Multiaxial mechanical response and constitutive modeling of esophageal tissues: Impact on esophageal tissue engineering

Specimen width affects vascular tissue integrity for in-vitro characterisation

The preparation of slender specimens for in-vitro tissue characterisation could potentially alter mechanical tissue properties. To investigate this factor, rectangular specimens were prepared from the wall of the porcine aorta for uniaxial tensile loading. Varying strip widths of 16 mm, 8 mm, and 4 mm were achieved by excising zero, one, and three cuts within the specimen along the loading direction, respectively. While specimens loaded along the vessel's circumferential direction acquired consistent tissue properties, the width of test specimens influenced the results of axially loaded tissue; vascular wall stiffness was reduced by approximately 40% in specimens with strips 4 mm wide. In addition, the cross-loading stretch was strongly influenced by specimen strip width, and fiber sliding contributed to the softening of slender tensile specimens, an outcome from finite element analysis of test specimens. We may, therefore, conclude that cutting orthogonal to the main direction of collagen fibers introduces mechanical trauma that weakens slender tensile specimens, compromising the determination of representative mechanical vessel wall properties.

Characterization of the layer, direction and time-dependent mechanical behaviour of the human oesophagus and the effects of formalin preservation

The mechanical characterization of the oesophagus is essential for applications such as medical device design, surgical simulations and tissue engineering, as well as for investigating the organ's pathophysiology. However, the material response of the oesophagus has not been established ex vivo in regard to the more complex aspects of its mechanical behaviour using fresh, human tissue: as of yet, in the literature, only the hyperelastic response of the intact wall has been studied. Therefore, in this study, the layer-dependent, anisotropic, visco-hyperelastic behaviour of the human oesophagus was investigated through various mechanical tests. For this, cyclic tests, with increasing stretch levels, were conducted on the layers of the human oesophagus in the longitudinal and circumferential directions and at two different strain rates. Additionally, stress-relaxation tests on the oesophageal layers were carried out in both directions. Overall, the results show discrete properties in each layer and direction, highlighting the importance of treating the oesophagus as a multi-layered composite material with direction-dependent behaviour. Previously, the authors conducted layer-dependent cyclic experimentation on formalin-embalmed human oesophagi. A comparison between the fresh and embalmed tissue response was carried out and revealed surprising similarities in terms of anisotropy, strain-rate dependency, stress-softening and hysteresis, with the main difference between the two preservation states being the magnitude of these properties. As formalin fixation is known to notably affect the formation of cross-links between the collagen of biological materials, the differences may reveal the influence of cross-links on the mechanical behaviour of soft tissues.

Mechanical experimentation of the gastrointestinal tract: a systematic review

The gastrointestinal (GI) organs of the human body are responsible for transporting and extracting nutrients from food and drink, as well as excreting solid waste. Biomechanical experimentation of the GI organs provides insight into the mechanisms involved in their normal physiological functions, as well as understanding of how diseases can cause disruption to these. Additionally, experimental findings form the basis of all finite element (FE) modelling of these organs, which have a wide array of applications within medicine and engineering. This systematic review summarises the experimental studies that are currently in the literature (n = 247) and outlines the areas in which experimentation is lacking, highlighting what is still required in order to more fully understand the mechanical behaviour of the GI organs. These include (i) more human data, allowing for more accurate modelling for applications within medicine, (ii) an increase in time-dependent studies, and (iii) more sophisticated in vivo testing methods which allow for both the layer- and direction-dependent characterisation of the GI organs. The findings of this review can also be used to identify experimental data for the readers' own constitutive or FE modelling as the experimental studies have been grouped in terms of organ (oesophagus, stomach, small intestine, large intestine or rectum), test condition (ex vivo or in vivo), number of directions studied (isotropic or anisotropic), species family (human, porcine, feline etc.), tissue condition (intact wall or layer-dependent) and the type of test performed (biaxial tension, inflation-extension, distension (pressure-diameter), etc.). Furthermore, the studies that investigated the time-dependent (viscoelastic) behaviour of the tissues have been presented.

Decellularized esophageal tubular scaffold microperforated by quantum molecular resonance technology and seeded with mesenchymal stromal cells for tissue engineering esophageal regeneration

Current surgical options for patients requiring esophageal replacement suffer from several limitations and do not assure a satisfactory quality of life. Tissue engineering techniques for the creation of customized “self-developing” esophageal substitutes, which are obtained by seeding autologous cells on artificial or natural scaffolds, allow simplifying surgical procedures and achieving good clinical outcomes. In this context, an appealing approach is based on the exploitation of decellularized tissues as biological matrices to be colonized by the appropriate cell types to regenerate the desired organs. With specific regard to the esophagus, the presence of a thick connective texture in the decellularized scaffold hampers an adequate penetration and spatial distribution of cells. In the present work, the Quantum Molecular Resonance^® (QMR) technology was used to create a regular microchannel structure inside the connective tissue of full-thickness decellularized tubular porcine esophagi to facilitate a diffuse and uniform spreading of seeded mesenchymal stromal cells within the scaffold. Esophageal samples were thoroughly characterized before and after decellularization and microperforation in terms of residual DNA content, matrix composition, structure and biomechanical features. The scaffold was seeded with mesenchymal stromal cells under dynamic conditions, to assess the ability to be repopulated before its implantation in a large animal model. At the end of the procedure, they resemble the original esophagus, preserving the characteristic multilayer composition and maintaining biomechanical properties adequate for surgery. After the sacrifice we had histological and immunohistochemical evidence of the full-thickness regeneration of the esophageal wall, resembling the native organ. These results suggest the QMR microperforated decellularized esophageal scaffold as a promising device for esophagus regeneration in patients needing esophageal substitution.

Experimental investigations of the human oesophagus: anisotropic properties of the embalmed mucosa–submucosa layer under large deformation

Mechanical characterisation of the layer-specific, viscoelastic properties of the human oesophagus is crucial in furthering the development of devices emerging in the field, such as robotic endoscopic biopsy devices, as well as in enhancing the realism, and therefore effectiveness, of surgical simulations. In this study, the viscoelastic and stress-softening behaviour of the passive human oesophagus was investigated through ex vivo cyclic mechanical tests. Due to restrictions placed on the laboratory as a result of COVID-19, only oesophagi from cadavers fixed in formalin were allowed for testing. Three oesophagi in total were separated into their two main layers and the mucosa–submucosa layer was investigated. A series of uniaxial tensile tests were conducted in the form of increasing stretch level cyclic tests at two different strain rates: 1% s\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{-1}$$\end{document}-1 and 10% s\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{-1}$$\end{document}-1. Rectangular samples in both the longitudinal and circumferential directions were tested to observe any anisotropy. Histological analysis was also performed through a variety of staining methods. Overall, the longitudinal direction was found to be much stiffer than the circumferential direction. Stress-softening was observed in both directions, as well as permanent set and hysteresis. Strain rate-dependent behaviour was also apparent in the two directions, with an increase in strain rate resulting in an increase in stiffness. This strain rate dependency was more pronounced in the longitudinal direction than the circumferential direction. Finally, the results were discussed in regard to the histological content of the layer, and the behaviour was modelled and validated using a visco-hyperelastic matrix-fibre model.

