A review of the lower extremity musculature surrounding the knee is provided as well as a lower extremity knee exoskeleton design proposed. The review provides a general understanding of the body m usculature around the knee with an emphasis on the geometry of the musculature. The proposed device design uses the reviewed musculature geometry as the basis for the design. In function, the proposed device focuses on creating a mechanical advantage at the knee joint which assists individuals who are suffering temporarily, or permanently, from quadriceps weakness or atrophy brought on by Osteoarthritis, Patellofemoral Pain Syndrome (PFPS), or other knee conditions. The design was analyzed over flexion angles between 0 to 90 degrees. Physical testing, as well as linear and nonlinear model calculations, were performed to determine the design’s strength capacity and function. The resulting force and momentum values of the device were compared to those characteristics of a healthy leg (a hip-to-knee length of 18 inches and a body weight of 180 pounds as the standard dimension and weight for testing). From the comparison data, the proposed device was found to be significantly similar to the body’s calculated maximum applied moment. Additionally, the comparison of the curves of the moment versus flexion angle for the device and body showed the linear model case to not be similar to the body while the nonlinear model case was similar to the body.

Edge-to-edge repair for mitral valve regurgitation is being increasingly performed in high-surgical risk patients using minimally invasive mitral clipping devices. Known procedural complications include chordal rupture and mitral leaflet perforation. Hence, it is important to quantitatively evaluate the effect of edge-to-edge repair on chordal integrity. in this study, we employ a computational mitral valve model to simulate functional mitral regurgitation (FMR) by creating papillary muscle displacement. Edge-to-edge repair is then modeled by simulated coaptation of the mid portion of the mitral leaflets. in the setting of simulated FMR, edge-to-edge repair was shown to sustain low regurgitant orifice area, until a two fold increase in the inter-papillary muscle distance as compared to the normal mitral valve. Strain in the chordae was evaluated near the papillary muscles and the leaflets. Following edge-to-edge repair, strain near the papillary muscles did not significantly change relative to the unrepaired valve, while strain near the leaflets increased significantly relative to the unrepaired valve. These data demonstrate the potential for computational simulations to aid in the pre-procedural evaluation of possible complications such as chordal rupture and leaflet perforation following percutaneous edge-to-edge repair.

Mitral regurgitation imposes a significant symptomatic burden on patients who are not candidates for conventional surgery. For these patients, transcatheter repair and replacement devices are emerging as alternative options. One such device is an intravalvular balloon or spacer that is inserted between the mitral valve leaflets to fill the gap that gives rise to mitral regurgitation. In this study, we apply a large-deformation fluid-structure interaction analysis to a fully 3D subject-specific mitral valve model to assess the efficacy of the intra-valvular spacer for reducing mitral regurgitation severity. The model includes a topologically 3D subvalvular apparatus with unprecedented detail. Results show that device fixation and anchoring at the location of the subject's regurgitant orifice is imperative for optimal reduction of mitral regurgitation.

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Over the years, three-dimensional models of the mitral valve have generally been organized around a simplified anatomy. Leaflets have been typically modeled as membranes, tethered to discrete chordae typically modeled as one-dimensional, non-linear cables. Yet, recent, high-resolution medical images have revealed that there is no clear boundary between the chordae and the leaflets. In fact, the mitral valve has been revealed to be more of a webbed structure whose architecture is continuous with the chordae and their extensions into the leaflets. Such detailed images can serve as the basis of anatomically accurate, subject-specific models, wherein the entire valve is modeled with solid elements that more faithfully represent the chordae, the leaflets, and the transition between the two. These models have the potential to enhance our understanding of mitral valve mechanics and to re-examine the role of the mitral valve chordae, which heretofore have been considered to be 'invisible' to the fluid and to be of secondary importance to the leaflets. However, these new models also require a rethinking of modeling assumptions. In this study, we examine the conventional practice of loading the leaflets only and not the chordae in order to study the structural response of the mitral valve apparatus. Specifically, we demonstrate that fully resolved 3D models of the mitral valve require a fluid-structure interaction analysis to correctly load the valve even in the case of quasi-static mechanics. While a fluid-structure interaction mode is still more computationally expensive than a structural-only model, we also show that advances in GPU computing have made such models tractable. Copyright © 2016 John Wiley & Sons, Ltd.

