In Vitro Investigation of Vocal Fold Cellular Response to Variations in Hydrogel Porosity and Elasticity

Tissue regeneration is intricately influenced by the dynamic interplay between the physical attributes of tissue engineering scaffolds and the resulting biological responses. A tunable microporous hydrogel system was engineered using gelatin methacryloyl (GelMA) and polyethylene glycol diacrylate (PEGDA), with polyethylene glycol (PEG) serving as a porogen. Through systematic variation of PEGDA molecular weights, hydrogels with varying mechanical and architectural properties were obtained. The objective of the present study was to elucidate the impact of substrate mechanics and architecture on the immunological and reparative activities of vocal fold tissues. Mechanical characterization of the hydrogels was performed using tensile strength measurements and rheometry. Their morphological properties were investigated using scanning electron microscopy (SEM) and confocal microscopy. A series of biological assays were conducted. Cellular morphology, differentiation, and collagen synthesis of human vocal fold fibroblasts (hVFFs) were evaluated using immunostaining. Fibroblast proliferation was studied using the WST-1 assay, and cell migration was investigated via the Boyden chamber assay. Macrophage polarization and secretions were also examined using immunostaining and ELISA. The results revealed that increasing the molecular weight of PEGDA from 700 Da to 10,000 Da resulted in decreased hydrogel stiffness, from 62.6 to 8.8 kPa, and increased pore dimensions from approximately 64.9 to 137.4 μm. Biological evaluations revealed that hydrogels with a higher stiffness promoted fibroblast proliferation and spreading, albeit with an increased propensity for fibrosis, as indicated by a surge in myofibroblast differentiation and collagen synthesis. In contrast, hydrogels with greater molecular weights had a softer matrix with expanded pores, enhancing cellular migration and promoting an M2 macrophage phenotype conducive to tissue healing. The findings show that the hydrogels formulated with a PEGDA molecular weight of 6000 Da are best among the hydrogels considered for vocal fold repair. The microporous hydrogels could be tuned to serve in other tissue engineering applications.

Range-separated density functional theory using multiresolution analysis and quantum computing

Quantum computers are expected to outperform classical computers for specific problems in quantum chemistry. Such calculations remain expensive, but costs can be lowered through the partition of the molecular system. In the present study, partition was achieved with range-separated density functional theory (RS-DFT). The use of RS-DFT reduces both the basis set size and the active space size dependence of the ground state energy in comparison with the use of wave function theory (WFT) alone. The utilization of pair natural orbitals (PNOs) in place of canonical molecular orbitals (MOs) results in more compact qubit Hamiltonians. To test this strategy, a basis-set independent framework, known as multiresolution analysis (MRA), was employed to generate PNOs. Tests were conducted with the variational quantum eigensolver for a number of molecules. The results show that the proposed approach reduces the number of qubits needed to reach a target energy accuracy.

Functional Analysis of Injectable Substance Treatment on Surgically Injured Rabbit Vocal Folds

OBJECTIVES

The objective of this study was to evaluate the efficacy of immediate injection treatments of dexamethasone, hyaluronic acid (HA)/gelatin (Ge) hydrogel and glycol-chitosan solution on the phonatory function of rabbit larynges at 42 days after surgical injury of the vocal folds, piloting a novel ex vivo phonatory functional analysis protocol.

METHODS

A modified microflap procedure was performed on the left vocal fold of 12 rabbits to induce an acute injury. Animals were randomized into one of four treatment groups with 0.1 mL injections of dexamethasone, HA/Ge hydrogel, glycol-chitosan or saline as control. The left mid vocal fold lamina propria was injected immediately following injury. The right vocal fold served as an uninjured control. Larynges were harvested at Day 42 after injection, then were subjected to airflow-bench evaluation. Acoustic, aerodynamic and laryngeal high-speed videoendoscopy (HSV) analyses were performed. HSV segments of the vibrating vocal folds were rated by three expert laryngologists. Six parameters related to vocal fold vibratory characteristics were evaluated on a Likert scale.

RESULTS

The fundamental frequency, one possible surrogate of vocal fold stiffness and scarring, was lower in the dexamethasone and HA/Ge hydrogel treatment groups compared to that of the saline control (411.52±11.63 Hz). The lowest fundamental frequency value was observed in the dexamethasone group (348.79±14.99 Hz). Expert visual ratings of the HSV segments indicated an overall positive outcome in the dexamethasone treatment group, though the impacts were below statistical significance.

CONCLUSION

Dexamethasone injections might be used as an adjunctive option for iatrogenic vocal fold scarring. An increased sample size, histological correlate, and experimental method improvements will be needed to confirm this finding. Results suggested a promising use of HSV and acoustic analysis techniques to identify and monitor post-surgical vocal fold repair and scarring, providing a useful tool for future studies of vocal fold scar treatments.

Airway Resistance and Respiratory Distress in Laryngeal Cancer: A Computational Fluid Dynamics Study

BACKGROUND

Obstructive upper airway pathologies are a great clinical challenge for the airway surgeon. Protection against acute obstruction is critical, but avoidance of unnecessary tracheostomy must also be considered. Decision-making regarding airway, although supported by some objective findings, is largely guided by subjective experience and training. This investigation aims to study the relationship between clinical respiratory distress and objective measures of airway resistance in laryngeal cancer as determined by computational fluid dynamic (CFD) and morphometric analysis.

METHODS

Retrospective CT and clinical data were obtained for series of 20 cases, defined as newly diagnosed laryngeal cancer patients who required admission or urgent airway surgery, and 20 controls. Cases and controls were matched based on T-staging. Image segmentation and morphometric analysis were first performed. Computational models based on the lattice Boltzmann method were then created and used to quantify the continuous mass flow, rigid wall, and constant static pressure inlet boundary conditions.

RESULTS

The analysis demonstrated a significant relationship between airway resistance and acute obstruction (OR 1.018, 95% CI 1.001-1.045). Morphometric analysis similarly demonstrated a significant relationship when relating measurements based on the minimum cross-section, but not on length of stenosis. Morphometric measurements also showed significance in predicting CFD results, and their relationship demonstrated that airway pressures increase exponentially below 2.5 mm. Tumor subsite did not show a significant difference, although the glottic subgroup tended to have higher resistances.

CONCLUSION

Airway resistance analysis from CFD computation correlated with presence of acute distress requiring emergent management. Morphometric analysis showed a similar correlation, demonstrating a radiologic airway assessment technique on which future risk estimation could be performed.

LEVEL OF EVIDENCE

4 (case-control study) Laryngoscope, 133:2734-2741, 2023.

Programming hydrogel adhesion with engineered polymer network topology

Hydrogel adhesion that can be easily modulated in magnitude, space, and time is desirable in many emerging applications ranging from tissue engineering and soft robotics to wearable devices. In synthetic materials, these complex adhesion behaviors are often achieved individually with mechanisms and apparatus that are difficult to integrate. Here, we report a universal strategy to embody multifaceted adhesion programmability in synthetic hydrogels. By designing the surface network topology of a hydrogel, supramolecular linkages that result in contrasting adhesion behaviors are formed on the hydrogel interface. The incorporation of different topological linkages leads to dynamically tunable adhesion with high-resolution spatial programmability without alteration of bulk mechanics and chemistry. Further, the association of linkages enables stable and tunable adhesion kinetics that can be tailored to suit different applications. We rationalize the physics of polymer chain slippage, rupture, and diffusion at play in the emergence of the programmable behaviors. With the understanding, we design and fabricate various soft devices such as smart wound patches, fluidic channels, drug-eluting devices, and reconfigurable soft robotics. Our study presents a simple and robust platform in which adhesion controllability in multiple aspects can be easily integrated into a single design of a hydrogel network.

