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PubMed1998

Superior hydrodynamics of a modified cavopulmonary connection for the Norwood operation.

BACKGROUND: In the Fontan circulation, energy consumption at the cavopulmonary connection is crucial. Our hypothesis was that a modification of the standard Norwood variant of cavopulmonary connection with an extended anastomosis would improve hydrodynamics. METHODS: The in vitro hydrodynamics of two different Perspex glass models resembling the Norwood variant of cavopulmonary connection (model I) and the modification (model II) were analyzed in a mock circulation at nonpulsatile flows of 2 to 5 L/min to simulate rest and exercise. The pulmonary flow split was varied to imitate varying lung resistances. Inferior-to-superior caval flow ratio and size of models were increased to simulate growth. RESULTS: The pulmonary flow was preferentially directed to the left lung in model I and was better balanced in model II. Power losses increased exponentially with total flow in both models and were markedly higher in model I. These differences were attenuated in the larger models. Anastomotic turbulences were larger in model I. Power losses in both models were relatively insensitive to changes in pulmonary flow split. CONCLUSIONS: The proposed modification of the Norwood variant of cavopulmonary connection seems to be hydrodynamically advantageous and warrants further evaluation.

Anastomosis, Surgical↗
PubMed1977

The technique of death masks making.

In taking death-masks two different techniques are used. In the technique using a plaster matrix the plaster mash is brought on the face. When the plaster-cast has dried it is filled with plaster mash. Later the matrix is removed in order to lay open the mask. In the technique using a plastic matrix the plastic powder Palgat is brought on the face after mixing it rapidly with icewater until it appears pappy. After that a layer of several centimeters of plaster mash follows in order to stabilize the delicate plastic matrix. Likewise the matrix is filled with plaster mash. The mask can be furnished with a collar and a fixation and the surface can be prepared. The skin relief of the face is reproduced finer using the cast of a plastic matrix.

Cadaver↗
PubMed1988

Effects of collagen microstructure on the mechanics of the left ventricle.

The microstructure of the collagen sheath or weave surrounding a myocyte and the collagen struts interconnecting neighboring myocytes is incorporated into a fluid-fiber-collagen continuum description of the myocardium. The sheaths contribute to anisotropic elasticity, whereas the struts contribute to an isotropic component. Elastic moduli of the composite myocyte-sheath complex and the strut matrix are estimated from existing passive biaxial loading data from sheets of canine myocardium. The contribution of the sheath to the elasticity of the myocyte-sheath complex is critically dependent on the helical pitch angle. Calculations for a cylindrical model of the left ventricle using both a fluid-fiber and fluid-fiber-collagen stress tensor show that the collagen strut matrix tends to limit muscle fiber lengthening; increase myocardial tissue pressure during systole, with endocardial tissue pressure exceeding left ventricular pressure; decrease tissue pressure during diastole, and thus facilitate myocardial blood flow; and aid filling during ventricular relaxation by providing a suction effect that relies on a release of stored elastic energy from the previous contraction. Calculations show that this energy is stored mostly in the collagen struts.

Animals↗
PubMed1990

A physical model of microtubule sliding in ciliary axonemes.

Ciliary movement is caused by coordinated sliding interactions between the peripheral doublet microtubules of the axoneme. In demembranated organelles treated with trypsin and ATP, this sliding can be visualized during progressive disintegration. In this paper, microtubule sliding behavior resulting from various patterns of dynein arm activity and elastic link breakage is determined using a simplified model of the axoneme. The model consists of a cylindrical array of microtubules joined, initially, by elastic links, with the possibility of dynein arm interaction between microtubules. If no elastic links are broken, sliding can produce stable distortion of the model, which finds application to straight sections of a motile cilium. If some elastic links break, the model predicts a variety of sliding patterns, some of which match, qualitatively, the observed disintegration behavior of real axonemes. Splitting of the axoneme is most likely to occur between two doublets N and N + 1 when either the arms on doublet N + 1 are active and arms on doublet N are inactive or arms on doublet N - 1 are active while arms on doublet N are inactive. The analysis suggests further experimental studies which, in conjunction with the model, will lead to a more detailed understanding of the sliding mechanism, and will allow the mechanical properties of some axonemal components to be evaluated.