Three-dimensional computational fluid dynamics and Lagrangian particle deposition models were developed to compare the deposition of aerosolized Bacillus anthracis spores in the respiratory airways of a human with that of the rabbit, a species commonly used in the study of anthrax disease. The respiratory airway geometries for each species were derived respectively from computed tomography (CT) and µCT images. Both models encompassed airways that extended from the external nose to the lung with a total of 272 outlets in the human model and 2878 outlets in the rabbit model. All simulations of spore deposition were conducted under transient, inhalation–exhalation breathing conditions using average species-specific minute volumes. Two different exposure scenarios were modeled in the rabbit based upon experimental inhalation studies. For comparison, human simulations were conducted at the highest exposure concentration used during the rabbit experimental exposures. Results demonstrated that regional spore deposition patterns were sensitive to airway geometry and ventilation profiles. Due to the complex airway geometries in the rabbit nose, higher spore deposition efficiency was predicted in the nasal sinus compared to the human at the same air concentration of anthrax spores. In contrast, higher spore deposition was predicted in the lower conducting airways of the human compared to the rabbit lung due to differences in airway branching pattern. This information can be used to refine published and ongoing biokinetic models of inhalation anthrax spore exposures, which currently estimate deposited spore concentrations based solely upon exposure concentrations and inhaled doses that do not factor in species-specific anatomy and physiology for deposition.

The chordal structure is a part of mitral valve geometry that has been commonly neglected or simplified in computational modeling due to its complexity. However, these simplifications cannot be used when investigating the roles of individual chordae tendineae in mitral valve closure. For the first time, advancements in imaging, computational techniques, and hardware technology make it possible to create models of the mitral valve without simplifications to its complex geometry, and to quickly run validated computer simulations that more realistically capture its function. Such simulations can then be used for a detailed analysis of chordae-related diseases. In this work, a comprehensive model of a subject-specific mitral valve with detailed chordal structure is used to analyze the distinct role played by individual chordae in closure of the mitral valve leaflets. Mitral closure was simulated for 51 possible chordal rupture points. Resultant regurgitant orifice area and strain change in the chordae at the papillary muscle tips were then calculated to examine the role of each ruptured chorda in the mitral valve closure. For certain subclassifications of chordae, regurgitant orifice area was found to trend positively with ruptured chordal diameter, and strain changes correlated negatively with regurgitant orifice area. Further advancements in clinical imaging modalities, coupled with the next generation of computational techniques will enable more physiologically realistic simulations.

The diversity of mitral valve (MV) geometries and multitude of surgical options for correction of MV diseases necessitates the use of computational modeling. Numerical simulations of the MV would allow surgeons and engineers to evaluate repairs, devices, procedures, and concepts before performing them and before moving on to more costly testing modalities. Constructing, tuning, and validating these models rely upon extensive in vitro characterization of valve structure, function, and response to change due to diseases. Micro-computed tomography (\(\mu \)CT) allows for unmatched spatial resolution for soft tissue imaging. However, it is still technically challenging to obtain an accurate geometry of the diastolic MV. We discuss here the development of a novel technique for treating MV specimens with glutaraldehyde fixative in order to minimize geometric distortions in preparation for \(\mu \)CT scanning. The technique provides a resulting MV geometry which is significantly more detailed in chordal structure, accurate in leaflet shape, and closer to its physiological diastolic geometry. In this paper, computational fluid–structure interaction (FSI) simulations are used to show the importance of more detailed subject-specific MV geometry with 3D chordal structure to simulate a proper closure validated against \(\mu \)CT images of the closed valve. Two computational models, before and after use of the aforementioned technique, are used to simulate closure of the MV.

