Pancreatic anastomosis training models: Current status and future directions.

Postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality after pancreatoduodenectomy (PD), and previous research has focused on patient-related risk factors and comparisons between anastomotic techniques. However, it is recognized that surgeon experience is an important factor in POPF outcomes, and that there is a significant learning curve for the pancreatic anastomosis. The aim of this study was to review the current literature on training models for the pancreatic anastomosis, and to explore areas for future research. It is concluded that research is needed to understand the mechanical properties of the human pancreas in an effort to develop a synthetic model that closely mimics its mechanical properties. Virtual reality (VR) is an attractive alternative to synthetic models for surgical training, and further work is needed to develop a VR pancreatic anastomosis training module that provides both high fidelity and haptic feedback.

Frequency and time dependent viscoelastic characterization of pediatric porcine brain tissue in compression.

Understanding the viscoelastic behavior of pediatric brain tissue is critical to interpret how external mechanical forces affect head injury in children. However, knowledge of the viscoelastic properties of pediatric brain tissue is limited, and this reduces the biofidelity of developed numeric simulations of the pediatric head in analysis of brain injury. Thus, it is essential to characterize the viscoelastic behavior of pediatric brain tissue in various loading conditions and to identify constitutive models. In this study, the pediatric porcine brain tissue was investigated in compression with determine the viscoelasticity under small and large strain, respectively. A range of frequencies between 0.1 and 40 Hz was applied to determine frequency-dependent viscoelastic behavior via dynamic mechanical analysis, while brain samples were divided into three strain rate groups of 0.01/s, 1/s and 10/s for compression up to 0.3 strain level and stress relaxation to obtain time-dependent viscoelastic properties. At frequencies above 20 Hz, the storage modulus did not increase, while the loss modulus increased continuously. With strain rate increasing from 0.01/s to 10/s, the mean stress at 0.1, 0.2 and 0.3 strain increased to approximate 6.8, 5.6 and 4.4 times, respectively. The brain compressive response was sensitive to strain rate and frequency. The characterization of brain tissue will be valuable for development of head protection systems and prediction of brain injury.

A geometry-based finite element tool for evaluating mitral valve biomechanics.

Mitral valve function depends on its complex geometry and tissue health, with alterations in shape and tissue response affecting the long-term restorarion of function. Previous computational frameworks for biomechanical assessment are mostly based on patient-specific geometries; however, these are not flexible enough to yield a variety of models and assess mitral closure for individually tuned morphological parameters or material property representations. This study details the finite element approach implemented in our previously developed toolbox to assess mitral valve biomechanics and showcases its flexibility through the generation and biomechanical evaluation of different models. A healthy valve geometry was generated and its computational predictions for biomechanics validated against data in the literature. Moreover, two mitral valve models including geometric alterations associated with disease were generated and analysed. The healthy mitral valve model yielded biomechanical predictions in terms of valve closure dynamics, leaflet stresses and papillary muscle and chordae forces comparable to previous computational and experimental studies. Mitral valve function was compromised in geometries representing disease, expressed by the presence of regurgitating areas, elevated stress on the leaflets and unbalanced subvalvular apparatus forces. This showcases the flexibility of the toolbox concerning the generation of a range of mitral valve models with varying geometric definitions and material properties and the evaluation of their biomechanics.

Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases.

Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.

Development and experimental validation of a dynamic numerical model for human articular cartilage.

The purpose of this study was to create a preliminary set of experimentally validated Finite Element Analysis (FEA) models, in order to predict the dynamic mechanical behaviour of human articular cartilage (AC). Current models consider static loading with limited independent experimental validation, while the models for this study assess dynamic loading of AC, with direct comparison and validation to physical testing. Three different FEA models of AC were constructed, which considered both linear elastic and hyperelastic models; Neo-Hookean and Ogden. Models were validated using the data collected from compression testing of human femoral heads across 0-1.7 MPa (quasi-static tests and dynamic mechanical analysis). The linear elastic model was inadequate, with a 10-fold over prediction of the displacement dynamic amplitude. The Neo-Hookean model accurately predicted the dynamic amplitude but failed to predict the initial compression of the cartilage, with a 10 times overprediction. The Ogden model provided the best results, with both the initial compression lying within one standard deviation of that observed in the validation data set, and the dynamic amplitude of the same order of magnitude. In conclusion, this study has found that the fast dynamic response of human AC is best represented by a third order Ogden model.

Analysis of hydration and subchondral bone density on the viscoelastic properties of bovine articular cartilage.