Animals↗
PubMed1976

Angiographic anatomy of the right heart.

Casts of human hearts were prepared and photographed to illustrate the anatomy of the right heart chambers and ventricular septum. The casts were used to illustrate the anatomy of certain common pathological abnormalities of the ventricular septum and the appearances compared to angiocardiograms.

Angiography↗
PubMed2002

Predictors of difficulty inserting the female condom.

This article describes the frequency of initial difficulty inserting the female condom and identifies predictors of insertion difficulty among women at risk of sexually transmitted diseases (STDs). Female STD clinic patients (n = 1144) were taught how to insert the female condom by using an anatomic model, then given an opportunity for self-insertion practice. Correct placement of the condom was verified by a nurse clinician, and the number of attempts required for correct insertion was recorded. Sociodemographic and psychosocial predictors of refusing the insertion practice and of difficulty inserting the female condom were evaluated using logistic regression. Only 5% of study participants refused the self-insertion practice. Women who never had a Papanicolaou smear test, did not use tampons, never used an inserted method of STD prevention/birth control, and disliked the insertion features of intravaginal barrier methods were more likely to refuse the self-insertion practice. Of those who attempted self-insertion, 25% were unable to insert the female condom correctly on the first attempt. Women who never expressed their sexual likes and were indifferent to the positive features of intravaginal contraceptive methods were more likely to experience difficulty their first insertion attempt. Other variables associated with insertion difficulty included longer fingernails. Insertion refusal and difficulty affect use of the female condom for a sizable proportion of women. Women in this study who refused the self-insertion practice had greater aversion to inserting intravaginal barrier methods. Women who had initial difficulty inserting the female condom had a different profile from those who refused and can benefit from intensive skills training that includes supervised self-insertion practice.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Ear by visual-field interaction on a cross-modal syllable-matching task.

Twenty-eight subjects (15 male, 13 female) performed a visual/auditory cross-modal matching task involving same/different judgements of CVC nonsense syllables. In the visual modality stimuli were presented either unilaterally or at the midline, and in the auditory modality, binaurally or monaurally--giving nine combinations of simultaneous input. Predictions for RT under each condition were derived by aggregating the assumed effects of single modality lateralized presentation on the basis of a simplistic anatomical model. An unpredicted ear X visual-field interaction emerged which, it is speculated, may in part reflect the operation of transcallosal inhibitory effects. Cross-modal matching is proposed as a paradigm for future investigations of interhemispheric integration.

Adolescent↗
PubMed1998

Volume conduction effects in EEG and MEG.

Volume conductor models that are commonly used to describe the EEG and MEG neglect holes in the skull, lesions, the ventricles, and anisotropic conductivity of the skull. To determine the influence of these features, simulations were carried out using the finite element method. The simulations showed that a hole in the skull will have a large effect on the EEG, and as one of the consequences localisation errors up to 15 mm may occur. The effect on the MEG is negligible. The presence of a lesion may cause the shape and magnitude of the EEG and MEG to change. Hence, a lesion has to be taken into account, if the active neurones are close to it. Moreover, a localisation procedure may fail if the lesion is not included in the volume conductor model. Inclusion of the ventricles in the volume conductor model is necessary only if sources are in their vicinity or if their sizes are unusually large. Anisotropic conductivity of the skull has a smearing effect on the EEG but does not influence the MEG.

Algorithms↗
PubMed2004

High performance force feedback mechanism for virtual reality training of endotracheal intubation.

A high-performance mechanism has been developed to provide force feedback during virtual reality simulations of endotracheal intubation for training purposes for the first time. The force feedback mechanism (FFM) prototype permits planar motion of the intubation tool with three degrees of freedom, each with force feedback. The FFM is computer controlled using a hybrid position-force feedback algorithm that includes a feedforward term to counterbalance the mechanism. This allows the intubation force profiles to be superimposed onto the FFM weight compensation to complete the overall force feedback effort. The development of a mechanism of this type introduces several theoretical and experimental design challenges that are addressed in this paper.

Algorithms↗
PubMed2000

A rigid body model of the forearm.

