Smoothed particle hydrodynamics implementation to enhance vertebral fracture finite element model in a cervical spine segment under compression.

Spinal cord injuries (SCIs) can arise from compression loading when a vertebra fractures and bone fragments are pushed into the spinal canal. Experimental studies have demonstrated the importance of both fracture initiation and post-fracture response in the investigation of vertebral fractures and spinal canal occlusion resulting from compression. Finite element models, such as the Global Human Body Models Consortium (GHBMC) model, focused on predicting the initiation location of fractures using element erosion to model hard tissue fracture. However, the element erosion method resulted in a loss of material and structural support during compression, which limited the ability of the model to predict the post-fracture response. The current study aimed to improve the post-fracture response by combining strain-based element erosion with smoothed particle hydrodynamics (SPH) to preserve the volume of the trabecular bone during compression fracture. The proposed implementation was evaluated using a model comprising two functional spinal units (FSUs) (C5-C6-C7) extracted from the GHBMC 50th percentile male model, and loaded under central compression. The original and enhanced models were compared to experimental force-displacement data and measured occlusion of the spinal canal. The enhanced model with SPH improved the shape and magnitude of the force-displacement response to be in good agreement with the experimental data. In contrast to the original model, the enhanced SPH model demonstrated occlusion on the same order of magnitude as reported in the experiments. The SPH implementation improved the post-fracture response by representing the damaged material post-fracture, providing structural support throughout compression loading and material flow leading to occlusion.

Methodology to geometrically age human body models to average and subject-specific anthropometrics, demonstrated using a small stature female model assessed in a side impact.

The aged population has been associated with an increased risk of injury in car-crash, creating a critical need for improved assessment of safety systems. Finite element human body models (HBMs) have been proposed, but require representative geometry of the aged population and high mesh quality. A new hybrid Morphing-CAD methodology was applied to a 26-year-old (YO) 5th percentile female model to create average 75YO and subject-specific 86YO HBMs. The method achieved accurate morphing targets while retaining high mesh quality. The three HBMs were integrated into a side sled impact test demonstrating similar kinematic response but differing rib fracture patterns.

Cortical bone continuum damage mechanics constitutive model with stress triaxiality criterion to predict fracture initiation and pattern.

A primary objective of finite element human body models (HBMs) is to predict response and injury risk in impact scenarios, including cortical bone fracture initiation, fracture pattern, and the potential to simulate post-fracture injury to underlying soft tissues. Current HBMs have been challenged to predict the onset of failure and bone fracture patterns owing to the use of simplified failure criteria. In the present study, a continuum damage mechanics (CDM) model, incorporating observed mechanical response (orthotropy, asymmetry, damage), was coupled to a novel phenomenological effective strain fracture criterion based on stress triaxiality and investigated to predict cortical bone response under different modes of loading. Three loading cases were assessed: a coupon level notched shear test, whole bone femur three-point bending, and whole bone femur axial torsion. The proposed material model and fracture criterion were able to predict both the fracture initiation and location, and the fracture pattern for whole bone and specimen level tests, within the variability of the reported experiments. There was a dependence of fracture threshold on finite element mesh size, where higher mesh density produced similar but more refined fracture patterns compared to coarser meshes. Importantly, the model was functional, accurate, and numerically stable even for relatively coarse mesh sizes used in contemporary HBMs. The proposed model and novel fracture criterion enable prediction of fracture initiation and resulting fracture pattern in cortical bone such that post-fracture response can be investigated in HBMs.

Vancomycin-Resistant Enterococci in Patients Attending for Colonoscopy: An Estimate of Community Prevalence.