Skin wrinkles and folds enable asymmetric stretch in the elephant trunk

The elephant's trunk is multifunctional: It must be flexible to wrap around vegetation, but tough to knock down trees and resist attack. How can one appendage satisfy both constraints? In this combined experimental and theoretical study, we challenged African elephants to reach far-away objects with only horizontal extensions of their trunk. Surprisingly, the trunk does not extend uniformly, but instead exhibits a dorsal "joint" that stretches 15% more than the corresponding ventral section. Using material testing with the skin of a deceased elephant, we show that the asymmetry is due in part to patterns of the skin. The dorsal skin is folded and 15% more pliable than the wrinkled ventral skin. Skin folds protect the dorsal section and stretch to facilitate downward wrapping, the most common gripping style when picking up items. The elephant's skin is also sufficiently stiff to influence its mechanics: At the joint, the skin requires 13 times more energy to stretch than the corresponding length of muscle. The use of wrinkles and folds to modulate stiffness may provide a valuable concept for both biology and soft robotics.

Biomechanical constitutive modeling of the gastrointestinal tissues: a systematic review

The gastrointestinal (GI) tract is a continuous channel through the body that consists of the esophagus, the stomach, the small intestine, the large intestine, and the rectum. Its primary functions are to move the intake of food for digestion before storing and ultimately expulsion of feces. The mechanical behavior of GI tissues thus plays a crucial role for GI function in health and disease. The mechanical properties are characterized by a biomechanical constitutive model, which is a mathematical representation of the relation between load and deformation in a tissue. Hence, validated biomechanical constitutive models are essential to characterize and simulate the mechanical behavior of the GI tract. Here, a systematic review of these constitutive models is provided. This review is limited to studies where a model of the strain energy function is proposed to characterize the stress-strain relation of a GI tissue. Several needs are identified for more advanced modeling including: 1) Microstructural models that provide actual structure-function relations; 2) Validation of coupled electro-mechanical models accounting for active muscle contractions; 3) Human data to develop and validate models. The findings from this review provide guidelines for using existing constitutive models as well as perspective and directions for future studies.

Experimental investigations of the human oesophagus: anisotropic properties of the embalmed muscular layer under large deformation

The oesophagus is a primarily mechanical organ whose material characterisation would aid in the investigation of its pathophysiology, help in the field of tissue engineering, and improve surgical simulations and the design of medical devices. However, the layer-dependent, anisotropic properties of the organ have not been investigated using human tissue, particularly in regard to its viscoelastic and stress-softening behaviour. Restrictions caused by the COVID-19 pandemic meant that fresh human tissue was not available for dissection. Therefore, in this study, the layer-specific material properties of the human oesophagus were investigated through ex vivo experimentation of the embalmed muscularis propria layer. For this, a series of uniaxial tension cyclic tests with increasing stretch levels were conducted at two different strain rates. The muscular layers from three different cadaveric specimens were tested in both the longitudinal and circumferential directions. The results displayed highly nonlinear and anisotropic behaviour, with both time- and history-dependent stress-softening. The longitudinal direction was found to be stiffer than the circumferential direction at both strain rates. Strain rate-dependent behaviour was apparent, with an increase in strain rate resulting in an increase in stiffness in both directions. Histological analysis was carried out via various staining methods; the results of which were discussed with regard to the experimentally observed stress-stretch response. Finally, the behaviour of the muscularis propria was simulated using a matrix-fibre model able to capture the various mechanical phenomena exhibited, the fibre orientation of which was driven by the histological findings of the study.

3D biomechanical properties of the layered esophagus: Fung-type SEF and new constitutive model

BACKGROUND AND PURPOSE

Most current studies on the passive biomechanical properties of esophageal tissues directly use the exponential strain energy function (SEF) to fit and calculate the constants of the constitutive equation. In the context of the extensive application of exponential SEF, in-depth research on the exponential SEF is still lacking. The purpose of this study is to combine the exponential function with the polynomial SEF to obtain the most suitable constitutive equation to describe the three-dimensional passive behavior of the esophagus.

METHODS

fresh pig esophagus with a length of 13 cm in the middle position was selected as esophageal samples. The esophageal sample was separated into muscular layer and mucosal layer with surgical scissors. Stretch-inflation mechanical tests of the intact esophagus, esophageal muscular, and esophageal mucosa were carried out on a triaxial test machine. The external radius, axial force, and internal pressure were recorded simultaneously. The seven-parameter Fung-type SEF and several new SEFs combining polynomials and exponents were used to fit the experimental data curves.

RESULTS

The stretch-inflation test data and the morphometric parameters at the zero-stress state of the layered esophagus were obtained. The new SEF with polynomial and exponential combination is more suitable to describe describing the three-dimensional passive biomechanical properties of esophageal tissue. Among them, New-Fung13 SEF is more suitable for describing the passive biomechanical properties of intact esophageal tissue, Sokolis-Fung13 SEF is more suitable for the esophageal muscle layer, and New-Fung10 SEF is more suitable for the esophageal mucosa. The constitutive parameters of the optimal constitutive model for each layer of the esophagus were obtained.

Anisotropic damage of soft tissues in supra-physiological deformations

Soft tissues may undergo mechanical damage under supra-physiological deformations caused by medical treatments such as balloon-angioplasty and stent deployment. This damage is exhibited as a softening in the mechanical behavior of tissues. In this work, alteration of the collagen network is treated as the origin of damage and loss of stiffness. Inspired by the hierarchical structure of the collagen network, the mechanical properties of collagenous tissues are connected to model parameters. Softening of esophageal and arterial tissues under directional cyclic loading is investigated to determine evolution of the associated material parameters through damage progress. An evolution law is proposed which predicts the mechanical behavior of tissues after excessive deformations. Various deformation measures are examined as the damage parameter to determine the most appropriate one for general 3D loading. It is observed that, if the Green-Lagrange strain in the direction of the fibers is used as the damage parameter, the proposed law well describes the evolution of the collagen network's stiffness. The results not only facilitate prediction of the deformation-induced damage under supra-physiological deformations but also are useful for surgeons in better planning of surgical procedures and stents design.

Esophagus stretch tests: Biomechanics for tissue engineering and possible implications on the outcome of esophageal atresia repairs performed under excessive tension

BACKGROUND

Esophageal biomechanical studies are important to understand structural changes resulting from stretches during repair of esophageal atresias as well as to obtain values to compare with the biomechanics of tissue-engineered esophagus in the future. This study aimed to investigate light microscopic changes after uniaxial stretching of the ovine esophagus.

METHODS

In vitro uniaxial stretching was performed on esophagi (n = 20) of 1-month-old lambs within 4-6 h post-mortem. Esophagi were divided into 5 groups: control and stretched (1.1, 1.2, 1.3 and 1.4). Force and lengthening were measured with 5 cycles performed on every specimen using a PBS organ bath at 37 °C. Histological studies were performed on the 5 groups.