In this article the forearm, with its complex, continuous motion of masses during pronation/supination, was approximated by a rigid body model consisting of a radial segment rotating around an ulnar segment. The method used to obtain the model parameters is based on three-dimensional voxel data that include velocity information. We propose a criterion that allows the voxels to be attributed to either of the two segments. It is based on the notion that the rotational kinetic energy determined from the voxel data equals the kinetic energy of the rigid body model. To obtain a three-dimensional smoothing we further propose a parameterization of the shape of both segments. These shapes can then be used to determine the dynamic integrals of the segments, i.e. mass, center of mass, and inertia. Using this approach we determined all model parameters for a human forearm from three series of MRI scans in a supinated, a pronated, and an intermediate position. In the appendix, a procedure is described that allows the dynamic quantities to be scaled homogeneously without recalculation of the integrals. Thus, this article provides all essential parameters required for three-dimensional dynamic simulations of general movements of the forearm.

Adult↗
PubMed2000

Biomechanical and morphological properties in rat large intestine.

Intestinal stress-strain distributions are important determinants of intestinal function and are determined by the mechanical properties of the intestinal wall, the physiological loading conditions and the zero-stress state of the intestine. In this study the distribution of morphometric measures, residual circumferential strains and stress-strain relationships along the rat large intestine were determined in vitro. Segments from four parts of the large intestine were excised, closed at both ends, and inflated with pressures up to 2kPa. The outer diameter and length were measured. The zero-stress state was obtained by cutting rings of large intestine radially. The geometric configuration at the zero-stress state is of fundamental importance because it is the basic state with respect to which the physical stresses and strains are defined. The outer and inner circumferences, wall thickness and opening angle were measured from digitised images. Subsequently, residual strain and stress-strain distributions were calculated. The wall thickness and wall thickness-to-circumference ratio increased in the distal direction. The opening angle varied between approximately 40 and approximately 125 degrees with the highest values in the beginning of proximal colon (F=1.739, P<0.05). The residual strain at the inner surface was negative indicating that the mucosa-submucosal layers of the large intestine in no-load state are in compression. The four segments showed stress-strain distributions that were exponential. All segments were stiffer in longitudinal direction than in the circumferential direction (P<0.05). The transverse colon seemed stiffest both in the circumferential and longitudinal directions. In conclusion, significant variations were found in morphometric and biomechanical properties along the large intestine. The circumferential residual strains and passive elastic properties must be taken into account in studies of physiological problems in which the stress and strain are important, e.g. large intestinal bolus transport function.

Animals↗
PubMed2000

Mechanical properties of brain tissue in-vivo: experiment and computer simulation.

Realistic computer simulation of neurosurgical procedures requires incorporation of the mechanical properties of brain tissue in the mathematical model. Possible applications of computer simulation of neurosurgery include non-rigid registration, virtual reality training and operation planning systems and robotic devices to perform minimally invasive brain surgery. A number of constitutive models of brain tissue, both single-phase and bi-phasic, have been proposed in recent years. The major deficiency of most of them, however, is the fact that they were identified using experimental data obtained in vitro and there is no certainty whether they can be applied in the realistic in vivo setting. In this paper we attempt to show that previously proposed by us hyper-viscoelastic constitutive model of brain tissue can be applied to simulating surgical procedures. An in vivo indentation experiment is described. The force-displacement curve for the loading speed typical for surgical procedures is concave upward containing no linear portion from which a meaningful elastic modulus might be determined. In order to properly analyse experimental data, a three-dimensional, non-linear finite element model of the brain was developed. Magnetic resonance imaging techniques were used to obtain geometric information needed for the model. The shape of the force-displacement curve obtained using the numerical solution was very similar to the experimental one. The predicted forces were about 31% lower than those recorded during the experiment. Having in mind that the coefficients in the model had been identified based on experimental data obtained in vitro, and large variability of mechanical properties of biological tissues, such agreement can be considered as very good. By appropriately increasing material parameters describing instantaneous stiffness of the tissue one is able, without changing the structure of the model, to reproduce experimental curve almost perfectly. Numerical studies showed also that the linear, viscoelastic model of brain tissue is not appropriate for the modelling brain tissue deformation even for moderate strains.

Animals↗
PubMed2001

Rotational moment arms of the medial hamstrings and adductors vary with femoral geometry and limb position: implications for the treatment of internally rotated gait.