Aims Ireland has the highest vancomycin-resistant Enterococcus faecium (VRE) bloodstream infection prevalence in Europe. Two patterns of VRE carriage are recognised. European, with widespread community prevalence and North American, where carriage is predominantly nosocomial. It is unclear which pattern is dominant in Ireland. This uncertainty limits infection control measures. This study sought to explore this issue via a cross sectional point prevalence study. Methods Asymptomatic community volunteers, represented by patients undergoing elective outpatient colonoscopy testing, were opportunistically screened for VRE. Demographic and risk factor data were collected via a patient survey. Rectal swabs were collected before colonoscopy and VRE was identified using the VITEK MS system. Results 102 patients were cultured. A single patient tested positive, representing a prevalence rate of 0.98% (95% CI <0.01-5.8%). This patient demonstrated traditional risk factors, suggesting nosocomial rather than community acquisition. 94% (N=94) of patients had no knowledge of VRE, while 83% (N=83) had low levels of concern regarding hospital acquired infections. Conclusion There is a low incidence of VRE in the Irish community setting, in contrast to other European Countries, suggesting asymptomatic community colonization is not responsible for the high rates of VRE seen in Ireland. Wider screening or atypical infection control measures would not be supported by this data.

Sex, Age and Stature Affects Neck Biomechanical Responses in Frontal and Rear Impacts Assessed Using Finite Element Head and Neck Models.

The increased incidence of injury demonstrated in epidemiological data for the elderly population, and females compared to males, has not been fully understood in the context of the biomechanical response to impact. A contributing factor to these differences in injury risk could be the variation in geometry between young and aged persons and between males and females. In this study, a new methodology, coupling a CAD and a repositioning software, was developed to reposture an existing Finite element neck while retaining a high level of mesh quality. A 5th percentile female aged neck model (F0575YO) and a 50th percentile male aged neck model (M5075YO) were developed from existing young (F0526YO and M5026YO) neck models (Global Human Body Models Consortium v5.1). The aged neck models included an increased cervical lordosis and an increase in the facet joint angles, as reported in the literature. The young and the aged models were simulated in frontal (2, 8, and 15 g) and rear (3, 7, and 10 g) impacts. The responses were compared using head and relative facet joint kinematics, and nominal intervertebral disc shear strain. In general, the aged models predicted higher tissue deformations, although the head kinematics were similar for all models. In the frontal impact, only the M5075YO model predicted hard tissue failure, attributed to the combined effect of the more anteriorly located head with age, when compared to the M5026YO, and greater neck length relative to the female models. In the rear impacts, the F0575YO model predicted higher relative facet joint shear compared to the F0526YO, and higher relative facet joint rotation and nominal intervertebral disc strain compared to the M5075YO. When comparing the male models, the relative facet joint kinematics predicted by the M5026YO and M5075YO were similar. The contrast in response between the male and female models in the rear impacts was attributed to the higher lordosis and facet angle in females compared to males. Epidemiological data reported that females were more likely to sustain Whiplash Associated Disorders in rear impacts compared to males, and that injury risk increases with age, in agreement with the findings in the present study. This study demonstrated that, although the increased lordosis and facet angle did not affect the head kinematics, changes at the tissue level were considerable (e.g., 26% higher relative facet shear in the female neck compared to the male, for rear impact) and relatable to the epidemiology. Future work will investigate tissue damage and failure through the incorporation of aged material properties and muscle activation.

Importance of the cervical capsular joint cartilage geometry on head and facet joint kinematics assessed in a Finite element neck model.

Finite element human neck models (NMs) aim to predict neck response and injury at the tissue level; however, contemporary models are most often assessed using global response such as head kinematics. Additionally, many NMs are developed from subject-specific imaging with limited soft tissue resolution in small structures such as the facet joints in the neck. Such details may be critical to enable NMs to predict tissue-level response. In the present study, the capsular joint cartilage (CJC) geometry in a contemporary NM was enhanced (M50-CJC) based on literature data. The M50-CJC was validated at the segment and full neck levels and assessed using relative facet joint kinematics (FJK), capsular ligament (CL) and intervertebral disc (IVD) strains, a relative vertebral rotation assessment (IV-NIC) and head kinematics in frontal and rear impact. The validation ratings at the segment level increased from 0.60 to 0.64, with improvements for modes of deformation associated with the facet joints, while no difference was noted at the head kinematic level. The improved CJC led to increased FJK rotation (188%) and IVD strain (152.2%,) attributed to the reduced facet joint gap. Further enhancements of the capsular joint representation or a link between the FJK and CL injury risk are recommended. Enhancements at the tissue level demonstrated a large effect on the IVD strain, but were not apparent in global metrics such as head kinematics. This study demonstrated that a biofidelic and detailed geometrical representation of the CJC contributes significantly to the predicted joint response, which is critical to investigate neck injury risk at the tissue level.

