In vivo mechanical characterization of human liver

Mechanical properties of human hepatic tissues to develop liver-mimicking phantoms for medical applications

Using liver phantoms for mimicking human tissue in clinical training, disease diagnosis, and treatment planning is a common practice. The fabrication material of the liver phantom should exhibit mechanical properties similar to those of the real liver organ in the human body. This tissue-equivalent material is essential for qualitative and quantitative investigation of the liver mechanisms in producing nutrients, excretion of waste metabolites, and tissue deformity at mechanical stimulus. This paper reviews the mechanical properties of human hepatic tissues to develop liver-mimicking phantoms. These properties include viscosity, elasticity, acoustic impedance, sound speed, and attenuation. The advantages and disadvantages of the most common fabrication materials for developing liver tissue-mimicking phantoms are also highlighted. Such phantoms will give a better insight into the real tissue damage during the disease progression and preservation for transplantation. The liver tissue-mimicking phantom will raise the quality assurance of patient diagnostic and treatment precision and offer a definitive clinical trial data collection.

Macro-indentation testing of soft biological materials and assessment of hyper-elastic material models from inverse finite element analysis

Mechanical characterization of hydrogels and ultra-soft tissues is a challenging task both from an experimental and material parameter estimation perspective because they are much softer than many biological materials, ceramics, or polymers. The elastic modulus of such materials is within the 1 - 100 kPa range, behaving as a hyperelastic solid with strain hardening capability at large strains. In the current study, indentation experiments have been performed on agarose hydrogels, bovine liver, and bovine lymph node specimens. This work reports on the reliable determination of the elastic modulus by indentation experiments carried out at the macro-scale (mm) using a spherical indenter. However, parameter identification of the hyperelastic material properties usually requires an inverse finite element analysis due to the lack of an analytical contact model of the indentation test. Hence a comprehensive study on the spherical indentation of hyperelastic soft materials is carried out through robust computational analysis. Neo-Hookean and first-order Ogden hyperelastic material models were found to be most suitable. A case study on known anisotropic hyperelastic material showed the inability of the inverse finite element method to uniquely identify the whole material parameter set.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review

OBJECTIVE

The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research.

INTRODUCTION

Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests.

INCLUSION CRITERIA

Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review.

METHODS

This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats.

RESULTS

Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values.

CONCLUSIONS

This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards.

REVIEW REGISTRATION

Open Science Framework https://osf.io/fgb34.

Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the availability of quantitative biomechanical measurements from human tissues. This review will also consider the primary motivations for collecting biomechanical measurements of human tissues. The overall purpose of our research is to develop medical skills trainers that provide better haptic fidelity than those that are currently available.

INTRODUCTION

Medical skills trainers are commonly used in clinician training, but trainers do not always have the same haptic properties as patients. This could be due to the limited availability or application of documented biomechanical properties of human tissues when developing trainers.

INCLUSION CRITERIA

This scoping review will examine studies that have quantitatively measured the mechanical properties of human tissues. Only macroscopic specimens will be included, and articles primarily considering optical, acoustic, and thermal properties will be excluded. Included sources of evidence are from primary research, systematic reviews, meta-analyses, and conference proceedings.

METHODS

This review will follow the JBI methodology for scoping reviews. Sources of evidence will be extracted from CINAHL, IEEE Xplore, MEDLINE, Scopus, and biomedical engineering conference proceedings. The search is limited to articles in English. Full articles will be retrieved if their title or abstract meet the inclusion criteria. Tabular, visual, and narrative summaries will be used to present the results.

SCOPING REVIEW PROTOCOL REGISTRATION

Open Science Framework https://osf.io/fgb34.

Decellularized organ biomatrices facilitate quantifiable in vitro 3D cancer metastasis models

Metastatic cancers are chemoresistant, involving complex interplay between disseminated cancer cell aggregates and the distant organ microenvironment (extracellular matrix and stromal cells). Conventional metastasis surrogates (scratch/wound healing, Transwell migration assays) lack 3D architecture and ECM presence. Metastasis studies can therefore significantly benefit from biomimetic 3D in vitro models recapitulating the complex cascade of distant organ invasion and colonization by collective clusters of cells. We aimed to engineer reproducible and quantifiable 3D models of highly therapy-resistant cancer processes: (i) colorectal cancer liver metastasis; and (ii) breast cancer lung metastasis. Metastatic seeds are engineered using 3D tumor spheroids to recapitulate the 3D aggregation of cancer cells both in the tumor and in circulation throughout the metastatic cascade of many cancers. Metastatic soil was engineered by decellularizing porcine livers and lungs to generate biomatrix scaffolds, followed by extensive materials characterization. HCT116 colorectal and MDA-MB-231 breast cancer spheroids were generated on hanging drop arrays to initiate clustered metastatic seeding into liver and lung biomatrix scaffolds, respectively. Between days 3-7, biomatrix cellular colonization was apparent with increased metabolic activity and the presence of cellular nests evaluated via multiphoton microscopy. HCT116 and MDA-MB-231 cells colonized liver and lung biomatrices, and at least 15% of the cells invaded more than 20 μm from the surface. Engineered metastases also expressed increased signatures of genes associated with the metastatic epithelial to mesenchymal transition (EMT). Importantly, inhibition of matrix metalloproteinase-9 inhibited metastatic invasion into the biomatrix. Furthermore, metastatic nests were significantly more chemoresistant (>3 times) to the anti-cancer drug oxaliplatin, compared to 3D spheroids. Together, our data indicated that HCT116 and MDA-MB-231 spheroids invade, colonize, and proliferate in livers and lungs establishing metastatic nests in 3D settings in vitro. The metastatic nature of these cells was confirmed with functional readouts regarding EMT and chemoresistance. Modeling the dynamic metastatic cascade in vitro has potential to identify therapeutic targets to treat or prevent metastatic progression in chemoresistant metastatic cancers.

