomes will be within- and between-subject mean changes in biomarkers' expression, skin structural and perceptual responses. This analysis will help identifying physiological and perceptual thresholds for the protective effects of cooling from mechanically induced damage underlying the development of pressure ulcers in individuals varying in age and clinical status.

Thermo-mechanical numerical analyses in support of fire endurance assessment of ordinary soda-lime structural glass elements

PurposeGlass material is largely used for load-bearing components in buildings. For this reason, standardized calculation methods can be used in support of safe structural design in common loading and boundary conditions. Differing from earlier literature efforts, the present study elaborates on the load-bearing capacity, failure time and fire endurance of ordinary glass elements under fire exposure and sustained mechanical loads, with evidence of major trends in terms of loading condition and cross-sectional layout. Traditional verification approaches for glass in cold conditions (i.e. stress peak check) and fire endurance of load-bearing members (i.e. deflection and deflection rate limits) are assessed based on parametric numerical simulations.Design/methodology/approachThe mechanical performance of structural glass elements in fire still represents an open challenge for design and vulnerability assessment. Often, special fire-resisting glass solutions are used for limited practical applications only, and ordinary soda-lime silica glass prevails in design applications for load-bearing members. Moreover, conventional recommendations and testing protocols in use for load-bearing members composed of traditional constructional materials are not already addressed for glass members. This paper elaborates on the fire endurance and failure detection methods for structural glass beams that are subjected to standard ISO time–temperature for fire exposure and in-plane bending mechanical loads. Fire endurance assessment methods are discussed with the support of Finite Element (FE) numerical analyses.FindingsBased on extended parametric FE analyses, multiple loading, geometrical and thermo-mechanical configurations are taken into account for the analysis of simple glass elements under in-plane bending setup and fire exposure. The comparative results show that – in most of cases – thermal effects due to fire exposure have major effects on the actual load-bearing capacity of these members. Moreover, the conventional stress peak verification approach needs specific elaborations, compared to traditional calculations carried out in cold conditions.Originality/valueThe presented numerical results confirm that the fire endurance analysis of ordinary structural glass elements is a rather complex issue, due to combination of multiple aspects and influencing parameters. Besides, FE simulations can provide useful support for a local and global analysis of major degradation and damage phenomena, and thus support the definition of simple and realistic verification procedures for fire exposed glass members.

Predicting corrosion in reinforced UHPC members through time-dependent multi-physics numerical simulation

Ultra-high-performance concrete (UHPC) has superior durability characteristics over traditional concrete. Improved durability behavior of UHPC has been attributed to the dense material property, which effectively constrains harmful material ingress and oxygen supply. However, the corrosion performance of reinforced UHPC under sustained mechanical loading, which may induce cracking, in addition to environmental conditioning is still not well characterized. This study investigates the electrochemical-mechanical coupling effects on deterioration mechanisms of reinforced UHPC beams subjected to service loading conditions and chloride attack through multi-physics simulation techniques. Finite element models were simulated considering the cracking induced by service loads and deformations caused by rust expansion on the cementitious matrix. Material transport properties such as chloride and oxygen penetration parameters were updated in each step of the time-dependent process based on cracking conditions. The simulation results show that there is substantial steel cross section and yielding load capacity loss, initial stiffness reduction, and damage area increase in reinforced concrete members while UHPC members showed relatively small cross section loss, negligible increase in UHPC damage, no observable reduction in initial stiffness, and minimal loss in yield load capacity. The effect of oxygen supply level on the corrosion performance is also explored showing that the corrosion rate of reinforced UHPC specimens were limited due to depleted oxygen at the steel-UHPC surface. Numerical simulation results were verified against experimental trends on corrosion performance of reinforced UHPC specimens. Further, the numerical framework herein provides an alternative way in predicting deterioration processes and evaluating service life performance of ductile reinforced concrete infrastructures in a computationally efficient manner.

The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region.

A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation-direct cell deformation, inflammatory oedema and ischaemic damage-which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery. Patients with deep PI in the pelvic region, who were operated on from 2011 to 2019, were retrospectively evaluated. The protocol of care included training in the prone position, followed by maintenance of the prone position for 4-6 weeks postoperatively. The reconstruction was performed with fasciocutaneous and myocutaneous local or regional flaps. The study evaluated a total of 26 patients. The rate of recurrence of PIs was 15.4% (4/26) in the mean follow-up of 54 months. Regarding postoperative complications, four cases of partial dehiscence of the suture occurred. This perioperative protocol of maintaining a prone position seems to be safe for the patient, and it can be used to prevent or reduce the recurrence of deep PIs on the pelvic region after reconstructive surgery.

