Analytical studies of injury criteria for the thorax

The viscous criterion is a recently developed criterion to assess injury severity of the human thorax. In the viscous criterion, the peak viscous response, which is defined as the maximum product of deformation velocity and compression of an object, is proposed as a predictor of injury risk. However, the physical meaning of the criterion is not very clear. In this paper, the mathematical properties of the viscous criterion are analyzed. A mechanical thorax model is then used to relate the criterion to the physical quantities of the model using energy concepts. It is found that the so-called peak viscous response is strongly related to the peak energy storing rate of the thorax which is not related to the viscosity of the thorax. It is also shown that the viscous response of the thorax is given by the integral of the velocity squared with respect to time. The analysis is further expanded to a more general case to result in four criteria based upon the energy concepts. A hypothesis for injury assessment is proposed by using the four criteria.     

Temporal development of hippocampal cell death is dependent on tissue strain but not strain rate

Deformation of brain tissue in response to mechanical loading of the head is the root-cause of traumatic brain injury (TBI). Even below ultimate failure limits, deformation activates pathophysiological cascades resulting in delayed cell death. Injury response of soft tissues, such as the chest and spinal cord, is dependent on the product of deformation and velocity, a parameter termed the viscous criterion. We set out to test if hippocampal cell death could be predicted by a similar combination of strain and strain rate and if the viscous criterion was valid for hippocampus. Quantitative prediction of the brain's biological response to mechanical stimuli is difficult to achieve in animal models of TBI, so we utilized an in vitro model of TBI based on hippocampal slice cultures. We quantified the temporal development of cell death after precisely controlled deformations for 30 combinations of strain (0.05-0.50) and strain rate (0.1-50s(-1)) relevant to TBI. Loading conditions for a subset of cultures were verified by analysis of high-speed video. Cell death was found to be significantly dependent on time-post injury, on strain magnitude, and to a lesser extent, on anatomical region by a repeated-measures, three-way ANOVA. The responses of the CA1 and CA3 regions of the hippocampus were not statistically different in contrast to some in vivo TBI studies. Surprisingly, cell death was not dependent on strain rate leading us to conclude that the viscous criterion is not a valid predictor for hippocampal tissue injury. Given the large data set and extensive combinations of biomechanical parameters, predictive mathematical functions relating independent variables (strain, region, and time post-injury) to the resultant cell death were defined. These functions can be used as tolerance criteria to equip finite element models of TBI with the added capability to predict biological consequences.     

Simulation of soft tissue failure using the material point method

Understanding the factors that control the extent of tissue damage as a result of material failure in soft tissues may provide means to improve diagnosis and treatment of soft tissue injuries. The objective of this research was to develop and test a computational framework for the study of the failure of anisotropic soft tissues subjected to finite deformation. An anisotropic constitutive model incorporating strain-based failure criteria was implemented in an existing computational solid mechanics software based on the material point method (MPM), a quasi-meshless particle method for simulations in computational mechanics. The constitutive model and the strain-based failure formulations were tested using simulations of simple shear and tensile mechanical tests. The model was then applied to investigate a scenario of a penetrating injury: a low-speed projectile was released through a myocardial material slab. Sensitivity studies were performed to establish the necessary grid resolution and time-step size. Results of the simple shear and tensile test simulations demonstrated the correct implementation of the constitutive model and the influence of both fiber family and matrix failure on predictions of overall tissue failure. The slab penetration simulations produced physically realistic wound tracts, exhibiting diameter increase from entrance to exit. Simulations examining the effect of bullet initial velocity showed that the anisotropy influenced the shape and size of the exit wound more at lower velocities. Furthermore, the size and taper of the wound cavity was smaller for the higher bullet velocity. It was concluded that these effects were due to the amount of momentum transfer. The results demonstrate the feasibility of using MPM and the associated failure model for large-scale numerical simulations of soft tissue failure.     

