Stromal lenticule addition keratoplasty with corneal crosslinking for corneal ectasia secondary to FS-LASIK: a case series.

AIM: To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty (SLAK) with corneal crosslinking (CXL) on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo. The lenticules were collected from patients undertaking small incision lenticule extraction (SMILE) for the correction of myopia. Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength. RESULTS: All surgeries were conducted successfully with no significant complications. Their best corrected visual acuity (BCVA) ranged from 0.05 to 0.8-2 before surgery. The pre-operational total corneal thickness ranged from 345-404 µm and maximum keratometry (Kmax) ranged from 50.8 to 86.3. After the combination surgery, both the corneal keratometry (range 55.9 to 92.8) and total corneal thickness (range 413-482 µm) significantly increased. Four out of 5 patients had improvement of corneal biomechanical parameters (reflected by stiffness parameter A1 in Corvis ST). However, 3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze. Despite the onset of corneal edema right after SLAK, the corneal topography and thickness generally stabilized after 3mo. CONCLUSION: SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia. Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.

Behavior and morphology combine to influence energy dissipation in mantis shrimp (Stomatopoda).

Animals deliver and withstand physical impacts in diverse behavioral contexts, from competing rams clashing their antlers together to archerfish impacting prey with jets of water. Though the ability of animals to withstand impact has generally been studied by focusing on morphology, behaviors may also influence impact resistance. Mantis shrimp exchange high-force strikes on each other's coiled, armored telsons (tailplates) during contests over territory. Prior work has shown that telson morphology has high impact resistance. I hypothesized that the behavior of coiling the telson also contributes to impact energy dissipation. By measuring impact dynamics from high-speed videos of strikes exchanged during contests between freely moving animals, I found that approximately 20% more impact energy was dissipated by the telson as compared with findings from a prior study that focused solely on morphology. This increase is likely due to behavior: because the telson is lifted off the substrate, the entire body flexes after contact, dissipating more energy than exoskeletal morphology does on its own. While variation in the degree of telson coil did not affect energy dissipation, proportionally more energy was dissipated from higher velocity strikes and from strikes from more massive appendages. Overall, these findings show that analysis of both behavior and morphology is crucial to understanding impact resistance, and suggest future research on the evolution of structure and function under the selective pressure of biological impacts.

Sitting versus standing work postures during simulated laparoscopic surgery: in terms of user preferences, comfort, performance and biomechanics.

Prolonged standing in surgery has been linked to an increased risk of musculoskeletal disorders. The aim of this study was to determine whether sitting could serve as an alternative work posture in laparoscopic procedures. Twenty medical students in their third and fourth years were recruited. Sitting and standing were compared at two task complexity levels on a laparoscopic surgery simulator. Measured variables included user posture preferences, perceived discomfort, performance and biomechanics. Electromyography data from the upper trapezius and erector spinae muscles were analysed. Results showed that posture did not affect surgical performance and erector spinae muscle activation. Sitting showed higher muscle activation at the trapezius muscles; however, perceived discomfort was unaffected. Most participants preferred sitting for the difficult task and standing for the easy task. Findings showed that sitting, with appropriate seat design considerations, could serve as an alternative or even as a preferred work posture for simulated laparoscopic procedures.

Prolonged standing in surgery has been linked to increased musculoskeletal disorder risks. This study investigated sitting as a potential alternative work posture to standing. Both postures were tested during simulated laparoscopic procedures. Results showed that sitting can serve as an alternative or even preferred work posture for simulated laparoscopic surgery.

Biomechanical effects of muscle loading on early healing of femoral stem fractures: a combined musculoskeletal dynamics and finite element approach.