Application of Self-Adhesive Soft Silicone Common Foam Dressing in Reducing Intraoperative Pressure Ulcers in Elderly ICU Patients.

Pressure ulcer (PU), also called pressure injury, is localized damage to the skin and underlying soft tissues, usually over bony prominences, as a result of sustained mechanical loads applied to the tissues. However, in many situations, complete off-loading of sacral PUs is not possible. Minimising the exposure of wounds and their surroundings to elevated mechanical loads is crucial for healing. We for the first time reported the application of Meipicang in the prevention and treatment of intraoperative pressure ulcers in elderly ICU patients with severe illness. We found that the pressure ulcer risk score (20.15 ± 2.17) in the dressing group after intervention was higher than that (17.42 ± 3.62) in the regular group. The incidence of pressure sores in the dressing group was 3.77% lower than the 18.88% in the regular group. The psychological concern score (31.41 ± 3.15) of the dressing group was higher than that (26.92 ± 3.43) of the regular group. The trust score (29.57 ± 2.61) of the dressing group was higher than the score (24.28 ± 2.29) of the regular group. The score of physiological problems in the dressing group (34.69 ± 3.82) is higher than that in the regular group (29.88 ± 3.54). The skin complication rate of the dressing group was 5.56% lower than that of the regular group (22.64%). The comfort score (92.46 ± 4.15) of the dressing group was higher than that (80.59 ± 5.43) of the regular group. The nursing satisfaction score (94.53 ± 3.72) of the dressing group was higher than that (81.79 ± 4.61) of the regular group. To conclude, in this study, we found that the Meipicang dressing can reduce the incidence of pressure ulcers in ICU patients with severe ICU and improve the comfort and nursing satisfaction of elderly ICU patients with severe ICU, which is worthy of promotion.

A combined thermomechanical and radiation testing platform for a 6 MV tandem accelerator

Cladding and structural materials for nuclear reactors must withstand elevated temperatures, energetic particle fluxes, and sustained mechanical loading, while maintaining mechanical strength and integrity. To address this experimental need for new materials, an accelerator end-station has been developed that mates a micro tensile test frame with a 6 MV Van de Graaff Tandem accelerator. This allows ion species with energies up to 100 MeV to strike a specimen during simultaneous heating up to 1200 ℃, uniaxial loading up to 450 kg, or cyclic loading at rates of up to 50 Hz. The ability to perform temperature-controlled tensile, creep, and high-cycle fatigue experiments during ion implantation or irradiation will provide a deeper understanding of the deformation response of materials under various combinations of extreme environments. The capabilities of this facility are demonstrated by inducing irradiation-enhanced creep in coarse-grained copper and suppressing failure during fatigue loading by simultaneous irradiation in nanocrystalline Ni-Fe.

Evaluation of facial tissue stresses under medical devices post application of a cyanoacrylate liquid skin protectant: An integrated experimental-computational study.

Medical device‐related pressure ulcers (PUs) (injuries) are a subclass of PUs, associated with pressure and/or shear applied by a medical device onto the skin. Clinical application of a cyanoacrylate liquid skin protectant (CLSP) under the contours of skin‐contacting medical devices to shield an intact skin from the sustained mechanical loads that are applied by medical devices is a preventative option, but no computer modelling work has been reported to assess the biomechanical efficacy of such interventions. Here, we investigated the biomechanical protective effect of a polymerised cyanoacrylate coating using three‐dimensional, anatomically realistic finite element models of the ear with oxygen cannula and the mouth with endotracheal attachment device, informed by experimental studies. We have compared tissue stress exposures under the devices at these facial sites between conditions where the cyanoacrylate skin protectant has been applied or where the device was contacting the skin directly, without the shielding of the cyanoacrylate coating. The CLSP considerably reduced the skin stress concentration levels and overall tissue stress exposures under the aforementioned medical devices. This demonstrates strong biomechanical effectiveness of the studied cyanoacrylate‐based skin protectant in prevention of facial medical device‐related injuries at small, curved and thereby difficult to protect facial sites.