Injectable, pore-forming, self-healing, and adhesive hyaluronan hydrogels for soft tissue engineering applications

Most existing injectable hydrogels are non-porous, thereby lacking a microporous structure to promote cell ingrowth. Also, most hydrogels do not effectively adhere to the host tissue. The present study describes an injectable double network hydrogel formed by combining two hyaluronic acid (HA) derivatives, namely dopamine grafted HA (DAHA) and methacrylated HA (HAMA). These constituents instantly form a physically crosslinked network through Fe3+-dopamine coordination, and confer fast gelation, pore formation, and self-healing properties to the hydrogel. Photocroslinked upon UV exposure, HAMA forms a chemically crosslinked network, thereby improving mechanical and degradation properties. The adhesive properties of this hydrogel are attributed to the presence of dopamine groups, inspired by mussel creatures. Proper modification of HA chains was confirmed by NMR spectroscopy. The physical, mechanical, rheological, and biological properties of the new hydrogels were quantified in wet laboratory conditions. The results revealed that the DAHA/HAMA hydrogel rapidly forms a self-healing microporous adhesive scaffold with a 26.9 µm pore size, 29.4 kPa compressive modulus, and 12.8 kPa adhesion strength in under 6 s. These findings suggest that the new hydrogel is a promising candidate for in situ repair of soft tissues, particularly mechanically dynamic ones such as the vocal folds, cartilage, and dermis.

Immunomodulatory Microgels Support Proregenerative Macrophage Activation and Attenuate Fibroblast Collagen Synthesis

Scars composed of fibrous connective tissues are natural consequences of injury upon incisional wound healing in soft tissues.  Hydrogels that feature a sustained presentation of immunomodulatory cytokines are known to modulate wound healing. However, existing immunomodulatory hydrogels lack interconnected micropores to promote cell ingrowth. Other limitations include invasive delivery procedures and harsh synthesis conditions that are incompatible with drug molecules. Here, hybrid nanocomposite microgels containing interleukin-10 (IL-10) are reported to modulate tissue macrophage phenotype during wound healing. The intercalation of laponite nanoparticles in the polymer network yields microgels with tissue-mimetic elasticity (Young's modulus in the range of 2-6 kPa) and allows the sustained release of IL-10 to promote the differentiation of macrophages toward proregenerative phenotypes. The porous interstitial spaces between microgels promote fibroblast proliferation and fast trafficking (an average speed of ≈14.4 µm h^-1 ). The incorporation of hyaluronic acid further enhances macrophage infiltration. The coculture of macrophages and fibroblasts treated with transforming growth factor-beta 1 resulted in a twofold reduction in collagen-I production for microgels releasing IL-10 compared to the IL-10 free group. The new microgels show potential toward regenerative healing by harnessing the antifibrotic behavior of host macrophages.

Efficacy of Aerosol Reduction Measures for Dental Aerosol Generating Procedures

Aerosol particles generated by dental procedures could facilitate the transmission of infectious diseases and contain carcinogen particles. Such particles can penetrate common surgical masks and reach the lungs, leading to increased risk for dental care professionals. However, the risk of inhaling contaminated aerosol and the effectiveness of aerosol reduction measures in dental offices remain unclear. The present study aimed to quantify aerosols produced by drilling and scaling procedures and to evaluate present recommendations for aerosol reduction. The concentration of aerosol particles released from the mock scaling and drilling procedures on dental mannequin were measured using a TSI Optical Particle Sizer (OPS 3330) during 15-min sessions carried out in a single-patient examination room. Using a drilling procedure as the aerosol source, the aerosol reduction performance of two types of high-volume evacuators (HVEs) and a commercial off-the-shelf air purifier was evaluated in a simulated clinical setting. Using either HVEs or the air purifier individually reduced the aerosol accumulated over the course of a 15-minutes drilling procedure at a reduction rate of 94.8 to 97.6%. Using both measures simultaneously raised the reduction rate to 99.6%. The results show that existing HVEs can effectively reduce aerosol concentration generated by a drilling procedure and can be further improved by using an air purifier. Following current regulatory guidelines can ensure a low risk of inhaling contaminated aerosol for dentists, assistants, and patients.

Freeform Cell-Laden Cryobioprinting for Shelf-Ready Tissue Fabrication and Storage

One significant drawback of existing bioprinted tissues is their lack of shelf-availability caused by complications in both fabrication and storage. Here, we report a cryobioprinting strategy for simultaneously fabricating and storing cell-laden volumetric tissue constructs through seamlessly combining extrusion bioprinting and cryopreservation. The cryobioprinting performance was investigated by designing, fabricating, and storing cell-laden constructs made of our optimized cryoprotective gelatin-based bioinks using a freezing plate with precisely controllable temperature. The in situ freezing process further promoted the printability of cell-laden hydrogel bioinks to achieve freeform structures otherwise inconvenient with direct extrusion bioprinting. The effects of bioink composition on printability and cell viability were evaluated. The functionality of the method was finally investigated using cell differentiation and chick ex ovo assays. The results confirmed the feasibility and efficacy of cryobioprinting as a single-step method for concurrent tissue biofabrication and storage.

Injectable, Pore-Forming, Perfusable Double-Network Hydrogels Resilient to Extreme Biomechanical Stimulations

Biological tissues hinge on blood perfusion and mechanical toughness to function. Injectable hydrogels that possess both high permeability and toughness have profound impacts on regenerative medicine but remain a long-standing challenge. To address this issue, injectable, pore-forming double-network hydrogels are fabricated by orchestrating stepwise gelation and phase separation processes. The interconnected pores of the resulting hydrogels enable direct medium perfusion through organ-sized matrices. The hydrogels are amenable to cell encapsulation and delivery while promoting cell proliferation and spreading. They are also pore insensitive, tough, and fatigue resistant. When tested in biomimetic perfusion bioreactors, the hydrogels maintain physical integrity under prolonged, high-frequency biomechanical stimulations (>6000 000 cycles at 120 Hz). The excellent biomechanical performance suggests the great potential of the new injectable hydrogel technology for repairing mechanically dynamic tissues, such as vocal folds, and other applications, such as tissue engineering, biofabrication, organs-on-chips, drug delivery, and disease modeling.

Emerging Technologies in Multi-Material Bioprinting

Bioprinting, within the emerging field of biofabrication, aims at the fabrication of functional biomimetic constructs. Different 3D bioprinting techniques have been adapted to bioprint cell-laden bioinks. However, single-material bioprinting techniques oftentimes fail to reproduce the complex compositions and diversity of native tissues. Multi-material bioprinting as an emerging approach enables the fabrication of heterogeneous multi-cellular constructs that replicate their host microenvironments better than single-material approaches. Here, bioprinting modalities are reviewed, their being adapted to multi-material bioprinting is discussed, and their advantages and challenges, encompassing both custom-designed and commercially available technologies are analyzed. A perspective of how multi-material bioprinting opens up new opportunities for tissue engineering, tissue model engineering, therapeutics development, and personalized medicine is offered.