Load-Sharing and Kinematics of the Human Cervical Spine Under Multi-Axial Transverse Shear Loading: Combined Experimental and Computational Investigation.

The cervical spine experiences shear forces during everyday activities and injurious events yet there is a paucity of biomechanical data characterizing the cervical spine under shear loading. This study aimed to (1) characterize load transmission paths and kinematics of the subaxial cervical spine under shear loading, and (2) assess a contemporary finite element cervical spine model using this data. Subaxial functional spinal units (FSUs) were subjected to anterior, posterior, and lateral shear forces (200 N) applied with and without superimposed axial compression preload (200 N) while monitoring spine kinematics. Load transmission paths were identified using strain gauges on the anterior vertebral body and lateral masses and a disc pressure sensor. Experimental conditions were simulated with cervical spine finite element model FSUs (GHBMC M50 version 5.0). The mean kinematics, vertebral strains, and disc pressures were compared to experimental results. The shear force-displacement response typically demonstrated a toe region followed by a linear response, with higher stiffness in anterior shear relative to lateral and posterior shear. Compressive axial preload decreased posterior and lateral shear stiffness and increased initial anterior shear stiffness. Load transmission patterns and kinematics suggest the facet joints play a key role in limiting anterior shear while the disc governs motion in posterior shear. The main cervical spine shear responses and trends are faithfully predicted by the GHBMC cervical spine model. These basic cervical spine biomechanics and the computational model can provide insight into mechanisms for facet dislocation in high severity impacts, and tissue distraction in low severity impacts.

Assessment of Thorax Finite Element Model Response for Behind Armor Blunt Trauma Impact Loading Using an Epidemiological Database.

Nonperforating ballistic impacts on thoracic armor can cause blunt injuries, known as behind-armor blunt trauma (BABT). To evaluate the potential for this injury, the back face deformation (BFD) imprinted into a clay backing is measured; however, the link between BFD and potential for injury is uncertain. Computational human body models (HBMs) have the potential to provide an improved understanding of BABT injury risk to inform armor design but require assessment with relevant loading scenarios. In this study, a methodology was developed to apply BABT loading to a computational thorax model, enhanced with refined finite element mesh and high-deformation rate mechanical properties. The model was assessed using an epidemiological BABT survivor database. BABT impact boundary conditions for 10 cases from the database were recreated using experimentally measured deformation for specific armor/projectile combinations, and applied to the thorax model using a novel prescribed displacement methodology. The computational thorax model demonstrated numerical stability under BABT impact conditions. The predicted number of rib fractures, the magnitude of pulmonary contusion, and injury rank, increased with armor BFD, back face velocity, and input energy to the thorax. In three of the 10 cases, the model overpredicted the number of rib fractures, attributed to impact location positional sensitivity and limited details from the database. The integration of an HBM with the BABT loading method predicted rib fractures and injury ranks that were in good agreement with available medical records, providing a potential tool for future armor evaluation and injury assessment.

Validation of a Football Helmet Finite Element Model and Quantification of Impact Energy Distribution.

Head injury in contact sports can be mitigated, in part, through the enhancement of protective helmets that may be enabled by detailed finite element models. However, many contemporary helmet FE models include simplified geometry and material properties and have limited verification and validation over a representative range of impact conditions. To address these limitations, a detailed numerical model of a modern football helmet was developed, integrated with two headforms and assessed for 60 impact conditions with excellent ratings (0.79-0.93). The strain energy of the helmet components was investigated for eight impact locations and three impact speeds. In general, the helmet shell had the highest strain energy followed by the compression shocks; however, the facemask and straps had the highest strain energy for impacts involving the facemask. The component strain energy was positively correlated with the Head Injury Criterion, while the strain energy was not strongly correlated with the Brain Injury Criterion due to the dependence on rotational kinematics. This study demonstrated the applicability of a detailed football helmet finite element model to investigate a range of impact conditions and to assess energy distribution as a function of impact location and severity as a means of future helmet optimization.