Femoral stem fractures (FST) are often accompanied by muscle injuries, however, what muscle injuries affect fracture healing and to what extent is unknown. The purpose of this study was to analyze the extent to which different muscles affect FST healing through a combined musculoskeletal dynamics and finite element approach. Modeling the lower extremity musculoskeletal system for 12 different muscle comprehensives. Muscle and joint reaction forces on the femur were calculated and these data were used as boundary conditions input to the FSTs model to predict the degree of muscle influence on fracture healing. Finally, we will investigate the extent to which muscle influences FST healing during knee flexion. Muscle and joint forces are highly dependent on joint motion and have a significant biomechanical influence on interfragmentary strain (IFS) healing. The psoas major (PM), gastrocnemius lateralis (GL) and gastrocnemius medialis (GM) muscles play a major role in standing, with GM > PM > GL, whereas the gluteus medius posterior (GMP), vastus intermedius (VI), vastus medialis (VM), vastus lateralis superior (VLS), and adductor magnus distalis (AMD) muscles play a major role in knee flexion, with VLS > VM > VI > AMD > GMP. Mechanical stimulus-controlled healing can be facilitated when the knee joint is flexed less than 20°. Different muscles exert varying degrees of influence on the healing of fractures. Therefore, comprehending the impact of particular muscles on fracture site tissue FST healing can aid orthopedic surgeons in formulating improved surgical and rehabilitation strategies.

Podiatric conditions observed in Special Olympics athletes: Contrasting data from a USA versus an international population.

OBJECTIVES: Persons with intellectual disabilities frequently have podiatric conditions. Findings from the 2018 United States Summer games (USA) venues are compared to those from athletes screened at the 2019 Special Olympics World Summer Games in Abu Dhabi, United Arab Emirates (UAE). METHODS: Data from Fit Feet screenings from 2445 United Arab Emirates (UAE) participants were compared to 1244 US participants. RESULTS: A sampling of results that reflect significant differences in findings between the USA cohort and Abu Dhabi cohort include ankle joint range of motion, excessive abduction, hallux abducto valgus and pes planus. The overall shoe to foot mismatch was found to be 52.2%. A professional referral was recommended 27.7% of the time in the USA data and 28.5% in the Abu Dhabi data. An urgent referral was requested 5.1% of the time for the USA data and 3.7% of the time in the Abu Dhabi data. CONCLUSION: Special Olympics athletes experience a greater prevalence of identifiable podiatric conditions as compared to the general population. Several of the conditions investigated in this study differed significantly between the international Special Olympics cohort and the USA cohort. Assessment of the feet of Special Olympics athletes can help to better appreciate the podiatric conditions in a population of individuals with intellectual disabilities. The variance identified between populations of Special Olympics athletes may be a reflection on the lack of standardization of conditions that are assessed for as well as the disparate characteristics of the clinical volunteers. Future Fit Feet events may wish to consider significant improvements in objectivity and standardization as it pertains to the conditions that are evaluated for in the Fit Feet exam.

Passive mechanical properties of adipose tissue and skeletal muscle from C57BL/6J mice.

Skeletal muscle and adipose tissue are characterized by unique structural features finely tuned to meet specific functional demands. In this study, we investigated the passive mechanical properties of soleus (SOL), extensor digitorum longus (EDL) and diaphragm (DIA) muscles, as well as subcutaneous (SAT), visceral (VAT) and brown (BAT) adipose tissues from 13 C57BL/6J mice. Thereto, alongside stress-relaxation assessments we subjected isolated muscles and adipose tissues (ATs) to force-extension tests up to 10% and 30% of their optimal length, respectively. Peak passive stress was highest in the DIA, followed by the SOL and lowest in the EDL (p < 0.05). SOL displayed also the highest Young's modulus and hysteresis among muscles (p < 0.05). BAT demonstrated highest peak passive stress and Young's modulus followed by VAT (p < 0.05), while SAT showed the highest hysteresis (p < 0.05). When comparing data across all six biological specimens at fixed passive force intervals (i.e., 20-40 and 50-70 mN), skeletal muscles exhibited significantly higher peak stresses and strains than ATs (p < 0.05). Young's modulus was higher in skeletal muscles than in ATs (p < 0.05). Muscle specimens exhibited slower force relaxation in the first phase compared to ATs (p < 0.05), while there was no significant difference in behavior between muscles and AT in the second phase of relaxation. The study revealed distinctive mechanical behaviors specific to different tissues, and even between different muscles and ATs. These variations in mechanical properties are likely such to optimize the specific functions performed by each biological tissue.