RESULTS

Low forces of ~ 2 N (N) were sufficient for a 1.2-1.25 stretch in the 1st cycle, whereas a three times higher force (~ 6 N) was needed for a stretch of 1.3. In the 2nd to 5th cycle, the tissue weakened and a force of ~ 3 N was sufficient for a stretch of 1.3. Histologically, in the 1.3-1.4 stretch groups, rupture of muscle fibers and capillaries were observed, respectively. Changes in mucosa and collagen fibers could not be observed.

CONCLUSIONS

These results offer norm values from the native esophagus to compare with the biomechanics of future tissue-engineered esophagus. Esophageal stretching > 1.3 leads to tears in muscle fibers and to rupture of capillaries. These findings can explain the decrease in microcirculation and scarring in mobilized tissue and possibly offer clues to impaired motility in esophagus atresias repaired under excessive tension.

Location- and layer-dependent biomechanical and microstructural characterisation of the porcine urinary bladder wall

The knowledge of the mechanical properties of the urinary bladder wall helps to explain its storage and micturition functions in health and disease studies; however, these properties largely remain unknown, especially with regard to its layer-specific characteristics and microstructure. Consequently, this study entails the assessment of the layer-specific differences in the mechanical properties and microstructure of the bladder wall, especially during loading. Accordingly, ninety-two (n=92) samples of porcine urinary bladder walls were mechanically and histologically analysed. Generally, the bladder wall and different tissue layers exhibit a non-linear stress-stretch relationship. In this study, the load transfer mechanisms were not only associated with the wavy structure of muscular and mucosal layers, but also with the entire bladder wall microstructure. Contextually, an interplay between the mucosal and muscular layers could be identified. Therefore, depending on the region and direction, the mucosal layer exhibited a stiffer mechanical response to equi-biaxial loading than that offered by the muscular layer when deformed to stretch levels higher than λ=1.6 to λ=2.2. For smaller stretches, the mucosal layer evinces no significant mechanical reaction, while the muscular layer bears the load. Owing to the orientation of its muscle fibres, the muscular layer shows an increased degree of anisotropy compared to the mucosal layer. Furthermore, the general incompressibility assumption is analysed for different layers by measuring the change in thickness during loading, which indicated a small volume loss.

Esophageal extracellular matrix hydrogel mitigates metaplastic change in a dog model of Barrett's esophagus

Chronic inflammatory gastric reflux alters the esophageal microenvironment and induces metaplastic transformation of the epithelium, a precancerous condition termed Barrett's esophagus (BE). The microenvironmental niche, which includes the extracellular matrix (ECM), substantially influences cell phenotype. ECM harvested from normal porcine esophageal mucosa (eECM) was formulated as a mucoadhesive hydrogel, and shown to largely retain basement membrane and matrix-cell adhesion proteins. Dogs with BE were treated orally with eECM hydrogel and omeprazole (n = 6) or omeprazole alone (n = 2) for 30 days. eECM treatment resolved esophagitis, reverted metaplasia to a normal, squamous epithelium in four of six animals, and downregulated the pro-inflammatory tumor necrosis factor-α+ cell infiltrate compared to control animals. The metaplastic tissue in control animals (n = 2) did not regress. The results suggest that in vivo alteration of the microenvironment with a site-appropriate, mucoadhesive ECM hydrogel can mitigate the inflammatory and metaplastic response in a dog model of BE.

Tissue engineering of the gastroesophageal junction

The gastroesophageal junction has been of clinical interest for some time due to its important role in preventing reflux of caustic stomach contents upward into the esophagus. Failure of this role has been identified as a key driver in gastroesophageal reflux disease, cancer of the lower esophagus, and aspiration-induced lung complications. Due to the large population burden and significant morbidity and mortality related to reflux barrier dysfunction, there is a pressing need to develop tissue engineering solutions which can replace diseased junctions. While good progress has been made in engineering the bodies of the esophagus and stomach, little has been done for the junction between the two. In this review, we discuss pertinent topics which should be considered as tissue engineers begin to address this anatomical region. The embryological development and adult anatomy and histology are discussed to provide context about the native structures which must be replicated. The roles of smooth muscle structures in the esophagus and stomach, as well as the contribution of the diaphragm to normal anti-reflux function are then examined. Finally, engineering considerations including mechanics and current progress in the field of tissue engineering are presented.

Biomechanical and microstructural characterisation of the porcine stomach wall: Location- and layer-dependent investigations

The mechanical properties of the stomach wall help to explain its function of storing, mixing, and emptying in health and disease. However, much remains unknown about its mechanical properties, especially regarding regional heterogeneities and wall microstructure. Consequently, the present study aimed to assess regional differences in the mechanical properties and microstructure of the stomach wall. In general, the stomach wall and the different tissue layers exhibited a nonlinear stress-stretch relationship. Regional differences were found in the mechanical response and the microstructure. The highest stresses of the entire stomach wall in longitudinal direction were found in the corpus (201.5 kPa), where food is ground followed by the antrum (73.1 kPa) and the fundus (26.6 kPa). In contrast, the maximum stresses in circumferential direction were 39.7 kPa, 26.2 kPa, and 15.7 kPa for the antrum, fundus, and corpus, respectively. Independent of the fibre orientation and with respect to the biaxial loading direction, partially clear anisotropic responses were detected in the intact wall and the muscular layer. In contrast, the innermost mucosal layer featured isotropic mechanical characteristics. Pronounced layers of circumferential and longitudinal muscle fibres were found in the fundus only, whereas corpus and antrum contained almost exclusively circumferential orientated muscle fibres. This specific stomach structure mirrors functional differences in the fundus as well as corpus and antrum. Within this study, the load transfer mechanisms, connected with these wavy layers but also in total with the stomach wall's microstructure, are discussed. STATEMENT OF SIGNIFICANCE: This article examines for the first time the layer-specific mechanical and histological properties of the stomach wall attending to the location of the sample. Moreover, both mechanical behaviour and microstructure were explicitly match identifying the heterogeneous characteristics of the stomach. On the one hand, the results of this study contribute to the understanding of stomach mechanics and thus to their functional understanding of stomach motility. On the other hand, they are relevant to the fields of constitutive formulation of stomach tissue, whole stomach mechanics, and stomach-derived scaffolds i.e., tissue-engineering grafts.