Needle-free Mental Incisive Nerve Block:In vitro, Cadaveric, and Pilot Clinical Studies

The present study aimed to optimize Needle-Free Liquid Jet Injection (NFLJI) for Mental Incisive Nerve Blocks (MINB) and evaluate its clinical safety and feasibility. A MINB protocol was developed and optimized by series of NFLJI experiments in soft tissue phantoms and cadavers, then validated in two pilot Randomized Controlled Trials (RCT). The NFLJI penetration depth was found to be directly proportional to the supply pressure and volume. High-pressure NFLJIs (620 kPa or above) created maximum force and total work significantly greater than needle injections. Low-pressure NFLJIs (413 kPa), however, produced results similar to those of needle injections. Additionally, high-pressure NFLJIs created jet impingement pressure and maximum jet penetration pressure higher than low-pressure NFLJIs. Pilot RCTs revealed that high-pressure NFLJI caused a high risk of discomfort (60%) and paresthesia (20%); meanwhile, low-pressure NFLJI was less likely to cause complications (0%). The preliminary success rates of MINB from cadavers using NFLJIs and needles were 83.3% and 87.5%. In comparison, those from RCTs are 60% and 70%, respectively. To conclude, NFLJI supply pressure can be adjusted to achieve effective MINB with minimal complications. Furthermore, the cadaver study and pilot RCTs confirmed the feasibility for further non-inferiority RCT.

Decellularized Extracellular Matrix Composite Hydrogel Bioinks for the Development of 3D Bioprinted Head and Neck in Vitro Tumor Models

Reinforced extracellular matrix (ECM)-based hydrogels recapitulate several mechanical and biochemical features found in the tumor microenvironment (TME) in vivo. While these gels retain several critical structural and bioactive molecules that promote cell-matrix interactivity, their mechanical properties tend toward the viscous regime limiting their ability to retain ordered structural characteristics when considered as architectured scaffolds. To overcome this limitation characteristic of pure ECM hydrogels, we present a composite material containing alginate, a seaweed-derived polysaccharide, and gelatin, denatured collagen, as rheological modifiers which impart mechanical integrity to the biologically active decellularized ECM (dECM). After an optimization process, the reinforced gel proposed is mechanically stable and bioprintable and has a stiffness within the expected physiological values. Our hydrogel's elastic modulus has no significant difference when compared to tumors induced in preclinical xenograft head and neck squamous cell carcinoma (HNSCC) mouse models. The bioprinted cell-laden model is highly reproducible and allows proliferation and reorganization of HNSCC cells while maintaining cell viability above 90% for periods of nearly 3 weeks. Cells encapsulated in our bioink produce spheroids of at least 3000 μm² of cross-sectional area by day 15 of culture and are positive for cytokeratin in immunofluorescence quantification, a common marker of HNSCC model validation in 2D and 3D models. We use this in vitro model system to evaluate the standard-of-care small molecule therapeutics used to treat HNSCC clinically and report a 4-fold increase in the IC₅₀ of cisplatin and an 80-fold increase for 5-fluorouracil compared to monolayer cultures. Our work suggests that fabricating in vitro models using reinforced dECM provides a physiologically relevant system to evaluate malignant neoplastic phenomena in vitro due to the physical and biological features replicated from the source tissue microenvironment.

Ionotronic Tough Adhesives with Intrinsic Multifunctionality

Ionotronic hydrogels find wide applications in flexible electronics, wearable/implantable devices, soft robotics, and human-machine interfaces. Their performance and practical translation have been bottlenecked by poor adhesiveness, limited mechanical properties, and the lack of biological functions. The remedies are often associated with complex formulations and sophisticated processing. Here, we report a rational design and facile synthesis of ionotronic tough adhesives (i-TAs), which have excellent mechanical, physical, electrical, and biological properties and promise high scalability and translational potential. They consist of an interpenetrating network with high-density amine groups and highly mobile chains, which enable intrinsic adhesiveness, self-healing, ionic stability, cytocompatibility, and antimicrobial functions. The i-TAs in both pristine and swollen states possess high toughness, stretchability, and strong adhesion to diverse substrates such as tissues and elastomers. The superior mechanical performance is achieved simultaneously with high ionic conductivity and stability in electrolyte solutions. We further demonstrate the use of i-TAs as wearable devices, strain sensors, and sensory sealants. This work is expected to open avenues for new ionotronics with novel functions and stimulate the development and translation of ionotronics.

Culture of Mesenchymal Stem Cells in a Hydrogel Model of Vocal Fold Lamina Propria

Stem cell injection has been proposed as an alternative approach for the restoration of vocal fold (VF) function in patients with VF scarring. To assess the therapeutic efficacy of this treatment strategy, we evaluated the behaviors of human mesenchymal stem cells (hMSCs) in hydrogels derived from thiolated hyaluronic acid (HA-SH) and poly(ethylene glycol) diacrylate (PEG-DA) entrapping assembled collagen fibrils (abbreviated as HPC gels). Three hydrogel formulations with varying amounts of collagen (0, 1 and 2 mg/mL) but a fixed HA-SH (5 mg/mL) and PEG-DA (2 mg/mL) concentration, designated as HPC0, HPC1 and HPC2, were investigated. The HPC gels exhibit similar pore sizes (35-50 nm) and AFM indentation moduli (~175 Pa), although the elastic shear modulus for HPC1 (~32 Pa) is lower than HPC0 and HPC2 (~55 Pa). Although HPC1 and HPC2 gels both promoted the development of an elongated cell morphology, greater cell spreading was observed in HPC2 than in HPC1 by day 7. At the transcript level, cells cultured in HPC1 and HPC2 gels had an increased expression of fibronectin and integrin β1, but a decreased expression of tissue inhibitor of metalloproteinase-1, collagen types I/III and HA synthase-1 when compared to cells cultured in HPC0 gels. Cellular expression of connective tissue growth factor was also elevated in HPC1 and HPC2 cultures. Importantly, the HPC2 hydrogels promoted a signficant up-regulation of matrix metalloproteinase 1, transforming growth factor β1, and epithelial growth factor receptor, indicating an increased tissue turnover. Overall, hMSCs cultured in HPC2 gels adopt a phenotype reminiscent of cells involved in the wound healing process, providing a platform to study the effectiveness of therapeutic stem cell treatments for VF scarring.

Polymeric Microspheres Containing Human Vocal Fold Fibroblasts for Vocal Fold Regeneration

OBJECTIVE

Most acellular injectable biomaterials for vocal fold (VF) wound treatment have limited regenerative potential due to their fast enzymatic degradation and limited recruitment of native cells postinjection. The injection of cells as therapeutic treatment often results in apoptosis due to stresses within the needle and the immune response of the host. Degradable microspheres may improve treatment effectiveness by increasing cell residence time, shielding cells during injection, and offering early protection against the immune system response. The objective of the present study was to investigate the potential of human VF fibroblasts encapsulated in polymeric microspheres as an injectable therapeutic treatment in vitro.

METHODS

Alginate, alginate-poly-L-lysine, and alginate-chitosan microspheres were fabricated using electrospraying and characterized in terms of biocompatibility, swelling, and mechanical properties as well as cytokine production.

RESULTS

Alginate microspheres were found to have the most desirable properties for VF regeneration. They were resistant to mechanical challenges. They were found to have a stiffness similar to that reported for native VF-lamina propria. They were found to be biocompatible and increased the proliferation of fibroblasts. Human VF fibroblasts encapsulated in alginate microspheres induced the production of interleukin (IL)-8 and IL-4 at 24 hours.

CONCLUSION

The alginate microspheres fabricated in this study were found to offer potential advantages, as cell delivery tool. This study highlights the importance of combining biomaterials and cells to expedite the wound-healing process through cytokine production. Future work is aimed to further analysis of the wound-healing properties the microspheres.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:1828-1834, 2021.