Influence of muscle activation on lumbar injury under a specific +Gz load.

PURPOSE: The aim of the present study was to analyze the influence of muscle activation on lumbar injury under a specific +Gz load. METHODS: A hybrid finite element human body model with detailed lumbar anatomy and lumbar muscle activation capabilities was developed. Using the specific +Gz loading acceleration as input, the kinematic and biomechanical responses of the occupant's lower back were studied for both activated and deactivated states of the lumbar muscles. RESULTS: The results indicated that activating the major lumbar muscles enhanced the stability of the occupant's torso, which delayed the contact between the occupant's head and the headrest. Lumbar muscle activation led to higher strain and stress output in the lumbar spine under +Gz load, such as the maximum Von-Mises stress of the vertebrae and intervertebral discs increased by 177.9% and 161.8%, respectively, and the damage response index increased by 84.5%. CONCLUSION: In both simulations, the occupant's risk of lumbar injury does not exceed 10% probability. Therefore, the activation of muscles could provide good protection for maintaining the lumbar spine and reduce the effect of acceleration in vehicle travel direction.

Stress Distribution within the Peri-Implant Bone for Different Implant Materials Obtained by Digital Image Correlation.

Stress distribution and its magnitude during loading heavily influence the osseointegration of dental implants. Currently, no high-resolution, three-dimensional method of directly measuring these biomechanical processes in the peri-implant bone is available. The aim of this study was to measure the influence of different implant materials on stress distribution in the peri-implant bone. Using the three-dimensional ARAMIS camera system, surface strain in the peri-implant bone area was compared under simulated masticatory forces of 300 N in axial and non-axial directions for titanium implants and zirconia implants. The investigated titanium implants led to a more homogeneous stress distribution than the investigated zirconia implants. Non-axial forces led to greater surface strain on the peri-implant bone than axial forces. Thus, the implant material, implant system, and direction of force could have a significant influence on biomechanical processes and osseointegration within the peri-implant bone.

A Review of Natural Fiber-Reinforced Composites for Lower-Limb Prosthetic Designs.

This paper presents a comprehensive review of natural fiber-reinforced composites (NFRCs) for lower-limb prosthetic designs. It covers the characteristics, types, and properties of natural fiber-reinforced composites as well as their advantages and drawbacks in prosthetic designs. This review also discusses successful prosthetic designs that incorporate NFRCs and the factors that make them effective. Additionally, this study explores the use of computational biomechanical models to evaluate the effectiveness of prosthetic devices and the key factors that are considered. Overall, this document provides a valuable resource for anyone interested in using NFRCs for lower-limb prosthetic designs.

Cortical and trabecular mechanical properties in the femoral neck vary differently with changes in bone mineral density.

Graphical Abstract.

Field Guide to Traction Force Microscopy.

Introduction: Traction force microscopy (TFM) is a widely used technique to measure cell contractility on compliant substrates that mimic the stiffness of human tissues. For every step in a TFM workflow, users make choices which impact the quantitative results, yet many times the rationales and consequences for making these decisions are unclear. We have found few papers which show the complete experimental and mathematical steps of TFM, thus obfuscating the full effects of these decisions on the final output. Methods: Therefore, we present this "Field Guide" with the goal to explain the mathematical basis of common TFM methods to practitioners in an accessible way. We specifically focus on how errors propagate in TFM workflows given specific experimental design and analytical choices. Results: We cover important assumptions and considerations in TFM substrate manufacturing, substrate mechanical properties, imaging techniques, image processing methods, approaches and parameters used in calculating traction stress, and data-reporting strategies. Conclusions: By presenting a conceptual review and analysis of TFM-focused research articles published over the last two decades, we provide researchers in the field with a better understanding of their options to make more informed choices when creating TFM workflows depending on the type of cell being studied. With this review, we aim to empower experimentalists to quantify cell contractility with confidence. Supplementary Information: The online version contains supplementary material available at 10.1007/s12195-024-00801-6.