Effects of intramuscular fat infiltration, scarring, and spasticity on the risk for sitting-acquired deep tissue injury in spinal cord injury patients

Sitting-acquired deep tissue injury (DTI) is a severe form of pressure ulcer (PU) often affecting patients with spinal cord injury (SCI) who also tend to suffer from intramuscular fat infiltration, soft tissue scarring (due to previous PU), and/or muscle spasticity in their buttocks. We previously used finite element (FE) modeling to evaluate whether abnormal bodyweight is a risk factor for sitting-acquired DTI. Here we hypothesize that fat infiltration, scarring, or spasms increase internal loads in the gluteus muscles in the vicinity of the ischial tuberosities during sitting, which consequently put SCI patients with these conditions at a higher risk for DTI. Our objective was to determine changes in gluteal strains and stresses and tissue volumes exposed to elevated strains/stresses associated with these factors. Thirty-five FE models of coronal slices through the seated buttocks, simulating these conditions at different severities, were developed. We calculated peak strains and stresses in glutei and percentage volumes of muscle tissue exposed to above-critical strains/stresses (compression strain≥50%, compression/von Mises stress≥2?kPa, and strain energy density≥0.5?kPa). Progressive intramuscular fat infiltration increased all the aforementioned outcome measures. Increase in size of scar patterns that were contained in both muscle and fat tissues similarly elevated the outcome measures. Spasms increased muscle stresses and volumetric exposures to stress, but tissue volumes at risk were ～1-2% and increases due to spasticity were slight. We conclude that the above potential risk factors can be listed according to the following order of importance: (i) fat infiltration, (ii) scars contained in both muscle and fat tissues, and (iii) spasms. This information should be considered when prioritizing prevention means and resources for patients with SCI.     

A parametric study of the thoracic injury potential of basic taekwondo kicks.

A parametric investigation of the thoracic injury potential of basic taekwondo kicks was conducted through the use of computer simulations. Linkage-based models were employed to simulate the kinetics of the kicking leg and were used to drive a human thorax model. The results of the analysis according to the thoracic compression criterion indicated a minimal probability of severe injury (AIS4+) for swing kicks, nearly 0 percent and thrust kicks, less than three percent. The thoracic viscous criteria, on the other hand, predicted a severe injury probability of up to 100 percent for swing kicks and up to 80 percent for thrust kicks. Additional analysis showed that the injury potential was a strong function of the kick velocity and a weak function of the applied constant force. The injury potential was also found to be a weak function of the size and weight of the kicking leg, with variations in the peak compression and viscous response being typically below 5 percent for a 20 percent change in either the mass or the length.     

Compression-induced damage and internal tissue strains are related

Prolonged mechanical loading of soft tissues adjacent to bony prominences can lead to degeneration of muscle tissue, resulting in a condition termed pressure-related deep tissue injury. This type of deep pressure ulcers can develop into a severe wound, associated with problematic healing and a variable prognosis. Limited knowledge of the underlying damage pathways impedes effective preventive strategies and early detection. Traditionally, pressure-induced ischaemia has been thought to be the main aetiological factor for initiating damage. Recent research, however, proposes tissue deformation per se as another candidate for initiating pressure-induced deep tissue injury. In this study, different strain parameters were evaluated on their suitability as a generic predictive indicator for deep tissue injury. With a combined animal-experimental numerical approach, we show that there is a reproducible monotonic increase in damage with increasing maximum shear strain once a strain threshold has been exceeded. This relationship between maximum shear strain and damage seems to reflect an intrinsic muscle property, as it applied across a considerable number of the experiments. This finding confirms that tissue deformation per se is important in the aetiology of deep tissue injury. Using dedicated finite element modeling, a considerable reduction in the inherent biological variation was obtained, leading to the proposal that muscle deformation can prove a generic predictive indicator of damage.     

Temporal differences in the influence of ischemic factors and deformation on the metabolism of engineered skeletal muscle.