Triggered micropore-forming bioprinting of porous viscoelastic hydrogels

Cell-laden scaffolds of architecture and mechanics that mimic those of the host tissues are important for a wide range of biomedical applications but remain challenging to bioprint. To address these challenges, we report a new method called triggered micropore-forming bioprinting. The approach can yield cell-laden scaffolds of defined architecture and interconnected pores over a range of sizes, encompassing that of many cell types. The viscoelasticity of the bioprinted scaffold can match that of biological tissues and be tuned independently of porosity and stiffness. The bioprinted scaffold also exhibits superior mechanical robustness despite high porosity. The bioprinting method and the resulting scaffolds support cell spreading, migration, and proliferation. The potential of the 3D bioprinting system is demonstrated for vocal fold tissue engineering and as an in vitro cancer model. Other possible applications are foreseen for tissue repair, regenerative medicine, organ-on-chip, drug screening, organ transplantation, and disease modeling.

Characterizing Vocal Fold Injury Recovery in a Rabbit Model With Three-Dimensional Virtual Histology

OBJECTIVES/HYPOTHESIS

In animal studies of vocal fold scarring and treatment, imaging-based evaluation is most often conducted by tissue slicing and histological staining. Given variation in anatomy, injury type, severity, and sacrifice timepoints, planar histological sections provide limited spatiotemporal details of tissue repair. Three-dimensional (3D) virtual histology may provide additional contextual spatial information, enhancing objective interpretation. The study's aim was to evaluate the suitability of magnetic resonance imaging (MRI), microscale computed tomography (CT), and nonlinear laser-scanning microscopy (NM) as virtual histology approaches for rabbit studies of vocal fold scarring.

METHODS

A unilateral injury was created using microcup forceps in the left vocal fold of three New Zealand White rabbits. Animals were sacrificed at 3, 10, and 39 days postinjury. ex vivo imaging of excised larynges was performed with MRI, CT, and NM modalities.

RESULTS

The MRI modality allowed visualization of injury location and morphological internal features with 100-μm spatial resolution. The CT modality provided a view of the injury defect surface with 12-μm spatial resolution. The NM modality with optical clearing resolved second-harmonic generation signal of collagen fibers and two-photon autofluorescence in vocal fold lamina propria, muscle, and surrounding cartilage structures at submicrometer spatial scales.

CONCLUSIONS

Features of vocal fold injury and wound healing were observed with MRI, CT, and NM. The MRI and CT modalities provided contextual spatial information and dissection guidance, whereas NM resolved extracellular matrix structure. The results serve as a proof of concept to motivate incorporation of 3D virtual histology techniques in future vocal fold injury animal studies.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:1578-1587, 2021.

Regulation of Stem Cell Function in an Engineered Vocal Fold-Mimetic Environment

Human mesenchymal stem cells (hMSCs) have been proposed as therapeutic cells for the treatment of vocal fold (VF) scarring. Although functional recovery was observed in animal models after stem cell injection, it is not clear how injected stem cells interact locally with the extracellular matrix (ECM) of the lamina propria (LP) and how such interactions affect stem cell behaviors to improve function. Herein, we developed an in vitro cell culture platform where hMSCs were encapsulated in a LP-mimetic matrix, derived from hyaluronic acid (HA), poly(ethylene glycol) (PEG) and collagen, and cultured dynamically in a custom-designed VF bioreactor. The cell culture system was characterized by oscillatory shear rheology, laser doppler vibrometry (LDV), and digital image correlation (DIC). A constitutive finite element analysis (FEA) model was further developed to predict vibratory responses of the hydrogel. LDV analysis demonstrated an average displacement of 47 μm in the center of the hydrogel construct at 200 Hz applied frequency without any harmonics. The predicted strains throughout the hydrogel ranged from 0 to 0.03, in good agreement with reported values for the VF. The 3D cellular construct was subjected to vibrational stimulations at 200 Hz for an optimized duration of 1 h, as confirmed by a maximal c-Fos upregulation at the transcript level. Vibrational culture over a 3-day period with a 1h-on/1h-off pattern did not compromise the overall cell viability, but resulted in a significant downregulation of fibrogenic markers and diminished staining for alpha smooth muscle actin (αSMA). Collectively, high frequency mechanical loading resulted in the loss of myofibrogenic potential and a shift away from a fibrotic phenotype.

Carbon nanotubes promote cell migration in hydrogels

Injectable hydrogels are increasingly used for in situ tissue regeneration and wound healing. Ideally, an injectable implant should promote the recruitment of cells from the surrounding native tissue and allow cells to migrate freely as they generate a new extracellular matrix network. Nanocomposite hydrogels such as carbon nanotube (CNT)-loaded hydrogels have been hypothesized to promote cell recruitment and cell migration relative to unloaded ones. To investigate this, CNT-glycol chitosan hydrogels were synthesized and studied. Chemoattractant-induced cell migration was studied using a modified Boyden Chamber experiment. Migrated cells were counted using flow cytometry. Cell adhesion was inferred from the morphology of the cells via an image segmentation method. Cell migration and recruitment results confirmed that small concentrations of CNT significantly increase cell migration in hydrogels, thereby accelerating tissue regeneration and wound healing in situations where there is insufficient migration in the unloaded matrix.

Towards a Physiological Scale of Vocal Fold Agent-Based Models of Surgical Injury and Repair: Sensitivity Analysis, Calibration and Verification

Agent based models (ABM) were developed to numerically simulate the biological response to surgical vocal fold injury and repair at the physiological level. This study aimed to improve the representation of existing ABM through a combination of empirical and computational experiments. Empirical data of vocal fold cell populations including neutrophils, macrophages and fibroblasts were obtained using flow cytometry up to four weeks following surgical injury. Random Forests were used as a sensitivity analysis method to identify model parameters that were most influential to ABM outputs. Statistical Parameter Optimization Tool for Python was used to calibrate those parameter values to match the ABM-simulation data with the corresponding empirical data from Day 1 to Day 5 following surgery. Model performance was evaluated by verifying if the empirical data fell within the 95% confidence intervals of ABM outputs of cell quantities at Day 7, Week 2 and Week 4. For Day 7, all empirical data were within the ABM output ranges. The trends of ABM-simulated cell populations were also qualitatively comparable to those of the empirical data beyond Day 7. Exact values, however, fell outside of the 95% statistical confidence intervals. Parameters related to fibroblast proliferation were indicative to the ABM-simulation of fibroblast dynamics in final stages of wound healing.

High-Performance Host-Device Scheduling and Data-Transfer Minimization Techniques for Visualization of 3D Agent-Based Wound Healing Applications

High-fidelity numerical simulations produce massive amounts of data. Analyzing these numerical data sets as they are being generated provides useful insights into the processes underlying the modeled phenomenon. However, developing real-time in-situ visualization techniques to process large amounts of data can be challenging since the data does not fit on the GPU, thus requiring expensive CPU-GPU data copies. In this work, we present a scheduling scheme that achieve real-time simulation and interactivity through GPU hyper-tasking. Furthermore, the CPU-GPU communications were minimized using an activity-aware technique to reduce redundant copies. Our simulation platform is capable of visualizing 1.7 billion protein data points in situ, with an average frame rate of 42.8 fps. This performance allows users to explore large data sets on remote server with real-time interactivity as they are performing their simulations.