BACKGROUND: Articular cartilage is known to be a viscoelastic material, however little research has explored the impact of cartilage water content and bone density on its viscoelasticity. This study aimed to isolate subchondral bone density and hydration of articular cartilage and analyse their effects on the viscoelastic properties of articular cartilage. METHODS: Dynamic mechanical analysis was used to test samples at frequencies of 1, 8, 12, 29, 49, 71, and 88 Hz. Synthetic bone material with densities of 663.7 kg/m3 and 156.8 kg/m3 were used to mimic the bone mineral density (BMD). Dehydration occurred in a stepwise manner at relative humidity (RH) levels of 100%, 30%, and 1%. These relative humidity levels led to water contents of approximately 76%, 8.5%, and ≈ 0% by mass, respectively. RESULTS: Samples from eight bovine femoral heads were tested under a sinusoidal load. Storage stiffness was lower on the lower substrate density. Storage stiffness, though, increased as cartilage samples were dehydrated from a water content of 76% to 8.5%; decreasing again as the water content was further reduced. Loss stiffness was lower on a lower density substrate and decreased as the water content decreased. CONCLUSIONS: In conclusions, a decrease in hydration decreases the loss stiffness, but a non-linear relationship between hydration and storage stiffness may exist. Additionally, higher BMD values led to greater storage and loss stiffnesses.

Lifecycle sustainability assessment for the comparison of traditional and sustainable drainage systems.

Urban drainage is a topic of increasing interest due to its key role for managing water-related disasters, which are being exacerbated by the effects of Climate Change and urbanization. Since traditional drainage systems struggle to deal with the combined action of these phenomena, Sustainable Drainage Systems (SuDS) are gaining attention as an alternative to help manage these high-water management demands. In this context, this research aimed at conducting a lifecycle sustainability assessment for comparing the economic, environmental and social performance of both drainage systems. The three dimensions of sustainable development were addressed with the support of the concepts of Net Present Value (NPV), Life Cycle Assessment (LCA) and a combination of the Leopold matrix and a semi structured interview, respectively. The results of applying this approach to the case study of the Rancho Bellavista housing development (Querétaro, Mexico) showed that SuDS outperformed traditional drainage systems in environmental and social terms; however, their high maintenance costs and shorter life expectancy hindered its economic feasibility. As such, future urban plans should focus on complementary designs whereby the strengths of both drainage alternatives are combined to boost their contributions to achieving sustainable development.

Spatial statistical analysis of the relationship between self-reported mental health during the COVID-19 lockdown and closeness to green infrastructure.

The COVID-19 pandemic has produced alterations in the behaviour and psychological health of people, who have had to learn living under uncertain circumstances escaping their control. This situation has been aggravated in those countries applying strict home confinement rules to try bending their epidemic curve. This is the case of Spain, where the stringent lockdown period was extended over three months. This study aimed at proving a research hypothesis whereby living close to Green Infrastructure (GI) during the confinement period was beneficial for mental health. To this end, La Palma (Canary Islands) and Zaragoza (Peninsular Spain) were taken as case studies, since both locations distributed a questionnaire to address citizenry's self-reported mental health under strict lockdown conditions. A spatial statistical analysis of the responses collected by these questionnaires revealed that variables such as stress, anger, medication use, alcohol consumption or visits to the doctor significantly decreased if citizens were close to GI, whereas people having very high expectations of enjoying the city after the confinement were positively correlated to proximity of green areas. Although these outcomes are limited by the inferential capacity of correlation analysis, they point out to a sense of relief derived from having visual contact with vegetated landscapes and feeling stimulated about using them for recreation, aesthetical or sporting purposes. The joint consideration of these psychological gains with the social and environmental benefits provided by GI emphasizes the importance of approaching urban regeneration through the design and implementation of interconnected green spaces.

Numerical modelling of blood rheology and platelet activation through a stenosed left coronary artery bifurcation.

Coronary bifurcations are prone to atherosclerotic plaque growth, experiencing regions of reduced wall shear stress (WSS) and increased platelet adhesion. This study compares effects across different rheological approaches on hemodynamics, combined with a shear stress exposure history model of platelets within a stenosed porcine bifurcation. Simulations used both single/multiphase blood models to determine which approach best predicts phenomena associated with atherosclerosis and atherothrombosis. A novel Lagrangian platelet tracking model was used to evaluate residence time and shear history of platelets indicating likely regions of thrombus formation. Results show a decrease in area of regions with pathologically low time-averaged WSS with the use of multiphase models, particularly in a stenotic bifurcation. Significant non-Newtonian effects were observed due to low-shear and varying hematocrit levels found on the outer walls of the bifurcation and distal to the stenosis. Platelet residence time increased 11% in the stenosed artery, with exposure times to low-shear sufficient for red blood cell aggregation (>1.5 s). increasing the risk of thrombosis. This shows stenotic artery hemodynamics are inherently non-Newtonian and multiphase, with variations in hematocrit (0.163-0.617) and elevated vorticity distal to stenosis (+15%) impairing the function of the endothelium via reduced time-averaged WSS regions, rheological properties and platelet activation/adhesion.