Prolonged periods of tissue compression may lead to the development of pressure ulcers, some of which may originate in, for example, skeletal muscle tissue and progress underneath intact skin, representing deep tissue injury. Their etiology is multifactorial and the interaction between individual causal factors and their relative importance remain unknown. The present study addressed the relative contributions of deformation and ischemic factors to altered metabolism and viability. Engineered muscle tissue was prepared as previously detailed (14) and subjected to a combination of factors including 0% oxygen, lactic acid concentrations resulting in pH from 5.3 to 7.4, 34% compression, and low glucose levels. Deformation had an immediate effect on tissue viability {[3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] (MTT) assay}, which increased with time. By contrast, hypoxia evoked metabolic responses (glucose and lactate levels) within 24 h, but viability was only reduced after 48 h. In addition, lactic acidification downregulated tissue metabolism up to an acid concentration ( approximately 23 mM) where metabolism was arrested and cell death enhanced. A similar tissue response was observed during glucose deprivation, which, at negligible concentration, resulted in both a cessation of metabolic activity and a reduction in cell viability. The combination of results suggests that in a short-term (<24 h) deformation, extreme acidification and glucose deprivation increased the level of cell death. By contrast, nonextreme acidification and hypoxia influenced tissue metabolism, but not the development of cell death. These data provide more insight into how compression-induced factors can lead to the onset of deep tissue injury.     

Inertia effects on characterization of dynamic response of brain tissue

Modeling and simulation of traumatic brain injury (TBI) resulted from collision or blast loading requires characterization of mechanical response over a wide range of loading rates under valid testing conditions. In this study, mechanical response of fresh bovine brain tissue was studied using the two modified Kolsky bar techniques. Radial deformation behavior of annular specimens, which are typically used to characterize the dynamic uniaxial compressive response of biological tissues, was examined using a modified Kolsky bar and a high speed camera to collect images while the specimen deforms at an axial strain rate of 2000s(-1). The high-speed images revealed inhomogeneous specimen deformation possibly brought about by radial inertia and causing a multi-axial stress state. To acquire valid stress-strain results that can be used to produce constitutive behavior of the soft materials, a novel torsion technique was developed to obtain pure shear response at dynamic loading rates. Experimental results show clear differences in the material response using the two methods. These results indicate that the previously demonstrated annular specimen geometry aimed at reducing inertia induced stress components for high rate soft materials uniaxial-compressive testing may still possess a significant component of radial inertia induced radial stress which consequently caused the observed inhomogeneous deformation in brain tissue test samples.     

Material characterization of the pig kidney in relation with the biomechanical analysis of renal trauma

The objective of this study was an investigation of the material properties of the fresh pig kidney and parametric characterization of its elastic and inelastic material behavior. The material investigation included density measurements, uniaxial as well as three-dimensional compression tests, tensile tests. and shear tests on the samples extracted from the fresh pig kidney. For comparison, density measurements on a number of soft synthetic materials were also performed. Compression tests on the radial and the tangential specimens from the cortex tissue were performed at various loading rates. Three-axial compression tests were performed on the cortex tissues placed in a compression chamber. Shear tests were performed by punching a cylinder into a slice of the cortex. Tensile tests were carried out on the outer capsule. For characterization of the material behavior, a non-linear theoretical simulation based on a two parameter Blatz model was used. For characterization of the time-dependent behavior of the pig kidney cortex, a four-parameter linear viscoelastic model was employed. From the present experimental and theoretical studies, a number of conclusions were derived: (1) The general behavior of the pig kidney cortex samples under compression showed the general non-linear features typical of the soft tissues; the stress strain diagram was composed of a very flat part at very low stress level to about 30% relative deformation which was followed by a steeply rising stiffening leading to the radial rupture of samples marked by a maximum nominal rupture strain of about 50%. (2) The uniaxial compression tests on the radial and the tangential samples from the cortex tissue showed an increase of the rupture stress with the increase in the loading rate, but a decrease in the related rupture strain. (3) The long-term uniaxial compression tests on the cortex specimens under sustained constant load showed an instantaneous deformation followed by a creep response which eventually approached an asymptote. (4) Simulation of the non-linear material behavior of the cortex tissue under uniaxial compression by the Blatz model gave two pairs of material parameters for the cortex in the radial and the tangential directions. Furthermore, fitting of the assumed four-parameter linear viscoelastic model with the experimental data resulted in the viscoelastic material parameters.     