Local experience of laboratory activities in a BS physical therapy course: integrating sEMG and kinematics technology with active learning across six cohorts.

Introduction: Integrating technology and active learning methods into Laboratory activities would be a transformative educational experience to familiarize physical therapy (PT) students with STEM backgrounds and STEM-based new technologies. However, PT students struggle with technology and feel comfortable memorizing under expositive lectures. Thus, we described the difficulties, uncertainties, and advances observed by faculties on students and the perceptions about learning, satisfaction, and grades of students after implementing laboratory activities in a PT undergraduate course, which integrated surface-electromyography (sEMG) and kinematic technology combined with active learning methods. Methods: Six cohorts of PT students (n = 482) of a second-year PT course were included. The course had expositive lectures and seven laboratory activities. Students interpreted the evidence and addressed different motor control problems related to daily life movements. The difficulties, uncertainties, and advances observed by faculties on students, as well as the students' perceptions about learning, satisfaction with the course activities, and grades of students, were described. Results: The number of students indicating that the methodology was "always" or "almost always," promoting creative, analytical, or critical thinking was 70.5% [61.0-88.0%]. Satisfaction with the whole course was 97.0% [93.0-98.0%]. Laboratory grades were linearly associated to course grades with a regression coefficient of 0.53 and 0.43 R-squared (p < 0.001). Conclusion: Integrating sEMG and kinematics technology with active learning into laboratory activities enhances students' engagement and understanding of human movement. This approach holds promises to improve teaching-learning processes, which were observed consistently across the cohorts of students.

Unanticipated mid-flight external trunk perturbation increased frontal plane ACL loading variables during sidestep cuttings.

Unanticipated trunk perturbation is commonly observed when anterior cruciate ligament (ACL) injuries occur during direction-changing manoeuvres. This study aimed to quantify the effect of mid-flight medial-lateral external trunk perturbation directions/locations on ACL loading variables during sidestep cuttings. Thirty-two recreational athletes performed sidestep cuttings under combinations of three perturbation directions (no-perturbation, ipsilateral-perturbation, and contralateral-perturbation relative to the cutting leg) and two perturbation locations (upper-trunk versus lower-trunk). The pushing perturbation was created by customised devices releasing a slam ball to contact participants near maximum jump height prior to cutting. Perturbation generally resulted in greater peak vertical ground reaction force and slower cutting velocity. Upper-trunk contralateral perturbation showed the greatest lateral trunk bending away from the travel direction, greatest peak knee flexion and abduction angles, and greatest peak internal knee adduction moments compared to other conditions. Such increased ACL loading variables were likely due to the increased lateral trunk bending and whole-body horizontal velocity away from the cutting direction caused by the contralateral perturbation act at the upper trunk. The findings may help understand the mechanisms of indirect contact ACL injuries and develop effective cutting techniques for ACL injury prevention.

Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue-Hard Tissue Insertions: A Comparative Review.

Connective tissue attaches to bone across an insertion with spatial gradients in components, microstructure, and biomechanics. Due to regional stress concentrations between two mechanically dissimilar materials, the insertion is vulnerable to mechanical damage during joint movements and difficult to repair completely, which remains a significant clinical challenge. Despite interface stress concentrations, the native insertion physiologically functions as the effective load-transfer device between soft tissue and bone. This review summarizes tendon, ligament, and meniscus insertions cross-sectionally, which is novel in this field. Herein, the similarities and differences between the three kinds of insertions in terms of components, microstructure, and biomechanics are compared in great detail. This review begins with describing the basic components existing in the four zones (original soft tissue, uncalcified fibrocartilage, calcified fibrocartilage, and bone) of each kind of insertion, respectively. It then discusses the microstructure constructed from collagen, glycosaminoglycans (GAGs), minerals and others, which provides key support for the biomechanical properties and affects its physiological functions. Finally, the review continues by describing variations in mechanical properties at the millimeter, micrometer, and nanometer scale, which minimize stress concentrations and control stretch at the insertion. In summary, investigating the contrasts between the three has enlightening significance for future directions of repair strategies of insertion diseases and for bioinspired approaches to effective soft-hard interfaces and other tough and robust materials in medicine and engineering.