Discrimination between Modal, Breathy and Pressed Voice for Single Vowels Using Neck-Surface Vibration Signals

The purpose of this study was to investigate the feasibility of using neck-surface acceleration signals to discriminate between modal, breathy and pressed voice. Voice data for five English single vowels were collected from 31 female native Canadian English speakers using a portable Neck Surface Accelerometer (NSA) and a condenser microphone. Firstly, auditory-perceptual ratings were conducted by five clinically-certificated Speech Language Pathologists (SLPs) to categorize voice type using the audio recordings. Intra- and inter-rater analyses were used to determine the SLPs' reliability for the perceptual categorization task. Mixed-type samples were screened out, and congruent samples were kept for the subsequent classification task. Secondly, features such as spectral harmonics, jitter, shimmer and spectral entropy were extracted from the NSA data. Supervised learning algorithms were used to map feature vectors to voice type categories. A feature wrapper strategy was used to evaluate the contribution of each feature or feature combinations to the classification between different voice types. The results showed that the highest classification accuracy on a full set was 82.5%. The breathy voice classification accuracy was notably greater (approximately 12%) than those of the other two voice types. Shimmer and spectral entropy were the best correlated metrics for the classification accuracy.

Investigation of surgical adhesives for vocal fold wound closure

OBJECTIVES

Surgical adhesives are increasingly used for vocal fold microsurgery to assist wound closure and reduce the risks of scar formation. Currently used vocal fold adhesives such as fibrin glue, however, have thus far not been found to promote wound closure or reduce scarring. The objectives of this study were to investigate the mechanical strength and the cytotoxicity of three commercially available adhesives (Glubran 2, GEM, Viareggio, Italy; BioGlue, CryoLife, Kennesaw, GA; and Tisseel, Baxter Healthcare, Deerfield, IL) for vocal fold wound closure.

METHODS

Shear and tension tests were performed on 150 porcine larynges. The cytotoxicity of the adhesives to immortalized human vocal fold fibroblasts was investigated using neutral red uptake assays.

RESULTS

The average shear adhesive strength for Tisseel, BioGlue, and Glubran 2 was 13.86 ± 5.03 kilopascal (kPa), 40.92 ± 17.94 kPa, and 68.79 ± 13.29 kPa, respectively. The tensile adhesive strength for Tisseel, BioGlue, and Glubran 2 was 10.70 ± 6.42 kPa, 34.27 ± 12.59 kPa, and 46.67 ± 12.13 kPa, respectively. The vocal fold cell viabilities in extracts of Tisseel, BioGlue, and Glubran 2 were 99.27%, 43.05%, and 1.79%, respectively.

CONCLUSION

There was a clear tradeoff between adhesive strength and toxicity. The maximum failure strength in shear or tension of the three surgical adhesives ranked from strongest to the weakest was: 1) Glubran 2, 2) BioGlue, and 3) Tisseel. Tisseel was found to be the least toxic of the three adhesives, whereas Glubran 2 was the most toxic.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:2139-2146, 2019.

Multimodal virtual histology of rabbit vocal folds by nonlinear microscopy and nano computed tomography

Human vocal folds (VFs) possess a unique anatomical structure and mechanical properties for human communication. However, VFs are prone to scarring as a consequence of overuse, injury, disease or surgery. Accumulation of scar tissue on VFs inhibits proper phonation and leads to partial or complete loss of voice, with significant consequences for the patient's quality of life. VF regeneration after scarring provides a significant challenge for tissue engineering therapies given the complexity of tissue microarchitecture. To establish an effective animal model for VF injury and scarring, new histological methods are required to visualize the wound repair process of the tissue in its three-dimensional native environment. In this work, we propose the use of a combination of nonlinear microscopy and nanotomography as contrast methods for virtual histology of rabbit VFs. We apply these methods to rabbit VF tissue to demonstrate their use as alternatives to conventional VF histology that may enable future clinical studies of this injury model.

High-Performance Agent-Based Modeling Applied to Vocal Fold Inflammation and Repair

Fast and accurate computational biology models offer the prospect of accelerating the development of personalized medicine. A tool capable of estimating treatment success can help prevent unnecessary and costly treatments and potential harmful side effects. A novel high-performance Agent-Based Model (ABM) was adopted to simulate and visualize multi-scale complex biological processes arising in vocal fold inflammation and repair. The computational scheme was designed to organize the 3D ABM sub-tasks to fully utilize the resources available on current heterogeneous platforms consisting of multi-core CPUs and many-core GPUs. Subtasks are further parallelized and convolution-based diffusion is used to enhance the performance of the ABM simulation. The scheme was implemented using a client-server protocol allowing the results of each iteration to be analyzed and visualized on the server (i.e., in-situ) while the simulation is running on the same server. The resulting simulation and visualization software enables users to interact with and steer the course of the simulation in real-time as needed. This high-resolution 3D ABM framework was used for a case study of surgical vocal fold injury and repair. The new framework is capable of completing the simulation, visualization and remote result delivery in under 7 s per iteration, where each iteration of the simulation represents 30 min in the real world. The case study model was simulated at the physiological scale of a human vocal fold. This simulation tracks 17 million biological cells as well as a total of 1.7 billion signaling chemical and structural protein data points. The visualization component processes and renders all simulated biological cells and 154 million signaling chemical data points. The proposed high-performance 3D ABM was verified through comparisons with empirical vocal fold data. Representative trends of biomarker predictions in surgically injured vocal folds were observed.

A tissue-mimetic nano-fibrillar hybrid injectable hydrogel for potential soft tissue engineering applications

While collagen type I (Col-I) is commonly used as a structural component of biomaterials, collagen type III (Col-III), another fibril forming collagen ubiquitous in many soft tissues, has not previously been used. In the present study, the novel concept of an injectable hydrogel with semi-interpenetrating polymeric networks of heterotypic collagen fibrils, with tissue-specific Col-III to Col-I ratios, in a glycol-chitosan matrix was investigated. Col-III was introduced as a component of the novel hydrogel, inspired by its co-presence with Col-I in many soft tissues, its influence on the Col-I fibrillogenesis in terms of diameter and mechanics, and its established role in regulating scar formation. The hydrogel has a nano-fibrillar porous structure, and is mechanically stable under continuous dynamic stimulation. It was found to provide a longer half-life of about 35 days than similar hyaluronic acid-based hydrogels, and to support cell implantation in terms of viability, metabolic activity, adhesion and migration. The specific case of pure Col-III fibrils in a glycol-chitosan matrix was investigated. The proposed hydrogels meet many essential requirements for soft tissue engineering applications, particularly for mechanically challenged tissues such as vocal folds and heart valves.

In Situ Visualization for 3D Agent-Based Vocal Fold Inflammation and Repair Simulation

A fast and insightful visualization is essential in modeling biological system behaviors and understanding underlying inter-cellular mechanisms. High fidelity models produce billions of data points per time step, making in situ visualization techniques extremely desirable as they mitigate I/O bottlenecks and provide computational steering capability. In this work, we present a novel high-performance scheme to couple in situ visualization with the simulation of the vocal fold inflammation and repair using little to no extra cost in execution time or computing resources. The visualization component is first optimized with an adaptive sampling scheme to accelerate the rendering process while maintaining the precision of the displayed visual results. Our software employs VirtualGL to perform visualization in situ. The scheme overlaps visualization and simulation, resulting in the optimal utilization of computing resources. This results in an in situ system biology simulation suite capable of remote simulation of 17 million biological cells and 1.2 billion chemical data points, remote visualization of the results, and delivery of visualized frames with aggregated statistics to remote clients in real-time.