Effect of non-uniform thickness of samples in stress relaxation tests under unconfined compression of samples of articular discs

A precise information of the biomechanical properties of soft tissues is required to develop a suitable simulation model, with which the distribution of stress and strain in the complex structures can be estimated. Many soft tissues have been mechanically characterized by stress relaxation tests under unconfined or confined compression. In general, full-thickness samples are extracted to reduce the damage in the tissue as much as possible. However, it is not guaranteed that these samples have a uniform thickness or, in other words, planar parallel faces. In particular, in the articular disc of the temporomandibular joint, many studies can be found testing full-thickness samples for which that thickness is known to be non-uniform, while making the assumption of uniaxial stress state to extract the mechanical properties from those tests. That inaccuracy may have a strong influence in some cases and needs a profound revision. The main goal of this work is to quantify the error committed in that assumption and the influence of the variation of thickness on that error in a particular test: stress relaxation tests under unconfined compression. Based on this error and defining an allowable tolerance, a criterion is established to reject samples depending on their aspect ratio.     

Lubricated squeezing flow: a useful method for measuring the viscoelastic properties of soft tissues

Conducting experiments on very soft biological tissues can be difficult. Traditionally, unconfined compression and shear have been used. Here, an improved method of compression testing, lubricated squeezing flow is described. This gives a uniform compression along the squeezing axis and almost uniform equi-biaxial elongation at right angles to the squeezing axis, with minimal shear deformation due to the constant lubrication of the sample surfaces during testing. Sample results for porcine liver obtained using this method are described here.     

Investment into Human Risks in Railways and Decision Optimization

ABSTRACT

The Life Quality Index (LQI) is a rational way to establish a relationship among the resources utilized to improve human safety and the expected fatalities that can be avoided by safety improvement. This article uses the LQI approach to quantify the social benefits of a number of safety management plans for a railway facility such as level crossing (LC). We apply influence diagrams (IDs), which are the extensions of Bayesian Networks, to model and assess the life safety risks. In IDs, problems of probabilistic inference, economics-based utility values, and decision alternatives are combined and optimized. The optimal decision, which maximizes total benefits to society, is obtained for the LC. As low as reasonably practicable (ALARP) case, and is a widely accepted risk acceptance criteria in the railway industry. According to the ALARP, there exists a so-called tolerable region between the regions of intolerable and negligible risks. In the tolerable region, risk is undertaken only if a benefit is desired. To quantify socioeconomic benefits, one needs to have an additional risk acceptance criterion such as LQI. In this article we apply and discuss the advantages of the LQI and the IDs for a number of safety management plans for railway LCs.     

Subject-specific finite element models implementing a maximum principal strain criterion are able to estimate failure risk and fracture location on human femurs tested in vitro

No agreement on the choice of the failure criterion to adopt for the bone tissue can be found in the literature among the finite element studies aiming at predicting fracture risk of bones. The use of stress-based criteria seems to prevail on strain-based ones, while basic bone biomechanics suggest using strain parameters to describe failure. The aim of the present combined experimental-numerical study was to verify, using subject-specific finite element models able to accurately predict strains, if a strain-based failure criterion could identify the failure patterns of bones. Three cadaver femurs were CT-scanned and subsequently fractured in a clinically relevant single-stance loading scenario. Load-displacement curves and high-speed movies were acquired to define the failure load and the location of fracture onset, respectively. Subject-specific finite element models of the three femurs were built from CT data following a validated procedure. A maximum principal strain criterion was implemented in the finite element models, and two stress-based criteria selected for comparison. The failure loads measured were applied to the models, and the computed risks of fracture were compared to the results of the experimental tests. The proposed principal strain criterion managed to correctly identify the level of failure risk and the location of fracture onset in all the modelled specimens, while Von Mises or maximum principal stress criteria did not give significant information. A maximum principal strain criterion can thus be defined a suitable candidate for the in vivo risk factor assessment on long bones.     