A surgical technique for individual control of the muscles of the rabbit lower hindlimb.

Little is known regarding the precise muscle, bone and joint actions resulting from individual and simultaneous muscle activation(s) of the lower limb. An in situ experimental approach is described herein to control the muscles of the rabbit lower hindlimb, including the medial and lateral gastrocnemius, soleus, plantaris and tibialis anterior. The muscles were stimulated using nerve-cuff electrodes placed around the innervating nerves of each muscle. Animals were fixed in a stereotactic frame with the ankle angle set at 90 deg. To demonstrate the efficacy of the experimental technique, isometric plantarflexion torque was measured at the 90 deg ankle joint angle at a stimulation frequency of 100, 60 and 30 Hz. Individual muscle torque and the torque produced during simultaneous activation of all plantarflexor muscles are presented for four animals. These results demonstrate that the experimental approach was reliable, with insignificant variation in torque between repeated contractions. The experimental approach described herein provides the potential for measuring a diverse array of muscle properties, which is important to improve our understanding of musculoskeletal biomechanics.

Normative contact mechanics of the ankle Joint: Quantitative assessment utilizing bilateral weightbearing CT.

Alterations in ankle's articular contact mechanics serve as one of the fundamental causes of significant pathology. Nevertheless, computationally intensive algorithms and lack of bilateral weightbearing imaging have rendered it difficult to investigate the normative articular contact stress and side-to-side differences. The aims of our study were two-fold: 1) to determine and quantify the presence of side-to-side contact differences in healthy ankles and 2) to establish normative ranges for articular ankle contact parameters. In this retrospective comparative study, 50 subjects with healthy ankles on bilateral weight-bearing CT were confirmed eligible. Segmentation into 3D bony models was performed semi-automatically, and individualized cartilage layers were modelled based on a previously validated methodology. Contact mechanics were evaluated by using the mean and maximum contact stress of the tibiotalar articulation. Absolute and percentage reference range values were determined for the side-to-side difference. Amongst a cohort of individuals devoid of ankle pathology, mean side-to-side variation in these measurements was < 12 %, while respective differences of > 17 % talar peak stress and > 31 % talar mean stress indicate abnormality. No significant differences were found between laterality in any of the evaluated contact parameters. Understanding these values may promote a more accurate assessment of ankle joint biomechanics when distinguishing acceptable versus pathological contact mechanics in clinical practice.

Biomechanical activation of keloid fibroblasts promotes lysosomal remodelling and exocytosis.

Keloids are a severe form of scarring for which the underlying mechanisms are poorly understood, and treatment options are limited or inconsistent. While biomechanical forces are potential drivers of keloid scarring, the direct cellular responses to mechanical cues have yet to be defined. The aim of this study was to examine the distinct responses of normal dermal fibroblasts (NDFs) and keloid-derived fibroblasts (KDFs) to changes in extracellular matrix (ECM) stiffness. When cultured on hydrogels mimicking the elasticity of normal or scarred skin, KDFs displayed greater stiffness-dependent increases in cell spreading, F-actin stress fibre formation, and focal adhesion assembly. Elevated acto-myosin contractility in KDFs disrupted the normal mechanical regulation of ECM deposition and conferred resistance myosin inhibitors. Transcriptional profiling identified mechanically-regulated pathways in NDFs and KDFs, including the actin cytoskeleton, Hippo signalling, and autophagy. Further analysis of the autophagy pathway revealed that autophagic flux was intact in both fibroblast populations and depended on acto-myosin contractility. However, KDFs displayed marked changes in lysosome organisation and an increase in lysosomal exocytosis, which was mediated by acto-myosin contractility. Together, these findings demonstrate that KDFs possess an intrinsic increase in cytoskeletal tension, which heightens the response to ECM mechanics and promotes lysosomal exocytosis.

Multiscale computational model of aortic remodeling following postnatal disruption of TGFß signaling.

