Journal of Biomechanical Engineering

Background: Ascending thoracic aortic aneurysm (ATAA) is characterized by progressive biomechanical remodeling that is incompletely captured by maximum aortic diameter. The relationships between age, sex, aortic valve phenotype (BAV vs TAV), and aneurysmal mechanics remains incompletely understood. Methods: Ascending aortic specimens from 54 patients undergoing elective ATAA repair were evaluated. Biaxial testing quantified Green strain and local stiffness at membrane tensions of 60 and 120 N/m. Opening angle was used to assess circumferential residual stress and stretch. Associations with age were evaluated using Pearson correlations, and differences between sex and valve phenotype were also explored. Multivariable linear regression models including age, sex, and valve phenotype were used to evaluate their adjusted associations with each mechanical outcome. Results: Increasing age was associated with increased local stiffness and reduced Green strain and remained the strongest determinant of biaxial mechanical properties after adjustment. Compared with tricuspid aortic valve specimens, BAV specimens exhibited lower Green strain together with lower local stiffness. Females demonstrated greater Green strain in unadjusted analyses; however, after adjustment, sex remained associated only with longitudinal Green strain at 60 N/m. None of the evaluated clinical characteristics consistently explained opening angle or residual stretch. Conclusions: Age was the predominant clinical determinant of biaxial mechanical remodeling in ATAA, whereas valve phenotype demonstrated selective associations and sex contributed comparatively little after adjustment. Circumferential residual stress appeared largely independent of these clinical characteristics, suggesting that residual stress and biaxial mechanics capture complementary aspects of aneurysmal remodeling.

Introduction: The femoropopliteal artery undergoes substantial axial compression, bending, torsion, and pinching during limb flexion. When an implanted stent does not accommodate these deformations, repetitive biomechanical mismatch may alter the vascular response to implantation and contribute to restenosis. We tested whether designing a peripheral stent to better accommodate physiologic limb-flexion deformation reduces the subsequent inflammatory and neointimal response. Methods: A nitinol stent was developed using multi-objective computational optimization to maintain arterial apposition while reducing wall stress and luminal pinching during physiologic deformation. Sixteen Yucatan minipigs were studied in independent 3- and 6-month cohorts (n=8 each). Each animal received the optimized stent in one limb and a commercial stent with representative biomechanical behavior contralaterally. CTA quantified in vivo limb-flexion deformation, while CT and histology assessed stenosis, neointimal accumulation, inflammatory-cell burden, SMA-positive tissue, and extracellular-matrix composition. Results: The optimized stent accommodated greater axial shortening than the commercial comparator at both 3 months (11.2{+/-}2.7% vs. 6.6{+/-}2.1%, p=0.003) and 6 months (13.7{+/-}4.4% vs. 6.8{+/-}2.3%, p=0.004). Intimal hyperplasia volume was lower with the optimized stent at 3 months (227.5{+/-}85.2 vs. 350.0{+/-}130.5 mm3, p=0.002) and 6 months (183.6{+/-}46.2 vs. 261.2{+/-}60.6 mm3, p=0.001), with significantly lower maximum, mean, and median stenosis at both timepoints. At 3 months, macrophage and total inflammatory-cell counts were 51% and 45% lower, respectively, with the optimized stent. Histologic tissue area was 28% lower at 3 months and 12% lower at 6 months. SMA-positive tissue fraction was higher with the optimized stent at both timepoints, whereas elastin, glycosaminoglycan, and collagen fractions were similar between devices. Discussion: Improved accommodation of limb-flexion deformation was associated with a smaller inflammatory and neointimal response to stent implantation through 6 months, while overall neointimal matrix composition remained largely unchanged. These findings provide in vivo evidence that biomechanical compatibility with the dynamic lower-limb environment can influence vascular healing and should be considered a mechanistic design criterion for peripheral artery stents.