Assessing liver fibrosis distribution through liver elasticity estimates obtained using a biomechanical model of respiratory motion with magnetic resonance elastography

Objective. This study aimed to produce a three-dimensional liver elasticity map using the finite element method (FEM) and respiration-induced motion captured by T1-weighted magnetic resonance images (FEM-E-map) and to evaluate whether FEM-E-maps can be an imaging biomarker comparable to magnetic resonance elastography (MRE) for assessing the distribution and severity of liver fibrosis. Approach. We enrolled 14 patients who underwent MRI and MRE. T1-weighted MR images were acquired during shallow inspiration and expiration breath-holding, and the displacement vector field (DVF) between two images was calculated using deformable image registration. FEM-E-maps were constructed using FEM and DVF. First, three Poisson’s ratio settings (0.45, 0.49, and 0.499995) were validated and optimized to minimize the difference in liver elasticity between the FEM-E-map and MRE. Then, the whole and regional liver elasticity values estimated using FEM-E-maps were compared with those obtained from MRE using Pearson’s correlation coefficients. Spearman rank correlations and chi-square histograms were used to compare the voxel-level elasticity distribution. Main results. The optimal Poisson’s ratio was 0.49. Whole liver elasticity estimated using FEM-E-maps was strongly correlated with that measured using MRE (r = 0.96). For regional liver elasticity, the correlation was 0.84 for the right lobe and 0.82 for the left lobe. Spearman analysis revealed a moderate correlation for the voxel-level elasticity distribution between FEM-E-maps and MRE (0.61 ± 0.10). The small chi-square distances between the two histograms (0.11 ± 0.07) indicated good agreement. Significance. FEM-E-maps represent a potential imaging biomarker for visualizing the distribution of liver fibrosis using only T1-weighted images obtained with a common MR scanner, without any additional examination or special elastography equipment. However, additional studies including comparisons with biopsy findings are required to verify the reliability of this method for clinical application.

On multiscale tension-compression asymmetry in skeletal muscle

Skeletal muscle tissue shows a clear asymmetry with regard to the passive stresses under tensile and compressive deformation, referred to as tension-compression asymmetry (TCA). The present study is the first one reporting on TCA at different length scales, associated with muscle tissue and muscle fibres, respectively. This allows for the first time the comparison of TCA between the tissue and one of its individual components, and thus to identify the length scale at which this phenomenon originates. Not only the passive stress-stretch characteristics were recorded, but also the volume changes during the axial tension and compression experiments. The study reveals clear differences in the characteristics of TCA between fibres and tissue. At tissue level TCA increases non-linearly with increasing deformation and the ratio of tensile to compressive stresses at the same magnitude of strain reaches a value of approximately 130 at 13.5% deformation. At fibre level instead it initially drops to a value of 6 and then rises again to a TCA of 14. At a deformation of 13.5%, the tensile stress is about 6 times higher. Thus, TCA is about 22 times more expressed at tissue than fibre scale. Moreover, the analysis of volume changes revealed little compressibility at tissue scale whereas at fibre level, especially under compressive stress, the volume decreases significantly. The data collected in this study suggests that the extracellular matrix has a distinct role in amplifying the TCA, and leads to more incompressible tissue behaviour. STATEMENT OF SIGNIFICANCE: This article analyses and compares for the first time the tension-compression asymmetry (TCA) displayed by skeletal muscle at tissue and fibre scale. In addition, the volume changes of tissue and fibre specimens with application of passive tensile and compressive loads are studied. The study identifies a key role of the extracellular matrix in establishing the mechanical response of skeletal muscle tissue: It contributes significantly to the passive stress, it is responsible for the major part of tissue-scale TCA and, most probably, prevents/balances the volume changes of muscle fibres during deformation. These new results thus shed light on the origin of TCA and provide new information to be used in microstructure-based approaches to model and simulate skeletal muscle tissue.

Biophysics involved in the process of tumor immune escape

Much of the current research into immune escape from cancer is focused on molecular and cellular biology, an area of biophysics that is easily overlooked. A large number of immune drugs entering the clinic are not effective for all patients. Apart from the molecular heterogeneity of tumors, the biggest reason for this may be that knowledge of biophysics has not been considered, and therefore an exploration of biophysics may help to address this challenge. To help researchers better investigate the relationship between tumor immune escape and biophysics, this paper provides a brief overview on recent advances and challenges of the biophysical factors and strategies by which tumors acquire immune escape and a comprehensive analysis of the relevant forces acting on tumor cells during immune escape. These include tumor and stromal stiffness, fluid interstitial pressure, shear stress, and viscoelasticity. In addition, advances in biophysics cannot be made without the development of detection tools, and this paper also provides a comprehensive summary of the important detection tools available at this stage in the field of biophysics.

Liver Tumor Localization Based on YOLOv3 and 3D-Semantic Segmentation Using Deep Neural Networks

Worldwide, more than 1.5 million deaths are occur due to liver cancer every year. The use of computed tomography (CT) for early detection of liver cancer could save millions of lives per year. There is also an urgent need for a computerized method to interpret, detect and analyze CT scans reliably, easily, and correctly. However, precise segmentation of minute tumors is a difficult task because of variation in the shape, intensity, size, low contrast of the tumor, and the adjacent tissues of the liver. To address these concerns, a model comprised of three parts: synthetic image generation, localization, and segmentation, is proposed. An optimized generative adversarial network (GAN) is utilized for generation of synthetic images. The generated images are localized by using the improved localization model, in which deep features are extracted from pre-trained Resnet-50 models and fed into a YOLOv3 detector as an input. The proposed modified model localizes and classifies the minute liver tumor with 0.99 mean average precision (mAp). The third part is segmentation, in which pre-trained Inceptionresnetv2 employed as a base-Network of Deeplabv3 and subsequently is trained on fine-tuned parameters with annotated ground masks. The experiments reflect that the proposed approach has achieved greater than 95% accuracy in the testing phase and it is proven that, in comparison to the recently published work in this domain, this research has localized and segmented the liver and minute liver tumor with more accuracy.