Development and validation of a 3D-printed model of the ostiomeatal complex and frontal sinus for endoscopic sinus surgery training

BACKGROUND

Endoscopic sinus surgery poses unique training challenges due to complex and variable anatomy, and the risk of major complications. We sought to create and provide validity evidence for a novel 3D-printed simulator of the nose and paranasal sinuses.

METHODS

Sinonasal computed tomography (CT) images of a patient were imported into 3D visualization software. Segmentation of bony and soft tissue structures was then performed. The model was printed using simulated bone and soft tissue materials. Rhinologists and otolaryngology residents completed 6 prespecified tasks including maxillary antrostomy and frontal recess dissection on the simulator. Participants evaluated the model using survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated. Descriptive analysis was used to evaluate ratings, and thematic analysis was done for qualitative questions.

RESULTS

A total of 20 participants (10 rhinologists and 10 otolaryngology residents) tested the model and answered the survey. Overall the participants felt that the simulator would be useful as a training/educational tool (4.6/5), and that it should be integrated as part of the rhinology training curriculum (4.5/5). The following responses were obtained: visual appearance 4.25/5; realism of materials 3.8/5; and surgical experience 3.9/5. The average time to complete each task was lower for the rhinologist group than for the residents.

CONCLUSION

We describe the development and validation of a novel 3D-printed model for the training of endoscopic sinus surgery skills. Although participants found the simulator to be a useful training and educational tool, further model development could improve the outcome.

Real-Time Agent-Based Modeling Simulation with in-situ Visualization of Complex Biological Systems: A Case Study on Vocal Fold Inflammation and Healing

We present an efficient and scalable scheme for implementing agent-based modeling (ABM) simulation with In Situ visualization of large complex systems on heterogeneous computing platforms. The scheme is designed to make optimal use of the resources available on a heterogeneous platform consisting of a multicore CPU and a GPU, resulting in minimal to no resource idle time. Furthermore, the scheme was implemented under a client-server paradigm that enables remote users to visualize and analyze simulation data as it is being generated at each time step of the model. Performance of a simulation case study of vocal fold inflammation and wound healing with 3.8 million agents shows 35× and 7× speedup in execution time over single-core and multi-core CPU respectively. Each iteration of the model took less than 200 ms to simulate, visualize and send the results to the client. This enables users to monitor the simulation in real-time and modify its course as needed.

A Flow Perfusion Bioreactor System for Vocal Fold Tissue Engineering Applications

The human vocal folds (VFs) undergo complex biomechanical stimulation during phonation. The aim of the present study was to develop and validate a phono-mimetic VF flow perfusion bioreactor, which mimics the mechanical microenvironment of the human VFs in vitro. The bioreactor uses airflow-induced self-oscillations, which have been shown to produce mechanical loading and contact forces that are representative of human phonation. The bioreactor consisted of two synthetic VF replicas within a silicone body. A cell-scaffold mixture (CSM) consisting of human VF fibroblasts, hyaluronic acid, gelatin, and a polyethylene glycol cross-linker was injected into cavities within the replicas. Cell culture medium (CCM) was perfused through the scaffold by using a customized secondary flow loop. After the injection, the bioreactor was operated with no stimulation over a 3-day period to allow for cell adaptation. Phonation was subsequently induced by using a variable speed centrifugal blower for 2 h each day over a period of 4 days. A similar bioreactor without biomechanical stimulation was used as the nonphonatory control. The CSM was harvested from both VF replicas 7 days after the injection. The results confirmed that the phono-mimetic bioreactor supports cell viability and extracellular matrix proteins synthesis, as expected. Many scaffold materials were found to degrade because of challenges from phonation-induced biomechanical stimulation as well as due to biochemical reactions with the CCM. The bioreactor concept enables future investigations of the effects of different phonatory characteristics, that is, voice regimes, on the behavior of the human VF cells. It will also help study the long-term functional outcomes of the VF-specific biomaterials before animal and clinical studies.

Investigation of the Viability, Adhesion, and Migration of Human Fibroblasts in a Hyaluronic Acid/Gelatin Microgel-Reinforced Composite Hydrogel for Vocal Fold Tissue Regeneration

The potential use of a novel scaffold biomaterial consisting of cross-linked hyaluronic acid (HA)-gelatin (Ge) composite microgels is investigated for use in treating vocal fold injury and scarring. Cell adhesion integrins and kinematics of cell motion are investigated in 2D and 3D culture conditions, respectively. Human vocal fold fibroblast (hVFF) cells are seeded on HA-Ge microgels attached to a HA hydrogel thin film. The results show that hVFF cells establish effective adhesion to HA-Ge microgels through the ubiquitous expression of β1 integrin in the cell membrane. The microgels are then encapsulated in a 3D HA hydrogel for the study of cell migration. The cells within the HA-Ge microgel-reinforced composite hydrogel (MRCH) scaffold have an average motility speed of 0.24 ± 0.08 μm min(-1) . The recorded microscopic images reveal features that are presumably associated with lobopodial and lamellipodial cell migration modes within the MRCH scaffold. Average cell speed during lobopodial migration is greater than that during lamellipodial migration. The cells move faster in the MRCH than in the HA-Ge gel without microgels. These findings support the hypothesis that HA-Ge MRCH promotes cell adhesion and migration; thereby they constitute a promising biomaterial for vocal fold repair.

Fracture Toughness of Vocal Fold Tissue: A Preliminary Study

A customized mechanical tester that slices thin, soft samples was used to measure the fracture toughness of vocal fold tissue. Porcine vocal fold lamina propria was subjected to quasi-static, guillotine-like tests at three equally distanced regions along the anterior-posterior direction. The central one-third where high-velocity collisions between vocal folds occur was found to have the maximum fracture toughness. In contrast, the anterior one-third featured a lower toughness. Fracture toughness can be indicative of the risk of benign and malignant lesions in vocal fold tissue.

Viscoelasticity of hyaluronic acid-gelatin hydrogels for vocal fold tissue engineering

Crosslinked injectable hyaluronic acid (HA)-gelatin (Ge) hydrogels have remarkable viscoelastic and biological properties for vocal fold tissue engineering. Patient-specific tuning of the viscoelastic properties of this injectable biomaterial could improve tissue regeneration. The frequency-dependent viscoelasticity of crosslinked HA-Ge hydrogels was measured as a function of the concentration of HA, Ge, and crosslinker. Synthetic extracellular matrix hydrogels were fabricated using thiol-modified HA and Ge, and crosslinked by poly(ethylene glycol) diacrylate. A recently developed characterization method based on Rayleigh wave propagation was used to quantify the frequency-dependent viscoelastic properties of these hydrogels, including shear storage and loss moduli, over a broad frequency range; that is, from 40 to 4000 Hz. The viscoelastic properties of the hydrogels increased with frequency. The storage and loss moduli values and the rate of increase with frequency varied with the concentrations of the constituents. The range of the viscoelastic properties of the hydrogels was within that of human vocal fold tissue obtained from in vivo and ex vivo measurements. Frequency-dependent parametric relations were obtained using a linear least-squares regression. The results are useful to better fine-tune the storage and loss moduli of HA-Ge hydrogels by varying the concentrations of the constituents for use in patient-specific treatments.