Cavitation threshold evaluation of porcine cerebrospinal fluid using a Polymeric Split Hopkinson Pressure Bar-Confinement chamber apparatus.

Studies investigating mild Traumatic Brain Injury (mTBI) in the military population using experimental head surrogates and Finite Element (FE) head models have demonstrated the existence of transient negative pressures occurring within the head at the contrecoup location to the blast wave impingement. It has been hypothesized that this negative pressure may cause cavitation of cerebrospinal fluid (CSF) and possibly lead to brain tissue damage from cavitation bubble collapse. The cavitation pressure threshold of human CSF is presently unknown, although existing FE studies in the literature have assumed a value of -100 kPa. In the present study, the cavitation threshold of degassed porcine CSF at body temperature (37 °C) was measured using a unique modified Polymeric Split Hopkinson Pressure Bar apparatus, and compared to thresholds of distilled water at various conditions. The loading pulse generated in the apparatus was comparable to experimentally measured pressures resulting from blast exposure, and those predicted by an FE model. The occurrence of cavitation was identified using high-speed imaging and the corresponding pressures were determined using a computational model of the apparatus that was previously developed and validated. The probability of cavitation was calculated (ISO/TS, 18506) from forty-one experimental tests on porcine CSF, representing an upper bound for in vivo CSF. The 50% probability of cavitation for CSF (-0.467 MPa ±â€¯7%) was lower than that of distilled water (-1.37 MPa ±â€¯16%) under the same conditions. The lesser threshold of CSF could be related to the constituents such as blood cells and proteins. The results of this study can be used to inform FE head models subjected to blast exposure and improve prediction of the potential for CSF cavitation and response of brain tissue.

Comparison of porcine brain mechanical properties to potential tissue simulant materials in quasi-static and sinusoidal compression.

In both finite element and physical surrogate models of head blast injury, accurate material properties of the brain and/or tissue simulants are necessary to ensure biofidelity in predicted response. Thus, there is a need for experimental comparisons between tissue and simulant materials under the same experimental conditions. This study compares the response of porcine brain tissue and a variety of brain tissue simulants in quasi-static and sinusoidal compression tests. Fresh porcine brain tissue was obtained from a local abattoir and tested within 4 h post mortem. Additionally, the effect of post mortem time was investigated by comparing samples stored at room temperature and stored frozen (-18 °C), at various time intervals. The brain tissue simulants tested were bovine gelatin (3%, 5%, and 10% concentration), agarose gelatin (e0.4%, 0.6%, 0.8% concentration), and Sylgard 527. The experiments were performed using a DMA apparatus (TA Instruments Q800). The quasi-static compression data were fit to Ogden hyperelastic functions so that parameters could be compared. It was found that bovine gelatin at 3% and 5% concentration demonstrated the closest response to brain tissue in quasi-static compression. Conversely, in sinusoidal compression, the agarose gel and Sylgard 527 were found to be in closer agreement with the tissue, than bovine gel. In terms of post mortem time and storage, there was no statistically significant difference detected in the response of tissue samples after 48 h, regardless of storage method. However, samples stored at room temperature after 48 h appeared to demonstrate a reduction in stiffness.

Importance of asymmetry and anisotropy in predicting cortical bone response and fracture using human body model femur in three-point bending and axial rotation.

Modeling of cortical bone response and failure is critical for the prediction of Crash Induced Injuries (CII) using advanced finite element (FE) Human Body Models (HBM). Although cortical bone is anisotropic and asymmetric in tension and compression, current HBM often utilize simple isotropic, symmetric, elastic-plastic constitutive models. In this study, a 50th percentile male femur FE model was used to quantify the effect of asymmetry and anisotropy in three-point bending and axial torsion. A complete set of cortical bone mechanical properties was identified from a literature review, and the femur model was used to investigate the importance of material asymmetry and anisotropy on the failure load/moment, failure displacement/rotation and fracture pattern. All models were able to predict failure load in bending, since this was dominated by the cortical bone material tensile response. However, only the orthotropic model was able to predict the torsional response and failure moment. Only the orthotropic model predicted the fracture initiation location and fracture pattern in bending, and the fracture initiation location in torsion; however, the anticipated spiral fracture pattern was not predicted by the models for torsional loading. The results demonstrated that asymmetry did not significantly improve the prediction capability, and that orthotropic material model with the identified material properties was able to predict the kinetics and kinematics for both three-point bending and axial torsion. This will help to provide an improved method for modeling hard tissue response and failure in full HBM.