Despite using rabbits in several inhalation exposure experiments to study diseases such as anthrax, there is a lack of understanding regarding deposition characteristics and fate of inhaled particles (bio-aerosols and viruses) in the respiratory tracts of rabbits. Such information allows dosimetric extrapolation to humans to inform human outcomes. The lung geometry of the New Zealand white rabbit (referred to simply as rabbits throughout the article) was constructed using recently acquired scanned images of the conducting airways of rabbits and available information on its acinar region. In addition, functional relationships were developed for the lung and breathing parameters of rabbits as a function of body weight. The lung geometry and breathing parameters were used to extend the existing deposition model for humans and several other species to rabbits. Evaluation of the deposition model for rabbits was made by comparing predictions with available measurements in the literature. Deposition predictions in the lungs of rabbits indicated smaller deposition fractions compared to those found in humans across various particle diameter ranges. The application of the deposition model for rabbits was demonstrated by extrapolating deposition predictions in rabbits to find equivalent human exposure concentrations assuming the same dose-response relationship between the two species. Human equivalent exposure concentration levels were found to be much smaller than those for rabbits.

CONTEXT:Computational fluid dynamics (CFD) simulations of airflows coupled with physiologically based pharmacokinetic (PBPK) modeling of respiratory tissue doses of airborne materials have traditionally used either steady-state inhalation or a sinusoidal approximation of the breathing cycle for airflow simulations despite their differences from normal breathing patterns.OBJECTIVE:Evaluate the impact of realistic breathing patterns, including sniffing, on predicted nasal tissue concentrations of a reactive vapor that targets the nose in rats as a case study.MATERIALS AND METHODS:Whole-body plethysmography measurements from a free-breathing rat were used to produce profiles of normal breathing, sniffing and combinations of both as flow inputs to CFD/PBPK simulations of acetaldehyde exposure.RESULTS:For the normal measured ventilation profile, modest reductions in time- and tissue depth-dependent areas under the curve (AUC) acetaldehyde concentrations were predicted in the wet squamous, respiratory and transitional epithelium along the main airflow path, while corresponding increases were predicted in the olfactory epithelium, especially the most distal regions of the ethmoid turbinates, versus the idealized profile. The higher amplitude/frequency sniffing profile produced greater AUC increases over the idealized profile in the olfactory epithelium, especially in the posterior region.CONCLUSIONS:The differences in tissue AUCs at known lesion-forming regions for acetaldehyde between normal and idealized profiles were minimal, suggesting that sinusoidal profiles may be used for this chemical and exposure concentration. However, depending upon the chemical, exposure system and concentration and the time spent sniffing, the use of realistic breathing profiles, including sniffing, could become an important modulator for local tissue dose predictions.

Despite increasing use of pigs as surrogates for humans in inhalation studies, measurements of particle deposition in the lungs of pigs are lacking. No comprehensive models are available for deposition of inhaled particles in the lungs of pigs to bridge the gap between exposure and biological response. In this study, a mathematical model was developed for the deposition of particles in the respiratory tract of pigs. Semi-empirical equations were developed to relate particle deposition efficiency in the pig nasal passages to non-dimensional parameters for diffusion and impaction deposition. The conducting airway tree of pigs was reconstructed from scanned images and other morphometric data in the literature. The pulmonary airway region was reconstructed assuming geometric similarities between humans and pigs due to a lack of information available on the pulmonary airways of pigs. The tracheobronchial and alveolar trees were combined to obtain a limited-monopodial lung geometry for pigs. A lung ventilation model was developed in this geometry based on lung compliance, airway resistance, and airflow inertance using breathing parameters from the literature. The lung deposition model was constructed based on models for lung ventilation, particle transport, and deposition in the asymmetric (monopodial) lung structure to predict particle deposition in the lungs of pigs. Model predictions indicated that the largest airflow and particle deposition occurred in the basal (diaphragmatic) lobes, which possessed the largest airway dimensions and volumes. The predicted site of deposition was related to particle size with larger particles depositing proximally and smaller particles depositing distally. There was limited penetration of coarse particles into the alveolar region because most of these particles were removed from inhaled air in the nasal and tracheobronchial regions. The deposition model developed in this study is a powerful tool to relate exposure environment to biological response and assess the dose of the delivered particles to the lungs.