Microstructural and mechanical characterization of scarred vocal folds

The goal of this study was to characterize the vocal folds microstructure and elasticity using nonlinear laser scanning microscopy and atomic force microscopy-based indentation, respectively. As a pilot study, the vocal folds of fourteen rats were unilaterally injured by full removal of lamina propria; the uninjured folds of the same animals served as controls. The area fraction of collagen fibrils was found to be greater in scarred tissues two months after injury than the uninjured controls. A novel mathematical model was also proposed to relate collagen concentration and tissue bulk modulus. This work presents a first step towards systematic investigation of microstructural and mechanical characteristics in scarred vocal fold tissue.

Prediction of sound absorption by a circular orifice termination in a turbulent pipe flow using the Lattice-Boltzmann method

The Lattice Boltzmann method was used to perform numerical simulations of the sound and turbulent flow inside a standing wave tube terminated by a circular orifice in presence of a forced mean flow. The computational domain comprised a standard virtual impedance tube apparatus in which sound waves were produced by periodic pressure oscillations imposed at one end. An orifice plate was located between the driver and the tube termination. All waves transmitted through the orifice were effectively dissipated by a passively non-reflecting (i.e. anechoic) boundary at the tube termination. A turbulent jet was formed at the discharge of the orifice by the forced mean flow inside the tube. The acoustic impedance and sound absorption coefficient of the orifice plate were calculated from a wave decomposition of the sound field upstream of the orifice. Simulations were carried out for different excitation frequencies, and orifice Mach numbers. Results and trends were in good quantitative agreement with available analytical solutions and experimental data. The Lattice Boltzmann method was found to be an efficient numerical scheme for prediction of sound absorption by realistic three dimensional orifice configurations.

Determination of the elastic properties of rabbit vocal fold tissue using uniaxial tensile testing and a tailored finite element model

The aim of the present study was to quantify the effects of the specimen shape on the accuracy of mechanical properties determined from a shape-specific model generation strategy. Digital images of five rabbit vocal folds (VFs) in their initial undeformed conditions were used to build corresponding specific solid models. The displacement field of the VFs under uniaxial tensile test was then measured over the visible portion of the surface using digital image correlation. A three-dimensional finite element model was built, using ABAQUS, for each solid model, while imposing measured boundary conditions. An inverse-problem method was used, assuming a homogeneous isotropic linear elastic constitutive model. Unknown elastic properties were identified iteratively through an error minimization technique between simulated and measured force-time data. The longitudinal elastic moduli of the five rabbit VFs were calculated and compared to values from a simple analytical method and those obtained by approximating the cross-section as elliptical. The use of shape-specific models significantly reduced the standard deviation of the Young׳s moduli of the tested specimens. However, a non-parametric statistical analysis test, i.e., the Friedman test, yielded no statistically significant differences between the shape-specific method and the elliptic cylindrical finite element model. Considering the required procedures to reconstruct the shape-specific finite element model for each tissue specimen, it might be expedient to use the simpler method when large numbers of tissue specimens are to be compared regarding their Young׳s moduli.

An in vivo study of composite microgels based on hyaluronic acid and gelatin for the reconstruction of surgically injured rat vocal folds

PURPOSE The objective of this study was to investigate local injection with a hierarchically microstructured hyaluronic acid-gelatin (HA-Ge) hydrogel for the treatment of acute vocal fold injury using a rat model. METHOD Vocal fold stripping was performed unilaterally in 108 Sprague-Dawley rats. A volume of 25 μl saline (placebo controls), HA-bulk, or HA-Ge hydrogel was injected into the lamina propria (LP) 5 days after surgery. The vocal folds were harvested at 3, 14, and 28 days after injection and analyzed using hematoxylin and eosin staining and immunohistochemistry staining for macrophages, myofibroblasts, elastin, collagen type I, and collagen type III. RESULTS The macrophage count was statistically significantly lower in the HA-Ge group than in the saline group (p < .05) at Day 28. Results suggested that the HA-Ge injection did not induce inflammatory or rejection response. Myofibroblast counts and elastin were statistically insignificant across treatment groups at all time points. Increased elastin deposition was qualitatively observed in both HA groups from Day 3 to Day 28, and not in the saline group. Significantly more elastin was observed in the HA-bulk group than in the uninjured group at Day 28. Significantly more collagen type I was observed in the HA-bulk and HA-Ge groups than in the saline group (p < .05) at Day 28. The collagen type I concentration in the HA-Ge and saline groups was found to be comparable to that in the uninjured controls at Day 28. The concentration of collagen type III in all treatment groups was similar to that in uninjured controls at Day 28. CONCLUSION Local HA-Ge and HA-bulk injections for acute injured vocal folds were biocompatible and did not induce adverse response.

Non-invasive in vivo measurement of the shear modulus of human vocal fold tissue

Voice is the essential part of singing and speech communication. Voice disorders significantly affect the quality of life. The viscoelastic mechanical properties of the vocal fold mucosa determine the characteristics of the vocal folds oscillations, and thereby voice quality. In the present study, a non-invasive method was developed to determine the shear modulus of human vocal fold tissue in vivo via measurements of the mucosal wave propagation speed during phonation. Images of four human subjects' vocal folds were captured using high speed digital imaging (HSDI) and magnetic resonance imaging (MRI) for different phonation pitches, specifically fundamental frequencies between 110 and 440 Hz. The MRI images were used to obtain the morphometric dimensions of each subject's vocal folds in order to determine the pixel size in the high-speed images. The mucosal wave propagation speed was determined for each subject and at each pitch value using an automated image processing algorithm. The transverse shear modulus of the vocal fold mucosa was then calculated from a surface (Rayleigh) wave propagation dispersion equation using the measured wave speeds. It was found that the mucosal wave propagation speed and therefore the shear modulus of the vocal fold tissue were generally greater at higher pitches. The results were in good agreement with those from other studies obtained via in vitro measurements, thereby supporting the validity of the proposed measurement method. This method offers the potential for in vivo clinical assessments of vocal folds viscoelasticity from HSDI.

Nanoscale viscoelasticity of extracellular matrix proteins in soft tissues: A multiscale approach

It is hypothesized that the bulk viscoelasticity of soft tissues is determined by two length-scale-dependent mechanisms: the time-dependent response of the extracellular matrix (ECM) proteins at the nanometer scale and the biophysical interactions between the ECM solid structure and interstitial fluid at the micrometer scale. The latter is governed by poroelasticity theory assuming free motion of the interstitial fluid within the porous ECM structure. In a recent study (Heris, H.K., Miri, A.K., Tripathy, U., Barthelat, F., Mongeau, L., 2013. J. Mech. Behav. Biomed. Mater.), atomic force microscopy was used to measure the response of porcine vocal folds to a creep loading and a 50-nm sinusoidal oscillation. A constitutive model was calibrated and verified using a finite element model to accurately predict the nanoscale viscoelastic moduli of ECM. A generally good correlation was obtained between the predicted variation of the viscoelastic moduli with depth and that of hyaluronic acids in vocal fold tissue. We conclude that hyaluronic acids may regulate vocal fold viscoelasticity. The proposed methodology offers a characterization tool for biomaterials used in vocal fold augmentations.