Healing of the gastrointestinal (GI) tract following surgical interventions is governed by coupled mechanobiological processes and may lead to severe complications such as perforation or stricture formation. A first comprehensive mechanobiological modeling framework of GI healing is herein proposed. The framework addresses two clinically relevant applications of bioprinting: endoscopic treatment of GI tissue defects and bioprinting-assisted surgical anastomosis. Tissue remodeling is based upon a hyperelastic material model with fiber dispersion coupling the spatiotemporal reaction diffusion dynamics of fibroblasts and cytokines with collagen deposition, reorientation, and plastic deformation. An active stress formulation drives fibroblasts and myofibroblast contraction while a multiplicative decomposition approach is adopted for collagen remodeling as a permanent change. The governing equations are discretised in time with an implicit Euler scheme, finite element in space and solved by a staggered algorithm implemented in the open-source platform FEniCS. Numerical simulations show that the initial collagen fibers content and orientation strongly influence fibroblast infiltration and scar contracture formation. The study quantifies the advantage of having a collagen bioprinted architecture aligned with tissue fibers, to reduce structural remodeling distortion. The model also predicts a strong correlation between collagen deposition and luminal burst pressure during the recovery of mechanical integrity in GI anastomosis.

To correct lower limb length discrepancies, orthopedic surgeons often perform limb lengthening procedures. These procedures involve directly lengthening a primary bone (e.g., femur), which also stretches the muscles and tendons spanning the elongation site. Limb lengthening procedures improve lower-limb length symmetry, often at the expense of chronic joint-level decrements. For example, knee joint range of motion and strength does not always return to pre-surgery values following femur lengthening. These joint-level decrements governed by altered muscle force-length characteristics, but it is unestablished how human muscles remodel during surgical limb lengthening. Here, we characterized bilateral human vastus lateralis fascicle force-length profiles following femur lengthening. At 2.2 {+/-} 1.7 years (Avg {+/-} SE) post-initial surgery, the lengthened limb's vastus lateralis fascicles were longer, effectively stiffer, and weaker than the contralateral limb. The lengthened limb's vastus lateralis fascicles were 38 mm longer (Avg) than that of the contralateral limb, even though the lengthened limb's femur was only 31 mm longer (Avg). The onset of vastus lateralis fascicle passive force production began at 22% shorter (Avg) operating lengths in lengthened versus contralateral limb muscles. Additionally, vastus lateralis peak active force production was 34% less (Avg) in the lengthened versus contralateral limbs, and in-series quadriceps tendon stiffness was not stiffer in lengthened limbs. These data suggest that active muscle tissues lengthen more than passive muscle tissues following limb lengthening, effectively creating stiffer muscles. Years after limb lengthening, patient muscles exhibit numerous differences in their force-length properties versus that of natural growth, likely contributing to impaired joint-function.

Despite lacking a dedicated structural function, brain tissue is exposed to severe mechanical loading during accidents and trauma, with potentially permanent or lethal consequences. Therefore, characterizing its mechanical behavior assumes particular importance for designing protective equipment, planning surgeries, and training neurosurgeons, tasks that often rely on physical brain replicas made from phantom materials. Although the mechanics of brain tissue has been extensively studied, the selection of suitable phantom materials still relies on simplified metrics that fail to capture the highly nonlinear and rate-dependent behavior of the brain. In this work, we characterize the mechanical response at low-to-medium strain rates of common synthetic brain phantom materials, including Sylgard 527, Ecoflex Gel, and a composite hydrogel, and establish rigorous comparisons with porcine brain tissue as a benchmark. To this end, we employ a multi-step stress relaxation protocol under both uniaxial extension and compression across two different strain rates, introduce thermodynamic metrics, and perform comparisons based on rigorous statistical analysis. In particular, we isolate the thermodynamic equilibrium stress-strain curves, representing the baseline material's response, from rate-dependent dissipative inelastic effects, relatable to viscoelastic and poroelastic mechanisms. Our results provide a thorough comparison, revealing critical limitations in existing simulant materials and highlighting significant space for developing improved brain surrogates. The comprehensive dataset collected can also support the calibration of constitutive models, enhancing the predictive accuracy of numerical simulations involving brain tissue and its surrogates. More broadly, this study highlights the need to move beyond simplistic, scalar-metric-based comparisons of mechanical responses across materials.