Investigation of the Compressive Viscoelastic Properties of Brain Tissue Under Time and Frequency Dependent Loading Conditions.

The mechanical characterization of brain tissue has been generally analyzed in the frequency and time domain. It is crucial to understand the mechanics of the brain under realistic, dynamic conditions and convert it to enable mathematical modelling in a time domain. In this study, the compressive viscoelastic properties of brain tissue were investigated under time and frequency domains with the same physical conditions and the theory of viscoelasticity was applied to estimate the prediction of viscoelastic response in the time domain based on frequency-dependent mechanical moduli through Finite Element models. Storage and loss modulus were obtained from white and grey matter, of bovine brains, using dynamic mechanical analysis and time domain material functions were derived based on a Prony series representation. The material models were evaluated using brain testing data from stress relaxation and hysteresis in the time dependent analysis. The Finite Element models were able to represent the trend of viscoelastic characterization of brain tissue under both testing domains. The outcomes of this study contribute to a better understanding of brain tissue mechanical behaviour and demonstrate the feasibility of deriving time-domain viscoelastic parameters from frequency-dependent compressive data for biological tissue, as validated by comparing experimental tests with computational simulations.

ArcDrain: A GIS Add-In for Automated Determination of Surface Runoff in Urban Catchments.

Surface runoff determination in urban areas is crucial to facilitate ex ante water planning, especially in the context of climate and land cover changes, which are increasing the frequency of floods, due to a combination of violent storms and increased imperviousness. To this end, the spatial identification of urban areas prone to runoff accumulation is essential, to guarantee effective water management in the future. Under these premises, this work sought to produce a tool for automated determination of urban surface runoff using a geographic information systems (GIS). This tool, which was designed as an ArcGIS add-in called ArcDrain, consists of the discretization of urban areas into subcatchments and the subsequent application of the rational method for runoff depth estimation. The formulation of this method directly depends on land cover type and soil permeability, thereby enabling the identification of areas with a low infiltration capacity. ArcDrain was tested using the city of Santander (northern Spain) as a case study. The results achieved demonstrated the accuracy of the tool for detecting high runoff rates and how the inclusion of mitigation measures in the form of sustainable drainage systems (SuDS) and green infrastructure (GI) can help reduce flood hazards in critical zones.

A toolbox for generating scalable mitral valve morphometric models.

The mitral valve is a complex anatomical structure, whose shape is key to several traits of its function and disease, being crucial for the success of surgical repair and implantation of medical devices. The aim of this study was to develop a parametric, scalable, and clinically useful model of the mitral valve, enabling the biomechanical evaluation of mitral repair techniques through finite element simulations. MATLAB was used to parameterize the valve: the annular boundary was sampled from a porcine mitral valve mesh model and landmark points and relevant boundaries were selected for the parameterization of leaflets using polynomial fitting. Several geometric parameters describing the annulus, leaflet shape and papillary muscle position were implemented and used to scale the model according to patient dimensions. The developed model, available as a toolbox, allows for the generation of a population of models using patient-specific dimensions obtained from medical imaging or averaged dimensions evaluated from empirical equations based on the Golden Proportion. The average model developed using this framework accurately represents mitral valve shapes, associated with relative errors reaching less than 10% for annular and leaflet length dimensions, and less than 24% in comparison with clinical data. Moreover, model generation takes less than 5 min of computing time, and the toolbox can account for individual morphological variations and be employed to evaluate mitral valve biomechanics; following further development and validation, it will aid clinicians when choosing the best patient-specific clinical intervention and improve the design process of new medical devices.

The effect of injurious compression on the elastic, hyper-elastic and visco-elastic properties of porcine peripheral nerves.