A parameter reduced adaptive quasi-linear viscoelastic model for soft biological tissue in uniaxial tension

Mechanical characterisation of soft viscous materials is essential for many applications including aerospace industries, material models for surgical simulation, and tissue mimicking materials for anatomical models. Constitutive material models are, therefore, necessary to describe soft biological tissues in physiologically relevant strain ranges. Hereby, the adaptive quasi-linear viscoelastic (AQLV) model enables accurate modelling of the strain-dependent non-linear viscoelastic behaviour of soft tissues with a high flexibility. However, the higher flexibility produces a large number of model parameters. In this study, porcine muscle and liver tissue samples were modelled in the framework of the originally published AQLV (3-layers of Maxwell elements) model using four incremental ramp-hold experiments in uniaxial tension. AQLV model parameters were reduced by decreasing model layers (M) as well as the number of experimental ramp-hold steps (N). Leave One out cross validation tests show that the original AQLV model (3M4N) with 19 parameters, accurately describes porcine muscle tissue with an average R² of 0.90 and porcine liver tissue, R² of 0.86. Reducing the number of layers (N) in the model produced acceptable model fits for 1-layer (R² of 0.83) and 2-layer models (R² of 0.89) for porcine muscle tissue and 1-layer (R² of 0.84) and 2-layer model (R² of 0.85) for porcine liver tissue. Additionally, a 2 step (2N) ramp-hold experiment was performed on additional samples of porcine muscle tissue only to further reduce model parameters. Calibrated spring constant values for 2N ramp-hold tests parameters k₁ and k₂ had a 16.8% and 38.0% deviation from those calibrated for a 4 step (4N) ramp hold experiment. This enables further reduction of material parameters by means of step reduction, effectively reducing the number of parameters required to calibrate the AQLV model from 19 for a 3M4N model to 8 for a 2M2N model, with the added advantage of reducing the time per experiment by 50%. This study proposes a 'reduced-parameter' AQLV model (2M2N) for the modelling of soft biological tissues at finite strain ranges. Sequentially, the comparison of model parameters of soft tissues is easier and the experimental burden is reduced.

The biophysics of cancer: emerging insights from micro- and nanoscale tools

Cancer is a complex and dynamic disease that is aberrant both biologically and physically. There is growing appreciation that physical abnormalities with both cancer cells and their microenvironment that span multiple length scales are important drivers for cancer growth and metastasis. The scope of this review is to highlight the key advancements in micro- and nano-scale tools for delineating the cause and consequences of the aberrant physical properties of tumors. We focus our review on three important physical aspects of cancer: 1) solid mechanical properties, 2) fluid mechanical properties, and 3) mechanical alterations to cancer cells. Beyond posing physical barriers to the delivery of cancer therapeutics, these properties are also known to influence numerous biological processes, including cancer cell invasion and migration leading to metastasis, and response and resistance to therapy. We comment on how micro- and nanoscale tools have transformed our fundamental understanding of the physical dynamics of cancer progression and their potential for bridging towards future applications at the interface of oncology and physical sciences.

Non-destructive vacuum-assisted measurement of lung elastic modulus

In living tissues, mechanical stiffness and biological function are intrinsically linked. Alterations in the stiffness of tissues can induce pathological interactions that affect cellular activity and tissue function. Underlying connections between tissue stiffness and disease highlights the importance of accurate quantitative characterizations of soft tissue mechanics, which can improve our understanding of disease and inform therapeutic development. In particular, accurate measurement of lung mechanical properties has been especially challenging due to the anatomical and mechanobiological complexities of the lung. Discrepancies between measured mechanical properties of dissected lung tissue samples and intact lung tissues in vivo has limited the ability to accurately characterize integral lung mechanics. Here, we report a non-destructive vacuum-assisted method to evaluate mechanical properties of soft biomaterials, including intact tissues and hydrogels. Using this approach, we measured elastic moduli of rat lung tissue that varied depending on stress-strain distribution throughout the lung. We also observed that the elastic moduli of enzymatically disrupted lung parenchyma increased by at least 64%. The reported methodology enables assessment of the nonlinear viscoelastic characteristics of intact lungs under normal and abnormal (i.e., injured, diseased) conditions and allows measurement of mechanical properties of tissue-mimetic biomaterials for use in therapeutics or in vitro models. STATEMENT OF SIGNIFICANCE: Accurate quantification of tissue stiffness is critical for understanding mechanisms of disease and developing effective therapeutics. Current modalities to measure tissue stiffness are destructive and preclude accurate assessment of lung mechanical properties, as lung mechanics are determined by complex features of the intact lung. To address the need for alternative methods to assess lung mechanics, we report a non-destructive vacuum-based approach to quantify tissue stiffness. We applied this method to correlate lung tissue mechanics with tissue disruption, and to assess the stiffness of biomaterials. This method can be used to inform the development of tissue-mimetic materials for use in therapeutics and disease models, and could potentially be applied for in-situ evaluation of tissue stiffness as a diagnostic or prognostic tool.

Application of micro-computer tomography and inverse finite element analysis for characterizing the visco-hyperelastic response of bulk liver tissue using indentation

Abstract

In-vitro mechanical indentation experimentation is performed on bulk liver tissue of lamb to characterize its nonlinear material behaviour. The material response is characterized by a visco-hyperelastic material model by the use of 2-dimensional inverse finite element (FE) analysis. The time-dependent behaviour is characterized by the viscoelastic model represented by a 4-parameter Prony series, whereas the large deformations are modelled using the hyperelastic Neo-Hookean model. The shear response described by the initial and final shear moduli and the corresponding Prony series parameters are optimized using ANSYS with the Root Mean Square (RMS) error being the objective function. Optimized material properties are validated using experimental results obtained under different loading histories. To study the efficacy of a 2D model, a three dimensional (3D) model of the specimen is developed using Micro-CT of the specimen. The initial elastic modulus of the lamb liver obtained was found to 13.5 kPa for 5% indentation depth at a loading rate of 1 mm/sec for 1-cycle. These properties are able to predict the response at 8.33% depth and a loading rate of 5 mm/sec at multiple cycles with reasonable accuracy.

Article highlights

NUMERICAL COUPLING ANALYSIS OF THE INFLUENCE OF BLOOD FLOW ON THE MECHANICAL RESPONSE FOR LIVER

As an important basis for determining the state of the liver, the mechanical responses are associated with many factors, and belong to a complex coupling system. Liver tissue has significantly complicated vascular channels. The vascular diameter, vascular deflection angle and vascular depth are defined as the key characteristic parameters. The influences of these parameters on the mechanical responses were analyzed. On the basis of the real mechanical parameters, the coupled numerical model of blood vessel, blood flow and liver tissue was established. The corresponding mechanical responses are obtained by utilizing the different vascular parameters. The effects of vascular parameters on the differences among the mechanical response difference and high strain modulus were analyzed. It was found that the blood vessels in the central area could reduce the liver mechanical response. The inner diameter parameter had main influences on the regions where the stain was more than 0.1. The mechanical difference is greater with larger inner diameter. The influences of vascular depth are greatest when the vascular depth was in the intermediate value, which would increase the liver mechanical responses. With the increment of vascular deflection angle, the liver mechanical response would also increase, and exceed the mechanical response without blood vessels. The findings after analyzing the influence of vascular parameters will provide a basis for the quantitative studies on the influence of blood vessels.