Failure properties and microstructure of healthy and aneurysmatic human thoracic aortas subjected to uniaxial extension with a focus on the media

Current clinical practice for aneurysmatic interventions is often based on the maximum diameter of the vessel and/or on the growth rate, although rupture can occur at any diameter and growth rate, leading to fatality. For 27 medial samples obtained from 12 non-aneurysmatic (control) and 9 aneurysmatic human descending thoracic aortas we examined: the mechanical responses up to rupture using uniaxial extension tests of circumferential and longitudinal specimens; the structure of these tissues using second-harmonic imaging and histology, in particular, the content proportions of collagen, elastic fibers and smooth muscle cells in the media. It was found that the mean failure stresses were higher in the circumferential directions (Control-C 1474kPa; Aneurysmatic-C 1446kPa), than in the longitudinal directions (Aneurysmatic-L 735kPa; Control-L 579kPa). This trend was the opposite to that observed for the mean collagen fiber directions measured from the loading axis (Control-L > Aneurysmatic-L > Aneurysmatic-C > Control-C), thus suggesting that the trend in the failure stress can in part be attributed to the collagen architecture. The difference in the mean values of the out-of-plane dispersion in the radial/longitudinal plane between the control and aneurysmatic groups was significant. The difference in the mean values of the mean fiber angle from the circumferential direction was also significantly different between the two groups. Most specimens showed delamination zones near the ruptured region in addition to ruptured collagen and elastic fibers. This study provides a basis for further studies on the microstructure and the uniaxial failure properties of (aneurysmatic) arterial walls towards realistic modeling and prediction of tissue failure. STATEMENT OF SIGNIFICANCE: A data set relating uniaxial failure properties to the microstructure of non-aneurysmatic and aneurysmatic human thoracic aortic medias under uniaxial extension tests is presented for the first time. It was found that the mean failure stresses were higher in the circumferential directions, than in the longitudinal directions. The general trend for the failure stresses was Control-C > Aneurysmatic-C > Aneurysmatic-L > Control-L, which was the opposite of that observed for the mean collagen fiber direction relative to the loading axis (Control-L > Aneurysmatic-L > Aneurysmatic-C > Control-C) suggesting that the trend in the failure stress can in part be attributed to the collagen architecture. This study provides a first step towards more realistic modeling and prediction of tissue failure.

Visceral pain from colon and rectum: the mechanotransduction and biomechanics

Visceral pain is the cardinal symptom of functional gastrointestinal (GI) disorders such as the irritable bowel syndrome (IBS) and the leading cause of patients' visit to gastroenterologists. IBS-related visceral pain usually arises from the distal colon and rectum (colorectum), an intraluminal environment that differs greatly from environment outside the body in chemical, biological, thermal, and mechanical conditions. Accordingly, visceral pain is different from cutaneous pain in several key psychophysical characteristics, which likely underlies the unsatisfactory management of visceral pain by drugs developed for other types of pain. Colorectal visceral pain is usually elicited from mechanical distension/stretch, rather than from heating, cutting, pinching, or piercing that usually evoke pain from the skin. Thus, mechanotransduction, i.e., the encoding of colorectal mechanical stimuli by sensory afferents, is crucial to the underlying mechanisms of GI-related visceral pain. This review will focus on colorectal mechanotransduction, the process of converting colorectal mechanical stimuli into trains of action potentials by the sensory afferents to inform the central nervous system (CNS). We will summarize neurophysiological studies on afferent encoding of colorectal mechanical stimuli, highlight recent advances in our understanding of colorectal biomechanics that plays critical roles in mechanotransduction, and review studies on mechano-sensitive ion channels in colorectal afferents. This review calls for focused attention on targeting colorectal mechanotransduction as a new strategy for managing visceral pain, which can also have an added benefit of limited CNS side effects, because mechanotransduction arises from peripheral organs.

Differential biomechanical properties of mouse distal colon and rectum innervated by the splanchnic and pelvic afferents

Visceral pain is one of the principal complaints of patients with irritable bowel syndrome, and this pain is reliably evoked by mechanical distension and stretch of distal colon and rectum (colorectum). This study focuses on the biomechanics of the colorectum that could play critical roles in mechanical neural encoding. We harvested the distal 30 mm of the colorectum from mice, divided evenly into three 10-mm-long segments (colonic, intermediate and rectal), and conducted biaxial mechanical stretch tests and opening-angle measurements for each tissue segment. In addition, we determined the collagen fiber orientations and contents across the thickness of the colorectal wall by nonlinear imaging via second harmonic generation (SHG). Our results reveal a progressive increase in tissue compliance and prestress from colonic to rectal segments, which supports prior electrophysiological findings of distinct mechanical neural encodings by afferents in the lumbar splanchnic nerves (LSN) and pelvic nerves (PN) that dominate colonic and rectal innervations, respectively. The colorectum is significantly more viscoelastic in the circumferential direction than in the axial direction. In addition, our SHG results reveal a rich collagen network in the submucosa and orients approximately ±30° to the axial direction, consistent with the biaxial test results presenting almost twice the stiffness in axial direction versus the circumferential direction. Results from current biomechanical study strongly indicate the prominent roles of local tissue biomechanics in determining the differential mechanical neural encoding functions in different regions of the colorectum. NEW & NOTEWORTHY Mechanical distension and stretch-not heat, cutting, or pinching-reliably evoke pain from distal colon and rectum. We report different local mechanics along the longitudinal length of the colorectum, which is consistent with the existing literature on distinct mechanotransduction of afferents innervating proximal and distal regions of the colorectum. This study draws attention to local mechanics as a potential determinant factor for mechanical neural encoding of the colorectum, which is crucial in visceral nociception.

In vivo Layer-specific Mechanical Characterization of Porcine Stomach Tissue using Ultrasound Elastography

This paper presents in vivo mechanical characterization of the muscularis, submucosa and mucosa of the porcine stomach wall under large deformation loading. This is important for the development of gastrointestinal pathology-specific surgical intervention techniques. The study is based on testing the cardiac and fundic glandular stomach regions using a custom-developed compression elastography setup. Particular attention has been paid to elucidate the heterogeneity and anisotropy of tissue response. A Fung hyperelastic material model has been used to model the mechanical response of each tissue layer. A univariate analysis comparing the initial shear moduli of the three layers indicates that the muscularis (5.69±4.06 kPa) is the stiffest followed by the submucosa (3.04±3.32 kPa) and the mucosa (0.56±0.28 kPa). The muscularis is found to be strongly distinguishable from the mucosa tissue in the cardiac and fundic region based on a multivariate discriminant analysis. The cardiac muscularis is observed to be stiffer than the fundic muscularis tissue (shear moduli of 7.96±3.82 kPa vs. 3.42±2.96 kPa), more anisotropic (anisotropic parameter of 2.21±0.77 vs. 1.41±0.38), and strongly distinguishable from its fundic counterpart. Finally, a univariate comparison of the in vivo and ex vivo initial shear moduli for each layer shows that the muscularis and submucosa tissues are softer while in vivo, but the mucosa tissue is stiffer while in vivo. The mechanical properties highlight the inhomogeneity and anisotropy of multilayer stomach tissue.

Esophageal Biomechanics Revisited: A Tale of Tenacity, Anastomoses, and Suture Bite Lengths in Swine

BACKGROUND

Anastomotic tension has repeatedly been associated with anastomotic leakages after esophagectomy for cancer or esophageal atresia repair. We therefore aimed to determine which anastomotic technique would come as close as possible to the native esophagus in sustaining traction forces. Constant traction for several minutes at esophageal remnants and large suture bites are also considered relevant in long-gap esophageal atresia repair.