The aim of this study was to characterise the viscoelastic and hyper-elastic properties of the ulnar nerve before and after compression has been induced, in order to aid the understanding of how the mechanical properties of nerves are altered during nerve compression, a contributing factor to cubital tunnel syndrome. Ulnar nerves were dissected from porcine legs and tensile tested to 10% strain. The Young's modulus and Yeoh hyper-elastic model were used to evaluate the materials elastic and hyper-elastic properties respectively. Dynamic mechanical analysis (DMA) was used to evaluate the viscoelastic properties over a range of frequencies between 0.5 Hz and 38 Hz. The nerves were then compressed to 40% for 60 s and the same tests were carried out after compression. The nerves were stiffer after compression, the mean Young's modulus before was 0.181 MPa and increased to 0.601 MPa after compression. The mean shear modulus calculated from the Yeoh hyper-elastic model was also higher after compression increasing from 5 kPa to 7 kPa. After compression, these properties had significantly increased (p < 0.05). The DMA results showed that the nerves exhibit frequency dependent viscoelastic behaviour across all tested frequencies. The median values of storage modulus before compression ranged between 0.605 and 0.757 MPa across the frequencies and after compression between 1.161 MPa and 1.381 MPa. There was a larger range of median values for loss modulus, before compression, median values ranged between 0.073 MPa and 0.216 MPa and after compression from 0.165 MPa to 0.410 MPa. There was a significant increase in both storage and loss modulus after compression (p < 0.05). The mechanical properties of the nerve change following compression, however the response to decompression in vivo requires further evaluation to determine whether the observed changes persist, which may have implications for clinical recovery after surgical decompression in entrapment neuropathy.

Bringing Facilitated Industrial Symbiosis and Game Theory together to strengthen waste exchange in industrial parks.

Industrial Symbiosis (IS) provides an opportunity to foster resource exchange, whereby the wastes of some companies are used as the feed to others. However, putting IS into practice requires overcoming a series of obstacles such as mistrust and lack of information. In this context, this research proposed the coupling of Facilitated Industrial Symbiosis (FIS) and Game Theory (GT) to break down these barriers. On the one hand, the consideration of FIS entailed the incorporation of the figure of the facilitator into the IS process throughout six different steps, thereby improving the confidence between companies and their access to information about potential synergies. On the other hand, GT was implemented through utility functions that served to favor the achievement of agreements, since their application supported the identification of collective solutions optimizing the benefits of all the parties. The proposed approach was tested through a hypothetical industrial park involving ten companies with different interests and magnitudes. The stepwise examination of the results achieved in this case study emphasized the key role played by the facilitator and GT to foster the participation of companies in waste exchanges and maximize their benefits, respectively.

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters.

Central venous catheters are widely used in haemodialysis therapy, having to respect design requirements for appropriate performance. These are placed within the right atrium (RA); however, there is no prior computational study assessing different catheter designs while mimicking their native environment. Here, a computational fluid dynamics model of the RA, based on realistic geometry and transient physiological boundary conditions, was developed and validated. Symmetric, split and step catheter designs were virtually placed in the RA and their performance was evaluated by: assessing their interaction with the RA haemodynamic environment through prediction of flow vorticity and wall shear stress (WSS) magnitudes (1); and quantifying recirculation and tip shear stress (2). Haemodynamic predictions from our RA model showed good agreement with the literature. Catheter placement in the RA increased average vorticity, which could indicate alterations of normal blood flow, and altered WSS magnitudes and distribution, which could indicate changes in tissue mechanical properties. All designs had recirculation and elevated shear stress values, which can induce platelet activation and subsequently thrombosis. The symmetric design, however, had the lowest associated values (best performance), while step design catheters working in reverse mode were associated with worsened performance. Different tip placements also impacted on catheter performance. Our findings suggest that using a realistically anatomical RA model to study catheter performance and interaction with the haemodynamic environment is crucial, and that care needs to be given to correct tip placement within the RA for improved recirculation percentages and diminished shear stress values.

Dynamic mechanical characterization and viscoelastic modeling of bovine brain tissue.

Brain tissue is vulnerable and sensitive, predisposed to potential damage under various conditions of mechanical loading. Although its material properties have been investigated extensively, the frequency-dependent viscoelastic characterization is currently limited. Computational models can provide a non-invasive method by which to analyze brain injuries and predict the mechanical response of the tissue. The brain injuries are expected to be induced by dynamic loading, mostly in compression and measurement of dynamic viscoelastic properties are essential to improve the accuracy and variety of finite element simulations on brain tissue. Thus, the aim of this study was to investigate the compressive frequency-dependent properties of brain tissue and present a mathematical model in the frequency domain to capture the tissue behavior based on experimental results. Bovine brain specimens, obtained from four locations of corona radiata, corpus callosum, basal ganglia and cortex, were tested under compression using dynamic mechanical analysis over a range of frequencies between 0.5 and 35 Hz to characterize the regional and directional response of the tissue. The compressive dynamic properties of bovine brain tissue were heterogenous for regions but not sensitive to orientation showing frequency dependent statistical results, with viscoelastic properties increasing with frequency. The mean storage and loss modulus were found to be 12.41 kPa and 5.54 kPa, respectively. The material parameters were obtained using the linear viscoelastic model in the frequency domain and the numeric simulation can capture the compressive mechanical behavior of bovine brain tissue across a range of frequencies. The frequency-dependent viscoelastic characterization of brain tissue will improve the fidelity of the computational models of the head and provide essential information to the prediction and analysis of brain injuries in clinical treatments.