We present an Array-based Half-Facet mesh data structure, or AHF, for efficient mesh query and modification operations. The AHF extends the compact array-based half-edge and half-face data structures (T. J. Alumbaugh and X. Jiao, Compact array-based mesh data structures, IMR, 2005) to support mixed-dimensional and non-manifold meshes. The design goals of our data structure include generality to support such meshes, efficiency of neighborhood queries and mesh modification, compactness of memory footprint, and facilitation of interoperability of mesh-based application codes. To accomplish these goals, our data structure uses sibling half-facets as a core abstraction, coupled with other explicit and implicit representations of entities. A unique feature of our data structure is a comprehensive implementation in MATLAB, which allows rapid prototyping, debugging, testing, and deployment of meshing algorithms and other mesh-based numerical methods. We have also developed a C++ implementation built on top of MOAB (T.J. Tautges, R. Meyers, and K. Merkley, MOAB: A Mesh-Oriented Database, Sandia National Laboratories, 2004). We present some comparisons of the memory requirements and computational costs, and also demonstrate its effectiveness with a few sample applications.

Computational fluid dynamics (CFD) modeling is well suited for addressing species-specific anatomy and physiology in calculating respiratory tissue exposures to inhaled materials. In this study, we overcame prior CFD model limitations to demonstrate the importance of realistic, transient breathing patterns for predicting site-specific tissue dose. Specifically, extended airway CFD models of the rat and human were coupled with airway region-specific physiologically based pharmacokinetic (PBPK) tissue models to describe the kinetics of 3 reactive constituents of cigarette smoke: acrolein, acetaldehyde and formaldehyde. Simulations of aldehyde no-observed-adverse-effect levels for nasal toxicity in the rat were conducted until breath-by-breath tissue concentration profiles reached steady state. Human oral breathing simulations were conducted using representative aldehyde yields from cigarette smoke, measured puff ventilation profiles and numbers of cigarettes smoked per day. As with prior steady-state CFD/PBPK simulations, the anterior respiratory nasal epithelial tissues received the greatest initial uptake rates for each aldehyde in the rat. However, integrated time- and tissue depth-dependent area under the curve (AUC) concentrations were typically greater in the anterior dorsal olfactory epithelium using the more realistic transient breathing profiles. For human simulations, oral and laryngeal tissues received the highest local tissue dose with greater penetration to pulmonary tissues than predicted in the rat. Based upon lifetime average daily dose comparisons of tissue hot-spot AUCs (top 2.5% of surface area-normalized AUCs in each region) and numbers of cigarettes smoked/day, the order of concern for human exposures was acrolein > formaldehyde > acetaldehyde even though acetaldehyde yields were 10-fold greater than formaldehyde and acrolein.

PURPOSE:Computer models for inhalation toxicology and drug-aerosol delivery studies rely on ventilation pattern inputs for predictions of particle deposition and vapor uptake. However, changes in lung mechanics due to disease can impact airflow dynamics and model results. It has been demonstrated that non-invasive, in vivo, 4DCT imaging (3D imaging at multiple time points in the breathing cycle) can be used to map heterogeneities in ventilation patterns under healthy and disease conditions. The purpose of this study was to validate ventilation patterns measured from CT imaging by exposing the same rats to an aerosol of fluorescent microspheres (FMS) and examining particle deposition patterns using cryomicrotome imaging.MATERIALS AND METHODS:Six male Sprague-Dawley rats were intratracheally instilled with elastase to a single lobe to induce a heterogeneous disease. After four weeks, rats were imaged over the breathing cycle by CT then immediately exposed to an aerosol of ∼ 1 μm FMS for ∼ 5 minutes. After the exposure, the lungs were excised and prepared for cryomicrotome imaging, where a 3D image of FMS deposition was acquired using serial sectioning. Cryomicrotome images were spatially registered to match the live CT images to facilitate direct quantitative comparisons of FMS signal intensity with the CT-based ventilation maps.RESULTS:Comparisons of fractional ventilation in contiguous, non-overlapping, 3D regions between CT-based ventilation maps and FMS images showed strong correlations in fractional ventilation (r = 0.888, p < 0.0001).CONCLUSION:We conclude that ventilation maps derived from CT imaging are predictive of the 1 μm aerosol deposition used in ventilation-perfusion heterogeneity inhalation studies.