METHODS

Porcine esophagi were subjected to linear traction using a motorized horizontal test stand. We compared breaking strengths of native esophagi to simple continuous, simple interrupted, stapled, and barbed suture anastomoses. We also investigated the effects of suture bite length and phases of constant traction on breaking strengths and powered all experiments to at least 80% using exploratory investigations (n = 5 per group).

RESULTS

Continuous suture anastomoses had a breaking strength comparable to native esophagi (Δ = -5.25 Newton, 95% confidence interval: -10.69 to 0.19 Newton, p = 0.058) and outperformed all other investigated anastomoses (Δ ≥14.01 Newton, p ≤ 0.02). Breaking strength correlated with suture bite length (R = 0.905) and predicted breaking strength for the simple stitch (adjusted R² = 0.812, p < 0.0001), but not for anastomoses. Phases of incrementally increasing constant traction resulted in higher breaking strengths (Δ = 13.36 Newton, 95% confidence interval: 9.93 to 16.79 Newton, p < 0.0001) and higher length gain (Δ = 1.06 cm, 95% confidence interval: 0.65 to 1.48 cm, p < 0.0001) compared with controls.

CONCLUSIONS

Only simple continuous anastomoses achieved the linear breaking strength of native tissue. Our study provides important insights in tolerance to traction forces, but its results have to be corroborated in living animals as anastomotic leakages are multifactorial processes.

How important is sample alignment in planar biaxial testing of anisotropic soft biological tissues? A finite element study

Finite element models of biomedical applications increasingly use anisotropic hyperelastic material formulations. Appropriate material parameters are essential for a reliable outcome of these simulations, which is why planar biaxial testing of soft biological tissues is gaining importance. However, much is still to be learned regarding the ideal methodology for performing this type of test and the subsequent parameter fitting procedure. This paper focuses on the effect of an unknown sample orientation or a mistake in the sample orientation in a planar biaxial test using rakes. To this end, finite element simulations were conducted with various degrees of misalignment. Variations to the test method and subsequent fitting procedures are compared and evaluated. For a perfectly aligned sample and for a slightly misaligned sample, the parameters of the Gasser-Ogden-Holzapfel model can be found to a reasonable accuracy using a planar biaxial test with rakes and a parameter fitting procedure that takes into account the boundary conditions. However, after a certain threshold of misalignment, reliable parameters can no longer be found. The level of this threshold seems to be material dependent. For a sample with unknown sample orientation, material parameters could theoretically be obtained by increasing the degrees of freedom along which test data is obtained, e.g. by adding the data of a rail shear test. However, in the situation and the material model studied here, the inhomogeneous boundary conditions of the test set-ups render it impossible to obtain the correct parameters, even when using the parameter fitting method that takes into account boundary conditions. To conclude, it is always important to carefully track the sample orientation during harvesting and preparation and to minimize the misalignment during mounting. For transversely isotropic samples with an unknown orientation, we advise against parameter fitting based on a planar biaxial test, even when combined with a rail shear test.

Biomechanical properties and microstructure of neonatal porcine ventricles

Neonatal heart disorders represent a major clinical challenge, with congenital heart disease alone affecting 36,000 new-borns annually within the European Union. Surgical intervention to restore normal function includes the implantation of synthetic and biological materials; however, a lack of experimental data describing the mechanical behaviour of neonatal cardiac tissue is likely to contribute to the relatively poor short- and long-term outcome of these implants. This study focused on characterising the mechanical behaviour of neonatal cardiac tissue using a porcine model, to enhance the understanding of how this differs to the equivalent mature tissue. The biomechanical properties of neonatal porcine cardiac tissue were characterised by uniaxial tensile, biaxial tensile, and simple shear loading modes, using samples collected from the anterior and posterior walls of the right and left ventricles. Histological images were prepared using Masson's trichrome staining, to enable assessment of the microstructure and correlation with tissue behaviour. The mechanical tests demonstrated that the neonatal cardiac tissue is non-linear, anisotropic, viscoelastic and heterogeneous. Our data provide a baseline describing the biomechanical behaviour of immature porcine cardiac tissue. Comparison with published data also indicated that the neonatal porcine cardiac tissue exhibits one-half the stiffness of mature porcine tissue in uniaxial extension testing, one-third in biaxial extension testing, and one-fourth stiffness in simple shear testing; hence, it provides an indication as to the relative change in characteristics associated with tissue maturation. These data may prove valuable to researchers investigating neonatal cardiac mechanics.

Location-dependent correlation between tissue structure and the mechanical behaviour of the urinary bladder

The mechanical properties of the urinary bladder wall are important to understand its filling-voiding cycle in health and disease. However, much remains unknown about its mechanical properties, especially regarding regional heterogeneities and wall microstructure. The present study aimed to assess the regional differences in the mechanical properties and microstructure of the urinary bladder wall. Ninety (n=90) samples of porcine urinary bladder wall (ten samples from nine different locations) were mechanically and histologically analysed. Half of the samples (n=45) were equibiaxially tested within physiological conditions, and the other half, matching the sample location of the mechanical tests, was frozen, cryosectioned, and stained with Picro-Sirius red to differentiate smooth muscle cells, extracellular matrix, and fat. The bladder wall shows a non-linear stress-stretch relationship with hysteresis and softening effects. Regional differences were found in the mechanical response and in the microstructure. The trigone region presents higher peak stresses and thinner muscularis layer compared to the rest of the bladder. Furthermore, the ventral side of the bladder presents anisotropic characteristics, whereas the dorsal side features perfect isotropic behaviour. This response matches the smooth muscle fibre bundle orientation within the tunica muscularis. This layer, comprising approximately 78% of the wall thickness, is composed of two fibre bundle arrangements that are cross-oriented, one with respect to the other, varying the angle between them across the organ. That is, the ventral side presents a 60°/120° cross-orientation structure, while the muscle bundles were oriented perpendicular in the dorsal side.

STATEMENT OF SIGNIFICANCE

In the present study, we demonstrate that the mechanical properties and the microstructure of the urinary bladder wall are heterogeneous across the organ. The mechanical properties and the microstructure of the urinary bladder wall within nine specific locations matching explicitly the mechanical and structural variations have been examined. On the one hand, the results of this study contribute to the understanding of bladder mechanics and thus to their functional understanding of bladder filling and voiding. On the other hand, they are relevant to the fields of constitutive formulation of bladder tissue, whole bladder mechanics, and bladder-derived scaffolds i.e., tissue-engineering grafts.

Implementation and validation of constitutive relations for human dermis mechanical response

Finite element models in conjunction with adequate constitutive relations are pivotal in several physiological and medical applications related to both native and engineered tissues, allowing to predict the tissue response under various loading states. In order to get reliable results, however, the validation of the constitutive models is crucial. Therefore, the main purpose of this work is to provide an experimental-computational approach to the biomechanical investigation of soft tissues such as the dermis. This is accomplished by implementing and validating three widely adopted hyperelastic constitutive models (the Ogden, the Holzapfel, and the Gasser-Ogden-Holzapfel laws) supposed to be adequate to reproduce human reticular dermis mechanical behavior. Biaxial experimental data have represented the basis for the determination of the respective material parameters identified thanks to the definition of a cost function accounting for the discrepancy between experimental and predicted data. Afterwards, the experimental tests have been reproduced through finite element simulations. Hence, the constitutive laws have been validated comparing experimental and numerical outcomes in terms of displacements of four reference points and stress-strain relations. Hence, an experimental-numerical framework is proposed for the investigation of collagenous tissues, which could become more accurate with larger and independent experimental datasets. Graphical abstract ᅟ.