Influence of the chest compression measurement method on assessment of restraint performance in side-impact crash scenarios

Side impact crashes contribute a significant number of fatal injuries (25% of road fatalities in the USA in 2016), with severe thoracic injuries diagnosed in 58% of front near-side impact occupants. Epidemiological data indicate that thoracic-only side airbags (tSABs) are not as effective as laboratory testing has suggested, and one of the reasons for this may be the use of surrogate-specific injury assessment methods, which are not directly transferable between Anthropometric Test Devices (ATDs) and Post-Mortem Human Surrogates (PMHSs). This study examines the effect of the thorax deformation measurement location and method on the predicted performance of seatbelts and tSABs in a side impact using a Human Body Model (HBM). The HBM was integrated in a vehicle and subjected to a Moving Deformable Barrier (MDB) impact at 61 km/h, with four restraint configurations: belted and unbelted, with and without a tSAB. Occupant response was assessed through chest band (CB) deformation, and as a change in distance between markers on the ribs. Multiple measurement locations in the HBM enabled direct comparison between the methods. The CB method indicated a 35% increase of chest compression due to tSAB; the rib-deflection (RD) method was not sensitive to the tSAB. The RD method predicted a 20% reduction of chest compression due to the seatbelt, but the CB-measured change was negligible. This study highlights the importance of measurement method on the response outcome and demonstrates that different outcomes may be predicted using a HBM for the same impact scenario, depending on the measurement method.     

Poromechanics of compressible charged porous media using the theory of mixtures

Osmotic, electrostatic, and/or hydrational swellings are essential mechanisms in the deformation behavior of porous media, such as biological tissues, synthetic hydrogels, and clay-rich rocks. Present theories are restricted to incompressible constituents. This assumption typically fails for bone, in which electrokinetic effects are closely coupled to deformation. An electrochemomechanical formulation of quasistatic finite deformation of compressible charged porous media is derived from the theory of mixtures. The model consists of a compressible charged porous solid saturated with a compressible ionic solution. Four constituents following different kinematic paths are identified: a charged solid and three streaming constituents carrying either a positive, negative, or no electrical charge, which are the cations, anions, and fluid, respectively. The finite deformation model is reduced to infinitesimal theory. In the limiting case without ionic effects, the presented model is consistent with Blot's theory. Viscous drag compression is computed under closed circuit and open circuit conditions. Viscous drag compression is shown to be independent of the storage modulus. A compressible version of the electrochemomechanical theory is formulated. Using material parameter values for bone, the theory predicts a substantial influence of density changes on a viscous drag compression simulation. In the context of quasistatic deformations, conflicts between poromechanics and mixture theory are only semantic in nature.     

Effect of adrenaline on kidney lysosome function in rats during prolonged soft tissue crushing

The total and unsedimentable activity of acid DNase, RNase, phosphatase and arylsulfatases A and B was examined in the rat kidneys during long-term compression of soft tissues in the presence of high excitability of the sympathoadrenal system. Injection of adrenalin to rats with trauma reduced the total activity of DNase, acid phosphatase and arylsulfatases A and B, particularly at the late periods of soft tissue compression, whereas the total activity of acid RNase slightly increased as compared with control. Compression of soft tissues after adrenalin preinjection was accompanied by a substantial rise of unsedimentable activity of the lysosomal enzymes under study in the kidneys. The activity of the enzymes in cytosol progressively ascended as the time of soft tissue injury increased.     

Evidence for increased de novo synthesis of NAD in immune-activated RAW264.7 macrophages: a self-protective mechanism?

Chondrogenesis in cartilage development and repair and cartilage degeneration in arthritis can be regulated by mechanical-load-induced physical factors such as tissue deformation, interstitial fluid flow and pressure, and electrical fields or streaming potentials. Previous animal and tissue explant studies have shown that time-varying dynamic tissue loading can increase the synthesis and deposition of matrix molecules in an amplitude-, frequency-, and spatially dependent manner. To provide information on the cell-level physical factors which may stimulate chondrocytes to increase production and export of aggrecan, the main proteoglycan component of the cartilage matrix, we characterized local changes in aggrecan synthesis within cyclically loaded tissue explant disks and compared those changes to values of predicted local physical factors. Aggrecan synthesis following a 23-h compression/radiolabel protocol was measured with a spatial resolution of approximately 0.1 mm across the 1.5-mm radius of explanted disks using a quantitative autoradiography method. A uniform stimulation of aggrecan synthesis was observed at an intermediate frequency of 0.01 Hz, while, at a higher frequency of 0.1 Hz, stimulation was only seen at peripheral radial positions. Profiles of radial solid matrix deformation and interstitial fluid pressure and velocity predicted to be occurring across the radius of the disk during sinusoidal loading were estimated using a composite poroelastic model. Tissue regions experiencing high interstitial fluid velocities corresponded to those displaying increased aggrecan synthesis. These results reinforce the role of load-induced flow of interstitial fluid in the stimulation of aggrecan production during dynamic loading of cartilage.     

