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Background: Large and complex defects requiring reconstruction are challenging for orthopaedic surgeons. The use of human acellular dermal (HAD) matrices to augment large soft tissue defects such as those seen in massive rotator cuff tears, knee extensor mechanism failures and neglected Tendo-Achilles tears has proven to be a valuable tool in surgeons reconstructive armamentarium. Different methods for allograft decellularization and preservation alter the native properties of the scaffold. Traditional processing and preservation methods have shown to have drawbacks that preclude its widespread use. Some of the common issues include inferior biomechanical properties, the risk of rejection, limited customization, difficulty in storing and transporting, the requirement of pre-operative preparation, and last but not the least increased cost. Methods: We describe a novel processing and preservation method utilizing a two-step non-denaturing decellularization method coupled with preservation using a water-sequestering agent (glycerol) to remove immunogenic components while retaining biomechanical properties. The efficiency of this novel process was compared with the traditional freeze-drying method and verified by histological evaluation and biomechanical strength analysis. Results: The absence of cellular components and matrix integrity in hematoxylin and eosin-stained glycerol-preserved HAD (gly-HAD) samples compared to freeze-dried HAD (FD-HAD) demonstrated effective yet gentle decellularization. Biomechanical strength analysis revealed that gly-HADs are stronger with an ultimate tensile load to the failure strength of 210 N compared to FD-HAD (124N). The gly-HADs were found to have an optimal suture–retention strength of 126 N. Finally, sterility testing of the resultant grafts was checked to ensure a sterility assurance level of 10−6 to establish implantability. Conclusion: The novel processing and preservation technique is described in this paper to create a Human Acellular Dermis with higher biomechanical strength and superior histological characteristics. The processing and preservation technique ensured high sterility assurance levels to establish implantability. [ABSTRACT FROM AUTHOR]

The fallopian tube (FT) plays a crucial role in the reproductive process by providing an ideal biomechanical and biochemical environment for fertilization and early embryo development. Despite its importance, the biomechanical functions of the FT that originate from its morphological aspects, and ultrastructural aspects, as well as the mechanical properties of FT, have not been studied nor used sufficiently, which limits the understanding of fertilization, mechanotrasduction, and mechanobiology during embryo development, as well as the replication of the FT in laboratory settings for infertility treatments. This paper reviews and revives valuable information on human FT reported in medical literature in the past five decades relevant to the biomechanical aspects of FT. In this review, we summarized the current state of knowledge concerning the morphological, ultrastructural aspects, and mechanical properties of the human FT. We also investigate the potential arising from a thorough consideration of the biomechanical functions and exploring often neglected mechanical aspects. Our investigation encompasses both macroscopic measurements (such as length, diameter, and thickness) and microscopic measurements (including the height of epithelial cells, the percentage of ciliated cells, cilia structure, and ciliary beat frequency). Our primary focus has been on healthy women of reproductive age. We have examined various measurement techniques, encompassing conventional metrology, 2D histological data as well as new spatial measurement techniques such as micro-CT. [ABSTRACT FROM AUTHOR]

Background: The tethered swimming (TS) is an ergometer where swimming is simulated in an ecological environment, commonly used for assessing force in water. Objective: This systematic review aims at a critical appraise of the literature on the biomechanical and physiological variables obtained from many protocols and tests assessing force–time curve in TS. Methods: We explored the databases of PubMed, EMBASE, SPORTDiscus, Web of Science, and Academic Search Premier (PROSPERO protocol CRD42020204826), and manually searched the reference papers list. Observational studies with swimming protocols and tests were included (with any follow-up and published in the full version). The following exclusion criteria would be used, but they were not necessary, as no case met these criteria. Our search was based on the adapted Downs and Black Quality Assessment Checklist. Results: In total, 55 articles were examined extensively for fitting the established inclusion criteria. Quality of the articles included ranged from 35.7 to 85.7% (65.7 ± 13.3%). Most studies addressing TS were assessed [peak = 41 and average force = 39], whereas only a very few studies referred to measures of [force impulse = 21, fatigue index = 11, force development rate = 5], and physiological variables [oxygen consumption = 10, blood lactate concentration = 8, and heart rate = 6]. The studies were carried out with durations of 10 s, 15 s, 20 s, 25 s, 30 s, 55 s, 1, 2, or 3 min, related to the duration to perform 10 and 20 complete strokes in front crawl swimming technique. Conclusion: Based on the general results of this systematic review, the impulse seems to be the most reliable measure and presented linear correlation with swimming speed. In contrast, the TS physiological responses show compatibility for the aerobic response, critical force, and maximal oxygen uptake determination. [ABSTRACT FROM AUTHOR]

The single-incision anterior cruciate ligament (ACL) reconstruction evidently has its shortcomings. In an attempt to improve the biomechanical but also the biological state of the knees after an ACL-reconstruction, double, even triple-bundle reconstructions have been popularised recently. As a positive side effect, details concerning ACL-insertion anatomy were brought back into the focus. In our opinion it would be more straight forward and logical to replace the non-anatomical single-incision technique with a more anatomic single-bundle ACL-reconstruction technique. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics including the effect of increasing posterior tibial slope on anterior cruciate ligament strain, the influence of pre-operative laxity on anterior cruciate ligament reconstruction outcomes, and the quantitative detection of the pivot shift phenomenon by simple image analysis.

At what inclination does climbing begin? In this paper, we investigate the transition from walking to climbing in two species of parrot (Agapornis roseicollis and Nymphicus hollandicus) that are known to incorporate both their tail and their craniocervical system into the gait cycle during vertical climbing. Locomotor behaviors ranging in inclination were observed at angles between 0° and 90° for A. roseicollis, and 45°–85° degrees for N. hollandicus. Use of the tail in both species was observed at 45° inclination, and was joined at higher inclinations (> 65°) by use of the craniocervical system. Additionally, as inclination approached (but remained below) 90°, locomotor speeds were reduced while gaits were characterized by higher duty factors and lower stride frequency. These gait changes are consistent with those thought to increase stability. At 90°, A. roseicollis significantly increased its stride length, resulting in higher overall locomotor speed. Collectively these data demonstrate that the transition between horizontal walking and vertical climbing is gradual, incrementally altering several components of gait as inclinations increase. Such data underscore the need for further investigation into how exactly "climbing" is defined and the specific locomotor characteristics that differentiate this behavior from level walking. [ABSTRACT FROM AUTHOR]