Mechanical Characterization and Material Modeling of Diabetic Aortas in a Rabbit Model

Diabetes has been recognized as a major risk factor to cause macrovascular diseases and plays a key role in aortic wall remodeling. However, the effects of diabetes on elastic properties of aortas remain largely unknown and quantitative mechanical data are lacking. Thirty adult rabbits (1.6-2.2 kg) were collected and the type 1 diabetic rabbit model was induced by injection of alloxan. A total of 15 control and 15 diabetic rabbit (abdominal) aortas were harvested. Uniaxial and biaxial tensile tests were performed to measure ultimate tensile strength and to characterize biaxial mechanical behaviors of the aortas. A material model was fitted to the biaxial experimental data to obtain constitutive parameters. Histological and mass fraction analyses were performed to investigate the underlying microstructure and dry weight percentages of elastin and collagen in the control and the diabetic aortas. No statistically significant difference was found in ultimate tensile strength between the control and the diabetic aortas. Regarding biaxial mechanical responses, the diabetic aortas exhibited significantly lower extensibility and significantly higher tissue stiffness than the control aortas. Notably, tissue stiffening occurred in both circumferential and axial directions for the diabetic aortas; however, mechanical anisotropy does not change significantly. The material model was able to fit biaxial experimental data very well. Histology showed that a number of isolated foam cells were embedded in the diabetic aortas and hyperplasia of collagen was identified. The dry weight percentages of collagen within the diabetic aortas increased significantly as compared to the control aortas, whereas no significant change was found for that of elastin. Our data suggest that the diabetes impairs elastic properties and alters microstructure of the aortas and consequently, these changes may further contribute to complex aortic wall remodeling.

In Situ Mechanical Characterization of Multilayer Soft Tissue Using Ultrasound Imaging

In this paper, we report the development of a technique to characterize layer-specific nonlinear material properties of soft tissue in situ with the potential for in vivo testing. A soft tissue elastography robotic arm system comprising of a robotically manipulated 30 MHz high-resolution ultrasound probe, a custom designed compression head, and load cells has been developed to perform compression ultrasound imaging on the target tissue and measure reaction forces. A multilayer finite element model is iteratively optimized to identify the material coefficients of each layer. Validation has been performed using tissue mimicking agar-based phantoms with a low relative error of ∼7% for two-layer phantoms and ∼10% error for three layer phantoms when compared to known ground-truth values obtained using a commercial material testing system. The technique has then been used to successfully determine the in situ layer-specific mechanical properties of intact porcine stomach. The mean C10 and C20 for a second-order reduced polynomial material model were determined for the muscularis (6.41 ± 0.60, 4.29 ± 1.87 kPa), submucosal (5.21 ± 0.57, 3.68 ± 3.01 kPa), and mucosal layers (0.06 ± 0.02, 0.09 ± 0.24 kPa). Such a system can be utilized to perform in vivo mechanical characterization, which is left as future work.

A Procedure for the Automatic Analysis of High-Resolution Manometry Data to Support the Clinical Diagnosis of Esophageal Motility Disorders

OBJECTIVE

Degenerative phenomena may affect esophageal motility as a relevant social-health problem. The diagnosis of such disorders is usually performed by the analysis of data from high-resolution manometry (HRM). Inter- and intraobserver variability frequently affects the diagnosis, with potential interpretative and thus therapeutic errors, with unnecessary or worse treatments. This may be avoided with automatic procedures that minimize human intervention in data processing.

METHODS

In order to support the traditional diagnostic process, an automatic procedure was defined considering a specific physiomechanical model that is able to objectively interpret data from HRM. A training set (N = 226) of healthy volunteers and pathological subjects was collected in order to define the model parameters distributions of the different groups of subjects, providing a preliminary database. A statistical algorithm was defined for an objective identification of the patient's healthy or pathological condition by comparing patient parameters with the database.

RESULTS

A collection of HRMs including subjects of the training set has been built. Statistical relationships between parameters and pathologies have been established leading to a preliminary database. An automatic diagnosis procedure has been developed to compare model parameters of a specific patient with the database. The procedure was able to match the correct diagnosis up to 86% of the analyzed subjects.

CONCLUSION

The success rate of the automatic procedure addresses the suitability of the developed algorithms to provide a valid support to the clinicians for the diagnostic activity.

SIGNIFICANCE

The objectivity of developed tools increases the reliability of data interpretation and, consequently, patient acceptance.

Constitutive modeling of the passive inflation-extension behavior of the swine colon

In the present work, we propose the first structural constitutive model of the passive mechanical behavior of the swine colon that is validated against physiological inflation-extension tests, and accounts for residual strains. Sections from the spiral colon and the descending colon were considered to investigate potential regional variability. We found that the proposed constitutive model accurately captures the passive inflation-extension behavior of both regions of the swine colon (coefficient of determination R²=0.94±0.02). The model revealed that the circumferential muscle layer does not provide significant mechanical support under passive conditions and the circumferential load is actually carried by the submucosa layer. The stress analysis permitted by the model showed that the colon tissue can distend up to 30% radially without significant increase in the wall stresses suggesting a highly compliant behavior of the tissue. This is in-line with the requirement for the tissue to easily accommodate variable quantities of fecal matter. The analysis also showed that the descending colon is significantly more compliant than the spiral colon, which is relevant to the storage function of the descending colon. Histological analysis showed that the swine colon possesses a four-layer structure similar to the human colon, where the longitudinal muscle layer is organized into bands called taeniae, a typical feature of the human colon. The model and the estimated parameters can be used in a Finite Element framework to conduct simulations with realistic geometry of the swine colon. The resulting computational model will provide a foundation for virtual assessment of safe and effective devices for the treatment of colonic diseases.

The Esophagiome: concept, status, and future perspectives

The term "Esophagiome" is meant to imply a holistic, multiscale treatment of esophageal function from cellular and muscle physiology to the mechanical responses that transport and mix fluid contents. The development and application of multiscale mathematical models of esophageal function are central to the Esophagiome concept. These model elements underlie the development of a "virtual esophagus" modeling framework to characterize and analyze function and disease by quantitatively contrasting normal and pathophysiological function. Functional models incorporate anatomical details with sensory-motor properties and functional responses, especially related to biomechanical functions, such as bolus transport and gastrointestinal fluid mixing. This brief review provides insight into Esophagiome research. Future advanced models can provide predictive evaluations of the therapeutic consequences of surgical and endoscopic treatments and will aim to facilitate clinical diagnostics and treatment.