Estimation of liver elasticity using the finite element method and four-dimensional computed tomography images as a biomarker of liver fibrosis

PURPOSE

Current radiotherapy planning procedures are generally designed based on anatomical information only and use computed tomography (CT) images that do not incorporate organ-functional information. In this study, we developed a method for estimating liver elasticity using the finite element method (FEM) and four-dimensional CT (4DCT) images acquired during radiotherapy planning, and we subsequently evaluated its feasibility as a biomarker for liver fibrosis.

MATERIALS AND METHODS

Twenty patients who underwent 4DCT and ultrasound-based transient elastography (UTE) were enrolled. All patients had chronic liver disease or cirrhosis. Liver elasticity measurements of the UTE were performed on the right lobe of the patient's liver in 20 patients. The serum biomarkers of the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) were available in 18 of the 20 total patients, which were measured within 1 week after undergoing 4DCT. The displacement between the 4DCT images obtained at the endpoints of exhalation and inspiration was determined using the actual (via deformable image registration) and simulated (via FEM) respiration-induced displacement. The elasticity of each element of the liver model was optimized by minimizing the error between the actual and simulated respiration-induced displacement. Then, each patient's estimated liver elasticity was defined as the mean Young's modulus of the liver's right lobe and that of the whole liver using the estimated elasticity map. The estimated liver elasticity was evaluated for correlations with the elasticity obtained via UTE and with two serum biomarkers (APRI and FIB-4).

RESULTS

The mean ± standard deviation (SD) of the errors between the actual and simulated respiration-induced displacement in the liver model was 0.54 ± 0.33 mm. The estimated liver's right lobe elasticity was statistically significantly correlated with the UTE (r = 0.87, P < 0.001). Furthermore, the estimated whole liver elasticity was statistically significantly correlated with the UTE (r = 0.84, P < 0.001), APRI score (r = 0.62, P = 0.005), and FIB-4 score (r = 0.54, P = 0.021).

CONCLUSION

In this study, liver elasticity was estimated through FEM-based simulation and actual respiratory-induced liver displacement obtained from 4DCT images. Furthermore, we assessed that the estimated elasticity of the liver's right lobe was strongly correlated with the UTE. Therefore, the estimated elasticity has the potential to be a feasible imaging biomarker for assessing liver fibrosis using only 4DCT images without additional inspection or equipment costs. Because our results were derived from a limited sample of 20 patients, it is necessary to evaluate the accuracy of elasticity estimation for each liver segment on larger groups of biopsied patients to utilize liver elasticity information for radiotherapy planning.

In-vivo tongue stiffness measured by aspiration: Resting vs general anesthesia

Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants 'under General Anesthesia' (GA). We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models. The measurements AR provided a mean Young's Modulus of 1638 Pa (min 1035 - max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.

The Role of the Microenvironment in Controlling the Fate of Bioprinted Stem Cells

The field of tissue engineering and regenerative medicine has made numerous advances in recent years in the arena of fabricating multifunctional, three-dimensional (3D) tissue constructs. This can be attributed to novel approaches in the bioprinting of stem cells. There are expansive options in bioprinting technology that have become more refined and specialized over the years, and stem cells address many limitations in cell source, expansion, and development of bioengineered tissue constructs. While bioprinted stem cells present an opportunity to replicate physiological microenvironments with precision, the future of this practice relies heavily on the optimization of the cellular microenvironment. To fabricate tissue constructs that are useful in replicating physiological conditions in laboratory settings, or in preparation for transplantation to a living host, the microenvironment must mimic conditions that allow bioprinted stem cells to proliferate, differentiate, and migrate. The advances of bioprinting stem cells and directing cell fate have the potential to provide feasible and translatable approach to creating complex tissues and organs. This review will examine the methods through which bioprinted stem cells are differentiated into desired cell lineages through biochemical, biological, and biomechanical techniques.

Calibration of hyperelastic constitutive models: the role of boundary conditions, search algorithms, and experimental variability

The calibration of hyperelastic constitutive models of soft tissue and tissue surrogates is often treated as an exercise in curve-fitting to the average experimental response, and many of the complicating factors such as experimental boundary conditions and data variability are ignored. In this work, we focus on three questions that arise in this area: the ramifications of ignoring the experimental boundary conditions, the use of local optimizers, and the role of data variability. Using data from a uniaxial extension experiment on a tissue surrogate, we study how these three factors affect the calibration of isotropic hyperelastic constitutive models. Our results show that even with the simplest of constitutive models, it is necessary to look beyond a "good fit" to the average.

In vitro compressive properties of skeletal muscles and inverse finite element analysis: Comparison of human versus animals

Virtual finite element human body models have been widely used in biomedical engineering, traffic safety injury analysis, etc. Soft tissue modeling like skeletal muscle accounts for a large portion of a human body model establishment, and its modeling method is not enough explored. The present study aims to investigate the compressive properties of skeletal muscles due to different species, loading rates and fiber orientations, in order to obtain available parameters of specific material laws as references for building or improving the human body model concerning both modeling accuracy and computational cost. A series of compressive experiments of skeletal muscles were implemented for human gastrocnemius muscle, bovine and porcine hind leg muscle. To avoid long-time preservation effects, all experimental tests were carried out in 24 h after that the samples were harvested. Considering computational cost and generally used in the previous human body models, one-order hyperelastic Ogden model and three-term simplified viscoelastic quasi-linear viscoelastic (QLV) were selected for numerical analysis. Inverse finite element analysis was employed to obtain corresponding material parameters. With good fitting records, the simulation results presented available material parameters for human body model establishment, and also indicated significant differences of muscle compressive properties due to species, loading rates and fiber orientations. When considering one-order Ogden law, it is worthy of noting that the inversed material parameters of the porcine muscles are similar to those of the human gastrocnemius regardless of fiber orientations. In conclusion, the obtained material parameters in the present study can be references for global human body and body segment modeling.