The anterolateral ligament (ALL) was first described in 1879 in the context of Segond fractures, which correlate with a 75–100% chance of an anterior cruciate ligament (ACL) tear or a 66–75% chance of a meniscal tear. The purpose of this paper is to provide an updated comprehensive review on the anterolateral ligament complex of the knee focusing on the: (1) anatomy of the ALL/ALC; (2) associated biomechanics/function; and (3) important surgical considerations in contemporary anterior cruciate ligament (ACL) reconstruction and total knee arthroplasty (TKA). A systematic review of studies on ALL was conducted on Pubmed/MEDLINE and Cochrane databases (May 7th, 2020 to February 1st, 2022), with 20 studies meeting inclusion/exclusion criteria. Studies meeting inclusion criteria were anatomical/biomechanical studies assessing ALL function, cadaveric and computer simulations, and comparative studies on surgical outcomes of ALLR (concomitant with ACL reconstruction). Eight studies were included and graded by MINOR and Newcastle–Ottawa scale to identify potential biases. The anatomy of the ALL is part of the anterolateral ligament complex (ALC), which includes the superficial/deep iliotibial band (including the Kaplan fiber system), iliopatellar band, ALL, and anterolateral capsule. Multiple biomechanical studies have characterized the ALC as a secondary passive stabilizer in resisting tibial internal rotation. Given the role of the ALC in resisting internal tibial rotation, lateral extra-articular procedures including ALL augmentation may be considered for chronic ACL tears, ACL revisions, and a high-grade pivot shift test. In the context of TKA, in the event of injury to the ALC, a more constrained implant or soft-tissue reconstruction may be necessary to restore appropriate knee stability. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Feather structure, biomechanics and biomimetics: the incredible lightness of being" that was published in the 2014, volume 155 issue, is presented.

In this paper, we describe a proof-of-concept for the implementation of a wearable auditory biofeedback system based on a sensor-instrumented insole. Such a system aims to assist everyday users with static and dynamic exercises for gait rehabilitation interventions by providing auditory feedback based on plantar pressure distribution and automated classification of functional gait disorders. As ground reaction force (GRF) data are frequently used in clinical practice to quantitatively describe human motion and have been successfully used for the classification of gait patterns into clinically relevant classes, a feed-forward neural network was implemented on the firmware of the insoles to estimate the GRFs using pressure and acceleration data. The estimated GRFs approximated well the GRF measurements obtained from force plates. To distinguish between physiological gait and gait disorders, we trained and evaluated a support vector machine with labeled data from a publicly accessible dataset. The automated gait classification was then sonified for auditory feedback. The potential of the implemented auditory feedback for preventive and supportive applications in physical therapy was finally assessed with both expert and non-expert participants. A focus group revealed experts' expectations for the proposed system, while a usability study assessed the clarity of the auditory feedback to everyday users. The evaluation shows promising results regarding the usefulness of our system in this application area. [ABSTRACT FROM AUTHOR]

The larval stage is thought to play a significant role in radiations of Diptera (Insecta), but for the Cyclorrhapha (Diptera), a well-supported and diversified clade, evaluating larval roles is hindered by low taxon sampling, unresolved morphology and presumed similarity. This paper reviews investigations of the cyclorrhaphan larval head based on wider taxon sampling and functional assessment. It examines whether misunderstandings and superficial levels of analysis may have overestimated these difficulties. Functional assessment is a technique for investigating larvae and begins the process of making larvae better known as living organisms. For instance, functional assessments of larvae in the lower Cyclorrhapha helps resolve structures including the antenna and mandible whose homology is unclear. The levels of sclerotisation, alignment and fusion of head structures can predict feeding mechanisms and help turn the enigmatic cyclorrhaphan larval head into an analysable component. [ABSTRACT FROM AUTHOR]

Fundamental knowledge about in vivo kinematics and contact conditions at the articulating interfaces of total knee replacements are essential for predicting and optimizing their behavior and durability. However, the prevailing motions and contact stresses in total knee replacements cannot be precisely determined using conventional in vivo measurement methods. In silico modeling, in turn, allows for a prediction of the loads, velocities, deformations, stress, and lubrication conditions across the scales during gait. Within the scope of this paper, we therefore combine musculoskeletal modeling with tribo-contact modeling. In the first step, we compute contact forces and sliding velocities by means of inverse dynamics approach and force-dependent kinematic solver based upon experimental gait data, revealing contact forces during healthy/physiological gait of young subjects. In a second step, the derived data are employed as input data for an elastohydrodynamic model based upon the finite element method full-system approach taking into account elastic deformation, the synovial fluid's hydrodynamics as well as mixed lubrication to predict and discuss the subject-specific pressure and lubrication conditions. [ABSTRACT FROM AUTHOR]

Introduction: Distal femur fractures are challenging injuries historically associated with high rates of nonunion and varus collapse with operative management. As a result, clinical and research interest in dual plating (DP) of distal femur fractures has seen a dramatic increase in recent years. The purpose of this study was to systematically review the literature regarding vascular anatomy and biomechanics of distal femur fractures treated with DP constructs. Materials and methods: A systematic literature review of two medical databases (PubMed & Scopus) was performed to identify peer-reviewed studies on the anatomy and biomechanics regarding DP of distal femur fractures. A total of 1,001 papers were evaluated and 14 papers met inclusion criteria (6 anatomy and 8 biomechanics). Methodological quality scores were used to assess quality and potential bias in the included studies. Results: In the biomechanical studies, DP constructs demonstrated greater axial and rotational stiffness, as well as less displacement and fewer incidences of failure compared to all other constructs. Vascular studies showed that the femoral artery crosses the mid-shaft femur approximately 16.0–18.8 cm proximal to the adductor tubercle and it is located on average 16.6–31.1 mm from the femoral shaft at this location, suggesting that medial plate application can be achieved safely in the distal femur. The methodological quality of the included studies was good for biomechanical studies (Traa score 79.1; range 53–92.5) and excellent for anatomical studies (QUACs score 81.9; range 69.0–88.5). Conclusions: Existing biomechanics literature suggests that DP constructs are mechanically stronger than other constructs commonly used in the treatment of distal femur fractures. Furthermore, medial distal femoral anatomy allows for safe application of DP constructs, even in a minimally invasive fashion. Dual plating should be considered for patients with distal femur fractures that have risk factors for instability, varus collapse, or nonunion. [ABSTRACT FROM AUTHOR]

Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test–retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements. [ABSTRACT FROM AUTHOR]

Purpose: An observation was made by the senior author of this paper that patients reported changes in their hip function after a medial opening wedge high tibial osteotomy (MOHTO) for varus pattern osteoarthritis. Alignment changes at the hip after MOHTO have not been previously documented. This study assesses coronal alignment changes at the hip after MOHTO. Methods: We retrospectively analysed pre- and post-operative lower limb alignment radiographs of patients who underwent MOHTO. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the alignment changes created by the MOHTO. The coronal alignment changes at the hip were evaluated using the mechanical greater trochanter angle (MGTA). Results: 29 osteotomies in 27 patients were included in this study. Results showed MOHTO created alignment changes at the hip. A positive correlation was found between the size of the correction at the knee and the subsequent changes at the hip. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.684 vs. 0.585). It was found that age, weight, height and BMI had no significant influence on these correlations. Conclusions: Increased correction by the MOHTO lead to increased change in the coronal alignment of the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors and we recommend assessing the hip joint as part of pre-operative planning. Level of evidence: Prognostic level IV. [ABSTRACT FROM AUTHOR]