Renal Transplantation With Final Allocation Based on the Virtual Crossmatch.

Solid phase immunoassays (SPI) are now routinely used to detect HLA antibodies. However, the flow cytometric crossmatch (FCXM) remains the established method for assessing final donor-recipient compatibility. Since 2005 we have followed a protocol whereby the final allocation decision for renal transplantation is based on SPI (not the FCXM). Here we report long-term graft outcomes for 508 consecutive kidney transplants using this protocol. All recipients were negative for donor-specific antibody by SPI. Primary outcomes are graft survival and incidence of acute rejection within 1 year (AR <1 year) for FCXM+ (n = 54) and FCXM- (n = 454) recipients. Median follow-up is 7.1 years. FCXM+ recipients were significantly different from FCXM- recipients for the following risk factors: living donor (24% vs. 39%, p = 0.03), duration of dialysis (31.0 months vs. 13.5 months, p = 0.008), retransplants (17% vs. 7.3%, p = 0.04), % sensitized (63% vs. 19%, p = 0.001), and PRA >80% (20% vs. 4.8%, p = 0.001). Despite these differences, 5-year actual graft survival rates are 87% and 84%, respectively. AR <1 year occurred in 13% FCXM+ and 12% FCXM- recipients. Crossmatch status was not associated with graft outcomes in any univariate or multivariate model. Renal transplantation can be performed successfully, using SPI as the definitive test for donor-recipient compatibility.

A case study: refractory recurrent autoimmune hepatitis following liver transplantation in two male patients.

Autoimmune hepatitis (AIH) recurs after liver transplantation and significantly impacts graft function and patient survival. In this case report, we present 2 cases of male patients with refractory recurrent AIH after liver transplantation. Each patient lost their first graft due to refractory continuous AIH. We have not noticed a similar refractory course for our female patients with AIH post-transplantation at our center. Based on our single-center experience there appears to be a gender disparity in the aggressive nature of AIH recurrence after transplantation. Despite the aggressive nature of recurrent AIH in both patients, graft loss occurred beyond 3 years for both patients and did not influence the 1- and 3-year patient survival. If these findings are validated, they may have significant impact on post-transplantation immunosuppression management in male patients.

Combined effect of selected non-thermal technologies on Escherichia coli and Pichia fermentans inactivation in an apple and cranberry juice blend and on product shelf life.

The combination of novel, non-thermal technologies for preservation purposes is a recent trend in food processing research. In the present study, non-thermal hurdles such as ultraviolet light (UV) (5.3 J/cm²), high intensity light pulses (HILP) (3.3 J/cm²), pulsed electric fields (PEF) (34 kV/cm, 18 Hz, 93 µs) or manothermosonication (MTS) (4bar, 43 °C, 750 W, 20 kHz) were examined. The objective was to establish the potential of these technologies, applied individually or in paired sequences, to inactivate Escherichia coli and Pichia fermentans inoculated in a fresh blend of apple and cranberry juice. The shelf-life evaluation of selected non-thermally treated samples was conducted over 35 days and compared to pasteurised samples and untreated juices. All treatments applied individually significantly reduced (1.8-6.0 log cfu/ml) microbial counts compared to the untreated sample (p<0.01). Furthermore, UV treatment produced significantly greater inactivation (p<0.05) for E. coli compared to P. fermentans. Combinations of non-thermal hurdles consisting of UV or HILP followed by either PEF or MTS resulted in comparable reductions for both microorganisms (p ≥ 0.05) to those observed in thermally pasteurised samples (approx. 6 log cfu/ml). Thermally pasteurised samples had a shelf life exceeding 35 days, while that of UV+PEF and HILP+PEF-treated samples was 14 and 21 days, respectively. These results indicate that combinations of these non-thermal technologies could successfully reduce levels of E. coli and P. fermentans in apple and cranberry juice, although optimisation is required in order to further extend shelf life.