The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework

Pressure ulcers are localized sites of tissue damage which form due to the continuous exposure of skin and underlying soft tissues to sustained mechanical loading, by bodyweight forces or because a body site is in prolonged contact with an interfacing object. The latter is the common cause for the specific sub-class of pressure ulcers termed ‘medical device-related pressure ulcers’, where the injury is known to have been caused by a medical device applied for a diagnostic or therapeutic purpose. Etiological research has established three key contributors to pressure ulcer formation, namely direct cell and tissue deformation, inflammatory edema and ischemic damage which are typically activated sequentially to fuel the injury spiral. Here, we visualize and analyze the above etiological mechanism using a new cell-scale modeling framework. Specifically, we consider here the deformation-inflicted and inflammatory contributors to the damage progression in a medical device-related pressure ulcer scenario, forming under a continuous positive airway pressure ventilation mask at the microarchitecture of the nasal bridge. We demonstrate the detrimental effects of exposure to high-level continuous external strains, which causes deformation-inflicted cell damage almost immediately. This in turn induces localized edema, which exacerbates the cell-scale mechanical loading state and thereby progresses cell damage further in a nonlinear, escalating pattern. The cell-scale quantitative description of the damage cascade provided here is important not only from a basic science perspective, but also for creating awareness among clinicians as well as industry and regulators with regards to the need for improving the design of skin-contacting medical devices.

Sensitivity to Input Parameters of Failure Detection Methods for Out-of-Plane Loaded Glass Panels in Fire

In recent years, glass has been a largely used material for load-bearing or non-structural components in buildings and constructions. For this reason, dedicated calculation methods and approaches are required for the major loading and boundary conditions that are of technical interest for safe design purposes. Among others, the resistance and mechanical performance of glass elements under fire exposure still represents an open challenge. This paper elaborates on the failure detection methods for out-of-plane loaded glass panels that are subjected to fire loading and simultaneous mechanical loads. As known, the conventional method for thermal failure detection is based on the maximum temperature gradient in glass, and its comparison with a set of allowable standardized values. However, especially for ordinary glass components in buildings that are required to sustain combined mechanical loads, the overall structural performance is even more complex to predict. This design issue is given to a combination of pure mechanical aspects (i.e., sustained loads and corresponding stress–strain analysis) and thermo-physical phenomena, that depend on the progressive modification of material properties while increasing temperatures. This research study, accordingly, investigates the sensitivity of input parameters on the failure time of a given glass element under fire and sustained mechanical loads. A major advantage is taken from finite element (FE) numerical analyses and standardized failure detection methods of literature, that are selected for comparative purposes. Further, the paper also introduces the “stress approach” that can be used to quantify (in place of the conventional thermal gradient) the actual effects of assigned thermal exposure and mechanical loads.

Experimental study on the effect of hygrothermal environments combined with the sustained mechanical loads on the strength of composite rings

Despite the high strength-to-weight ratio and corrosion resistance, the performance of composite pipes is strongly affected by the hygrothermal conditions. In this study, the E-glass/Epoxy composite pipes are produced by the filament winding method. The specimens are cut according to ASTM D2290 standard and exposed to three different environmental conditions. The first group of samples is kept intact, the second group is immersed in water, and the third group is subjected to transverse diametrical load and then immersed in water at different temperatures. At the specified time intervals, samples are subjected to the split-disk test method (ASTM D2290) to determine the Hoop Tensile Strength (HTS) of samples. The results show that the moisture uptake behavior at low temperatures followed the Fick's law and at higher temperatures the non-Fickian behavior is seen. The applied preload has no significant effect on the type of moisture absorption behavior. Applying the hygrothermal and strain corrosion conditions to the samples, the HTS of the samples decreases. SEM images shows that the moisture absorption decreases the bonding between the fibers and matrix and also reduction of bonded epoxy on the outer surface of the fiber in saturated specimens is clearly seen.

COVID-19: pressure ulcers, pain and the cytokine storm.

COVID-19: pressure ulcers, pain and the cytokine storm.