The differences in measured prostate material properties between probing and unconfined compression testing methods

Characterization of the mechanical properties of organs is important for determining their behavior under load and understanding and predicting their response. In order to appropriately understand behavior, including developing predictive models, the method used to measure the properties should match the application as different testing techniques can yield different results. One of the organs where little mechanical testing has been performed is the prostate. Therefore, the goal of this paper is to expand the knowledge of prostate gland mechanical behavior by using two different compressive testing methods under various loading rates. No differences were found between the elastic modulus measured using the compression and probing protocols for both human and porcine specimens. The elastic modulus ranged from 0.08 MPa at 1%/s to 0.24 MPa at 25%/s for human specimens and from 0.2 MPa at 1%/s to 0.4 MPa at 25%/s for porcine specimens. A strain rate dependency of the elastic modulus was observed for both testing methods. The dependency on strain rate started to saturate at higher rates and a material model was created to quantify this dependence as well as the stress-strain behavior. No strain rate dependency was observed for failure stress or failure strain. Overall, similar values of elastic modulus were found for both probing and compression protocols and the relationship developed between elastic modulus and strain rate could be implemented in models of the prostate gland to aid in understanding the response to dynamic loads.

The effect of steatosis and fibrosis on blunt force vulnerability of the liver

The aim of our study was to examine the possible effect of steatosis and fibrosis on the blunt force vulnerability of human liver tissue. 3.5 × 3.5 × 2-cm-sized liver tissue blocks were removed from 135 cadavers. All specimens underwent microscopical analysis. The tissue samples were put into a test stand, and a metal rod with a square-shaped head was pushed against the capsular surface. The force (Pmax) causing liver rupture was measured and registered with a Mecmesin AFG-500 force gauge. Six groups were formed according to the histological appearance of the liver tissue: intact (group 1), mild steatosis (group 2), moderate steatosis (group 3), severe steatosis (group 4), fibrosis (group 5), and cirrhosis (group 6). The average Pmax value was 34.1 N in intact liver samples (range from 18.1 to 60.8 N, SD ± 8.7), 45.1 N in mild steatosis (range from 24.2 to 79.8 N SD ± 12.6), 55.4 N in moderate steatosis (range from 28.9 to 92.5 N, SD ± 16.0), 57.6 N in severe steatosis (range from 39.8 to 71.5 N, SD ± 11.9), 63.7 N in fibrosis (range from 37.8 to 112.2 N, SD ± 19.5), and 87.1 N in the case of definite cirrhosis (range from 52.7 to 162.7 N, 30.3). The Pmax values were significantly higher in samples with visible structural change than in intact liver sample (p = 0.023, 0.001, 0.009, 0.0001, 0.0001 between group 1 and groups 2 to 6 respectively). Significant difference was found between mild steatosis (group 2) and cirrhosis (group 6) (p = 0.0001), but the difference between mild, moderate, and severe steatosis (groups 2, 3, and 4) was not significant. Our study demonstrated that contrary to what is expected as received wisdom dictates, the diseases of the parenchyma (steatosis and presence of fibrosis) positively correlate with the blunt force resistance of the liver tissue.

Spectral Quantification of Nonlinear Elasticity Using Acoustoelasticity and Shear-Wave Dispersion

Tissue biomechanical properties are known to be sensitive to pathological changes. Accordingly, various techniques have been developed to estimate tissue mechanical properties. Shear-wave elastography (SWE) measures shear-wave speed (SWS) in tissues, which can be related to shear modulus. Although viscosity or stress-strain nonlinearity may act as confounder of SWE, their explicit characterization may also provide additional information about tissue composition as a contrast modality. Viscosity can be related to frequency dispersion of SWS, which can be characterized using multi-frequency measurements, herein called spectral SWE (SSWE). Additionally, nonlinear shear modulus can be quantified and parameterized based on SWS changes with respect to applied stress, a phenomenon called acoustoelasticity (AE). In this work, we characterize the nonlinear parameters of tissue as a function of excitation frequency by utilizing both AE and SSWE together. For this, we apply incremental amounts of quasi-static stress on a medium, while imaging and quantifying SWS dispersion via SSWE. Results from phantom and ex vivo porcine liver experiments demonstrate the feasibility of measuring frequency-dependent nonlinear parameters using the proposed method. SWS propagation in porcine liver tissue was observed to change from 1.8 m/s at 100 Hz to 3.3 m/s at 700 Hz, while increasing by approximately 25% from a strain of 0% to 12% across these frequencies.

Prediction of duration of labor based on biomechanical measurements of the cervix: A preliminary study

OBJECTIVE

Induction of labor is a common procedure in obstetrics. Predictability of duration of labor could facilitate planning as well as patient's satisfaction. The primary purpose of this study was to evaluate the usefulness of a new biomechanical measurement of the cervix based on the aspiration technique for predicting the duration of labor after induction.

STUDY DESIGN

This was a prospective single centre study. Inclusion criteria were term nulliparous pregnant women with an unfavourable cervix who needed an induction of labor. Digital (Bishop score), sonographic (cervical length and cervical consistency index (CCI)) as well as aspiration measurements (closure pressure) of the cervix were performed and compared to duration of labor. The technical feasibility and the acceptability of the measurements were explored.

RESULTS

There were no technical complications of the sonographic or aspiration measurements. Measuring the Bishop score was reported as most painful examination. Both the time to active phase of labor and the time to delivery is significantly correlated with the Bishop score, but not with the cervical length, CCI or closure pressure.

CONCLUSION

The new biomechanical measurement of the cervix, based on the aspiration technique, is technically feasible and acceptable. In our small cohort no correlation was found between the closure pressure and the duration of labor.