Smoothed particle hydrodynamics (SPH), as one of the earliest meshfree methods, has broad prospects in modeling a wide range of problems in engineering and science, including extremely large deformation problems such as explosion and high velocity impact. This paper aims to provide a comprehensive overview on the recent advances of SPH method in the fields of fluid, solid, and biomechanics. First, the theory of SPH is described, and improved algorithms of SPH with high accuracy are summarized, such as the finite particle method (FPM). Techniques used in SPH method for simulating fluid, solid and biomechanics problems are discussed. The δ-SPH method and Godunov SPH (GSPH) based on the Riemann model are described for handling instability issues in fluid dynamics. Next, the interface contact algorithm for fluid-structure interaction is also discussed. The common algorithms for improving the tensile instability and the framework of total Lagrangian SPH are examined for challenging tasks in solid mechanics. In terms of biomechanics, the governing equations and the coupling forces based on SPH method are exemplified. Then, various typical engineering applications and recent advances are elaborated. The application of fluid mainly depicts the interaction between fluid and rigid body as well as elastomer, while some complicated fluid-structure interaction ocean engineering problems are also presented. In the aspect of solid dynamics, galaxy, geotechnical mechanics, explosion and impact, and additive manufacturing are summarized. Furthermore, the recent advancements of SPH method in biomechanics, such as hemodynamically and gut health, are discussed in general. In addition, to overcome the limitations of computational efficiency and computational scale, the multiscale adaptive resolution, the parallel algorithm and the automated mesh generation are addressed. The development of SPH software in China and abroad is also summarized. Finally, the challenging task of SPH method in the future is summarized. In future research work, the establishment of multi-scale coupled SPH model and deep learning technology in solid and biodynamics will be the focus of expanding the engineering applications of SPH methods. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic cervical artery dissections carry significant morbidity and mortality among blunt trauma victims. The current paper illustrates a case with a young male who presented with atlantoaxial dislocation associated with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) infarction. Case Report: We report a young male who presented to the emergency department with ipsilateral carotid and vertebral artery dissections complicated by middle cerebral artery (MCA) stroke associated with atlantoaxial dislocation after jumping into the water from a height. A young patient presented to us 1 year after sustaining an injury. We did posterior C1/2 fusion using the technique described by Harms and Goel to treat his atlantoaxial dislocation. The patient tolerated the surgery well and was discharged on postoperative day 4. Conclusions: We highlighted the complicated course of the simultaneously traumatic dissections of ipsilateral cervical arteries along with atlantoaxial dislocation, the biomechanics of this combination of injuries, and their management strategy. [ABSTRACT FROM AUTHOR]

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS. [ABSTRACT FROM AUTHOR]

Background: Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. Objective: To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. Design: Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). Data Sources: PubMed. Connected Papers. The search was performed in February 2021. Eligibility Criteria: English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. Results: Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. Conclusion: This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted. [ABSTRACT FROM AUTHOR]

Systematically review the comparison of anterior and posterior framed walker in terms of biomechanical analysis and energy expenditure and to discuss the implications for clinical practice. A systematic literature search was performed to identify studies that evaluated the gait pattern, upper extremity (UE) kinetics and kinematics and energy consumption. Outcome measures and treatment results for them were identified. 6 studies met the criteria and were included in this systematic review. Gait analysis, UE kinetics and kinematics and energy consumption were all assessed in 4 different papers. Gait parameters were comparable between walkers but declined torso tilt was found in the posterior walker group. In UE joints, two groups showed no significant difference but adaptive therapeutic posterior walker helped decrease UE burden. Most of papers prefer posterior walkers because of low oxygen cost. For better gait pattern, less UE burden and energy consumption, the adaptive therapeutic posterior walker is relatively the proper choice among all. For future studies, crossover studies or randomized controlled trails (RCTs) with larger sample size and more accurate measurement equipment may provide more persuasive evidence. Long term effects of walker users can also be investigated. [ABSTRACT FROM AUTHOR]

In this paper, the material length scale parameter of the modified couple stress theory for trabecular bones is studied. For this reason, experimental data for the buckling of single wet and dry trabeculae from the subchondral region of the human medial tibial plateau are used from the literature. A material length scale parameter is extracted using the modified couple stress theory-based buckling relation and the experimental results. This parameter can capture the size-dependent behavior of trabeculae and can be beneficial for micro-mechanical investigation of trabecular bones. In addition, this paper proposes a size-dependent length scale parameter for trabeculae to estimate the buckling behaviors of dry and wet trabeculae, more accurately. Therefore, this paper confirms that the softening (weakening) effects of the modified couple stress theory and size-dependent behavior of the material length scale parameter can be considered for some special cases, and additionally, a correct value for the length scale parameter of the trabecula is revealed. [ABSTRACT FROM AUTHOR]

Coronary arteries have high curvatures, and hence, flow through them causes disturbed flow patterns, resulting in stenosis and atherosclerosis. This in turn decreases the myocardial flow perfusion, causing myocardial ischemia and infarction. Therefore, in order to understand the mechanisms of these phenomena caused by high curvatures and branching of coronary arteries, we have conducted elaborate hemodynamic analysis for both (i) idealized coronary arteries with geometrical parameters representing realistic curvatures and stenosis and (ii) patient-specific coronary arteries with stenoses. Firstly, in idealized coronary arteries with approximated realistic arterial geometry representative of their curvedness and stenosis, we have computed the hemodynamic parameters of pressure drop, wall shear stress (WSS) and wall pressure gradient (WPG), and their association with the geometrical parameters of curvedness and stenosis. Secondly, we have similarly determined the wall shear stress and wall pressure gradient distributions in four patient-specific curved stenotic right coronary arteries (RCAs), which were reconstructed from medical images of patients diagnosed with atherosclerosis and stenosis; our results show high WSS and WPG regions at the stenoses and inner wall of the arterial curves. This paper provides useful insights into the causative mechanisms of the high incidence of atherosclerosis in coronary arteries. It also provides guidelines for how simulation of blood flow in patient's coronary arteries and determination of the hemodynamic parameters of WSS and WPG can provide a medical assessment of the risk of development of atherosclerosis and plaque formation, leading to myocardial ischemia and infarction. The novelty of our paper is in our showing how in actual coronary arteries (based on their CT imaging) curvilinearity and narrowing complications affect the computed WSS and WPG, associated with risk of atherosclerosis. This is very important for cardiologists to be able to properly take care of their patients and provide remedial measures before coronary complications lead to myocardial infarctions and necessitate stenting or coronary bypass surgery. We want to go one step further and provide clinical application of our research work. For that, we are offering to cardiologists worldwide to carry out hemodynamic analysis of the medically imaged coronary arteries of their patients and compute the values of the hemodynamic parameters of WSS and WPG, so as to provide them an assessment of the risk of atherosclerosis for their patients. Graphical abstract Theme and aims: Coronary arteries have high curvatures, and hence flow through them causes disturbed flow patterns, resulting in stenosis and atherosclerosis. This in turn decreases the myocardial flow perfusion, causing myocardial ischemia and infarction. Therefore, in order to understand the mechanisms of these phenomena caused by high curvatures and branching of coronary arteries, we have conducted elaborate hemodynamic analysis for both (i) idealized coronary arteries with geometrical parameters representing curvatures and stenosis, and (ii) patient-specific coronary arteries with stenoses. Methods and results: Firstly, in idealized coronary arteries with approximated realistic arterial geometry representative of their curvedness and stenosis, we have computed the hemodynamic parameters of pressure drop, wall shear stress (WSS) and wall pressure gradient (WPG), and their association with the geometrical parameters of curvedness and stenosis. Then, we have determined the wall shear stress and wall pressure gradient distributions in four patient-specific curved stenotic right coronary arteries (RCAs), that were reconstructed from medical images of patients diagnosed with atherosclerosis and stenosis, as illustrated in Figure 1, in which the locations of the stenoses are highlighted by arrows. Figure 1: Three-dimensional CT visualization of arteries in patients with suspected coronary disease. The arteries can be seen as a combination of various curved segments with stenoses at unspecific locations highlighted by arrows. Our results show high WSS and WPG regions at the stenoses and inner wall of the arterial curves, as depicted in Figure 2. Therein, the encapsulations show (i) high WSS, and (ii) high WPG regions at the stenosis and inner wall of the arterial curves. Figure 2: WSS and WPG surface plot of realistic arteries (a), (b), (c) and (d), wherein the small squared parts are enlarged to show the detailed localized contour plots at the stenotic regions. Therein, the circular encapsulations show (i) high WSS and (ii) high WPG regions at the stenosis and inner wall of the arterial curves. Conclusion and novelty: This paper provides useful insights into the causative mechanisms of the high incidence of atherosclerosis in coronary arteries. It also provides guidelines for how simulation of blood flow in patient coronary arteries and determination of the hemodynamic parameters of WSS and WPG can provide a medical assessment of the risk of development of atherosclerosis and plaque formation, leading to myocardial ischemia and infarction. The novelty of our paper is our showing how in actual coronary arteries (based on their CT imaging), curvilinearity and narrowing complications affect the computed WSS and WPG associated with risk of atherosclerosis. This is very important for cardiologists to be able to properly take care of their patients and provide remedial measures before coronary complications lead to myocardial infarctions and necessitate stenting or coronary bypass surgery. [ABSTRACT FROM AUTHOR]

The maternal vasculature undergoes tremendous growth and remodeling (G&R) that enables a > 15-fold increase in blood flow through the uterine vasculature from conception to term. Hemodynamic metrics (e.g., uterine artery pulsatility index, UA-PI) are useful for the prognosis of pregnancy complications; however, improved characterization of the maternal hemodynamics is necessary to improve prognosis. The goal of this paper is to develop a mathematical framework to characterize maternal vascular G&R and hemodynamics in uncomplicated human pregnancies. A validated 1D model of the human vascular tree from the literature was adapted and inlet blood flow waveforms at the ascending aorta at 4 week increments from 0 to 40 weeks of gestation were prescribed. Peripheral resistances of each terminal vessel were adjusted to achieve target flow rates and mean arterial pressure at each gestational age. Vessel growth was governed by wall shear stress (and axial lengthening in uterine vessels), and changes in vessel distensibility were related to vessel growth. Uterine artery velocity waveforms generated from this model closely resembled ultrasound results from the literature. The literature UA-PI values changed significantly across gestation, increasing in the first month of gestation, then dramatically decreasing from 4 to 20 weeks. Our results captured well the time-course of vessel geometry, material properties, and UA-PI. This 1D fluid-G&R model captured the salient hemodynamic features across a broad range of clinical reports and across gestation for uncomplicated human pregnancy. While results capture available data well, this study highlights significant gaps in available data required to better understand vascular remodeling in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. Purpose: To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. Study Design: Systematic review. Methods: This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. Results: Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. Clinical Significance: This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. Conclusion: We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices. [ABSTRACT FROM AUTHOR]

Background: Patellar tendinopathy (PT) is common and debilitating for jumping athletes. Intriguingly, despite its high prevalence and many research studies, a causal explanation for PT presence remains elusive. Objective: Our objective was to investigate whether landing biomechanics among jumping athletes are associated with PT and can predict onset. Methods: We conducted a systematic review with evidence gap map and meta-analysis. We searched three databases from inception to May 2021 for observational studies or trials evaluating landing biomechanics in jumping athletes with PT (JPTs). We assessed quality with a modified Downs and Black checklist, risk of bias with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, and evidence levels with van Tulder's criteria and provided an evidence gap map. Results: One prospective cohort (moderate quality), one cross-sectional cohort (moderate quality), and 14 case–control (four high-, seven moderate-, and three low-quality) studies, including 104 JPTs, 14 with previous PT, 45 with asymptomatic patellar tendon abnormality (PTA), and 190 controls were retained. All studies had a high risk of bias. Meta-analysis showed an association between lower ankle dorsiflexion and the presence of tendinopathy during drop and spike landings, and JPTs had reduced knee joint power and work during volleyball approach or drop landings (moderate evidence). Limited evidence suggested that JPTs had lower patellar tendon loads during drop landings. Strong or moderate evidence showed no relation between PT and sagittal plane peak knee and hip angles or range of motion; hip, knee, or ankle angles at initial contact (IC); knee angular velocities, peak trunk kinematics, or trunk angles at IC; sagittal plane hip, knee, or ankle moments; and peak vertical ground reaction force (vGRF) and vGRF impulse. Identified gaps were that no study simultaneously investigated athletes with previous PT, current PT, and PTA, and studies of joint angular velocities at IC, ankle and hip angular velocities after touchdown, leg stiffness, loading rate of forces, and muscle activation are lacking. Conclusion: Despite the voluminous literature, large number of participants, multitude of investigated parameters, and consistent research focus on landing biomechanics, only a few associations can be identified, such as reduced ankle dorsiflexion–plantarflexion range. Further, the quality of the existing literature is inadequate to draw strong conclusions, with only four high-quality papers being found. We were unable to determine biomechanical factors that predicted PT onset, as longitudinal/prospective studies enabling causal inference are absent. The identified gaps indicate useful areas in which to explore causal relationships to inform intervention development. Therefore, high-quality prospective studies are essential to definitively determine whether landing biomechanics play a part in the development, recurrence, or management of PT and represent a potential therapeutic or preventive target alongside non-biomechanical factors. [ABSTRACT FROM AUTHOR]

Computational models are increasingly used for diagnosis and treatment of cardiovascular disease. To provide a quantitative hemodynamic understanding that can be effectively used in the clinic, it is crucial to quantify the variability in the outputs from these models due to multiple sources of uncertainty. To quantify this variability, the analyst invariably needs to generate a large collection of high-fidelity model solutions, typically requiring a substantial computational effort. In this paper, we show how an explicit-in-time ensemble cardiovascular solver offers superior performance with respect to the embarrassingly parallel solution with implicit-in-time algorithms, typical of an inner-outer loop paradigm for non-intrusive uncertainty propagation. We discuss in detail the numerics and efficient distributed implementation of a segregated FSI cardiovascular solver on both CPU and GPU systems, and demonstrate its applicability to idealized and patient-specific cardiovascular models, analyzed under steady and pulsatile flow conditions. [ABSTRACT FROM AUTHOR]

In the context of cardiac muscle modeling, the availability of the myosin heads in the sarcomeres varies over the heart cycle contributing to the Frank–Starling mechanism at the organ level. In this paper, we propose a new approach that allows to extend the Huxley'57 muscle contraction model equations to incorporate this variation. This extension is built in a thermodynamically consistent manner, and we also propose adapted numerical methods that satisfy thermodynamical balances at the discrete level. Moreover, this whole approach—both for the model and the numerics—is devised within a hierarchical strategy enabling the coupling of the microscopic sarcomere-level equations with the macroscopic tissue-level description. As an important illustration, coupling our model with a previously proposed simplified heart model, we demonstrate the ability of the modeling and numerical framework to capture the essential features of the Frank–Starling mechanism. [ABSTRACT FROM AUTHOR]

This paper proposes a novel experimental investigation based on 3D printing to validate numerical models for biomechanics simulations. Soft elastomeric materials have been used in Polyjet multi-material 3D printer to mimicking arteries affected by atherosclerotic plaque. The nonlinear mechanical properties of five digital materials are characterized and used as an input for finite element (FE) modeling. Pressurized air is applied to the internal cavity of the printed model to reproduce the internal blood pressure in the artery. Digital Imaging Correlation is adopted to measure the displacement and deformation. A 1D linear higher-order FE model based on the Carrera Unified Formulation is compared to 3D nonlinear FE solutions. [ABSTRACT FROM AUTHOR]

Complication rates of anterior cruciate ligament reconstruction (ACL-R) were reported to be around 15% although it is a common arthroscopic procedure with good outcomes. Breakage and migration of fixators are still possible even months after surgery. A fixator with optimum stability can minimise those two complications. Factors that affect the stability of a fixator are its configuration, material, and design. Thus, this paper aims to analyse the biomechanical effects of different types of fixators (cross-pin, interference screw, and cortical button) towards the stability of the knee joint after ACL-R. In this study, finite element modelling and analyses of a knee joint attached with double semitendinosus graft and fixators were carried out. Mimics and 3-Matic softwares were used in the development of the knee joint models. Meanwhile, the graft and fixators were designed by using SolidWorks software. Once the meshes of all models were finished in 3-Matic, simulation of the configurations was done using MSC Marc Mentat software. A 100-N anterior tibial load was applied onto the tibia to simulate the anterior drawer test. Based on the findings, cross-pin was found to have optimum stability in terms of stress and strain at the femoral fixation site for better treatment of ACL-R. [ABSTRACT FROM AUTHOR]

Introduction: Hip fracture is a common health risk among elderly people, due to the prevalence of osteoporosis and accidental fall in the population. Accurate assessment of fracture risk is a crucial step for clinicians to consider patient-by-patient optimal treatments for effective prevention of fractures. Image-based biomechanical modeling has shown promising progress in assessment of fracture risk, and there is still a great possibility for improvement. The purpose of this paper is to identify key issues that need be addressed to improve image-based biomechanical modeling. Materials and Methods: We critically examined issues in consideration and determination of the four biomechanical variables, i.e., risk of fall, fall-induced impact force, bone geometry and bone material quality, which are essential for prediction of hip fracture risk. We closely inspected: limitations introduced by assumptions that are adopted in existing models; deficiencies in methods for construction of biomechanical models, especially for determination of bone material properties from bone images; problems caused by separate use of the variables in clinical study of hip fracture risk; availability of clinical information that are required for validation of biomechanical models. Results and Conclusions: A number of critical issues and gaps were identified. Strategies for effectively addressing the issues were discussed. [ABSTRACT FROM AUTHOR]

Due to the complexity and high degrees of freedom, the detailed assessment of human biomechanics is necessary for the design and optimization of an effective exoskeleton. In this paper, we present full kinematics, dynamics, and biomechanics assessment of unpowered exoskeleton augmentation for human running gait. To do so, the considered case study is the assistive torque profile of I-RUN. Our approach is using some extensive data-driven OpenSim simulation results employing a generic lower limb model with 92-muscles and 29-DOF. In the simulation, it is observed that exoskeleton augmentation leads to 4.62 % metabolic rate reduction for the stiffness coefficient of α ∗ = 0.6 . Moreover, this optimum stiffness coefficient minimizes the biological hip moment by 26 % . The optimum stiffness coefficient ( α ∗ = 0.6 ) also reduces the average force of four major hip muscles, i.e., Psoas, Gluteus Maximus, Rectus Femoris, and Semimembranosus. The effect of assistive torque profile on the muscles' fatigue is also studied. Interestingly, it is observed that at α # = 0.8 , both all 92 lower limb muscles' fatigue and two hip major mono-articular muscles' fatigue have the maximum reduction. This result re-confirm our hypothesis that "reducing the forces of two antagonistic mono-articular muscles is sufficient for involved muscles' total fatigue reduction." Finally, the relation between the amount of metabolic rate reduction and kinematics of hip joint is examined carefully where for the first time, we present a reliable kinematic index for prediction of the metabolic rate reduction by I-RUN augmentation. This index not only explains individual differences in metabolic rate reduction but also provides a quantitative measure for training the subjects to maximize their benefits from I-RUN. [ABSTRACT FROM AUTHOR]

During physiological or 'natural' childbirth, the fetal head follows a distinct motion pattern—often referred to as the cardinal movements or 'mechanisms' of childbirth—due to the biomechanical interaction between the fetus and maternal pelvic anatomy. The research presented in this paper introduces a virtual reality-based simulation of physiological childbirth. The underpinning science is based on two numerical algorithms including the total Lagrangian explicit dynamics method to calculate soft tissue deformation and the partial Dirichlet–Neumann contact method to calculate the mechanical contact interaction between the fetal head and maternal pelvic anatomy. The paper describes the underlying mathematics and algorithms of the solution and their combination into a computer-based implementation. The experimental section covers first a number of validation experiments on simple contact mechanical problems which is followed by the main experiment of running a virtual reality childbirth. Realistic mesh models of the fetus, bony pelvis and pelvic floor muscles were subjected to the intra-uterine expulsion forces which aim to propel the virtual fetus through the virtual birth canal. Following a series of simulations, taking variations in the shape and size of the geometric models into account, we consistently observed the cardinal movements in the simulator just as they happen in physiological childbirth. The results confirm the potential of the simulator as a predictive tool for problematic childbirths subject to patient-specific adaptations. [ABSTRACT FROM AUTHOR]

This paper serves as a resource guide for Sports Engineering educators. The paper covers key topics in Sports Engineering, including ball impact, friction, safety and materials. A variety of resource types are presented to reflect modern methods of learning and searching for information, including textbooks, research and review papers, websites and videos. The field could benefit from more resources specifically designated for teaching Sports Engineering, particularly textbooks. [ABSTRACT FROM AUTHOR]

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population. [ABSTRACT FROM AUTHOR]

The vestibular receptor of cupula acts an important role in maintaining body balance. However, the cupula buried in the semicircular canals (SCCs) will be destroyed if it is detached from the relevant environment. The mechanical properties of human cupula still remain ambiguous. In this paper, we explored the cupula responses changing with temperature by experiments and numerical simulation of SCCs model. We obtained 3 volunteers' nystagmus induced by constant angular acceleration when the temperature of volunteers' SCCs was 36 °C and 37 °C respectively. The slow-phase velocity of 3 volunteers decreased by approximately 3°/s when the temperature of SCCs reduced by 1 °C, which corresponded to the reduction of cupula deformation by 0.3–0.8 μm in the numerical model. Furthermore, we investigated the effects of the variation of endolymphatic properties induced by temperature reduction on cupula deformation through numerical simulation. We found that the decrease of cupula deformation was not caused by the change of endolymphatic properties, but probably by the increase of cupula's elastic modulus. With the temperature reducing by 1 °C, the cupula's elastic modulus may increase by 6–20%, suggesting that the stiffness of cupula is enhanced. This exploration of temperature characteristic of human cupula promotes the research of alleviating vestibular diseases. [ABSTRACT FROM AUTHOR]

Abnormal cortical folding patterns, such as lissencephaly, pachygyria and polymicrogyria malformations, may be related to neurodevelopmental disorders. In this context, computational modeling is a powerful tool to provide a better understanding of the early brain folding process. Recent studies based on biomechanical modeling have shown that mechanical forces play a crucial role in the formation of cortical convolutions. However, the effect of biophysical parameters in these models remain unclear. In this paper, we investigate the effect of the cortical growth, the initial geometry and the initial cortical thickness on folding patterns. In addition, we not only use several descriptors of the folds such as the dimensionless mean curvature, the surface-based three-dimensional gyrification index and the sulcal depth, but also propose a new metric to quantify the folds orientation. The results demonstrate that the cortical growth mode does almost not affect the complexity degree of surface morphology; the variation in the initial geometry changes the folds orientation and depth, and in particular, the slenderer the shape is, the more folds along its longest axis could be seen and the deeper the sulci become. Moreover, the thinner the initial cortical thickness is, the higher the spatial frequency of the folds is, but the shallower the sulci become, which is in agreement with the previously reported effects of cortical thickness. [ABSTRACT FROM AUTHOR]

The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries. Level of evidence V. [ABSTRACT FROM AUTHOR]

A key problem for biological motor control is to establish a link between an idea of a movement and the generation of a set of muscle-stimulating signals that lead to the movement execution. The number of signals to generate is thereby larger than the body's mechanical degrees of freedom in which the idea of the movement may be easily expressed, as the movement is actually executed in this space. A mathematical formulation that provides a solving link is presented in this paper in the form of a layered, hierarchical control architecture. It is meant to synthesise a wide range of complex three-dimensional muscle-driven movements. The control architecture consists of a 'conceptional layer', where the movement is planned, a 'structural layer', where the muscles are stimulated, and between both an additional 'transformational layer', where the muscle-joint redundancy is resolved. We demonstrate the operativeness by simulating human stance and squatting in a three-dimensional digital human model (DHM). The DHM considers 20 angular DoFs and 36 Hill-type muscle–tendon units (MTUs) and is exposed to gravity, while its feet contact the ground via reversible stick–slip interactions. The control architecture continuously stimulates all MTUs ('structural layer') based on a high-level, torque-based task formulation within its 'conceptional layer'. Desired states of joint angles (postural plan) are fed to two mid-level joint controllers in the 'transformational layer'. The 'transformational layer' communicates with the biophysical structures in the 'structural layer' by providing direct MTU stimulation contributions and further input signals for low-level MTU controllers. Thereby, the redundancy of the MTU stimulations with respect to the joint angles is resolved, i.e. a link between plan and execution is established, by exploiting some properties of the biophysical structures modelled. The resulting joint torques generated by the MTUs via their moment arms are fed back to the conceptional layer, closing the high-level control loop. Within our mathematical formulations of the Jacobian matrix-based layer transformations, we identify the crucial information for the redundancy solution to be the muscle moment arms, the stiffness relations of muscle and tendon tissue within the muscle model, and the length–stimulation relation of the muscle activation dynamics. The present control architecture allows the straightforward feeding of conceptional movement task formulations to MTUs. With this approach, the problem of movement planning is eased, as solely the mechanical system has to be considered in the conceptional plan. [ABSTRACT FROM AUTHOR]

The scar is a predominant outcome of adult mammalian wound healing despite being associated with partial function loss. Here in this paper, we have described the structure of a full-thickness normal scar as a "di-fork" with dual biomechanical compartments using in vivo and ex vivo experiments. We used structural mechanics simulations to model the deformation fields computationally and stress distribution in the scar in response to external forces. Despite its loss of tissue components, we have found that the scar has stress-adaptive features that cushion the underlying tissues from external mechanical impacts. Thus, this new finding can motivate research to understand the biomechanical advantages of a scar in maintaining the primary function of the skin, i.e., mechanical barrier despite permanent loss of some tissues and specialized functions. [ABSTRACT FROM AUTHOR]

Safety standards for domestic trampolines are based on static-load testing using a factor of five times the maximum intended user mass. This paper presents a dynamic test method for trampolines, and provides measures of the users’ performance (e.g., peak acceleration, Accmax) and injury risk (e.g., mean rate of change of acceleration, Jerkmean). Uniform masses (41–116 kg) were dropped from 0.66 m onto the bed centre of nineteen different trampolines. Trampoline bed and spring stretches, mass flight time (FlightT) and accelerations were recorded using motion capture and accelerometers. Thirty-seven percent of trampolines exceeded the static safety standard bed deformation limits (80% of frame height) by 11 ± 6% with dynamic testing (mean ± standard deviation). Across all trampolines and masses dropped, the Accmax ranged from 5.1 to 7.6 g, suggesting the factor of five used in static-loading safety standards needs reviewing. Statistically significant negative correlations (p < 0.05) were found between trampoline bed diameter and Accmax (r = – 0.88), Jerkmean (r = – 0.77) and FlightT (r = – 0.82). Furthermore, significant correlations (p < 0.05) were also found between the mass dropped and Accmax (r = – 0.27), Jerkmean (r = – 0.59) and FlightT (r = 0.25). The combined effects of the spring constants, number of springs, bed diameters and masses dropped were described in predictive multivariate equations for Accmax (explained variance, R2 = 95%) and maximum vertical bed deformation (R2 = 85%). These findings from dynamic testing may assist manufacturers in designing trampolines that meet safety standards while maximising user performance and reducing injury risk. [ABSTRACT FROM AUTHOR]