Results of Laboratory Testing for Immersion, Envelopment, and Horizontal Stiffness on Turn and Position Devices to Manage Pressure Injury

A continuing complication, pressure injuries are due to sustained mechanical loading and tissue deformations, which can then be exacerbated by additional intrinsic and extrinsic risk factors. Although support surfaces are designed to mitigate risk factors for pressure injuries, the presence of a turn and position device (TPD) between the patient and support surface may interfere with how support surfaces affect these risk factors. Report the use of the NPIAP's S3I standard test methods to characterize the performance of a support surface when used in conjunction with three different TPDs. Laboratory testing compared three TPDs for Immersion, Envelopment, and Horizontal Stiffness in each of five surface combinations. Immersion test measures how far mannequin indenter immerses into surface. Envelopment test measures immersion and pressure distribution with hemispherical-indenter with mounted sensor rings. Horizontal Stiffness test measures the shear modulus of the support surface with epicondyle indenter. For the specific TPDs tested here, the one with an adjustable integrated air bladder improved rather than compromised both the envelopment and the immersion of the support surface alone. Additionally, this TPD provided potential protection against sliding and the associated frictional shear forces. This paper describes how TPDs should perform in order to help establish which features are needed in a new medical device of this type. Laboratory testing demonstrates it is possible to improve performance of a support surface by applying a TPD as an add-on, thus relieving tissue deformation exposure through more effective pressure redistribution.

Structural Capacity of One-Way Spanning Large-Scale Cross-Laminated Timber Slabs in Standard and Natural Fires

This paper describes selected observations, measurements, and analysis from a series of large-scale experiments on cross-laminated timber (CLT) slabs that were exposed to fire from below, using four different heating scenarios, with a sustained mechanical loading of 6.3 kN m per metre width of slab. The deflection response and in-depth timber temperatures are used to compare the experimental response against a relatively simple structural fire model to assess the load bearing capacity of CLT elements in fire, including during the decay phase of natural fires. It is demonstrated that the ventilation conditions in experiments with a fixed fuel load are important in achieving burnout of the contents before structural collapse occurs. A mechanics-based structural fire model is shown to provide reasonably accurate predictions of structural failure (or lack thereof) for the experiments presented herein. The results confirm the importance of the ventilation conditions on the fire dynamics, burning duration, and the achievement of functional fire safety objectives (i.e. maintaining stability and compartmentation), in compartments with exposed CLT.

Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review.

Deep tissue injuries are pressure ulcers which initiate in the subcutaneous tissues and extend through a bottom-up pathway. Once deep tissue injuries are visual at skin level, serious irreversible tissue damage has already occurred. In pressure ulcer development, inflammation and edema are coupled physiological processes associated with tissue damage arising due to sustained mechanical loading. This study aimed to provide an in-depth overview of the physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues, in the context of pressure ulceration. A scoping review was performed according to the framework by Arksey and O'Malley. The databases MEDLINE, EMBASE, Web of Science, and Scopus, and the reference lists of included studies were searched for in vivo (animal, human), and in vitro studies matching the study objectives (from inception to 28 May 2018). No restrictions for inclusion were applied for study design, setting, participants, and year of publication. A total of 12 studies were included, varying in study design, sample characteristics, amount and duration of mechanical loads that were applied, follow-up time, and assessment methods. Neutrophil infiltration and edema occur in the subcutaneous tissues nearly immediately after the application of load on soft tissues. The amount of neutrophils and edema increase in the first days after the mechanical insult and decrease once healing has been initiated and no supplementary mechanical load was applied. One study indicated that edema may extend up to the level of the dermo-epidermal junction. Further research should focus on how deep tissue inflammation and edema are reflected into unique tissue changes at skin level, and how abnormal inflammatory responses manifest (e.g. when the nervous system is not functioning normally).

Sodium pyruvate pre-treatment prevents cell death due to localised, damaging mechanical strains in the context of pressure ulcers.

