Definition of thermal indicators for the study of thermoregulation alterations in the foot of people living within diabetic peripheral neuropathy: A proof of concept.

AIMS: This study investigates how diabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms using a thermal camera, spectral thermal analysis and a physical test. METHODS: The plantar skin temperature of all participants was measured using a thermal camera following a 6-min walking exercise. The data were subjected to frequency decomposition, resulting in two frequency ranges corresponding to endothelial and neurogenic mechanisms. Then, 40 thermal indicators were evaluated for each participant. ROC curve and statistical tests allowed to identify indicators able to detect the presence or absence of diabetic peripheral neuropathy. RESULTS: The study included 33 participants living with diabetes. The results revealed that a 6-min walk exercise increased plantar foot temperature and highlighted a significant difference between people living with diabetes with and without peripheral neuropathy (p < 0.01). The results also revealed the advantages of using thermal images rather than single point measurements. CONCLUSIONS: Diabetic peripheral neuropathy is linked to impairment of thermoregulatory mechanisms. This link can be highlighted after a dedicated 6-min walk exercise, enabling to activate these mechanisms, and measuring with a thermal camera the temporal plantar skin temperature. Assessment of this link gave best results by filtering the thermal signal in the neurogenic range.

Experimental evaluation of the NeVa™ thrombectomy device a novel stent retriever conceived to improve efficacy of organized clot removal.

BACKGROUND AND PURPOSE: Stent retrievers are recognized as the most effective devices for intracranial thrombectomy. Although highly effective, such devices fail in clot removal when the brain vessel occlusion is due to organized, firm clots. The mechanism of failure is that during the retrieval, devices remain compressed by the organized clot and slide between it and the vessel wall without any removal effect. The aim of the current study is to present the preclinical evaluation of the Neva™ device, a novel stent retriever designed to improve the incorporation and removal of organized thrombi. MATERIALS AND METHODS: Preclinical evaluation of the Neva™ device was divided in three main chapters: efficacy analysis, mechanical analysis and safety analysis. Efficacy and mechanical analysis aimed to investigate the behavior during the retrieval of the Neva™ device and its interaction with experimental organized clots. Safety analysis was conducted on animals in order to investigate the effect of the Neva™ device on real arteries after simulated thrombectomy maneuvers. RESULTS: Neva™ device showed a high rate of "optimal clot integration" and "effective clot removal" which was related to constant cohesion to the vessel wall during retrievals. Safety analysis showed as the most frequent finding the disruption of the intima of the tested vessels with, in some cases, minimal disruption of the internal elastic lamina. CONCLUSIONS: The Neva™ device has demonstrated safety and efficacy in a pre-clinical study. Such encouraging, preliminary results have to be compared with those of clinical trials.

Noninvasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension.

End-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection ("ejection P-V curve" method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.NEW & NOTEWORTHY The use of real-time three-dimensional echocardiography-derived left ventricular volumes in conjunction with carotid tonometry was found to be reproducible and sensitive enough to detect expected differences in left ventricular elastance in arterial hypertension. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.

Finite element analysis in the optimization of posterior-stabilized total knee arthroplasty.

Posterior-stabilized total knee arthroplasty (PS-TKA) is associated with high rates of satisfaction and functional recovery. This is notably attributed to implant optimization in terms of design, choice of materials, positioning and understanding of biomechanics. Finite elements analysis (FEA) is an assessment technique that contributed to this optimization by ensuring mechanical results based on numerical simulation. By close teamwork between surgeons, researchers and engineers, FEA enabled testing of certain clinical impressions. However, the methodological features of the technique led to wide variations in the presentation and interpretation of results, requiring a certain understanding of numerical and biomechanical fields by the orthopedic community. The present study provides an up-to-date review, aiming to address the following questions: what are the principles of FEA? What is the role of FEA in studying PS design in TKA? What are the key elements in the literature for understanding the role of FEA in PS-TKA? What is the contribution of FEA for understanding of tibiofemoral and patellofemoral biomechanical behavior? What are the limitations and perspectives of digital simulation and FEA in routine practice, with a particular emphasis on the "digital twin" concept? LEVEL OF EVIDENCE: V, expert opinion.

Influence of gravity on the skin thermal behavior: experimental study using dynamic infrared thermography.