The shear mechanical properties of diabetic and non-diabetic plantar soft tissue

Changes in the plantar soft tissue shear properties may contribute to ulceration in diabetic patients, however, little is known about these shear parameters. This study examines the elastic and viscoelastic shear behavior of both diabetic and non-diabetic plantar tissue. Previously compression tested plantar tissue specimens (n=54) at six relevant plantar locations (hallux, first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus) from four cadaveric diabetic feet and five non-diabetic feet were utilized. Per in vivo data (i.e., combined deformation patterns of compression followed by shear), an initial static compressive strain (36-38%) was applied to the tissue followed by target shear strains of 50% and 85% of initial thickness. Triangle waves were used to quantify elastic parameters at both strain levels and a stress relaxation test (0.25 s ramp and 300 s hold) was used to quantify the viscoelastic parameters at the upper strain level. Several differences were found between test groups including a 52-62% increase in peak shear stress, a 63% increase in toe shear modulus, a 47% increase in final shear modulus, and a 67% increase in middle slope magnitude (sharper drop in relaxation) in the diabetic tissue. Beyond a 54% greater peak compressive stress in the third metatarsal compared to the lateral midfoot, there were no differences in shear properties between plantar locations. Notably, this study demonstrates that plantar soft tissue with diabetes is stiffer than healthy tissue, thereby compromising its ability to dissipate shear stresses borne by the foot that may increase ulceration risk.     

Strains and stresses in sub-dermal tissues of the buttocks are greater in paraplegics than in healthy during sitting

A pressure-related deep tissue injury (DTI) is a severe pressure ulcer, which initiates in muscle tissue overlying a bony prominence (e.g. the ischial tuberosities, IT) and progresses outwards through fat and skin, unnoticed by the paralyzed patient. We recently showed that internal strains and stresses in muscle and fat of individuals at anatomical sites susceptible to DTI can be evaluated by integrating Open-MRI scans with subject-specific finite element (FE) analyzes (Linder-Ganz et al., Journal of Biomechanics, 2007); however, sub-dermal soft tissue strains/stresses from paraplegics are still missing in literature. We hypothesize that the pathoanatomy of the buttocks in paraplegia increases the internal soft tissue loads under the IT, making these patients inherently susceptible to DTI. We hence compared the strain and stress peaks in the gluteus muscle and fat tissues under the IT of six healthy and six paraplegic patients, using the coupled MRI-FE method. Peak principal compression, principal tension, von Mises and shear strains in the gluteus were 1.2-, 3.1-, 1.4- and 1.4-fold higher in paraplegics than in healthy, respectively (p<0.02). Likewise, peak principal compression, principal tension, von Mises and shear stresses in the gluteus were 1.9-, 2.5-, 2.1- and 1.7-fold higher for the paraplegics (p<0.05). Peak gluteal compression and shear stresses decreased by as much as 70% when the paraplegic patients moved from a sitting to a lying posture, indicating on the effectiveness of recommending such patients to lie down after prolonged periods of sitting. This is the first attempt to compare internal soft tissue loads between paraplegic and healthy subjects, using an objective standardized bioengineering method of analysis. The findings support our hypothesis that internal tissue loads are significantly higher in paraplegics, and that postural changes significantly affect these loads. The method of analysis is useful for quantifying the effectiveness of various interventions to alleviate sub-dermal tissue loads at sites susceptible to pressure ulcers and DTI, including cushions, mattresses, recommendations for posture and postural changes, etc.