Bone strain and remodeling are important factors for bone health. Improved characterization of relationships between these factors in response to acute loading will improve our understanding of bone maintenance, adaptation to load, and pathophysiology. The purpose of this study was to evaluate colocalization between finite-element-estimated bone strain and [18F]sodium fluoride positron emission tomography imaging-estimated subchondral bone remodeling in the tibial diaphysis in response to acute exercise. We hypothesized that the exercise-induced change in standardized uptake values would be greatest in regions of higher strain. 26 participants underwent bilateral positron emission tomography/magnetic resonance scans before and after a bout of stair ascent and descent exercise. Finite element analysis was performed to calculate principal strain distributions in the tibial diaphysis. [18F]sodium fluoride standardized uptake values were calculated from pre- and post-exercise positron emission tomography data and mapped to the tibial surface. Mean pre-exercise and exercise-induced change in standardized uptake values were calculated and compared between regions defined by strain percentile. Both normalized mean pre-exercise and exercise-induced change in standardized uptake values increased with maximum principal strain in a pattern suggesting an exponential relationship. Pre-exercise and exercise-induced change in standardized uptake value were notably much greater in the region of highest maximum principal strains (estimated marginal means = 76.9 and 71.0 percentile, respectively) when compared to all other regions of the tibial diaphysis ([&le;] 61.1 and [&le;] 57.0 percentile, respectively, p < 0.001). This study is the first to directly show a relationship between bone mechanical loads and acute [18F]sodium fluoride uptake in humans in vivo. Our results highlight the influence of tensile strain magnitude on bone metabolic activity in response to acute loading. Furthermore, we demonstrate the utility of a combined finite element analysis and positron emission tomography approach to interrogate relationships between bone loading and bone metabolic response to acute exercise.

Computational models of the middle ear are typically developed within the linear range of the middle ear's response, which corresponds to typical sounds in daily life. Understanding middle-ear biomechanics under high-intensity sounds is also important for assessing potential auditory damage under adverse conditions. In this study, a finite-element (FE) model of the human middle ear plus the external ear canal is presented, employing a first-order Ogden hyperelastic material formulation and time-domain nonlinear analysis to capture nonlinear deformation of soft tissues and the resulting middle-ear response. The model was analyzed using pure-tone pressure excitations applied at the ear canal entrance over the 80 Hz to 8 kHz frequency range and 110 to 180 dB sound pressure levels (SPL). The ear canal pressure near the tympanic membrane (TM) and full-field three-dimensional response of the middle ear structures were examined. Across the investigated frequency range, the simulated middle-ear motion exhibited a transition from predominantly piston-like behavior at low frequencies, up to 1 kHz, to increasingly intricate multi-modal and multi-directional vibration patterns at higher frequencies. Nonlinear behaviors became increasingly significant at high frequencies and high stimulus levels, including compressive/expansive pressure-displacement relationships, waveform distortions, and the emergence of non-harmonic spectral components. The model developed in this study provides a computational framework for studying nonlinear sound transmission through the middle ear and its implications for high-intensity acoustic exposure. The findings contribute to a better understanding of middle-ear mechanics under adverse conditions and support future investigations of acoustic trauma and hearing protection strategies.