Defining the Relationship Between Compressive Stress and Tissue Trauma During Laparoscopic Surgery Using Human Large Intestine

Excessive magnitudes of compressive stress exerted on gastrointestinal tissues can lead to pathological scar tissue or adhesion formation, bleeding, inflammation or even death from bowel perforation and sepsis. It is currently unknown however, at exactly what magnitude of compressive stress that these pathologies occur. A novel simple compressive device was engineered to provide an objective means of producing discrete compressive stresses on human tissues. Samples of human large intestine (colon) were removed from consenting patients as a part of their standard surgical procedure. These samples were compressed with a range of loads normally produced by standard laparoscopic graspers in representative abdominal surgeries. After compression, specimens were processed for histological analysis and assessed. The two independent pathologists who were blinded to stress magnitudes were both able to quantify increasing tissue damage that corresponded to increasing amounts of compressive force. A threshold between 350–450 kPa was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. Whether the tissue injury quantified is pathologic is subject for future in-vivo longitudinal investigation but certainly based on literature, can be the basis of pathological adhesion formation or an area for hemorrhage and scar formation.

Advances in Micropipette Aspiration: Applications in Cell Biomechanics, Models, and Extended Studies

With five decades of sustained application, micropipette aspiration has enabled a wide range of biomechanical studies in the field of cell mechanics. Here, we provide an update on the use of the technique, with a focus on recent developments in the analysis of the experiments, innovative microaspiration-based approaches, and applications in a broad variety of cell types. We first recapitulate experimental variations of the technique. We then discuss analysis models focusing on important limitations of widely used biomechanical models, which underpin the urge to adopt the appropriate ones to avoid misleading conclusions. The possibilities of performing different studies on the same cell are also considered.

Multi-cellular transitional organotypic models to investigate liver fibrosis

Hepatic fibrosis is the result of wound healing and inflammation resulting in organ dysfunction. Hepatocytes, liver sinusoidal endothelial cells (LSECs), Kupffer cells (KCs), and hepatic stellate cells (HSCs) play critical roles in fibrogenesis. As the liver undergoes fibrosis, there are populations of cells that are healthy, fibrotic as well as those undergoing fibrosis. We investigated how a varying mechanical environment could induce changes in hepatic cells. In this study, a gradient in the mechanical properties of the microenvironment resulted in transitioning phenotypes in hepatic cells. We have designed detachable polyelectrolyte multilayers (PEMs) whose elastic moduli ranged from 21 to 43 kPa to serve as Space of Disse mimics. We assembled novel 3D organotypic liver models comprised of hepatocytes, LSECs, HSCs, KCs, and the Space of Disse mimic. We demonstrate how cells in contact with a mechanical gradient exhibit different properties compared to cells cultured using non-gradient PEMs. Significant differences were observed in HSC and KC proliferation between 3D cultures assembled with gradient and non-gradient PEMs. While HSCs on the stiffer regions of the gradient PEMs expressed both GFAP and α-SMA, cells in cultures assembled with homogeneous 43 kPa multilayers primarily expressed α-SMA. Over an 8-day culture, the elastic modulus in the 21 and 43 kPa regions of the gradient PEMs increased by 1.6 and 3.7-fold, respectively. This was accompanied by a 4-fold increase in hydroxyproline. Such in vitro tissues can be used to investigate the effects of liver fibrosis. STATEMENT OF SIGNIFICANCE: We have assembled a liver model assembled with four major primary hepatic cell types to investigate how a varying mechanical environment induces changes in hepatic cells. In this study, a gradient in the mechanical properties of the microenvironment results in transitioning phenotypes in hepatic cells. Our goal was to investigate the interplay between mechanical properties and a multi-cellular engineered liver tissue. In these models, Kupffer cell proliferation and hepatic stellate cell activation occurred due to mechanical cues and inter-cellular signaling across a distance of 2000 μm. These models are unique, in that, fibrosis was initiated purely through changes to the microenvironment. These models were not exposed to fibrogenic factors nor were the models assembled with cells from fibrotic rats. To the best of our knowledge, these are the first liver models that capture how a gradient microenvironment can result in transitioning cellular phenotypes.

Characterization of perfused and sectioned liver tissue in a full indentation cycle using a visco-hyperelastic model

Realistic modeling of biologic material is required for optimizing fidelity in computer-aided surgical training and assistance systems. The modeling of liver tissue has remained challenging due to its nonlinear viscoelastic properties and high hysteresis of the stress-strain relation. While prior studies have described the behavior of liver tissue during the loading status (in elongation, compression, or indentation tests) or unloading status (in stress relaxation or creep tests), a hysteresis curve with both loading and unloading processes was incompletely defined. We seek to use a single material model to characterize the mechanical properties of liver tissue in a full indentation cycle ex vivo perfused and then sectioned. Based on measurements taken from ex-vivo perfused porcine livers, we converted force-displacement curves to stress-strain curves and developed a visco-hyperelastic constitutive model to characterize the liver's mechanical behavior at different locations under various rates of indentation (1, 2, 5, 10, and 20 mm/s). The proposed model is a mixed visco-hyperelastic model with up to 6 coefficients. The normalized root mean square standard deviations of fitted curves are less than 5% and 10% in low (<0.05) and high strain (>0.3) conditions respectively.

Tyramine-conjugated alginate hydrogels as a platform for bioactive scaffolds

Alginate‐based hydrogels represent promising microenvironments for cell culture and tissue engineering, as their mechanical and porous characteristics are adjustable toward in vivo conditions. However, alginate scaffolds are bioinert and thus inhibit cellular interactions. To overcome this disadvantage, bioactive alginate surfaces were produced by conjugating tyramine molecules to high‐molecular‐weight alginates using the carbodiimide chemistry. Structural elucidation using nuclear magnetic resonance spectroscopy and contact angle measurements revealed a surface chemistry and wettability of tyramine‐alginate hydrogels similar to standard cell culture treated polystyrene. In contrast to stiff cell culture plastic, tyramine‐alginate scaffolds were found to be soft (60–80 kPa), meeting the elastic moduli of human tissues such as liver and heart. We further demonstrated an enhanced protein adsorption with increasing tyramine conjugation, stable for several weeks. Cell culture studies with human mesenchymal stem cells and human pluripotent stem cell‐derived cardiomyocytes qualified tyramine‐alginate hydrogels as bioactive platforms enabling cell adhesion and contraction on (structured) 2‐D layer and spherical matrices. Due to the alginate functionalization with tyramines, stable cell–matrix interactions were observed beneficial for an implementation in biology, biotechnology, and medicine toward efficient cell culture and tissue substitutes. © 2018 The Authors. Journal of Biomedical Materials Research Part A published by Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 114–121, 2019.