BACKGROUND/AIM: To better understand the thermomechanical behavior of the skin and its direct environment, we present an experimental study using dynamic infrared thermography. This experimental study aims to highlight quantitatively some effects of blood flow on the heat diffusion. METHODS: The originality of this research was to change the blood flow by using effects of gravity and to quantify the temperature changes. The experimental step consists of putting a cylindrical steel bar cooled or warmed on the skin of a human forearm and to measure the change of the temperature using an infrared camera. Measures have been recorded for different positions of the forearm. RESULT AND CONCLUSION: We noted very clearly the influence of blood circulation in the veins on the diffusion of the temperature. The return to thermal balance is faster when the arm is in a horizontal position. Moreover, a comparative study of experimental cooling and warming showed a symmetrical thermal behavior for the skin under this type of thermal solicitations. This work provided to build a database that can be used for the validation of predictive thermal models of human skin.

Validation of a novel finite-element model for evaluating patellofemoral forces and stress during squatting after posterior-stabilized total knee arthroplasty.

INTRODUCTION: Several studies have documented the relationship between patellofemoral pain and patient dissatisfaction after total knee arthroplasty (TKA). However, few computer simulations have been designed to evaluate the patellofemoral joint during flexion. The aim of this study was to validate a new computational simulation, driven by forces and moments, and to analyze patellofemoral reaction forces and stress under squat loading conditions after TKA implantation. HYPOTHESIS: This computational simulation of a squat using a model driven by forces and moments is comparable to in vitro and in silico data from the literature. MATERIAL AND METHODS: We developed a finite element model of the lower limb after implantation of a fixed-bearing posterior-stabilized TKA. To simulate squat loading conditions when standing on both legs, an initial load of 130N was applied to the center of the femoral head. Quadriceps force, patellofemoral contact force and Von Mises stress on the patellar implant, tibiofemoral contact forces and pressure on the tibial insert, and post-cam contact force were evaluated from 0° to 100° of knee flexion. RESULTS: Quadriceps force increased during flexion, up to 6 times the applied load. Von Mises stress on patellar implant increased up to 16MPa at 100° flexion. Tibiofemoral contact forces increased up to 415 N medially and 339 N laterally, with 64% distributed medially on the tibial insert. Post-cam contact started slightly before 70° of flexion. DISCUSSION: In this simulation, tibiofemoral, patellofemoral and post-cam contact forces, and pressure distribution on the tibial insert were consistent with various published studies. This agreement suggests that computational simulation driven by forces and moments can reproduce squat loading conditions during knee flexion after TKA, without experimental kinematic data used to drive the simulation. CONCLUSION: This study represents an initial step towards validating tibiofemoral and patellofemoral mechanical behavior under squat conditions, from this computational simulation driven by forces and moments. This model will help us better understand the influence of various implantation techniques on patellofemoral forces and stress during flexion. LEVEL OF EVIDENCE: IV, biomechanical computational study.

A Study of the Biomechanical Behavior of the Implantation Method of Inverted Shoulder Prosthesis (BIO⁻RSA) under Different Abduction Movements.

The shoulder is the most mobile joint of the human body, but it is very fragile; several pathologies, and especially muscular degenerations in the elderly, can affect its stability. These are more commonly called rotator cuff fractures. In the case of this type of pathology, the mobility of the shoulder decreases and pain appears. In order to restore mobility and reduce pain, implantation of an inverted shoulder prosthesis is recommended. Unfortunately, over time a notch phenomenon has been observed. In the lower position of the arm, part of the implant comes into contact with the scapula and therefore causes deterioration of the bone. Among the solutions adopted is the lateralized method with bone grafting. However, a main disadvantage of this method concerns the reconstruction of the graft in the case of prosthesis revision. In this context, the aim of the present work was to reconstruct the shoulder joint in 3D in order to obtain a bio-faithful geometry, and then study the behavior of different types of biomaterials that can replace bone grafting. To this end, three arm abduction motions were examined for three individuals. From the results obtained, it appears that grafts in ultra-high molecular weight polyethylene (UHMWPE) exhibit a behavior closer to that of bones.

Experimental and numerical identification of cortical bone permeability.

Bone is a complex system, and could be modeled as a poroelastic media. The aim of this paper is to identify the macroscopic value of the cortical bone permeability coefficient. A simple experimental method was designed in order to determine the permeability coefficient. Two bone samples taken from different ox femurs were filled with water, to place them under internal pressure. The measurements gave both the fluid flow through the lateral surfaces and the internal pressure. The originality of this work is the coupling between an experimental process and a structural computation performed with a finite element method. The mean cortical bone permeability coefficient identified was about k=1.1x10(-13)m(2). This value tends to confirm other values found in the literature, obtained by different methods and often at macroscopic scale. It confirms also the domination of vascular permeability (Haversian and Volkmann's canals).

Experimental evaluation of stent retrievers' mechanical properties and effectiveness.