Remeshing is an important problem in variety of applications, such as finite element methods and geometry processing. Surface remeshing poses some unique challenges, as it must deliver not only good mesh quality but also good geometric accuracy. For applications such as finite elements with high-order elements (quadratic or cubic elements), the geometry must be preserved to high-order (third-order or higher) accuracy, since low-order accuracy may undermine the convergence of numerical computations. The problem is particularly challenging if the CAD model is not available for the underlying geometry, and is even more so if the surface meshes contain some inverted elements. We describe remeshing strategies that can simultaneously produce high-quality triangular meshes, untangling mildly folded triangles and preserve the geometry to high-order of accuracy. Our approach extends our earlier works on high-order surface reconstruction and mesh optimization by enhancing its robustness with a geometric limiter for under-resolved geometries. We also integrate high-order surface reconstruction with surface mesh adaptation techniques, which alter the number of triangles and nodes. We demonstrate the utilization of our method to meshes for high-order finite elements, biomedical image-based surface meshes, and complex interface meshes in fluid simulations.

A Fungean solid is derived for membranous materials as a body defined by isotropic response functions whose mathematical structure is that of a Hookean solid where the elastic constants are replaced by functions of state derived from an implicit, thermodynamic, internal energy function. The theory utilizes Biot's (Lond Edinb Dublin Philos Mag J Sci 27:468–489, 1939) definitions for stress and strain that, in one-dimension, are the stress/strain measures adopted by Fung (Am J Physiol 28:1532–1544, 1967) when he postulated what is now known as Fung's law. Our Fungean membrane model is parameterized against a biaxial data set acquired from a porcine pleural membrane subjected to three, sequential, proportional, planar extensions. These data support an isotropic/deviatoric split in the stress and strain-rate hypothesized by our theory. These data also demonstrate that the material response is highly nonlinear but, otherwise, mechanically isotropic. These data are described reasonably well by our otherwise simple, four-parameter, material model.

While inhalation toxicological studies of various compounds have been conducted using a number of different strains of rats, mechanistic dosimetry models have only had tracheobronchial (TB) structural data for Long-Evans rats, detailed morphometric data on the alveolar region of Sprague-Dawley rats and limited alveolar data on other strains. Based upon CT imaging data for two male Sprague-Dawley rats, a 15-generation, symmetric typical path model was developed for the TB region. Literature data for the alveolar region of Sprague-Dawley rats were analyzed to develop an eight-generation model, and the two regions were joined to provide a complete lower respiratory tract model for Sprague-Dawley rats. The resulting lung model was used to examine particle deposition in Sprague-Dawley rats and to compare these results with predicted deposition in Long-Evans rats. Relationships of various physiologic variables and lung volumes were either developed in this study or extracted from the literature to provide the necessary input data for examining particle deposition. While the lengths, diameters and branching angles of the TB airways differed between the two Sprague-Dawley rats, the predicted deposition patterns in the three major respiratory tract regions were very similar. Between Sprague-Dawley and Long-Evans rats, significant differences in TB and alveolar predicted deposition fractions were observed over a wide range of particle sizes, with TB deposition fractions being up to 3- to 4-fold greater in Sprague-Dawley rats and alveolar deposition being significantly greater in Long-Evans rats. Thus, strain-specific lung geometry models should be used for particle deposition calculations and interspecies dose comparisons.

With the advancement of experimental and computational techniques, three-dimensional (3D) computational fluid dynamics (CFD) airflow models of the respiratory system have increasingly been used to evaluate aerosol deposition, gas exchange and airflow characteristics under various physiological and/or disease conditions. One specific application that is emerging in the field of toxicology is assessing the risk for exposure to highly reactive, water-soluble gases and vapors including formaldehyde, acetaldehyde, hydrogen sulfide, and acrolein by coupling CFD models of nasal airways of rats and humans to physiological based pharmacokinetic (PBPK) models.