We demonstrate sodium pyruvate (NaPy) pre-treatment as a successful approach for pressure ulcer (PU) prevention by averting their aetiological origin-cell-level damage and death by large, sustained mechanical loads. We evaluated the NaPy pre-treatment effect on permeability changes in the cell's plasma membrane (PM) following application of in vitro damaging-level strains. Fibroblasts or myoblasts, respectively, models for superficial or deep-tissue damage were grown in 0 or 1 mM NaPy, emulating typical physiological or cell culture conditions. Cells were pre-treated for 4 hours with 0 to 5 mM NaPy prior to 3-hour sustained, damaging-level loads (12% strain). PM permeability was quantified by the cell uptake of small (4 kDa), fluorescent dextran compared with unstrained control using fluorescence-activated cell sorting (FACS). Pre-treatment with 1 mM, and especially 5 mM, NaPy significantly reduces damage to PM integrity. Long-term NaPy pre-exposure can improve protective treatment, affecting fibroblasts and myoblasts differently. Pre-treating with NaPy, a natural cell metabolite, allows cells under damaging-level mechanical loads to maintain their PM integrity, that is, to avoid loss of homeostasis and inevitable, eventual cell death, by preventing initial, microscale stages of PU formation. This pre-treatment may be applied prior to planned periods of immobility, for example, planned surgery or transport, to prolong safe time in a position by preventing initial cell damage that can cascade and lead to PU formation.

Effect of Sustained Joint Loading on TMJ Disc Nutrient Environment

The temporomandibular joint (TMJ) disc nutrient environment profoundly affects cell energy metabolism, proliferation, and biosynthesis. Due to technical challenges of in vivo measurements, the human TMJ disc extracellular nutrient environment under load, which depends on metabolic rates, solute diffusion, and disc morphometry, remains unknown. Therefore, the study objective was to predict the TMJ disc nutrient environment under loading conditions using combined experimental and computational modeling approaches. Specifically, glucose consumption and lactate production rates of porcine TMJ discs were measured under varying tissue culture conditions (n = 40 discs), and mechanical strain-dependent glucose and lactate diffusivities were measured using a custom diffusion chamber (n = 6 discs). TMJ anatomy and loading area were obtained from magnetic resonance imaging of healthy human volunteers (n = 11, male, 30 ± 9 y). Using experimentally determined nutrient metabolic rates, solute diffusivities, TMJ anatomy, and loading areas, subject-specific finite element (FE) models were developed to predict the 3-dimensional nutrient profiles in unloaded and loaded TMJ discs (unloaded, 0% strain, 20% strain). From the FE models, glucose, lactate, and oxygen concentration ranges for unloaded healthy human TMJ discs were 0.6 to 4.0 mM, 0.9 to 5.0 mM, and 0% to 6%, respectively, with steep gradients in the anterior and posterior bands. Sustained mechanical loading significantly reduced nutrient levels (P < 0.001), with a critical zone in which cells may die representing approximately 13.5% of the total disc volume. In conclusion, this study experimentally determined TMJ disc metabolic rates, solute diffusivities, and disc morphometry, and through subject-specific FE modeling, revealed critical interactions between mechanical loading and nutrient supply and metabolism for the in vivo human TMJ disc. The results suggest that TMJ disc homeostasis may be vulnerable to pathological loading (e.g., clenching, bruxism), which impedes nutrient supply. Given difficulties associated with direct in vivo measurements, this study provides a new approach to systematically investigate homeostatic and degenerative mechanisms associated with the TMJ disc.

Effects of training with a custom-made visual feedback device on balance and functional lower-extremity strength in older adults: A randomized controlled trial

IntroductionTraining with a slow and sustained mechanical load, such as standing on one leg, is an effective method for improving balance and increasing lower-extremity strength. Also, visual feedback during motor learning is important in facilitating efficient postural responses and balance skills. In this study, a custom-made visual feedback device was invented to provide the training modality and program based on single-leg standing combined with augmented visual feedback training. This study aimed to investigate the effects of visual feedback training using the custom-made visual feedback device on balance and functional lower-extremity strength in older adults. MethodsThirty-four independent older adults were randomly allocated to a training group (TG) and a control group (CG). The participants in the TG received training with the custom-made visual feedback device. The training duration was three sessions per week, for four weeks. The participants in the CG continued their routine activities. Balance (static and dynamic balances, and balance confidence) and functional lower-extremity strength were assessed pre- and post-training. ResultsImprovements in static balance (sway velocity and limit of balance during one-leg standing with eyes open) and dynamic balance (directional control of limits of stability in the backward direction) were found after training in the TG compared with the CG. No significant differences in balance confidence or functional lower-extremity strength were found between groups after training. ConclusionIn older adults, training with a custom-made visual feedback device could be used to improve both static and dynamic balances, but not balance confidence and functional lower-extremity strength.