The healthy adult aorta is a remarkably resilient structure, able to resist relentless cardiac-induced and hemodynamic loads under normal conditions. Fundamental to such mechanical homeostasis is the mechano-sensitive cell signaling that controls gene products and thus the structural integrity of the wall. Mouse models have shown that smooth muscle cell-specific disruption of transforming growth factor-beta (TGFß) signaling during postnatal development compromises this resiliency, rendering the aortic wall susceptible to aneurysm and dissection under normal mechanical loading. By contrast, disruption of such signaling in the adult aorta appears to introduce a vulnerability that remains hidden under normal loading, but manifests under increased loading as experienced during hypertension. We present a multiscale (transcript to tissue) computational model to examine possible reasons for compromised mechanical homeostasis in the adult aorta following reduced TGFß signaling in smooth muscle cells.

Incorporating pathological gait into patient-specific finite element models of the haemophilic ankle.

Haemarthrosis is an inherent clinical feature of haemophilia, a disease characterised by an absence or reduction in clotting proteins. Patients with severe haemophilia experience joint bleeding leading to blood-induced ankle arthropathy (haemarthropathy). Altered biomechanics of the ankle have been reported in people with haemophilia; however, the consequence of this on joint health is little understood. The aim of this study was to assess the changes in joint contact due to haemophilia disease-specific gait features using patient-specific modelling, to better understand the link between biomechanics and joint outcomes. Four, image-based, finite element models of haemophilic ankles were simulated through consecutive events in the stance phase of gait, using both patient-specific and healthy control group (n = 36) biomechanical inputs. One healthy control FE model was simulated through the healthy control stance phase of the gait cycle for a point of comparison. The method developed allowed cartilage contact mechanics to be assessed throughout the loading phase of the gait cycle. This showed areas of increased contact pressure in the medial and lateral regions of the talar dome, which may be linked to collapse in these regions. This method may allow the relationship between structure and function in the tibiotalar joint to be better understood.

Effect of a Partial Superficial and Deep Medial Collateral Ligament Injury on Knee Joint Laxity.

BACKGROUND: Injuries to the medial collateral ligament (MCL), specifically the deep MCL (dMCL) and superficial MCL (sMCL), are both reported to be factors in anteromedial rotatory instability (AMRI); however, a partial sMCL (psMCL) injury is often present, the effect of which on AMRI is unknown. PURPOSE: To investigate the effect of a dMCL injury with or without a psMCL injury on knee joint laxity. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen fresh-frozen human cadaveric knees were tested using a 6 degrees of freedom robotic simulator. The anterior cruciate ligament (ACL) was cut first and last in protocols 1 and 2, respectively. The dMCL was cut completely, followed by an intermediary psMCL injury state before the sMCL was completely sectioned. Tibiofemoral kinematics were measured at 0°, 30°, 60°, and 90° of knee flexion for the following measurements: 8 N·m of valgus rotation (VR), 4 N·m of external tibial rotation, 4 N·m of internal tibial rotation, and combined 89 N of anterior tibial translation and 4 N·m of external tibial rotation for both anteromedial rotation (AMR) and anteromedial translation. The differences between subsequent states, as well as differences with respect to the intact state, were analyzed. RESULTS: In an ACL-intact or -deficient joint, a combined dMCL and psMCL injury increased external tibial rotation and VR compared with the intact state at all angles. A significant increase in AMR was seen in the ACL-intact knee after this combined injury. Cutting the dMCL alone showed lower mean increases in AMR compared with the psMCL injury, which were significant only when the ACL was intact in knee flexion. Moreover, cutting the dMCL had no effect on VR. The ACL was the most important structure in controlling anteromedial translation, followed by the psMCL or dMCL depending on the knee flexion angle. CONCLUSION: A dMCL injury alone may produce a small increase in AMRI but not in VR. A combined dMCL and psMCL injury caused an increase in AMRI and VR. CLINICAL RELEVANCE: In clinical practice, if an increase in AMRI at 30° and 90° of knee flexion is seen together with some increase in VR, a combined dMCL and psMCL injury should be suspected.