Predictive biomechanical models of the tricuspid valve require accurate representation of the chordae tendineae, yet subject-specific chordal geometry is difficult to reconstruct from non-invasive imaging. Here, we adopt a framework for generating functionally equivalent synthetic chordae without prior knowledge of in vivo chordal attachments. To this end, we first adapt an anatomy-informed hyperelastic shape-matching method that establishes correspondence between end-diastolic and end-systolic leaflet configurations using chordal-mimicking forces, a rigid contact template, and a Gaussian-smoothed locally corrective pressure field. We then generate synthetic chordal insertion sites using zone-based rejection sampling and calibrate the unloaded length of each chord by combining reaction forces with the chordal stress-stretch relationship. The framework was evaluated using Texas TriValve 1.1, a high-fidelity finite element model of a human tricuspid valve validated against beating-heart echocardiography. We found that shape matching reproduced the target end-systolic geometry with a mean inter-surface distance of 0.29 {+/-} 0.35 mm. Moreover, synthetic chordal insertions faithfully reproduce end-systolic leaflet deformations. We subsequently examined synthetic chordal configurations containing 202, 225, and 450 insertions, informed by measurements from eight explanted human tricuspid valves. Here, increasing insertion number reduced mean inter-surface distance from 0.63 {+/-} 0.52 mm to 0.49 {+/-} 0.44 mm and reduced contact area errors from 3.52% to 0.59%. Across all configurations, mean maximum principal stretch errors in leaflet belly regions remained below 2.4%, while areal strain errors ranged from 0.34% to 10.01%. These results demonstrate that anatomically informed shape matching coupled with stress-based chordal calibration can reproduce tricuspid valve closure without explicit subject-specific chordal geometry. This framework provides a foundation for generating synthetic subvalvular anatomy for future imaging-derived, predictive tricuspid valve models.

Current treatment of orthopedic ligament injury relies principally on non-regenerative materials and surgical repair rather than strategies that promote intrinsic tissue regeneration. This study evaluated whether biologic augmentation with XWRAP, a human amniotic membrane allograft, combined with a cryopreserved amniotic-fluid-derived biologic containing micronized human amnion membrane, promotes regeneration of ligament architecture in a rabbit medial collateral ligament (MCL) gap-defect model. Standardized 4-mm mid-substance MCL gap defects were created in New Zealand White rabbits (n=3) and either treated with the amniotic membrane/amniotic-fluid biologic combination or left untreated, with intact contralateral or adjacent MCL serving as native controls; ligaments were evaluated by transmission electron microscopy at 2 and 6 weeks post-procedure, with collagen fibril diameter quantified from calibrated high-magnification micrographs. Treated defects developed significantly larger mean collagen fibril diameters than untreated defects at both time points (75 vs. 50 nm at 2 weeks and 88 vs. 62 nm at 6 weeks; p<0.0001 for each comparison), reaching approximately 90% of native, uninjured ligament fibril diameter (98 nm) by 6 weeks. Treated defects also developed a broader, bimodal fibril-diameter distribution resembling native ligament architecture, whereas untreated defects remained characterized by a narrow, unimodal population of small-diameter fibrils typical of scar-associated repair. These findings indicate that biologic augmentation with XWRAP combined with an amniotic-fluid-derived biologic promotes a regenerative, rather than purely reparative, healing response following ligament injury, progressively restoring collagen fibril architecture toward that of native tissue in this preclinical model.