Persons with cerebral palsy frequently walk with a crouched, internally rotated gait. Spastic medial hamstrings or adductors are presumed to contribute to excessive hip internal rotation in some patients; however, the capacity of these muscles to produce internal rotation has not been adequately investigated. The purpose of this study was to determine the hip rotation moment arms of the medial hamstrings and adductors in persons with femoral anteversion deformities who walk with a crouched, internally rotated gait. A musculoskeletal model with a "deformable" femur was developed. This model was used, in conjunction with kinematic data obtained from gait analysis, to calculate the muscle moment arms for combinations of joint angles and anteversion deformities exhibited by 21 subjects with cerebral palsy and excessive hip internal rotation. We found that the semimembranosus, semitendinosus, and gracilis muscles in our model had negligible or external rotation moment arms when the hip was internally rotated or the knee was flexed -- the body positions assumed by the subjects during walking. When the femur was excessively anteverted, the rotational moment arms of the adductor brevis, adductor longus, pectineus, and proximal compartments of the adductor magnus in our model shifted toward external rotation. These results suggest that neither the medial hamstrings nor the adductors are likely to contribute substantially to excessive internal rotation of the hip and that other causes of internal rotation should be considered when planning treatments for these patients.

Adolescent↗
PubMed2001

Effects of curved inlet tubes on air flow and particle deposition in bifurcating lung models.

In vivo bifurcating airways are complex and the airway segments leading to the bifurcations are not always straight, but curved to various degrees. How do such curved inlet tubes influence the motion as well as local deposition and hence the biological responses of inhaled particulate matter in lung airways? In this paper steady laminar dilute suspension flows of micron-particles are simulated in realistic double bifurcations with curved inlet tubes, i.e., 0 degrees < or =theta< or =90 degrees, using a commercial finite-volume code with user-enhanced programs. The resulting air-flow patterns as well as particle transport and wall depositions were analyzed for different flow inlet conditions, i.e., uniform and parabolic velocity profiles, and geometric configurations. The curved inlet segments have quite pronounced effects on air-flow, particle motion and wall deposition in the downstream bifurcating airways. In contrast to straight double bifurcations, those with bent parent tubes also exhibit irregular variations in particle deposition efficiencies as a function of Stokes number and Reynolds number. There are fewer particles deposited at mildly curved inlet segments, but the particle deposition efficiencies at the downstream sequential bifurcations vary much when compared to those with straight inlets. Under certain flow conditions in sharply curved lung airways, relatively high, localized particle depositions may take place. The findings provide necessary information for toxicologic or therapeutic impact assessments and for global lung dosimetry models of inhaled particulate matter.

Biomechanical Phenomena↗
PubMed2001

Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing.

Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Biomechanical Phenomena↗
PubMed2001

Accuracy of the functional method of hip joint center location: effects of limited motion and varied implementation.

Accurate location of the hip joint center is essential for computation of hip kinematics and kinetics as well as for determination of the moment arms of muscles crossing the hip. The functional method of hip joint center location involves fitting a pelvis-fixed sphere to the path traced by a thigh-fixed point while a subject performs hip motions; the center of this sphere is the hip joint center. The aim of the present study was to evaluate the potential accuracy of the functional method and the dependence of its accuracy on variations in its implementation and the amount of available hip motion. The motions of a mechanical linkage were studied to isolate the factors of interest, removing errors due to skin movement and the palpation of bony landmarks that are always present in human studies. It was found that reducing the range of hip motion from 30 degrees to 15 degrees did significantly increase hip joint center location errors, but that restricting motion to a single plane did not. The magnitudes of these errors, however, even in the least accurate cases, were smaller than those previously reported for either the functional method or other methods based on pelvis measurements of living subjects and cadaver specimens. Neither increasing the number of motion data observations nor analyzing the motion of a single thigh marker (rather than the centroid of multiple markers) was found to significantly increase error. The results of this study (1) imply that the limited range of motion that is often evident in subjects with hip pathology does not preclude accurate determination of the hip joint center when the functional method is used; and (2) provide guidelines for the use of the functional method in human subjects.

Biomechanical Phenomena↗