Material Characterization of Hardening Soft Sponge Featuring MR Fluid and Application of 6-DOF MR Haptic Master for Robot-Assisted Surgery

In this work, the material characterization of hardening magneto-rheological (MR) sponge is analyzed and a robot-assisted surgery system integrated with a 6-degrees-of-freedom (DOF) haptic master and slave root is constructed. As a first step, the viscoelastic property of MR sponge is experimentally analyzed. Based on the viscoelastic property and controllability, a MR sponge which can mimic the several reaction force characteristics of human-like organs is devised and manufactured. Secondly, a slave robot corresponding to the degree of the haptic master is manufactured and integrated with the master. In order to manipulate the robot motion by the master, the kinematic analysis of the master and slave robots is performed. Subsequently, a simple robot cutting surgery system which is manipulated by the haptic master and MR sponge is established. It is then demonstrated from this system that using both MR devices can provide more accurate cutting surgery than the case using the haptic master only.

DISPOSABLE SYSTEM FOR IN-VIVO MECHANICAL CHARACTERIZATION OF SOFT TISSUES BASED ON VOLUME MEASUREMENT

In-vivo characterization of soft tissues is a key step toward biomechanical simulation and planning of intra-operative assisted surgery. To achieve this, aspiration method is a standard technique: tissue is aspirated through a hole while measuring the pressure and associated apex height. An inverse problem is then solved to identify the material mechanical properties. In the literature, the apex height is usually measured using a camera, which induces design difficulties, in particular in regards on the required sterilization process for in-vivo measurements. In this paper, the idea is to replace the apex height optical measurement by the measurement of the aspirated tissue volume. The proposed method enables to reduce the system head to a simple tube: sterilizations becomes easy and the system is disposable after use. The proposed system is thus the simplest, lightest and cheapest one could achieve. It is also to the authors knowledge the first time ever in aspiration method that the aspired volume is the extracted data. As the data signal-to-noise ratio is the main factor impacting any applied inverse method when extracting the mechanical properties, the aim of this work is to assess and compare the experimental signal-to-noise ratio in the raw volume measurements obtained either optically or with the method proposed. Explicit results of inverse methods using volumes as input data are not presented in this paper for concision purpose. The effects on accuracy of various experimental parameters has been investigated and quantified: the volume measurement has proved to present a same order or even better signal-to-noise ratio compared to optical measurements.

New MEMS Tweezers for the Viscoelastic Characterization of Soft Materials at the Microscale

As many studies show, there is a relation between the tissue's mechanical characteristics and some specific diseases. Knowing this relationship would help early diagnosis or microsurgery. In this paper, a new method for measuring the viscoelastic properties of soft materials at the microscale is proposed. This approach is based on the adoption of a microsystem whose mechanical structure can be reduced to a compliant four bar linkage where the connecting rod is substituted by the tissue sample. A procedure to identify both stiffness and damping coefficients of the tissue is then applied to the developed hardware. Particularly, stiffness is calculated solving the static equations of the mechanism in a desired configuration, while the damping coefficient is inferred from the dynamic equations, which are written under the hypothesis that the sample tissue is excited by a variable compression force characterized by a suitable wave form. The whole procedure is implemented by making use of a control system.

In Vivo Measurement of Surface Pressures and Retraction Distances Applied on Abdominal Organs During Surgery

This study undertook the in vivo measurement of surface pressures applied by the fingers of the surgeon during typical representative retraction movements of key human abdominal organs during both open and hand-assisted laparoscopic surgery. Surface pressures were measured using a flexible thin-film pressure sensor for 35 typical liver retractions to access the gall bladder, 36 bowel retractions, 9 kidney retractions, 8 stomach retractions, and 5 spleen retractions across 12 patients undergoing open and laparoscopic abdominal surgery. The maximum and root mean square surface pressures were calculated for each organ retraction. The maximum surface pressures applied to these key abdominal organs are in the range 1 to 41 kPa, and the average maximum surface pressure for all organs and procedures was 14 ± 3 kPa. Surface pressure relaxation during the retraction hold period was observed. Generally, the surface pressures are higher, and the rate of surface pressure relaxation is lower, in the more confined hand-assisted laparoscopic procedures than in open surgery. Combined video footage and pressure sensor data for retraction of the liver in open surgery enabled correlation of organ retraction distance with surface pressure application. The data provide a platform to design strategies for the prevention of retraction injuries. They also form a basis for the design of next-generation organ retraction and space creation surgical devices with embedded sensors that can further quantify intraoperative retraction forces to reduce injury or trauma to organs and surrounding tissues.

Measuring tissue displacement of the anterior vaginal wall using the novel aspiration technique in vivo

Little is known about the mechanical properties of pelvic floor structures and their role in the course and treatment of pelvic organ prolapse (POP). We hypothesize that in vivo mechanical properties of the vaginal wall are related to the appearance of POP and pre-and post-operative states. We used a suction device for intravaginal application, the aspiration device, to evaluate two in vivo mechanical parameters of the anterior vaginal wall, the load dependent tissue displacement and the initial displacement, by image analysis in pre- and post-menopausal women with (POP) and without (control) cystocele (POP: pre-menopausal: N = 6, post-menopausal: N = 19, control: pre-menopausal: N = 17, post-menopausal: N = 6). Mechanical parameters in women with and without cystocele and pre- and post-operative parameters were compared. Statistically significant differences were observed between the two mechanical parameters in pre- and post-operative states (P = 0.04, P = 0.03), but not between the parameters for women with and without cystocele (P = 0.92, P = 0.75). The mechanical behavior of pelvic floor structures is influenced by factors such as POP, age or estrogenization that are apparent at different length scales, which cannot be separated by the aspiration based biomechanical measurements. When comparing pre- and post-operative states of the same patient, a firmer tissue response was observed after intervention.