Purpose: Atrial fibrosis is associated with thromboembolic risk in atrial fibrillation, but how fibrosis-related contractile impairment alters blood transport in the left atrium (LA) and left atrial appendage (LAA) remains unclear. Prior multi-physics simulations coupled electromechanical (EM) and computational fluid dynamics (CFD) models to show that fibrosis impairs LA function and flow, but were limited to booster-only contraction and could not separate the effects of fibrosis burden from its spatial distribution. Here we examined how fibrosis burden and spatial pattern independently relate to long-term LA and LAA hemodynamics in full-cycle, multi-beat simulations on a common LA anatomy. Methods: Three fibrosis patterns derived from late gadolinium enhancement MRI were considered: one from the patient providing the common anatomy and two from additional patients, with the latter mapped onto the common anatomy via universal atrial coordinates. All three patterns were applied globally at matched burdens of 15.6% and 31.2%, yielding six global-fibrosis cases and a non-fibrotic reference. Two patterns were also confined to the LAA at three local burdens (10%, 25%, and 50%), yielding six LAA-fibrosis cases. A 3D EM model for the LA anatomy was coupled to a 0D circulatory model, so that the simulations resolved the reservoir, conduit, and booster phases. Full-cycle EM-derived wall motion drove subsequent multi-beat CFD simulations. Region-specific emptying fraction (EF), non-dimensional kinetic energy (KE), and the 90th percentile of blood residence time (TR) were evaluated for the LA and LAA. Results: Left ventricular stroke volume remained nearly constant across cases, while increasing global fibrosis burden progressively reduced LA and LAA EF (LA: 36% to 30-31%; LAA: 44% to 28-38%) and monotonically increased LA TR across all patterns. Non-dimensional LA KE showed an approximately quadratic association with LA EF across patterns, whereas LAA KE was more scattered but still increased with LAA EF. In contrast, the relationship between the 90th percentile of LAA TR and LAA EF showed pattern-specific, non-monotonic trends. Conclusions: Fibrosis burden and spatial distribution jointly shape LA and LAA hemodynamics, but through different mechanisms. LAA EF is a robust functional descriptor of chamber-averaged kinetic energy regardless of fibrosis pattern, whereas LAA blood stasis depends additionally on the spatial distribution of fibrosis beyond what bulk emptying fraction predicts. These findings support incorporating imaging-derived fibrosis pattern, and not only burden, alongside functional metrics when assessing thrombogenic risk in the LAA.

BACKGROUND: While the systemic right and left ventricles have different functional prognoses, only a limited number of reports have addressed their myocardial architecture. This study analyzed myofiber orientation of human specimens with various congenital heart diseases using X-ray phase-contrast tomography. METHODS: Three specimens of each normal heart, ventricular septal defect, right atrial isomerism, left atrial isomerism, and ventricular inversion were examined. In reconstructed images of both ventricles, the center of the free wall was resliced parallel to the myocardial surface. A myofiber helical angle was identified in each slice and plotted from epicardium to endocardium. The plotted curves were compared between both ventricles. RESULTS: In all ventricles, the helical angle was changed from left-handed on epicardial slices to right-handed on endocardial slices. Whereas the right ventricle?s helical angle curves showed a plateau with or without a rapid rise on the endocardial side, the left ventricle?s curves had sustained increase with or without a plateau in the middle. The median wall-thickness?scaled helical angle change rates were 53{degrees} and 102{degrees} in the right and left ventricle, respectively, and their distribution of each specimen was higher in the left ventricle than in the right ventricle. CONCLUSIONS: Ventricular myofiber orientation has a consistent transmural helical transition independently of cardiac morphology and looping. Their transitions can have a plateau and rapid changes permitting the identification of layers within the ventricular wall. The left ventricle has more helical fibers and the right ventricle has more circumferential fibers, which may explain their difference of ventricular performance.

Seroma is a common complication following abdominoplasty and other procedures involving extensive soft tissue dissection. Although animal seroma models have been reported, the stromal pathology underlying post-abdominoplasty seroma, particularly the role of oxidative stress, remains poorly characterized. Here, we developed a rat abdominal seroma model by surgically separating the subcutaneous tissue from the underlying muscle fascia and investigated the temporal evolution of the associated stromal response. Seroma developed in 9 of 20 operated rats, corresponding to a formation rate of 45.0%. Longitudinal ultrasound demonstrated that fluid accumulation peaked around postoperative day (POD) 7 and largely resolved by POD30. Despite macroscopic fluid resolution, substantial stromal remodeling persisted. Compared with normal abdominal tissue, seroma-associated tissues at POD14 and POD35 exhibited increased collagen deposition, macrophage accumulation, oxidative injury, and vascular remodeling. Additionally, at POD35, macrophage accumulation and 4-hydroxynonenal staining were greater than at POD14, whereas collagen deposition and vascular density remained elevated with no significant differences between postoperative time points. To our knowledge, this study presents the first rat model specifically designed to reproduce post-abdominoplasty seroma and the first temporal characterization of oxidative stress within seroma-associated tissue. These findings reveal that seroma fluid resolution does not coincide with stromal recovery and identify persistent oxidative stress, inflammation, fibrosis, and vascular remodeling as important features of seroma pathology.