Three-dimensional reconstruction of human vocal folds and standard laryngeal cartilages using computed tomography scan data

Three-dimensional (3D) computer models of the human larynx are useful tools for research and for eventual clinical applications. Recently, computed tomography (CT) scanning and magnetic resonance imaging (MRI) have been used to recreate realistic models of human larynx. In the present study, CT images were used to create computer models of vocal folds, vocal tract, and laryngeal cartilages, and the procedure to create solid models are explained in details. Vocal fold and vocal tract 3D models of healthy and postsurgery larynges during phonation and respiration were created and morphometric parameters were quantified. The laryngeal framework of eight patients was also reconstructed from CT scan images. For each cartilage, morphometric landmarks were measured on the basis of their importance for biomechanical modeling. A quantitative comparison was made between measured values from the reconstructions and those from human excised larynges in literature. The good agreement between these measurements supports the accuracy of CT scan-based 3D models. Generic standard models of the laryngeal framework were created using known features in modeling softwares. They were created based on the morphometric landmark dimensions previously defined, preserving all biomechanically important dimensions. These models are accessible, subject independent, easy to use for computational simulations, and make the comparisons between different studies possible.

Determination of strain field on the superior surface of excised larynx vocal folds using DIC

OBJECTIVE/HYPOTHESIS

The objective of the present study was to quantify the mechanical strain and stress in excised porcine larynges during self-oscillation using digital image correlation (DIC) method. The use of DIC in the excised larynx setup may yield accurate measurements of the vocal fold displacement field.

STUDY DESIGN

Ex vivo animal larynx.

METHODS

Measurements were performed using excised porcine larynges on a humidified flow bench, equipped with two high-speed cameras and a commercially available DIC software. Surface deformations were calculated from digital images recorded at 3000 frames per second during continuous self-oscillation for four excised porcine larynges. Larynx preparation consisted of removing the supraglottal wall and the false folds. DIC yielded the deformation field on the superior visible surface of the vocal folds. Measurement data for adducted and freely suspended vocal folds were also used to estimate the distribution of the initial prephonatory strain field. An isotropic constitutive law, the polymer eight-chain model, was used to estimate the surface distributions of planar stresses from the strain data.

RESULTS

The Lagrangian normal strain values were between ∼16% and ∼29% along the anterior-posterior direction. The motion of material points on the vocal fold surface described an elliptical trajectory during oscillation. A phase difference was observed between the anterior-posterior and the medial-lateral component of the displacement. The strain data and eight-chain model yielded a maximum stress of ∼4 kPa along the medial-lateral direction on the superior surface.

CONCLUSION

DIC allowed the strain field over the superior surface of an excised porcine larynx to be quantified during self-oscillation. The approach allowed the determination of the trajectory of specific points on the vocal fold surface. The results for the excised larynx were found to be significantly different than previous results obtained using synthetic replicas. The present study provides suggestions for future studies in human subjects.

Unsteady numerical simulation of a round jet with impinging microjets for noise suppression

The objective of this study was to determine the feasibility of a lattice-Boltzmann method (LBM)-Large Eddy Simulation methodology for the prediction of sound radiation from a round jet-microjet combination. The distinct advantage of LBM over traditional computational fluid dynamics methods is its ease of handling problems with complex geometries. Numerical simulations of an isothermal Mach 0.5, Re(D) = 1 × 10(5) circular jet (D(j) = 0.0508 m) with and without the presence of 18 microjets (D(mj) = 1 mm) were performed. The presence of microjets resulted in a decrease in the axial turbulence intensity and turbulent kinetic energy. The associated decrease in radiated sound pressure level was around 1 dB. The far-field sound was computed using the porous Ffowcs Williams-Hawkings surface integral acoustic method. The trend obtained is in qualitative agreement with experimental observations. The results of this study support the accuracy of LBM based numerical simulations for predictions of the effects of noise suppression devices on the radiated sound power.

Microstructural characterization of vocal folds toward a strain-energy model of collagen remodeling

Collagen fibrils are believed to control the immediate deformation of soft tissues under mechanical load. Most extracellular matrix proteins remain intact during frozen sectioning, which allows them to be scanned using atomic force microscopy (AFM). Collagen fibrils are distinguishable because of their periodic roughness wavelength. In the present study, the shape and organization of collagen fibrils in dissected porcine vocal folds were quantified using nonlinear laser scanning microscopy data at the micrometer scale and AFM data at the nanometer scale. Rope-shaped collagen fibrils were observed. The geometric characteristics for the fibrils were fed into a hyperelastic model to predict the biomechanical response of the tissue. The model simulates the micrometer-scale unlocking behavior of collagen bundles when extended from their unloaded configuration. Force spectroscopy using AFM was used to estimate the stiffness of collagen fibrils (1±0.5MPa). The presence of rope-shaped fibrils is postulated to change the slope of the force-deflection response near the onset of nonlinearity. The proposed model could ultimately be used to evaluate changes in elasticity of soft tissues that result from the collagen remodeling.

Indentation of poroviscoelastic vocal fold tissue using an atomic force microscope

The elastic properties of the vocal folds (VFs) vary as a function of depth relative to the epithelial surface. The poroelastic anisotropic properties of porcine VFs, at various depths, were measured using atomic force microscopy (AFM)-based indentation. The minimum tip diameter to effectively capture the local properties was found to be 25µm, based on nonlinear laser scanning microscopy data and image analysis. The effects of AFM tip dimensions and AFM cantilever stiffness were systematically investigated. The indentation tests were performed along the sagittal and coronal planes for an evaluation of the VF anisotropy. Hertzian contact theory was used along with the governing equations of linear poroelasticity to calculate the diffusivity coefficient of the tissue from AFM indentation creep testing. The permeability coefficient of the porcine VF was found to be 1.80±0.32×10(-15)m(4)/Ns.

Rayleigh wave propagation method for the characterization of a thin layer of biomaterials

An experimental method based on Rayleigh wave propagation was developed for quantifying the frequency-dependent viscoelastic properties of a small volume of expensive biomaterials over a broad frequency range. Synthetic silicone rubber and gelatin materials were fabricated and tested to evaluate the proposed method. Planar harmonic Rayleigh waves at different frequencies, from 80 to 4000 Hz, were launched on the surface of a sample composed of a substrate with known material properties coated with a thin layer of the soft material to be characterized. A transfer function method was used to obtain the complex Rayleigh wavenumber. An inverse wave propagation problem was solved and a complex nonlinear dispersion equation was obtained. The complex shear and elastic moduli of the sample materials were then calculated through the numerical solution of the obtained dispersion equation using the measured wavenumbers. The results were in good agreement with those of a previous independent study. The proposed method was found to be reliable and cost effective for the measurement of viscoelastic properties of a thin layer of expensive biomaterials, such as phonosurgical biomaterials, over a wide frequency range.

Experimental methods for the characterization of the frequency-dependent viscoelastic properties of soft materials

A characterization method based on Rayleigh wave propagation was developed for the quantification of the frequency-dependent viscoelastic properties of soft materials at high frequencies; i.e., up to 4 kHz. Planar harmonic surface waves were produced on the surface of silicone rubber samples. The phase and amplitude of the propagating waves were measured at different locations along the propagation direction, which allowed the calculation of the complex Rayleigh wavenumbers at each excitation frequency using a transfer function method. An inverse wave propagation problem was then solved to obtain the complex shear/elastic moduli from the measured wavenumbers. In a separate, related investigation, dynamic indentation tests using atomic force microscopy (AFM) were performed at frequencies up to 300 Hz. No systematic verification study is available for the AFM-based method, which can be used when the dimensions of the test samples are too small for other existing testing methods. The results obtained from the Rayleigh wave propagation and AFM-based indentation methods were compared with those from a well-established method, which involves the generation of standing longitudinal compression waves in rod-shaped test specimens. The results were cross validated and qualitatively confirmed theoretical expectations presented in the literature for the frequency-dependence of polymers.