BACKGROUND: Five randomized controlled trials recently appeared in the literature demonstrating that early mechanical thrombectomy in patients with acute ischemic stroke is significantly related to an improved outcome. Stent retrievers are accepted as the most effective devices for intracranial thrombectomy. OBJECTIVE: To analyze the mechanical properties of stent retrievers, their behavior during retrieval, and interaction with different clots and to identify device features that might correlate with the effectiveness of thrombus removal. MATERIALS AND METHODS: All stent retrievers available in France up to June 2015 were evaluated by mechanical and functional tests aimed at investigating the variation of their radial force and their behavior during retrieval. Devices were also tested during in vitro thrombectomies using white and red experimental thrombi produced with human blood. Functional tests and in vitro thrombectomies were conducted using a rigid 3D printed vascular model. RESULTS: Mechanical tests showed a variation in radial force during retrieval for each stent. A constant radial force during retrieval was related to continuous cohesion over the vessel wall and a higher rate of clot removal efficacy. All stent retrievers failed when interacting with white large thrombi (diameter ≥6 mm). CONCLUSIONS: None of the tested devices were effective in removing white clots of large diameter (≥6 mm). Constant radial force during retrieval allows constant cohesion to the vessel wall and pressure over the clot; such features allow for a higher rate of clot removal.

The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors.

Background and purpose Pore density (PD), surface metal coverage (SMC) and the number of wires are all different parameters which can influence the efficacy of a flow disruptor/diverter. Nevertheless, the relative importance of a parameter to induce intra-aneurysmal blood stasis is still poorly evaluated. Therefore, comparison between devices based on a unique value is not reliable. The aim of this study was to propose a new bench top parameter (the pressure reduction coefficient (PRC; ξ)) in order to assess the global haemodynamic effect of each flow diverter/disruptor to slow flow. Methods Eight devices were tested in vitro during three different flow conditions. For the eight devices, the PRC was computed at different volumetric flow rates to characterise flow reduction. Comparison was made with SMC, PD and the number of wires. Results The PRC obtained for flow disruptors was on average 1.5 times more efficient in reducing flow compared to flow diverters. PD (mm2) ranged from 24 to 38 for flow diverters and did not independently correlate with the PRC. The SMC of flow diverters ranged from 25% to 70%, and ranged from 20% to 100% for flow disruptors, without independent correlation to the PRC. The number of wires ranged from 48 to 96 for the flow diverters and did not correlate independently to the PRC. Conclusion There were no direct correlations between individual device characteristics and the PRC, suggesting a multifaceted and interrelating association of the overall design of each implant. Hence, the PRC could be used as a simple, reliable parameter to assess the overall capacity of flow disruptors/diverters to induce intra-aneurysmal blood stasis.

A 3D finite element model for hyperthermia injury of blood-perfused skin.

The objective of this study is to propose a numerical model of thermal damage to the skin. This model simulates the propagation of a burn and suggests treatments to prevent it from spreading. In order to achieve this goal, we developed a 3D multi-layer finite element model of the skin coupled with a model presenting hyperthermic damage. The numerical model of the skin takes account of not only the thermal properties of various layers, but also blood perfusion and veins. The model of thermal damage is based on the Arrhenius' law. We tested two various quick intervention treatments so as to prevent the burn from spreading. The first treatment consists of cooling the burned zone with a flow of cool water at 10°C, whereas the second solution simulates the apposition of ice on the burn. The results show that, according to the severity of the burn, the second treatment seems to be the most appropriate. Moreover, our model opens interesting prospects in the analysis of hyperthermic damage.

Numerical model of bone remodeling sensitive to loading frequency through a poroelastic behavior and internal fluid movements.

In this article, a phenomenological numerical model of bone remodeling is proposed. This model is based on the poroelasticity theory in order to take into account the effects of fluid movements in bone adaptation. Moreover, the proposed remodeling law is based on the classical 'Stanford' law, enriched in order to take into account the loading frequency, through fluid movements. This coupling is materialized by a quadratic function of Darcy velocity. The numerical model is carried out, using a finite element method, and calibrated using experimental results at macroscopic level, from the literature. First results concern cyclic loadings on a mouse ulna, at different frequencies between 1 Hz and 30 Hz, for a force amplitude of 1.5 N and 2 N. Experimental results exhibit a sensitivity to the loading frequency, with privileged frequency for bone remodeling between 5 Hz and 10 Hz, for the force amplitude of 2 N. For the force amplitude of 1.5 N, no privileged frequencies for bone remodeling are highlighted. This tendency is reproduced by the proposed numerical computations. The model is identified on a single case (one frequency and one force amplitude) and validated on the other ones. The second experimental validation deals with a different loading regime, an internal fluid pressure at 20 Hz on a turkey ulna. The same framework is applied, and the numerical and experimental data are still matching in terms of gain in bone mass density.