Altered walking mechanics in individuals with obesity can contribute to knee osteoarthritis. The gait deviations may become more pronounced during obstacle crossing. In women, body fat distribution may further influence knee load, especially when excess fat accumulates in the thighs and hips. However, relatively little is known about how regional fat distribution affects gait in women with obesity. This study investigated how obesity and, among women, different fat distributions (Apple: more abdominal fat; Pear: more lower-limb fat) influence knee biomechanics during walking with and without obstacle crossing. Participants were 15 controls without obesity (NB) and 27 with obesity (OB). Within female participants, 10 without obesity (fNB) were compared with 20 with obesity, stratified by waist-hip ratio (Apple:10, Pear:10). Speed-adjusted statistical parametric mapping applied a general linear model (NB vs. OB) and an analysis of covariance (fNB vs. Apple vs. Pear). OB exhibited a significantly greater late-stance knee extension moment than NB across all tasks, and this difference persisted among fNB, Apple, and Pear in obstacle tasks (p<0.05). OB walked with reduced knee flexion during the early-stance leading limb after crossing a medium-height obstacle (p=0.048) and a high-height obstacle (p=0.008) compared to NB. There were significant body-shape effects (p<0.05), and post-hoc comparisons confirmed that Pear had lower knee angles than fNB in both leading-limb conditions after crossing medium- and high-height obstacles (p=0.008 and p=0.001, respectively). These findings suggest that obstacle crossing helps illuminate how excess weight influences knee biomechanics, and how regional fat distribution modulates the degree of this alteration.

Fibrotic strictures are among the most disabling complications of Crohn's disease, permanently narrowing the bowel and impairing motility, yet no approved therapy reverses them. Chronic inflammation alters pacemaker-network coupling, smooth-muscle excitability, and calcium-dependent contractility, while fibrosis thickens the bowel wall, narrows the lumen, and changes tissue mechanics. The relative contributions of these coupled electrical, contractile, and structural alterations to motility loss remain unclear. To address this gap, we develop an integrated electromechanical finite-element framework for fibrostenosing Crohn's disease that couples a fibrosis-driven growth model with a FitzHugh-Nagumo electromechanical model. A full-factorial 25 design of experiments is used to quantify the relative effects of electrical diffusivity, excitation threshold, peak active stress, wall stiffness, and hypertrophic remodeling on cyclic lumen-volume deformation. Motility is quantified by the standard deviation of lumen volume over one contraction cycle. Within the parameter ranges examined, increased wall stiffness emerged as the dominant contributor to motility loss, followed by impaired smooth-muscle contractility. Changes in excitation threshold, hypertrophic remodeling, and electrical diffusivity produced substantially smaller effects. Pairwise interactions were small relative to the dominant main effects, indicating that the mechanisms contributed largely through their individual effects. Our findings suggest that limiting wall stiffening while preserving smooth-muscle contractile function may provide a therapeutic strategy for maintaining intestinal motility in fibrostenosing Crohn's disease.

Despite the use of technological countermeasures, studies show that the sensory conflict, and thus symptoms of motion sickness such as nausea, cannot be completely prevented while traveling as a car passenger. Accordingly, reliable prediction of motion sickness will represent a possible solution for intelligent vehicles to avoid the abortion of the drive, e.g., through adapted driving strategies or route planning. In previous works, the authors were able to demonstrate an application-oriented parameter set for the popular 6DOF-SVC model to estimate motion sickness incidence (MSI) in passengers with a lowered gaze on a non-driving-related task. In the current study, these parameters were validated and further optimized using five previous conducted motion sickness driving experiments. For the first time, it is also shown that the expected natural MSI fluctuations based on the driving dynamic profile, due to route characteristics or driving style, as well as the variation in experimental determined MSI is approximately 10%. Moreover, findings indicate that the participants appear to have an individual MSI threshold that correlates with their susceptibility to motion sickness, however, this threshold fluctuates too strongly across experiments to be suitable for practical application. As a result, the model can successfully estimate motion sickness risk across the test tracks, however, inaccuracies in the predicted MSI trajectories remain.