This paper presents the design, fabrication and experimental characterization of an electro-thermally actuated microgripper suitable for single-cell manipulation. The analysis of the mechanical properties of cells is of great interest both in medicine and biology because the study of the cellular mechanical behaviour and resistance is necessary in these fields. Microgrippers (Bio-MEMS) have an important role in the manipulation of biological tissues and cells. In recent works, the research group simulated the mechanical behavior of grippers and the different actuation strategies. Considering the dimensional specifications and targets imposed by actuation and biocompatibility, in this paper, a microgripper based on electro-thermal actuation is studied. Starting from previous numerical results, a novel SU8 structure is designed and realized according to the micro-fabrication constraints and then the structure is simulated using the finite element method (FEM)-based thermo-structural simulations in ANSYS. Therefore, the fabrication method and steps are presented and the gripper has been developed and tested. Finally, the tip displacements of the gripper, electro-thermally actuated in different operating conditions, are compared with those obtained by means of numerical FEM simulations. A good agreement is obtained between simulations and experimental results. [ABSTRACT FROM AUTHOR]

Soft tissue mechanical characterisation is important in many areas of medical research. Examples span from surgery training, device design and testing, sudden injury and disease diagnosis. The liver is of particular interest, as it is the most commonly injured organ in frontal and side motor vehicle crashes, and also assessed for inflammation and fibrosis in chronic liver diseases. Hence, an extensive rheological characterisation of liver tissue would contribute to advancements in these areas, which are dependent upon underlying biomechanical models. The aim of this paper is to define a liver constitutive equation that is able to characterise the nonlinear viscoelastic behaviour of liver tissue under a range of deformations and frequencies. The tissue response to large amplitude oscillatory shear (1–50%) under varying preloads (1–20%) and frequencies (0.5–2 Hz) is modelled using viscoelastic-adapted forms of the Mooney–Rivlin, Ogden and exponential models. These models are fit to the data using classical or modified objective norms. The results show that all three models are suitable for capturing the initial nonlinear regime, with the latter two being capable of capturing, simultaneously, the whole deformation range tested. The work presented here provides a comprehensive analysis across several material models and norms, leading to an identifiable constitutive equation that describes the nonlinear viscoelastic behaviour of the liver. [ABSTRACT FROM AUTHOR]

Lumbar ligaments play a key role in stabilizing the spine, particularly assisting muscles at wide-range movements. Hence, valid ligament force–strain data are required to generate physiological model predictions. These data have been obtained by experiments on single ligaments or functional units throughout the literature. However, contrary to detailed spine geometries, gained, for instance, from CT data, ligament characteristics are often inattentively transferred to multi-body system (MBS) or finite element models. In this paper, we use an elaborated MBS model of the lumbar spine to demonstrate how individualized ligament characteristics can be obtained by reversely reenacting stepwise reduction experiments, where the range of motion (ROM) was measured. We additionally validated the extracted characteristics with physiological experiments on intradiscal pressure (IDP). Our results on a total of in each case 160 ROM and 49 IDP simulations indicated superiority of our procedure (seven and eight outliers) toward the incorporation of classical literature data (on average 71 and 31 outliers). [ABSTRACT FROM AUTHOR]

Sharp force trauma is routinely encountered in forensic practice. Often the question is posed, how much pressure or energy would have been necessary to inflict a cut with a specific knife, in order to further characterize the perpetrator or determine his intent to cause harm. This paper investigates two knife blades and its individual pressures needed to cut through the epidermis and dermis. In order to examine the necessary force for cutting through the skin, we performed experiments on a piglet skin-on-gelatin phantom. Two similarly small knives—a paring knife with a serrated blade and a Swiss Army pocket knife with a smooth blade—were moved over the phantom surface using a mobile cutting apparatus with varying weight on the load arm with the knife. The depth of the cut was to be determined according to a scale from zero to three: grade 0 = no cut; grade 1 = cut into epidermis only; grade 2 = cut into dermis; grade 3 = complete transection of the entire skin. Each cut inflicted at a specific pressure force was assessed closely in order to ascertain depth, calculate the velocity, and ultimately determine the point at which a cut would inflict grade 3 damage. The smooth blade of a pocket knife needed at least 1900g pressure in order to slice through pig skin mounted on a thick gelatin block, whereas a serrated blade of a paring knife managed to cut into or through the dermis at a comparatively lower force of 700g. Our study shows that at the same cutting velocity, a significant difference in pressure is necessary to inflict the same degree of damage. [ABSTRACT FROM AUTHOR]

According to recent studies, cancer is an evolving complex ecosystem. It means that tumor cells are well differentiated and involved in heterotypic interactions with their microenvironment competing for available resources to proliferate and survive. In this paper, we propose a chemo-mechanical model for the growth of specific subtypes of an invasive breast carcinoma. The model suggests that a carcinoma is a heterogeneous entity comprising cells of different phenotypes, which perform different functions in a tumor. Every cell is represented by an elastic polygon changing its form and size under pressure from the tissue. The mechanical model is based on the elastic potential energy of the tissue including the effects of contractile forces within the cell perimeter and the elastic resistance to stretching or compressing the cell with respect to the reference area. A tissue can evolve via mechanisms of cell division and intercalation. The phenotype of each cell is determined by its environment and can dynamically change via an epithelial–mesenchymal transition and vice versa. The phenotype defines the cell adhesion to the adjacent tissue and the ability to divide. In this part, we focus on the forms of collective migration of large groups of cells. Numerical simulations show the different architectural subtypes of invasive carcinoma. For each communication, we examine the dynamics of the cell population and evaluate the complexity of the pattern in terms of the synergistic paradigm. The patterns are compared with the morphological structures previously identified in clinical studies. [ABSTRACT FROM AUTHOR]

Fracture healing and growth of the bones are highly related to the stress level. Numerical analysis of stresses is the most effective means to determine the stress level, but it usually requires sufficient resolution to ensure an accurate description of geometry features of bones. In this paper, high-fidelity smoothed finite element method (S-FEM) skull models are created using computed tomography (CT) and micro-computed tomography (μCT) images of a juvenile pig skull. The material properties of the heterogeneous bone are modeled by a varying distribution of Young's modulus mapped to each element and smoothing domain to accurately capture the high heterogeneity. Different types of S-FEM models, including node-based, edge-based, and face-based, are developed for this high-fidelity modeling work. It is found that S-FEM has higher accuracy, in terms of displacements, stresses, and strain energy, compared to the traditional finite element method (FEM). Graphical abstract. [ABSTRACT FROM AUTHOR]

Human functional spinal unit (FSU) is comprised of two adjacent vertebrae, the intervertebral disc (IVD), the cartilage endplates and the connecting ligamentous tissues. As humans age, trabecular, cortical bone and IVD change in mechanical properties. These changes influence the movement of the FSU (displacements, rotations and disc bulges). This paper proposes a method to determine the influence of sex, age, weight and height on the movements of the FSU using a combination of the FEM and RSM. The work concentrates on the medium-sized human FSU (L3–L4 lumbar level with standard dimensions of IVD: width = 50 mm, depth = 35 mm and height = 11 mm). Also, the proposed method could be an improvement to the determination of risk of damage based on body mass index (BMI), as well as an alternative method of searching for a healthy weight. The method was developed as follows: First, a three-dimensional parameterized human healthy FSU FE model was generated based on the standard test (for compression, flexion, extension, lateral bending, torsion and shear). The movements of the FSU FE model based on the aforementioned standardized test when the sex, age, weight and height varies in a range for each individual (30–80 years; 70–120 kg; 160–190 cm) were simulated. Quadratic regression models were generated for each standardized test using RSM. An ANOVA test showed that all of the tests have a significant influence on weight and age, whereas height influences only those tests that involve rotation of the FSU (flexion, extension and lateral bending). Normal weight, overweight and obesity BMI classifications were considered in determining the healthy weight with the following constraints: the limit angles of flexion and lateral bending, as well as the maximum posterior bulge limit of the IVD, could not exceed of one-third of the spinal canal. The proposed method concluded that: (1) normal BMI values do not cause damage to the FSU, (2) some overweight BMI values may cause damage to the FSU for a certain range of ages and heights and (3) for BMI obesity values, the risk of damage to the FSU may be imminent. [ABSTRACT FROM AUTHOR]

Degenerative disc disease (DDD) is a common condition in elderly population that can be painful and can significantly affect individual's quality of life. Diagnosis of DDD allows prompt corrective actions but it is challenging due to the absence of any symptoms at early stages. In studying disc degeneration, measurement of the range of motion (RoM) and loads acting on the spine are crucial factors. However, direct measurement of RoM involves increased instrumentation and risk. In this paper, an innovative method is proposed for calculating RoM, emphasizing repeatability and reliability by considering the posterior thickness of the spine. This is achieved by offsetting the position of markers in relation to the actual vertebral loci. Three geometrically identical finite element models of L3-L4 are developed from a CT scan with different types of elements, and thereafter, mesh element-related metrics are provided for the assessment of the quality of models. The model with the best mesh quality is used for further analysis, where RoM are within ranges as reported in literature and in vivo experiment results. Various kinds of stresses acting on individual components including facet joints are analysed for normal and abnormal loading conditions. The results showed that the stresses in abnormal load conditions for all components including cortical (76.67 MPa), cancellous (69.18 MPa), annulus (6.30 MPa) and nucleus (0.343 MPa) are significantly greater as compared to normal loads (49.96 MPa, 44.2 MPa, 4.28 MPa and 0.23 MPa respectively). However, stress levels for both conditions are within safe limits (167-215 MPa for cortical, 46 MPa for the annulus and 3 MPa for facets). The results obtained could be used as a baseline motion and stresses of healthy subjects based on their respective lifestyles, which could benefit clinicians to suggest corrective actions for those affected by DDD. [ABSTRACT FROM AUTHOR]

The main objective of this paper is to help the orthopaedic in selecting the most suitable artificial intervertebral disc material that can be used in intervertebral disc replacement surgery based on the finite element method. The study uses a three-dimensional model for the lumber 4–lumber 5 spine vertebras for real patient DICOM dataset and saves as stereolithography format. The stereolithography file for the vertebras is converted into a computer-aided diagnostic file to be suitably imported in SolidWorks software. The integrated three-dimensional model assembles and boundary conditions are applied to the model, including axial force applied on the lumber 4–lumber 5 spine. The disc is designed and constructed using SolidWorks, and then four materials are applied to the artificial intervertebral disc. The results show that cobalt–chromium material is the most suitable material to be used in artificial spinal disc according to the maximum stress under an axial compression force of 300 N for cobalt–chromium and titanium was 109,308,136 N/m2 and 95,111,200 N/m2, while the maximum stress under an axial extension for cobalt–chromium and titanium was 109,308,136 N/m2 and 95,111,184 N/m2. The maximum stress under a right-side bending for cobalt–chromium and titanium was 30,456,905,728 N/m2 and 29,162,355,200 N/m2, and the maximum stress under a right-side bending for cobalt–chromium and titanium was 34,716,794,880 N/m2 and 33,086,228,480 N/m2. [ABSTRACT FROM AUTHOR]

Background: A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability. Objective: The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e.g. surgical technique and strength asymmetries) affecting running biomechanics. Methods: MEDLINE, EMBASE, SPORTDiscus and CINAHL databases were searched from inception to 10 December, 2018. The search identified studies comparing kinematic, kinetic or muscle activation data during running between the involved limb and contralateral or control limbs. Studies analysing the effect of intrinsic factors in the ACL-R group were also included. Risk of bias was assessed, qualitative and quantitative analyses performed, and levels of evidence determined. Results: A total of 1993 papers were identified and 25 were included for analysis. Pooled analyses reported a deficit of knee flexion motion and internal knee extension moment, compared with both contralateral or control limbs, during the stance phase of running from 3 months to 5 years after ACL-R (strong evidence). Inconsistent results were found for both peak vertical ground reaction force and impact forces after ACL-R. Patellofemoral and tibiofemoral joint contact forces differed from both contralateral or control limbs up until at least 2.5 years after ACL-R and moderate evidence indicated no difference for muscle activations during moderate speed running. Quadriceps and hamstring strength asymmetries, and knee function, but not surgical techniques, were likely to be associated with both knee kinematics and kinetics during running after ACL-R. Conclusion: After ACL-R, knee flexion motion and internal knee extension moment are the most affected variables and are consistently smaller in the injured limb during running when pooling evidence. Clinicians should be aware that these deficits do not appear to resolve with time and, thus, specific clinical interventions may be needed to reduce long-term disability. Systematic review registration: Registered in PROSPERO 2017, CRD42017077130. [ABSTRACT FROM AUTHOR]

Background: Several disc disease nomenclatures and approaches for LDH exist. The traditional midline bone-destructive procedures together with approaches requiring extreme muscular retraction are being replaced by muscle sparing, targeted, stability-preserving surgical routes. The increasing speculation on LDHs and the innovative corridors described to treat them have lead to an extensive production of papers frequently treating the same topic but adopting different terminologies and reporting contradictory results. Methods: The review of such literature somehow confounding gave us the chance to regroup by surgical corridors the vast amount of approaches for LDH differently renamed over time. Likewise, LDHs were simplified in intra-foraminal (ILDH), extra-foraminal (ELDH), and intra−/extra-foraminal (IELDH) in relation to precise anatomical boundaries and extent of bulging disc. Results: Through the analysis of the papers, it was possible to identify ideal surgical corridors for ILDHs, ELDHs, and IELDHs, distinguishing for each approach the exposure provided and the technical advantages/disadvantages in terms of muscle trauma, biomechanical stability, and nerve root preservation. A significant disproportion was noted between studies discussing traditional midline approaches or variants of the posterolateral route and those investigating pros and cons of simple or combined alternative corridors. Although rarely discussed, these latter represent valuable strategies particularly for the challenging IELDHs, thanks to the optimal compromise between herniation exposure and bone-muscle preservation. Conclusions: The integration of adequate mastery of traditional approaches together with a greater confidence through unfamiliar surgical corridors can improve the development of combined mini-invasive procedures, which seem promising for future targeted LDH excisions. [ABSTRACT FROM AUTHOR]