Modelling the failure precursor mechanism of lamellar fibrous tissues, example of the annulus fibrosus

The aims of this study were to assess the damage and failure strengths of lamellar fibrous tissues, such as the anterior annulus fibrosus (AF), and to develop a mathematical model of damage propagation of the lamellae and inter-lamellar connections. This level of modelling is needed to accurately predict the effect of damage and failure induced by trauma or clinical interventions. 26 ovine anterior AF cuboid specimens from 11 lumbar intervertebral discs were tested in radial tension and mechanical parameters defining damage and failure were extracted from the in-vitro data. Equivalent 1D analytical models were developed to represent the specimen strength and the damage propagation, accounting for the specimen dimensions and number of lamellae. Model parameters were calibrated on the in-vitro data. Similar to stiffness values reported for other orientations, the outer annulus was found stronger than the inner annulus in the radial direction, with failure at higher stress values. The inner annulus failed more progressively, showing macroscopic failure at a higher strain value. The 1D analytical model of damage showed that lamellar damage is predominant in the failure mechanism of the AF. The analytical model of the connections between lamellae allowed us to represent separately damage processes in the lamellae and the inter-lamellar connections, which cannot be experimentally tested individually.

Very large and giant microsurgical bifurcation aneurysms in rabbits: Proof of feasibility and comparability using computational fluid dynamics and biomechanical testing

BACKGROUND

Giant aneurysms are challenging lesions with unacceptable high rates of aneurysm recanalization and rerupture following embolization. Reliable in vivo models are urgently needed to test the performance of new more efficient endovascular devices.

MATERIALS AND METHODS

Aneurysms were created in 11 New Zealand white rabbits (4.5-5.5kg): A long venous pouch (length 25-30mm) mimicking the aneurysm sac was derived from the external jugular vein and sutured into a microsurgically created bifurcation between both common carotid arteries. After 4 weeks the rabbits underwent 3T Magnetic resonance angiography (3T-MRA). Exemplary computational fluid dynamics (CFD) simulations were performed to compare the flow conditions of giant rabbit and human aneurysms. We used species-related boundary conditions, in particular, we measured blood viscosity values. Biaxial mechanical tests were performed for the mechanical characterization and comparison.

COMPARISON WITH EXISITING METHOD(S)

None.

RESULTS

No peri- or postoperative mortality was observed. 3T-MRA showed aneurysm patency in 10 out of 11 aneurysms (90.9%). Aneurysm lengths ranged from 21.5-25.6mm and aneurysm necks from 7.3-9.8mm. CFD showed complex flow profiles with multiple vortices in both, rabbit and human aneurysms. Lower blood viscosity values of the rabbit (3.92mPas vs. human 5.34mPas) resulted in considerable lower wall shear stress rates (rabbit 0.38Pa vs. human 1.66Pa). Mechanical tests showed lower stiffness of rabbit aneurysms compared to unruptured human aneurysms.

CONCLUSIONS

The proposed model showed favorable aneurysm patency rates, low morbidity and good hemodynamic comparability with complex flow patterns. Biomechanical testing suggests that experimental aneurysms might be even more fragile compared to human aneurysms.

Mechanical strength of aneurysmatic and dissected human thoracic aortas at different shear loading modes

Rupture of aneurysms and acute dissection of the thoracic aorta are life-threatening events which affect tens of thousands of people per year. The underlying mechanisms remain unclear and the aortic wall is known to lose its structural integrity, which in turn affects its mechanical response to the loading conditions. Hence, research on such aortic diseases is an important area in biomechanics. The present study investigates the mechanical properties of aneurysmatic and dissected human thoracic aortas via triaxial shear and uniaxial tensile testing with a focus on the former. In particular, ultimate stress values from triaxial shear tests in different orientations regarding the aorta׳s orthotropic microstructure, and from uniaxial tensile tests in radial, circumferential and longitudinal directions were determined. In total, 16 human thoracic aortas were investigated from which it is evident that the aortic media has much stronger resistance to rupture under 'out-of-plane' than under 'in-plane' shear loadings. Under different shear loadings the aortic tissues revealed anisotropic failure properties with higher ultimate shear stresses and amounts of shear in the longitudinal than in the circumferential direction. Furthermore, the aortic media decreased its tensile strength as follows: circumferential direction >longitudinaldirection> radial direction. Anisotropic and nonlinear tissue properties are apparent from the experimental data. The results clearly showed interspecimen differences influenced by the anamnesis of the donors such as aortic diseases or connective tissue disorders, e.g., dissected specimens exhibited on average a markedly lower mechanical strength than aneurysmatic specimens. The rupture data based on the combination of triaxial shear and uniaxial extension testing are unique and build a good basis for developing a 3D failure criterion of diseased human thoracic aortic media. This is a step forward to more realistic modeling of mechanically induced tissue failure i.e. rupture of aneurysms or progression of aortic dissections.

Planar biaxial testing of soft biological tissue using rakes: A critical analysis of protocol and fitting process

Mechanical characterization of soft biological tissue is becoming more and more prevalent. Despite the growing use of planar biaxial testing for soft tissue characterization, testing conditions and subsequent data analysis have not been standardized and vary widely. This also influences the quality of the result of the parameter fitting. Moreover, the testing conditions and data analysis are often not or incompletely reported, which impedes the proper comparison of parameters obtained from different studies. With a focus on planar biaxial tests using rakes, this paper investigates varying testing conditions and varying data analysis methods and their effect on the quality of the parameter fitting results. By means of a series of finite element simulations, aspects such as number of rakes, rakes׳ width, loading protocol, constitutive model, material stiffness and anisotropy are evaluated based on the degree of homogeneity of the stress field, and on the correlation between the experimentally obtained stress and the stress derived from the constitutive model. When calculating the aforementioned stresses, different definitions of the section width and deformation gradient are used in literature, each of which are looked into. Apart from this degree of homogeneity and correlation, also the effect on the quality of the parameter fitting result is evaluated. The results show that inhomogeneities can be reduced to a minimum for wise choices of testing conditions and analysis methods, but never completely eliminated. Therefore, a new parameter optimization procedure is proposed that corrects for the inhomogeneities in the stress field and induces significant improvements to the fitting results. Recommendations are made for best practice in rake-based planar biaxial testing of soft biological tissues and subsequent parameter fitting, and guidelines are formulated for reporting thereof in publications.

Prediction of mechanical behaviour from histology in thin collagenous tissues

A method of generating a rough, robust estimate of tensile modulus, elongation at break, and tear out of tissue from histology for the purpose of accelerating medical device and simulator design is presented. The known properties of the individual structural components of tissue are utilized by organizing these components according to existing histological data. This method was able to predict the elastic modulus of esophageal tissue by layer and direction with accuracy close to the standard deviation of the tissue properties, to provide a robust upper limit on tear out force for small (< 0.2mm or 3-0) sutures or clips, and predict force distribution between the layers during tear out.

Heart valve tissue engineering: how far is the bedside from the bench?