Background: Articulated laparoscopic instruments require a reliable mechanical connection between the handle and shaft to maintain the intended instrument configuration during surgical manipulation. The handle shaft locking interface should resist unintended relative displacement under external loading. However, the appropriateness of a specific slip resistance threshold must be evaluated in relation to the instrument design and intended conditions of use. Objective: To evaluate the mechanical performance associated with an 8 N slip resistance specification for the locked handle shaft interface of an articulated laparoscopic instrument using a controlled bench model. Methods: A bench based mechanical evaluation method was designed using the instrument under test, mechanical fixtures, a calibrated force measurement device, and displacement measurement equipment. After engagement of the handle shaft locking mechanism, external forces were applied to evaluate resistance to relative displacement. Testing included axial loading, loading in relevant transverse directions, and repeated locking unlocking cycles. The primary outcome was the force corresponding to the onset of relative slippage at the locked interface. Secondary outcomes included displacement under load, complete locking failure, and changes in mechanical performance after repeated operation. Acceptance criteria should be established before confirmatory testing. Results: All 30 instruments from three production batches met the 8 N axial requirement (30/30). The axial slip onset force was 12.40 N . Under a sustained load of 8 N for 60 s, mean relative displacement increased from 0.06 mm to 0.10 mm, and mean residual displacement was 0.02 mm. After 1,000 cycles, the axial slip-onset force was 12.00 N . Conclusions: This study provides a bench-testing framework for evaluating an 8 N slip resistance specification for the handle shaft locking interface of an articulated laparoscopic instrument. Whether this specification provides adequate mechanical stability can be determined only by comparing the measured performance with engineering acceptance criteria established in advance on the basis of the instrument's intended use and foreseeable loading conditions.

Conventional clinical assessment of upper limb kinematics relies on goniometry or visual estimation, methods that provide limited information on multi-segment 3D kinematics and can have poor inter-rater reliability. Inertial measurement units (IMUs) represent a viable alternative; however, extracting anatomically meaningful joint angles from skin-mounted sensors remains challenging owing to sensor-to-segment misalignment, soft-tissue artefact, and suboptimal orientation estimation under dynamic conditions. This study developed and validated a multi-segment IMU-based framework for upper limb kinematic assessment, addressing three stages of the measurement pipeline: (i) sensor fusion gain optimisation as a function of task mean segment angular velocity; (ii) accuracy of an anatomical landmark registration-based alignment method; and (iii) comparative evaluation of landmark-based alignment against manual and neutral-pose alignment approaches. Twenty participants with typical shoulder function performed clinical and functional upper limb tasks, recorded simultaneously with an optoelectronic motion capture system and six IMUs tracking the thorax, clavicle, scapula, humerus, forearm, and hand. Orientation estimation used a gradient-descent complementary filter with velocity-dependent gain modulation. Sensor-to-segment alignment was achieved via manual, neutral-pose, and landmark registration methods. Mean sensor orientation errors ranged from 1.5 to 3 degrees across segments/tasks and increased with angular velocity. Landmark registration produced substantially lower joint angle errors than manual and neutral-pose alignment across all joints (root mean square error range: 3.7-7.8 degrees; manual: 8.3-24.2 degrees; neutral: 15.5-35.5 degrees). These results indicate that IMU-derived kinematic accuracy is context-dependent, varying with joint and movement type, suggesting that accuracy should be established for the specific movements and joints relevant to each clinical application.

Tissue expansion is an established technique for the reconstruction of skin defects, but the cost of conventional silicone expanders may limit its application in contexts with lower resource availability. This study evaluated, in an experimental model, whether a container for storing saline solution could act as a low-cost alternative device for tissue expansion. An experimental, prospective, controlled and randomized study was carried out with 10 Wistar rats, distributed in two groups: conventional silicone expander and saline storage container. Both underwent the same surgical and expansion protocol. Abdominal circumference gain, final expanded skin length, histological and histomorphometric aspects of the skin, including collagen types I and III, as well as exploratory cost analysis, were analyzed. The conventional expander produced a greater gain in abdominal circumference, but the final length of the expanded skin was similar between the groups. Microscopic evaluation showed preservation of the cutaneous architecture, intact epidermis, cellularized dermis, and collagen deposition in both groups. There was no significant difference in the proportion of type I or type III collagen. The saline solution container had a substantially lower cost per centimeter of expanded skin than the conventional expander. These findings suggest that the saline container can produce experimental skin expansion with final length and collagen composition similar to the conventional method, at a lower cost, although additional studies are needed before clinical application.

Background: Transthoracic echocardiography (TTE) remains the gold standard for assessing left ventricular (LV) diastolic dysfunction (DD), but noninvasive alternatives are needed to overcome geometric and acoustic limitations. 4D-Flow MRI enables comprehensive assessment of intraventricular pressure differences (IVPDs) and flow propagation velocity (VP). We aimed to evaluate 4D-Flow-derived IVPDs and VP in patients with hypertrophic cardiomyopathy (HCM). Methods: Thirty-eight HCM patients and 38 age- and sex-matched healthy controls underwent TTE and 4D-Flow MRI. Spatiotemporal maps of velocity and IVPDs, decomposed into inertial and convective components, were derived along the main inflow streamline from the mitral valve to the apex. Peak early filling rate (PEFR) was used to normalize IVPDs and VP. Results: While absolute peak flow rates were comparable, HCM patients exhibited significantly faster VP (100.4 vs. 60.2 cm/s, p < 0.01) and higher positive early E IVPD (1.40 vs. 0.92 mmHg, p < 0.01) compared to controls. Normalizing IVPDs by PEFR amplified group differences, revealing a markedly increased flow-normalized E-IVPD (5.13 vs. 2.94 x 103 mmHg.ml1.s, p < 0.001) and deeper reverse ER IVPD (-6.06 vs. -4.61 x 103 mmHg.ml1.s, p < 0.01) in HCM. These differences were primarily driven by the inertial components. Multivariable analysis demonstrated that ER IVPD is independently determined by PEFR and the TTE E/E' ratio (r = 0.65, p < 0.001). Conclusions: 4D-Flow MRI-derived, flow-normalized IVPDs and propagation velocity provide robust, noninvasive markers of altered LV chamber stiffness and impaired diastolic filling in HCM, offering deeper 3D hemodynamic insights into diastolic dysfunction.

Abstract Background Advanced in vitro models of the human heart have become promising tools for studying cardiac diseases and drug discovery. Three-dimensional (3D) engineered heart tissues (EHTs) provide more adult cardiac tissue-like structural organization compared to traditional two-dimensional (2D) in vitro models with straightforward contractile readouts. However, the assessment of the architecture of EHTs, especially the quantification of cellular and tissue structural components, has remained poorly studied. Here we demonstrate the use of light-sheet microscopy for structural imaging of intact EHTs and provide quantification of the EHT cellular and subcellular structures. Methods We developed an in-house inverted selective plane illumination microscopy (iSPIM) platform and combined it with iterative indirect immunofluorescence (IT-IF) staining for better signal acquisition. We developed an image-processing and analysis pipeline dedicated to volumetric EHT analysis. Results With this integrated platform, we achieved volumetric imaging of intact EHTs and quantification of 3D tissue architecture, revealing aligned cardiomyocytes within the imaged volume and increasing cardiac nuclei content towards the core of the tissue. The developed methods allowed the detection of heterogeneities between tissue sections, demonstrating the sensitivity required for future disease modeling or maturation studies. Conclusions The developed integrated platform opens new possibilities for volumetric analysis and characterization of 3D tissue structure using iSPIM, providing new insights into EHT architecture and the use of EHTs as disease modeling tools.