Combinations of High Intensity Light Pulses and Thermosonication for the inactivation of Escherichia coli in orange juice.

The non-thermal technologies High Intensity Light Pulses (HILP) and Thermosonication (TS) were applied alone and in combination to study their effect on Escherichia coli inactivation in orange juice. Two different energy settings were chosen in the current study, 'Low' (L) and 'High' (H), being the combinations applied: HILP(L) (4.03 J/cm(2)), HILP(H) (5.1 J/cm(2)), TS(L) (2.8 min residence time at 40 °C) and TS(H) (5 min residence time at 50 °C). Both the individual technologies and their combinations (HILP&TS and TS&HILP) were studied. Results showed inactivation ranging from 1.10 (TS(H)) to 2.42 (HILP(H)) log cfu/ml for the hurdles when applied individually and from 2.5 (HILP(L)&TS(H)) to 3.93 (HILP(H)&TS(L)) log cfu/ml for the combined treatments. Similar reductions in E. coli populations were achieved in orange juice by all treatment combinations irrespective of the sequence in which they were applied.

Efficacy of UV light treatment for the microbiological decontamination of chicken, associated packaging, and contact surfaces.

UV light was investigated for the decontamination of raw chicken, associated packaging, and contact surfaces. The UV susceptibilities of a number of Campylobacter isolates (seven Campylobacter jejuni isolates and three Campylobacter coli isolates), Escherichia coli ATCC 25922, and Salmonella enterica serovar Enteritidis ATCC 10376 in liquid media were also investigated. From an initial level of 7 log CFU/ml, no viable Campylobacter cells were detected following exposure to the most intense UV dose (0.192 J/cm(2)) in liquid media (skim milk subjected to ultrahigh-temperature treatment and diluted 1:4 with maximum recovery diluent). Maximum reductions of 4.8 and 6.2 log CFU/ml were achieved for E. coli and serovar Enteritidis, respectively, in liquid media. Considerable differences in susceptibilities were found between the Campylobacter isolates examined, with variations of up to 4 log CFU/ml being observed. UV treatment of raw chicken fillet (0.192 J/cm(2)) reduced C. jejuni, E. coli, serovar Enteritidis, total viable counts, and Enterobacteriaceae by 0.76, 0.98, 1.34, 1.76, and 1.29 log CFU/g, respectively. Following UV treatment of packaging and surface materials, reductions of up to 3.97, 4.50, and 4.20 log CFU/cm(2) were obtained for C. jejuni, E. coli, and serovar Enteritidis, respectively (P < 0.05). Overall, the color of UV-treated chicken was not significantly affected (P ≥ 0.05). The findings of this study indicate that Campylobacter is susceptible to UV technology and that differences in sensitivities exist between investigated isolates. Overall, UV could be used for improving the microbiological quality of raw chicken and for decontaminating associated packaging and surface materials.

Effectiveness of High Intensity Light Pulses (HILP) treatments for the control of Escherichia coli and Listeria innocua in apple juice, orange juice and milk.

High Intensity Light Pulses (HILP) represent an emerging processing technology which uses short (100-400 µs) light pulses (200-1100 nm) for product decontamination. In this study, model and real foods of differing transparencies (maximum recovery diluent (MRD), apple and orange juices and milk) were exposed to HILP in a batch system for 0, 2, 4 or 8 s at a frequency of 3 Hz. After treatment, inactivation of Escherichia coli or Listeria innocua was evaluated in pre-inoculated samples. Sensory and other quality attributes (colour, pH, Brix, titratable acidity, non-enzymatic browning, total phenols and antioxidant capacity (TEAC)) were assessed in apple juice. Microbial kill decreased with decreasing transparency of the medium. In apple juice (the most transparent beverage) E. coli decreased by 2.65 and 4.5 after exposure times of 2 or 4 s, respectively. No cell recovery was observed after 48 h storage at 4°C. No significant differences were observed in quality parameters, excepting TEAC and flavour score, where 8 s exposure caused a significant decrease (p<0.05). Based on these results, HILP with short exposure times could represent a potential alternative to thermal processing to eliminate undesirable microorganisms, while maintaining product quality, in transparent fruit juices.