The role of strut chordae in mitral valve competence during annular dilation.

Strut chordae, on their own, are not typically thought to aid mitral valve competence. The aim of this study is to assess whether strut chordae aid mitral valve competence during acute annular dilation. Twelve porcine hearts were dissected and tested using an in vitro simulator, with the mitral annulus tested in either a 'normal' or a dilated configuration. The normal configuration included a diameter of 30 mm, a posterior leaflet 'radius' of 15 mm and a commissural corner 'radius' of 7.5 mm; the dilated annular template instead used dimensions of 50 mm, 25 mm and 12.5 mm, respectively. Each mitral valve underwent ten repeat tests with a target systolic pressure of 100 mmHg. No significant difference in the pressure was detected between the dilated and regular annuli for the mitral valves tested (95 ± 3 mmHg cf. 95 ± 2 mmHg). However, the volume of regurgitation for a dilated annulus was 28 ml greater than for a valve with a normal annulus. Following severing of strut chordae, there was a significant reduction in the systolic pressure withstood before regurgitation by mitral valves with dilated annuli (60 ± 29 mmHg cf. 95 ± 2 mmHg for normal annular dimensions; p < 0.05). In conclusion, strut chordae tendineae may play a role in aiding mitral valve competence during pathophysiology.

Mechanical testing of glutaraldehyde cross-linked mitral valves. Part one: In vitro mechanical behaviour.

The aim of this study was to perform an initial assessment, in vitro, of the feasibility of using a glutaraldehyde cross-linked porcine mitral valve to retain acute functionality, focusing on assessing mitral regurgitation. Six porcine hearts were tested using an in vitro simulator. Testing was repeated following cross-linking of mitral valves; where cross-linking was achieved by placing them in a glutaraldehyde solution. The simulator enabled systolic pressure on the ventricular side of the valve to be mimicked. Following testing, mitral valve leaflets underwent Scanning Electron Microscopy of the ventricular surface of both the anterior and posterior leaflets (1 cm2 samples). The peak pressure withstood by cross-linked valves was significantly lower than for untreated valves (108 mmHg cf. 128 mmHg for untreated valves; p < 0.05). The peak pressure was typically reached 0.5 s later than for the untreated valve. While both cross-linked and untreated valves exhibited endothelium denudation, the unfixed valve had less endothelial loss. Glutaraldehyde cross-linking of porcine mitral valves may be of potential value in assessing improved bioprosthetic mitral valve replacements. However, a more immobile valve exhibiting endothelial denudation (i.e. sclerosis) was a possible concerns identified following in vitro acute assessment.

Mechanical testing of glutaraldehyde cross-linked mitral valves. Part two: Elastic and viscoelastic properties of chordae tendineae.

The aim of this study was to assess whether the mechanical properties of mitral valve chordae tendineae are sensitive to being cross-linked under load. A total 64 chordae were extracted from eight porcine hearts. Two chordae (posterior basal) from each heart were subjected to uniaxial ramp testing and six chordae (two strut, two anterior basal and two posterior basal) were subjected to dynamic mechanical analysis over frequencies between 0.5 and 10 Hz. Chordae were either cross-linked in tension or cross-linked in the absence of loading. Chordae cross-linked under load transitioned from high to low extension at a lower strain than cross-linked unloaded chordae (0.07 cf. 0.22), with greater pre-transitional (30.8 MPa cf. 5.78 MPa) and post-transitional (139 MPa cf. 74.1 MPa) moduli. The mean storage modulus of anterior strut chordae ranged from 48 to 54 MPa for cross-linked unloaded chordae, as compared to 53-61 MPa cross-linked loaded chordae. The mean loss modulus of anterior strut chordae ranged from 2.3 to 2.9 MPa for cross-linked unloaded chordae, as compared to 3.8-4.8 MPa cross-linked loaded chordae. The elastic and viscoelastic properties of chordae following glutaraldehyde cross-linking are dependent on the inclusion/exclusion of loading during the cross-linking process; with loading increasing the magnitude of the material properties measured.