Numerical simulation and identification of macroscopic vascularised liver behaviour: Case of indentation tests

Mini-invasive surgery restricts the surgeon information to two-dimensional digital representation without the corresponding physical information obtained in previous open surgery. To overcome these drawbacks, real time augmented reality interfaces including the true mechanical behaviour of organs depending on their internal microstructure need to be developed. For the case of tumour resection, we present here a finite element numerical study of the liver mechanical behaviour including the effects of its own vascularisation through numerical indentation tests in order extract the corresponding macroscopic behaviour. The obtained numerical results show excellent correlation of the corresponding force-displacement curves when compared with macroscopic experimental data available in the literature.

Simple empirical model for identifying rheological properties of soft biological tissues

Understanding the rheological properties of soft biological tissue is a key issue for mechanical systems used in the health care field. We propose a simple empirical model using fractional dynamics and exponential nonlinearity (FDEN) to identify the rheological properties of soft biological tissue. The model is derived from detailed material measurements using samples isolated from porcine liver. We conducted dynamic viscoelastic and creep tests on liver samples using a plate-plate rheometer. The experimental results indicated that biological tissue has specific properties: (i) power law increase in the storage elastic modulus and the loss elastic modulus of the same slope; (ii) power law compliance (gain) decrease and constant phase delay in the frequency domain; (iii) power law dependence between time and strain relationships in the time domain; and (iv) linear dependence in the low strain range and exponential law dependence in the high strain range between stress-strain relationships. Our simple FDEN model uses only three dependent parameters and represents the specific properties of soft biological tissue.

ANALYSIS OF LIVER IMPACT RESPONSES THROUGH A CHINESE HUMAN BODY FINITE ELEMENT MODEL

Human liver biomechanical responses associated with frontal impacts, lateral impacts were studied using a simplified Chinese human body Finite Element Model (FEM) with more geometrical-accurate liver model for an average Chinese adult male from high resolution CT data. The developed model in this paper was composed by geometrically detailed liver model, simplified models of thoracic-abdominal organs, and the human skeleton model. Then, the whole model was validated at various velocities by comparing simulation outcomes with Post Mortem Human Subjects (PMHS) experimental results in frontal and lateral pendulum impacts. The force–deflection and force–time characteristics were in good agreement with the test results. The validated model was then applied for studying liver dynamic responses and injuries in simulations. Pressure, tensile stress and peak strain that may induce hepatic injuries was computed from model simulations and were analyzed about the correlation with the global parameters, like thoracic deflection, viscous criterion value, contact force. This study demonstrated that the method of developing a simplified finite element thorax-abdomen model with detailed liver model could be effective of hepatic injury assessment in various impacts reported in literature.

STUDY ON MECHANICAL CHARACTERIZATION OF LIVER TISSUE BASED ON HAPTIC DEVICES FOR VIRTUAL SURGICAL SIMULATION

In recent years, virtual surgical simulation has been one of the hot direction of digital medical research, it is mainly used in teaching, training, diagnosis, preoperative planning, rehabilitation and modeling and analysis of surgical instruments. The modeling of soft tissue of human organs is the basis to realize the virtual surgical simulation. The quasi-linear viscoelastic (QLV) theory has been proposed by Fung, and it was widely used for modeling the constitutive equation of soft tissues. The purpose of this study is to determine the mechanical characterization of the liver soft tissue based on the PHANTOM Omni Haptic devices. Five parameters are included in the constitutive equation with QLV theory, which must be determined experimentally. The specimens were obtained from fresh porcine liver tissues in vitro. The liver tissues were cut into 14[Formula: see text]mm[Formula: see text][Formula: see text][Formula: see text]14[Formula: see text]mm[Formula: see text][Formula: see text][Formula: see text]14[Formula: see text]mm cubes. Two types of unconfined compression tests were performed on cube liver specimens. Puncture tests were performed on the complete liver. The material parameters of the QLV constitutive equation were obtained by fitting the experimental data. These parameters will provide the references for the computational modeling of the liver in the virtual surgical simulation.

Sample, testing and analysis variables affecting liver mechanical properties: A review

Given the critical role of liver mechanics in regulating cell response and directing the development of tissue fibrosis, accurately characterising its mechanical behaviour is of relevance for both diagnostic purposes as well as for tissue engineering and for the development of in-vitro models. Determining and quantifying the mechanical behaviour of soft biological tissues is, however, highly challenging due to their intrinsic labile nature. Indeed, a unique set of values of liver mechanical properties is still lacking to date; testing conditions can significantly affect sample status and hence the measured behaviour and reported results are strongly dependent on the adopted testing method and configuration as well as sample type and status. This review aims at summarising the bulk mechanical properties of liver described in the literature, discussing the possible sources of variation and their implications on the reported results. We distinguish between the intrinsic mechanical behaviour of hepatic tissue, which depends on sample variables, and the measured mechanical properties which also depend on the testing and analysis methods. Finally, the review provides guidelines on tissue preparation and testing conditions for generating reproducible data which can be meaningfully compared across laboratories.

STATEMENT OF SIGNIFICANCE

Soft tissue mechanics is widely investigated, but poorly understood. This review identifies and discusses sample and testing variables which can influence the mechanical behaviour of hepatic tissue and consequently the measured mechanical properties. To encourage the biomaterial community towards more standardized testing of soft tissues and enable comparisons between data from different laboratories, we have established new testing methods and experimental recommendations for sample preparation and testing. The review could be of wide interest to scientists involved in biomaterials research because it addresses and proposes guidelines for several issues related to the mechanical testing of soft tissues whose implications have not been considered together before.

Mechanical Characteristics of Bovine Glisson's Capsule as a Model Tissue for Soft Collagenous Membranes

An extensive multiaxial experimental campaign on the monotonic, time- and history-dependent mechanical response of bovine Glisson's capsule (GC) is presented. Reproducible characteristics were observed such as J-shaped curves in uniaxial and biaxial configurations, large lateral contraction, cyclic tension softening, large tension relaxation, and moderate creep strain accumulation. The substantial influence of the reference state selection on the kinematic response and the tension versus stretch curves is demonstrated and discussed. The parameters of a large-strain viscoelastic constitutive model were determined based on the data of uniaxial tension relaxation experiments. The model is shown to well predict the uniaxial and biaxial viscoelastic responses in all other configurations. GC, the corresponding model, and the experimental protocols are proposed as a useful basis for future studies on the relation between microstructure and tissue functionality and on the factors influencing the mechanical response of soft collagenous membranes.

Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis

We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimetre-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted with direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion.