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Sensitivity of the shear wave speed-stress relationship to soft tissue material properties and fiber alignment. 剪切波速度-应力关系对软组织材料性能和纤维排列的敏感性。
Pub Date : 2021-08-05 DOI: 10.31224/osf.io/54btr
Jonathon L. Blank, D. Thelen, M. Allen, J. Roth
The use of shear wave propagation to noninvasively measure material properties and loading in tendons and ligaments is a growing area of interest in biomechanics. Prior models and experiments suggest that shear wave speed primarily depends on the apparent shear modulus (i.e., shear modulus accounting for contributions from all constituents) at low loads, and then increases with axial stress when axially loaded. However, differences in the magnitudes of shear wave speeds between ligaments and tendons, which have different substructures, suggest that the tissue's composition and fiber alignment may also affect shear wave propagation. Accordingly, the objectives of this study were to (1) characterize changes in the apparent shear modulus induced by variations in constitutive properties and fiber alignment, and (2) determine the sensitivity of the shear wave speed-stress relationship to variations in constitutive properties and fiber alignment. To enable systematic variations of both constitutive properties and fiber alignment, we developed a finite element model that represented an isotropic ground matrix with an embedded fiber distribution. Using this model, we performed dynamic simulations of shear wave propagation at axial strains from 0% to 10%. We characterized the shear wave speed-stress relationship using a simple linear regression between shear wave speed squared and axial stress, which is based on an analytical relationship derived from a tensioned beam model. We found that predicted shear wave speeds were both in-range with shear wave speeds in previous in vivo and ex vivo studies, and strongly correlated with the axial stress (R2 = 0.99). The slope of the squared shear wave speed-axial stress relationship was highly sensitive to changes in tissue density. Both the intercept of this relationship and the apparent shear modulus were sensitive to both the shear modulus of the ground matrix and the stiffness of the fibers' toe-region when the fibers were less well-aligned to the loading direction. We also determined that the tensioned beam model overpredicted the axial tissue stress with increasing load when the model had less well-aligned fibers. This indicates that the shear wave speed increases likely in response to a load-dependent increase in the apparent shear modulus. Our findings suggest that researchers may need to consider both the material and structural properties (i.e., fiber alignment) of tendon and ligament when measuring shear wave speeds in pathological tissues or tissues with less well-aligned fibers.
使用剪切波传播来无创地测量肌腱和韧带中的材料特性和载荷是生物力学中越来越感兴趣的领域。先前的模型和实验表明,剪切波速主要取决于低载荷下的表观剪切模量(即,考虑所有成分贡献的剪切模量),然后在轴向载荷时随轴向应力增加。然而,具有不同亚结构的韧带和肌腱之间剪切波速度大小的差异表明,组织的组成和纤维排列也可能影响剪切波的传播。因此,本研究的目的是(1)表征本构特性和纤维排列变化引起的表观剪切模量的变化,以及(2)确定剪切波速-应力关系对本构特性变化和纤维排列的敏感性。为了实现本构特性和纤维排列的系统变化,我们开发了一个有限元模型,该模型表示具有嵌入纤维分布的各向同性基底。使用该模型,我们对轴向应变从0%到10%的剪切波传播进行了动态模拟。我们使用剪切波速度平方和轴向应力之间的简单线性回归来表征剪切波速度-应力关系,该回归基于从张拉梁模型导出的分析关系。我们发现,在先前的体内和离体研究中,预测的剪切波速都在剪切波速的范围内,并且与轴向应力强相关(R2=0.99)。剪切波速-轴向应力关系的平方斜率对组织密度的变化高度敏感。当纤维与载荷方向不太一致时,这种关系的截距和表观剪切模量对基底的剪切模量和纤维趾部区域的刚度都很敏感。我们还确定,当张拉梁模型的纤维排列不太好时,随着载荷的增加,该模型高估了轴向组织应力。这表明剪切波速度的增加可能是对视剪切模量的负载相关增加的响应。我们的研究结果表明,研究人员在测量病理组织或纤维排列不太好的组织中的剪切波速时,可能需要考虑肌腱和韧带的材料和结构特性(即纤维排列)。
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引用次数: 8
Bending properties of additively manufactured commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs: Effect of surface treatment. 增材制造商业纯钛(CPTi)有限接触动态压缩板(LC-DCP)结构的弯曲性能:表面处理的影响。
Pub Date : 2021-05-29 DOI: 10.21203/RS.3.RS-529184/V1
Seungjong Lee, N. Ahmad, Kayla M. Corriveau, Cameron J Himel, Daniel Silva, N. Shamsaei
Additive manufacturing of metallic materials, a layer-wise manufacturing method, is currently gaining attention in the biomedical industry because of its capability to fabricate complex geometries including customized parts fitting to patient requirements. However, one of the major challenges hindering the full implementation of additively manufactured parts in safety-critical applications is their poor mechanical performance under cyclic loading. This study investigated both quasi-static bending properties (bending stiffness, bending structural stiffness, and bending strength) and bending fatigue properties of additively manufactured (AM) commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs based on ASTM International standard for metallic bone plates (ASTM F382). In addition, the effect of post surface treatment methods including single shot-peened (SP), dual shot-peened (DP), and chemically assisted surface enhancement (CASE) on bending fatigue performance was also evaluated. Results indicated that bending stiffness and bending structural stiffness of AM CPTi LC-DCPs are comparable to conventionally manufactured (CM) counterparts; however, the bending strength of AM CPTi LC-DCPs is lower than CM counterparts. While the fatigue strength of as-built AM CPTi LC-DCPs is lower compared to the CM counterparts, AM CPTi LC-DCPs after post surface treatments (SP, DP, and CASE) exhibit statistically comparable fatigue strength to the CM CPTi LC-DCPs.
金属材料的增材制造是一种分层制造方法,由于其能够制造复杂的几何形状,包括符合患者要求的定制零件,因此目前在生物医学行业受到关注。然而,阻碍在安全关键应用中全面实施添加制造零件的主要挑战之一是它们在循环载荷下的机械性能较差。本研究基于ASTM金属骨板国际标准(ASTM F382),研究了添加制造的(AM)商业纯钛(CPTi)有限接触动态压缩板(LC-DCP)结构的准静态弯曲性能(弯曲刚度、弯曲结构刚度和弯曲强度)和弯曲疲劳性能。此外,还评估了单喷丸(SP)、双喷丸(DP)和化学辅助表面增强(CASE)等后表面处理方法对弯曲疲劳性能的影响。结果表明,AM CPTi-LC DCP的弯曲刚度和弯曲结构刚度与传统制造的CM相当;然而,AM CPTi-LC DCP的弯曲强度低于CM对应物。虽然竣工AM CPTi-LC DCP的疲劳强度低于CM DCP,但经过后表面处理(SP、DP和CASE)后的AM CPTi-LCDCP在统计上表现出与CM CPTi-LC-DCP相当的疲劳强度。
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引用次数: 2
The effect of cortical thickness and thread profile dimensions on stress and strain in bone-anchored implants for amputation prostheses. 皮质厚度和螺纹轮廓尺寸对骨锚定截肢假体应力应变的影响。
Pub Date : 2021-04-30 DOI: 10.36227/TECHRXIV.14499759.V1
Alexander Thesleff, M. Ortiz-Catalán, R. Brånemark
Skeletal attachment of limb prostheses ensures load transfer between the prosthetic leg and the skeleton. For individuals with lower limb amputation, these loads may be of substantial magnitude. To optimize the design of such systems, knowledge about the structural interplay between implant design features, dimensional changes, and material properties of the implant and the surrounding bone is needed. Here, we present the results from a parametric finite element investigation on a generic bone-anchored implant system of screw design, exposed to external loads corresponding to average and high ambulatory loading. Of the investigated parameters, cortical thickness had the largest effect on the stress and strain in the bone-anchored implant and in the cortical bone. 36%-44% reductions in maximum longitudinal stress in the bone-anchored implant was observed as a result of increased cortical thickness from 2 mm to 5 mm. A change in thread depth from 1.5 mm to 0.75 mm resulted in 20%-22% and 10%-18% reductions in maximum longitudinal stress in the bone-anchored implant at 2 mm and 5 mm cortical thickness respectively. The effect of changes in the thread root radius was less prominent, with 8% reduction in the maximum longitudinal stress in the bone-anchored implant being the largest observed effect, resulting from an increased thread root radius from 0.1 mm to 0.5 mm at a thread depth of 1.5 mm. Autologous transplantation of bone tissue distal to the fixture resulted in reductions in the longitudinal stress in the percutaneous abutment. The observed stress reduction of 10%-31% was dependent on the stiffness of the transplanted bone graft and the cortical thickness of surrounding bone. Results from this investigation may guide structural design optimization for bone-anchored implant systems for attachment of limb prostheses.
假肢的骨骼附着确保了义肢与骨骼之间的载荷传递。对于下肢截肢的个体,这些负荷可能是相当大的。为了优化这种系统的设计,需要了解种植体设计特征、尺寸变化以及种植体和周围骨的材料特性之间的结构相互作用。在这里,我们展示了参数化有限元研究的结果,研究对象是一种通用的螺钉设计的骨锚定种植体系统,暴露于对应于平均和高动态载荷的外部载荷下。在研究的参数中,皮质厚度对骨锚定种植体和皮质骨的应力和应变影响最大。由于皮质厚度从2mm增加到5mm,观察到骨锚定种植体的最大纵向应力降低了36%-44%。当螺纹深度从1.5 mm增加到0.75 mm时,骨锚定种植体在皮质厚度为2mm和5mm时的最大纵向应力分别降低了20%-22%和10%-18%。螺纹根半径变化的影响不太明显,在螺纹深度为1.5 mm时,将螺纹根半径从0.1 mm增加到0.5 mm,观察到的最大影响是将骨锚定种植体的最大纵向应力降低8%。自体骨组织移植远端固定导致减少纵向应力在经皮基台。观察到的应力降低10%-31%取决于移植骨的刚度和周围骨的皮质厚度。本研究结果可指导骨锚定假肢系统的结构设计优化。
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引用次数: 1
Thoracic aortic parallel stent-graft behaviour when subjected to radial loading. 胸主动脉平行支架移植物在径向载荷下的行为。
Pub Date : 2020-07-11 DOI: 10.31224/osf.io/3zx2b
J. Kwieciński, Christopher P. Cheng, R. Uberoi, Mohammed Hadi, P. Hempel, Christoph Degel, Z. You
To manage complex aortic arch disease using minimally invasive techniques, interventionalists have reported the use of multiple stent-graft devices deployed in a parallel configuration. The structural device-device and device-artery interactions arising during aortic arch parallel endografting, also known as chimney thoracic endovascular aortic repair (ch-TEVAR), is not well understood. Through the use of a radial force testing system we sought to characterise both the loading and deformation behaviour of parallel endografts in representative ch-TEVAR configurations. Four commercially available devices (Bentley BeGraft, Gore TAG, Gore Viabahn, and Medtronic Valiant) were subjected to uniform radial load individually, and in six combinations, to quantify loading profiles. Image data collected during testing were analysed to evaluate mechanical deformations in terms of gutters, chimney and main endograft compression, as well as graft infolding. Parallel endografting was found to increase radial loads when compared to standard TEVAR. Chronic outward force during ch-TEVAR was dependent on main endograft manufacturer, with TAG combinations leading to consistently higher loads than Valiant, but independent of chimney graft type. Endograft deformations were dependent on chimney graft type, with Viabahn combinations presenting with lower gutter areas and increased lumen compression than BeGraft. Chimney graft deformations were also influenced by deployment arrangement in the case of double ch-TEVAR. This study emphasizes the significant variability in both radial loads and mechanical deformations between clinically relevant ch-TEVAR configurations.
为了使用微创技术治疗复杂的主动脉弓疾病,介入医生报道了平行配置多个支架移植装置的使用。在主动脉弓平行内移植术(也称为烟囱胸血管内主动脉修复术(ch-TEVAR))中产生的结构装置-装置和装置-动脉相互作用尚未得到很好的理解。通过使用径向力测试系统,我们试图在代表性的ch-TEVAR配置中描述平行内植骨的加载和变形行为。四种市售设备(Bentley BeGraft、Gore TAG、Gore Viabahn和Medtronic Valiant)分别受到均匀径向载荷和六种组合,以量化载荷剖面。分析测试期间收集的图像数据,以评估排水沟,烟囱和主要内接枝压缩以及接枝内折叠方面的机械变形。与标准TEVAR相比,平行内移植术增加了径向负荷。ch-TEVAR期间的慢性向外力依赖于主要的内移植物制造商,TAG组合导致的负荷始终高于Valiant,但与烟囱移植物类型无关。内移植物变形依赖于烟囱移植物类型,与BeGraft相比,Viabahn组合呈现出更低的沟区和更大的管腔压迫。在双ch-TEVAR情况下,烟囱接枝变形也受布置方式的影响。本研究强调了临床相关的ch-TEVAR配置在径向载荷和机械变形方面的显著差异。
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引用次数: 1
Novel expandable architected breathing tube for improving airway securement in emergency care. 一种新型可扩展呼吸管,用于改善急诊护理中气道的安全。
Pub Date : 2020-05-27 DOI: 10.21203/rs.3.rs-31211/v1
David Berard, Juan David Navarro, Gregg Bascos, Angel Harb, Yusheng Feng, R. D. De Lorenzo, R. L. Hood, D. Restrepo
Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.
挽救生命的干预措施利用气管插管来确保患者的气道,但临床护理标准气管插管(ETT)的表现是不足的。例如,在当前的COVID-19危机中,患者可能需要长时间插管。这种长期插管可能产生健康并发症,如气管狭窄、肺炎和气管组织坏死,因为目前的气管插管不适合长期使用。在这项工作中,我们提出了一种改进的ETT设计,旨在通过利用独特的几何形状来克服这些限制,从而实现一种新的扩展圆柱体。该机制提供了ETT和气管之间更好的接触力分布,这应该提高患者的耐受性。结果表明,在完全膨胀时,我们的新ETT在硅胶气管假体中施加压力,完全符合推荐的护理标准。此外,初步的人体模型测试表明,与目前的黄金标准ETT相比,新的ETT在气压和风量方面可以提供相似的性能。这种新型结构化ETT的潜在好处有三:通过简化插管过程限制医疗保健提供者对患者病原体的暴露,减少下游并发症,并且消除了多种尺寸ETT的需要,因为一个结构化ETT适合所有人。
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引用次数: 5
Full-field microscale strain measurements of a nitinol medical device using digital image correlation. 使用数字图像相关性对镍钛诺医疗设备进行全场微尺度应变测量。
Pub Date : 2020-02-19 DOI: 10.31224/osf.io/a3twm
K. Aycock, J. Weaver, H. Paranjape, K. Senthilnathan, C. Bonsignore, B. Craven
Computational modeling and simulation are commonly used during the development of cardiovascular implants to predict peak strains and strain amplitudes and to estimate the associated durability and fatigue life of these devices. However, simulation validation has historically relied on comparison with surrogate quantities like force and displacement due to barriers to direct strain measurement-most notably, the small spatial scale of these devices. We demonstrate the use of microscale two-dimensional digital image correlation (2D-DIC) to directly characterize full-field surface strains on a nitinol medical device coupon under emulated physiological and hyperphysiological loading. Experiments are performed using a digital optical microscope and a custom, temperature-controlled load frame. Following applicable recommendations from the International DIC Society, hardware and environmental heating studies, noise floor analyses, and in- and out-of-plane rigid body translation studies are first performed to characterize the microscale DIC setup. Uniaxial tension experiments are also performed using a polymeric test specimen to characterize the strain accuracy of the approach up to nominal stains of 5%. Sub-millimeter fields of view and sub-micron displacement accuracies (9nm mean error) are achieved, and systematic (mean) and random (standard deviation) errors in strain are each estimated to be approximately 1,000μϵ. The system is then demonstrated by acquiring measurements at the root of a 300μm-wide nitinol medical device strut undergoing fixed-free cantilever bending motion. Lüders-like transformation bands are observed originating from the tensile side of the strut that spread toward the neutral axis at an angle of approximately 55°. Despite the inherent limitations of optical microscopy and 2D-DIC, simple and relatively economical setups like that demonstrated herein could provide a practical and accessible solution for characterizing cardiovascular implant micromechanics, validating computational model strain predictions, and guiding the development of next-generation material models for simulating superelastic nitinol.
在心血管植入物的开发过程中,计算建模和仿真通常用于预测峰值应变和应变幅值,并估计这些设备的相关耐久性和疲劳寿命。然而,由于直接应变测量的障碍,模拟验证历来依赖于与替代量(如力和位移)的比较-最值得注意的是,这些设备的小空间尺度。我们展示了使用微尺度二维数字图像相关(2D-DIC)来直接表征镍钛诺医疗器械在模拟生理和超生理载荷下的全场表面应变。实验使用数字光学显微镜和定制的温控负载框架进行。根据国际DIC协会的适用建议,首先进行了硬件和环境加热研究,噪声底分析以及平面内和平面外刚体平移研究,以表征微尺度DIC装置。单轴拉伸实验也使用聚合物试样进行,以表征该方法的应变精度高达5%的标称污渍。该系统实现了亚毫米视场和亚微米位移精度(平均误差为9nm),应变的系统(平均)和随机(标准偏差)误差均约为1000 μ λ。然后,通过在300μm宽的镍钛诺医疗器械支柱根部进行无固定悬臂弯曲运动来验证该系统。观察到从支柱的拉伸侧开始的l德尔斯样转变带,以约55°的角度向中性轴扩散。尽管光学显微镜和2D-DIC存在固有的局限性,但本文所展示的简单且相对经济的设置可以为表征心血管植入物的微观力学,验证计算模型应变预测以及指导下一代模拟超弹性镍钛诺材料模型的开发提供实用且可访问的解决方案。
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引用次数: 11
A thermodynamic transient cross-bridge model for prediction of contractility and remodelling of the ventricle. 用于预测心室收缩性和重塑的热力学瞬态跨桥模型。
Pub Date : 2020-01-26 DOI: 10.31224/osf.io/zfrhq
Eóin McEvoy, W. Wijns, P. McGarry
Cardiac hypertrophy is an adaption of the heart to a change in cardiovascular loading conditions. The current understanding is that progression may be stress or strain driven, but the multi-scale nature of the cellular remodelling processes have yet to be uncovered. In this study, we develop a model of the contractile left ventricle, with the active cell tension described by a thermodynamically motivated cross-bridge cycling model. Simulation of the transient recruitment of myosin results in correct patterns of ventricular pressure predicted over a cardiac cycle. We investigate how changes in tissue loading and associated deviations in transient force generation can drive restructuring of cellular myofibrils in the heart wall. Our thermodynamic framework predicts in-series sarcomere addition (eccentric remodelling) in response to volume overload, and sarcomere addition in parallel (concentric remodelling) in response to valve and signalling disfunction. This framework provides a significant advance in the current understanding of the fundamental sub-sarcomere level biomechanisms underlying cardiac remodelling. Simulations reveal that pathological tissue loading conditions can significantly alter actin-myosin cross-bridge cycling over the course of the cardiac cycle. The resultant variation in sarcomere stress pushes an imbalance between the internal free energy of the myofibril and that of unbound contractile proteins, initiating remodelling. The link between cross-bridge thermodynamics and myofibril remodelling proposed in this study may significantly advance current understanding of cardiac disease onset.
心脏肥大是心脏对心血管负荷条件变化的适应。目前的理解是,进展可能是由应力或应变驱动的,但细胞重塑过程的多尺度性质尚未揭示。在这项研究中,我们开发了一个可收缩左心室的模型,通过热力学驱动的跨桥循环模型来描述活动细胞张力。肌球蛋白瞬时募集的模拟导致在心动周期内预测的心室压力的正确模式。我们研究了组织负荷的变化和瞬时力产生的相关偏差如何驱动心壁细胞肌原纤维的重组。我们的热力学框架预测了响应体积过载的串联肌节增加(偏心重塑),以及响应瓣膜和信号功能紊乱的并联肌节添加(同心重塑)。该框架为目前对心脏重塑背后的基本亚肌节水平生物机制的理解提供了重大进展。模拟显示,病理组织负荷条件可以显著改变心动周期过程中的肌动蛋白-肌球蛋白跨桥循环。由此产生的肌节应力变化推动了肌原纤维的内部自由能和未结合的收缩蛋白之间的不平衡,从而启动了重塑。本研究中提出的跨桥热力学和肌原纤维重塑之间的联系可能会显著促进目前对心脏病发作的理解。
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引用次数: 4
Understanding the deformation gradient in Abaqus and key guidelines for anisotropic hyperelastic user material subroutines (UMATs). 了解Abaqus中的变形梯度和各向异性超弹性用户材料子程序(UMAT)的关键指南。
Pub Date : 2019-11-19 DOI: 10.31224/osf.io/4ryu2
David Nolan, C. Lally, Patrick McGarry
This tutorial paper provides a step-by-step guide to developing a comprehensive understanding of the different forms of the deformation gradient used in Abaqus, and outlines a number of key issues that must be considered when developing an Abaqus user defined material subroutine (UMAT) in which the Cauchy stress is computed from the deformation gradient. Firstly, we examine the "classical" forms of global and local deformation gradients. We then show that Abaqus/Standard does not use the classical form of the local deformation gradient when continuum elements are used, and we highlight the important implications for UMAT development. We outline the key steps that must be implemented in developing an anisotropic fibre-reinforced hyperelastic UMAT for use with continuum elements and local orientation systems. We also demonstrate that a classical local deformation gradient is provided by Abaqus/Standard if structural (shell and membrane) elements are used, and by Abaqus/Explicit for all element types. We emphasise, however, that the majority of biomechanical simulations rely on the use of continuum elements with a local coordinate system in Abaqus/Standard, and therefore the development of a hyperelastic UMAT requires an in-depth and precise understanding of the form of the non-classical deformation gradient provided as input by Abaqus. Several worked examples and case studies are provided for each section, so that the details and implications of the form of the deformation gradient can be fully understood. For each worked example in this tutorial paper the source files and code (Abaqus input files, UMATs, and Matlab script files) are provided, allowing the reader to efficiently explore the implications of the form of the deformation gradient in the development of a UMAT.
本教程提供了一个循序渐进的指南,以全面了解在Abaqus中使用的不同形式的变形梯度,并概述了在开发Abaqus用户定义的材料子程序(UMAT)时必须考虑的一些关键问题,其中从变形梯度计算柯西应力。首先,我们研究了全局和局部变形梯度的“经典”形式。然后,我们表明,当使用连续单元时,Abaqus/Standard不使用局部变形梯度的经典形式,并且我们强调了UMAT开发的重要含义。我们概述了开发用于连续单元和局部定向系统的各向异性纤维增强超弹性UMAT必须实施的关键步骤。我们还证明,如果使用结构(壳和膜)单元,则由Abaqus/Standard提供经典的局部变形梯度,而对于所有单元类型,则由Abaqus/Explicit提供。然而,我们强调,大多数生物力学模拟依赖于在Abaqus/Standard中使用具有局部坐标系的连续体元素,因此,超弹性UMAT的开发需要对Abaqus提供的输入的非经典变形梯度的形式进行深入和精确的理解。每个部分都提供了几个工作示例和案例研究,以便可以充分理解变形梯度形式的细节和含义。对于本教程中的每个工作示例,提供了源文件和代码(Abaqus输入文件,UMAT和Matlab脚本文件),使读者能够有效地探索变形梯度形式在UMAT开发中的含义。
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引用次数: 5
Shear wave speeds track axial stress in porcine collateral ligaments. 横波速度跟踪轴向应力在猪副韧带。
Pub Date : 2019-10-20 DOI: 10.31224/osf.io/ksg2p
Jonathon L. Blank, D. Thelen, J. Roth
Ligament tension is an important factor that can affect the success of total knee arthroplasty (TKA) procedures. However, surgeons currently lack objective approaches for assessing tension in a particular ligament intraoperatively. The purpose of this study was to investigate the use of noninvasive shear wave tensiometry to characterize stress in medial and lateral collateral ligaments (MCLs and LCLs) ex vivo and evaluate the capacity of shear wave speed to predict axial load. Nine porcine MCL and LCL specimens were subjected to cyclic axial loading while shear wave speeds were measured using laser vibrometry. We found that squared shear wave speed increased linearly with stress in both the MCL (r2avg = 0.94) and LCL (r2avg = 0.98). Shear wave speeds were slightly lower in the MCL than the LCL when subjected to a comparable axial stress (p < 0.001). Specimen-specific calibrations predicted tension within 13.0 N, or 5.2% of the maximum load. A leave-one-out analysis was also performed and showed that calibrated relationships based on ligament type could predict axial tension within 15% of the maximum load. These observations suggest it may be feasible to use noninvasive shear wave speed measures as a proxy of ligament loading, which in the future might enhance decision making during orthopedic procedures such as TKA.
韧带张力是影响全膝关节置换术成功与否的重要因素。然而,外科医生目前缺乏客观的方法来评估术中特定韧带的张力。本研究的目的是研究使用无创剪切波张力测量法来表征体内内侧和外侧副韧带(mcl和LCLs)的应力,并评估剪切波速度预测轴向载荷的能力。采用激光振动仪对9个猪MCL和LCL试件进行了轴向循环加载,同时测量了剪切波速。我们发现,在MCL (r2avg = 0.94)和LCL (r2avg = 0.98)中,剪切波速的平方随应力的增加而线性增加。当受到相当的轴向应力时,MCL的横波速度略低于LCL (p < 0.001)。样品特异性校准预测张力在13.0 N,或最大负载的5.2%。我们还进行了一项遗漏分析,结果显示,基于韧带类型的校准关系可以在最大载荷的15%内预测轴向张力。这些观察结果表明,使用无创剪切波速测量作为韧带负荷的代表是可行的,这在未来可能会增强诸如TKA等骨科手术中的决策。
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引用次数: 9
Evolving landscape in the management of transthyretin amyloidosis. 转甲状腺素淀粉样变性管理的演变趋势。
IF 4.4 Pub Date : 2015-01-01 Epub Date: 2015-11-27 DOI: 10.3109/07853890.2015.1068949
Philip N Hawkins, Yukio Ando, Angela Dispenzeri, Alejandra Gonzalez-Duarte, David Adams, Ole B Suhr

Transthyretin (TTR) amyloidosis (ATTR amyloidosis) is a multisystemic, multigenotypic disease resulting from deposition of insoluble ATTR amyloid fibrils in various organs and tissues. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific and diagnosis largely relies on amyloid detection in tissue biopsies. Treatment is guided by which tissues/organs are involved, although therapeutic options are limited for patients with late-stage disease. Indeed, enthusiasm for liver transplantation for familial ATTR amyloidosis with polyneuropathy was dampened by poor outcomes among patients with significant neurological deficits or cardiac involvement. Hence, there remains an unmet medical need for new therapies. The TTR stabilizers tafamidis and diflunisal slow disease progression in some patients with ATTR amyloidosis with polyneuropathy, and the postulated synergistic effect of doxycycline and tauroursodeoxycholic acid on dissolution of amyloid is under investigation. Another therapeutic approach is to reduce production of the amyloidogenic protein, TTR. Plasma TTR concentration can be significantly reduced with ISIS-TTR(Rx), an investigational antisense oligonucleotide-based drug, or with patisiran and revusiran, which are investigational RNA interference-based therapeutics that target the liver. The evolving treatment landscape for ATTR amyloidosis brings hope for further improvements in clinical outcomes for patients with this debilitating disease.

转甲状腺素(TTR)淀粉样变性(ATTR amyloidosis)是一种多系统、多基因型疾病,由不溶性 ATTR 淀粉样纤维沉积在各种器官和组织中引起。尽管被认为是罕见病,但这种严重疾病的发病率很可能被低估了,因为症状可能是非特异性的,诊断主要依赖于组织活检中的淀粉样蛋白检测。虽然晚期患者的治疗选择有限,但治疗方法是根据受累组织/器官而定的。事实上,对于家族性ATTR淀粉样变性伴有多发性神经病变的患者,肝移植的治疗效果并不理想,这打击了患者的积极性。因此,对新疗法的医疗需求仍未得到满足。TTR稳定剂他非米迪和地氟尼沙可减缓一些ATTR淀粉样变性伴多发性神经病患者的病情进展,多西环素和牛磺去氧胆酸对淀粉样蛋白溶解的协同作用也在研究之中。另一种治疗方法是减少淀粉样蛋白 TTR 的产生。使用ISIS-TTR(Rx)(一种基于反义寡核苷酸的在研药物)或Patisiran和revusiran(一种基于RNA干扰的在研药物,以肝脏为靶点)可显著降低血浆TTR浓度。ATTR淀粉样变性不断发展的治疗前景为进一步改善这种使人衰弱的疾病患者的临床疗效带来了希望。
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Journal of the mechanical behavior of biomedical materials
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