Heart disease, including valve pathologies, is the leading cause of death worldwide. Despite the progress made thanks to improving transplantation techniques, a perfect valve substitute has not yet been developed: once a diseased valve is replaced with current technologies, the newly implanted valve still needs to be changed some time in the future. This situation is particularly dramatic in the case of children and young adults, because of the necessity of valve growth during the patient's life. Our review focuses on the current status of heart valve (HV) therapy and the challenges that must be solved in the development of new approaches based on tissue engineering. Scientists and physicians have proposed tissue-engineered heart valves (TEHVs) as the most promising solution for HV replacement, especially given that they can help to avoid thrombosis, structural deterioration and xenoinfections. Lastly, TEHVs might also serve as a model for studying human valve development and pathologies.

Biomechanical properties and microstructure of human ventricular myocardium

In the multidisciplinary field of heart research it is of utmost importance to identify accurate myocardium material properties for the description of phenomena such as mechano-electric feedback or heart wall thickening. A rationally-based material model is required to understand the highly nonlinear mechanics of complex structures such as the passive myocardium under different loading conditions. Unfortunately, to date there are no experimental data of human heart tissues available to estimate material parameters and to develop adequate material models. This study aimed to determine biaxial extension and triaxial shear properties and the underlying microstructure of the passive human ventricular myocardium. Using new state-of-the-art equipment, planar biaxial extension tests were performed to determine the biaxial extension properties of the passive ventricular human myocardium. Shear properties of the myocardium were examined by triaxial simple shear tests performed on small cubic specimens excised from an adjacent region of the biaxial extension specimens. The three-dimensional microstructure was investigated through second-harmonic generation (SHG) microscopy on optically cleared tissues, which emphasized the 3D orientation and dispersion of the myofibers and adjacent collagen fabrics. The results suggest that the passive human LV myocardium under quasi-static and dynamic multiaxial loadings is a nonlinear, anisotropic (orthotropic), viscoelastic and history-dependent soft biological material undergoing large deformations. Material properties of the tissue components along local microstructural axes drive the nonlinear and orthotropic features of the myocardium. SHG microscopy investigation revealed detailed information about the myocardial microstructure due to its high resolution. It enabled the identification of structural parameters such as the fiber and the sheet orientations and corresponding dispersions. With this complete set of material data, a sophisticated material model and associated material parameters can be defined for a better description of the biomechanical response of the ventricular myocardium in humans. Such a model will lead to more accurate computational simulations to better understand the fundamental underlying ventricular mechanics, a step needed in the improvement of medical treatment of heart diseases.

STATEMENT OF SIGNIFICANCE

Unfortunately, to date there are no experimental data of human heart tissues available for material parameter estimation and the development of adequate material models. In this manuscript novel biaxial tensile and shear test data at different specimen orientations are presented, which allowed to adequately capture the direction-dependent material response. With these complete sets of mechanical data, combined with their underlying microstructural data (also presented herein), sophisticated material models and associated material parameters can be defined for the description of the mechanical behavior of the ventricular myocardium in humans. Such models will lead to accurate computational simulations to better understand the fundamental underlying ventricular mechanics, a step needed in the improvement of medical treatment of heart diseases.

Quantification of Shear Deformations and Corresponding Stresses in the Biaxially Tested Human Myocardium

One goal of cardiac research is to perform numerical simulations to describe/reproduce the mechanoelectrical function of the human myocardium in health and disease. Such simulations are based on a complex combination of mathematical models describing the passive mechanical behavior of the myocardium and its electrophysiology, i.e., the activation of cardiac muscle cells. The problem in developing adequate constitutive models is the shortage of experimental data suitable for detailed parameter estimation in specific functional forms. A combination of shear and biaxial extension tests with different loading protocols on different specimen orientations is necessary to capture adequately the direction-dependent (orthotropic) response of the myocardium. In most experimental animal studies, where planar biaxial extension tests on the myocardium have been conducted, the generated shear stresses were neither considered nor discussed. Hence, in this study a method is presented which allows the quantification of shear deformations and related stresses. It demonstrates an approach for experimenters as to how the generation of these shear stresses can be minimized during mechanical testing. Experimental results on 14 passive human myocardial specimens, obtained from nine human hearts, show the efficiency of this newly developed method. Moreover, the influence of the clamping technique of the specimen, i.e., the load transmission between the testing device and the tissue, on the stress response is determined by testing an isotropic material (Latex). We identified that the force transmission between the testing device and the specimen by means of hooks and cords does not influence the performed experiments. We further showed that in-plane shear stresses definitely exist in biaxially tested human ventricular myocardium, but can be reduced to a minimum by preparing the specimens in an appropriate manner. Moreover, we showed whether shear stresses can be neglected when performing planar biaxial extension tests on fiber-reinforced materials. The used method appears to be robust to quantify normal and shear deformations and corresponding stresses in biaxially tested human myocardium. This method can be applied for the mechanical characterization of any fiber-reinforced material using planar biaxial extension tests.

Interaction of human smooth muscle cells with nanofibrous scaffolds: Effect of fiber orientation on cell adhesion, proliferation, and functional gene expression

Poly(ɛ-caprolactone) (PCL) and PCL-gelatin random and aligned nanofibers with diameters in the range of 200-400 nm were developed through electrospinning. Mechanical properties of aligned PCL and PCL-gelatin nanofibers were compared, and it was found that aligned PCL nanofibers showed significantly higher tensile strength and Young's modulus than the PCL-gelatin nanofiber system (p < 0.05). The in vitro degradation of aligned nanofibers showed that PCL-gelatin nanofibers degrade faster than aligned PCL nanofibers. Further, human smooth muscle cells were cultured on the random and aligned PCL-gelatin nanofibers and evaluated for adhesion, orientation, morphology, viability, proliferation and gene expression. Our results demonstrate that PCL-gelatin promotes higher cell adhesion and proliferation than the PCL nanofibers after 3, 7, and 10 days of culture. Aligned topography favored orientation of the cells along their directions and cell stretching was better in aligned nanofibers than the random nanofibers. The upregulation of α-actin, myosin heavy chain, collagen type I, and elastin genes demonstrate good cell-matrix interactions in both random and aligned scaffolds. Therefore, the present study concludes that aligned PCL-gelatin nanofibers could serve as potential scaffolding for culture of smooth muscle cells and may promote functional regeneration of tubular organs.

Unrealistic statistics: how average constitutive coefficients can produce non-physical results

The coefficients of constitutive models are frequently averaged in order to concisely summarize the complex, nonlinear, material properties of biomedical materials. However, when dealing with nonlinear systems, average inputs (e.g. average constitutive coefficients) often fail to generate average behavior. This raises an important issue because average nonlinear constitutive coefficients of biomedical materials are commonly reported in the literature. This paper provides examples which demonstrate that average constitutive coefficients applied to nonlinear constitutive laws in the field of biomedical material characterization can fail to produce average stress-strain responses and in some cases produce non-physical responses. Results are presented from a literature survey which indicates that approximately 90% of tissue measurement studies that employ a nonlinear constitutive model report average nonlinear constitutive coefficients. We suggest that reviewers and editors of future measurement studies discourage the reporting of average nonlinear constitutive coefficients. Reporting of individual coefficient sets for each test sample should be considered and discussed as designation for a "best practice" in the field of biomedical material characterization.