Showing papers in "Proceedings Of The Institution Of Mechanical Engineers, Part H: Journal Of Engineering In Medicine in 2022"

Review on electromyography based intention for upper limb control using pattern recognition for human-machine interaction

Abstract: Upper limb myoelectric prosthetic control is an essential topic in the field of rehabilitation. The technique controls prostheses using surface electromyogram (sEMG) and intramuscular EMG (iEMG) signals. EMG signals are extensively used in controlling prosthetic upper and lower limbs, virtual reality entertainment, and human-machine interface (HMI). EMG signals are vital parameters for machine learning and deep learning algorithms and help to give an insight into the human brain’s function and mechanisms. Pattern recognition techniques pertaining to support vector machine (SVM), k-nearest neighbor (KNN) and Bayesian classifiers have been utilized to classify EMG signals. This paper presents a review on current EMG signal techniques, including electrode array utilization, signal acquisition, signal preprocessing and post-processing, feature selection and extraction, data dimensionality reduction, classification, and ultimate application to the community. The paper also discusses using alternatives to EMG signals, such as force sensors, to measure muscle activity with reliable results. Future implications for EMG classification include employing deep learning techniques such as artificial neural networks (ANN) and recurrent neural networks (RNN) for achieving robust results.

A review on experimental and numerical investigations of cortical bone fracture

Abstract: This paper comprehensively reviews the various experimental and numerical techniques, which were considered to determine the fracture characteristics of the cortical bone. This study also provides some recommendations along with the critical review, which would be beneficial for future research of fracture analysis of cortical bone. Cortical bone fractures due to sports activities, climbing, running, and engagement in transport or industrial accidents. Individuals having different diseases are also at high risk of cortical bone fracture. It has been observed that osteon orientation influences cortical bone fracture toughness and fracture mechanisms. Apart from this, recent studies indicate that fracture parameters of cortical bone also depend on many factors such as age, sex, temperature, osteoporosis, orientation, location, loading condition, strain rate, and storage facility, etc. The cortical bone regains its fracture toughness due to various toughening mechanisms. Owing to these factors, several experimental, clinical, and numerical investigations have been carried out to determine the fracture parameters of the cortical bone. Cortical bone is the dense outer surface of the bone and contributes to 80%–82% of the skeleton mass. Cortical bone experiences load far exceeding body weight due to muscle contraction and the dynamics of motion. It is very important to know the fracture pattern, direction of fracture, location of the fracture, and toughening mechanism of cortical bone. A basic understanding of the different factors that affect the fracture parameters and fracture mechanisms of the cortical bone is necessary to prevent the failure and fracture of cortical bone. This review has summarized the advancement considered in the various experimental techniques and numerical methods to get complete information about the fracture mechanisms of cortical bone.

The role of NiTi shape memory alloys in quality of life improvement through medical advancements: A comprehensive review

Abstract: The significance of advanced smart materials in recent technological research and advancement is apparent from its extensive use in present day devices and instruments. Of the various smart materials in use today, the fascinating category of shape memory alloys (SMAs) is equipped with the ability to return to a previously memorized shape under certain thermomechanical or magnetic stimuli. The unique property of shape memory effect and superelasticity displayed by these materials along with good biocompatibility and corrosion resistance make them ideal for biomedical applications. The various applications of SMAs in surgical instruments, surgical implants, and assistive and rehabilitative devices have significant effect on the day to day life of people in the present age. Majority of these biomedical devices belong to the orthodontic, orthopedic, or surgical fields. Other remarkable applications of SMAs such as in the production of prostheses and orthoses designed through the biomimetic approach are also highly influential in improving the quality of life. The present paper provides an overview of the various properties of shape memory alloys and their applications in the biomedical field over the years, that have had a significant impact on the realm of medical science.

Revealing the compressive and flow properties of novel bone scaffold structure manufactured by selective laser sintering technique

Abstract: Additive manufacturing is revolutionizing the field of medical sciences through its key application in the development of bone scaffolds. During scaffold fabrication, achieving a good level of porosity for enhanced mechanical strength is very challenging. The bone scaffolds should hold both the porosity and load withstanding capacity. In this research, a novel structure was designed with the aim of the evaluation of flexible porosity. A CAD model was generated for the novel structure using specific input parameters, whereas the porosity was controlled by varying the input parameters. Poly Amide (PA 2200) material was used for the fabrication of bone scaffolds, which is a biocompatible material. To fabricate a novel structure for bone scaffolds, a Selective Laser Sintering machine (SLS) was used. The displacement under compression loads was observed using a Universal Testing Machine (UTM). In addition to this, numerical analysis of the components was also carried out. The compressive stiffness found through the analysis enables the verification of the load withstanding capacity of the specific bone scaffold model. The experimental porosity was compared with the theoretical porosity and showed almost 29% to 30% reductions when compared to the theoretical porosity. Structural analysis was carried out using ANSYS by changing the geometry. Computational Fluid Dynamics (CFD) analysis was carried out using ANSYS FLUENT to estimate the blood pressure and Wall Shear Stress (WSS). From the CFD analysis, maximum pressure of 1.799 Pa was observed. Though the porosity was less than 50%, there was not much variation of WSS. The achievement from this study endorses the great potential of the proposed models which can successfully be adapted for the required bone implant applications.

On 3D printed biomedical sensors for non-enzymatic glucose sensing applications

Abstract: Some studies have been reported in the recent past on smart sensors for non-enzymatic glucose sensing applications. Nevertheless, little has been reported on the in-house development of low-cost 3D printed smart biomedical sensors with tunable sensitivity. This study reports investigations on the in-house, low-cost fabrication of polyvinyl difluoride (PVDF) matrix-based 3D printed tunable non-enzymatic glucose sensors. For fabrication of smart sensors, Cu (4%) doped ZnO nanoparticles have been reinforced (in different weight proportions (wt%) in PVDF matrix through melt processing. The results suggest that 4% reinforcement (of 4% Cu doped-ZnO), processed at 190°C, 40 rpm screw speed on twin screw extrusion (TSE) followed by post heat treatment (HT) at 60°C are the best settings for fabrication of feedstock filaments (for bio-sensor 3D printing). Finally, a PVDF-based sensor to support bioreceptor and transducer requirements has been successfully prepared (with 4D properties (i.e. one-way programing feature), optical, morphological, bond strength, piezoelectric and mechanical characteristics). The 3D printed electro-active sensor, (of selected composition) resulted in acceptable mechanical, piezoelectric, and dielectric properties (modulus of toughness (MoT) 1.46 MPa, Young’s modulus (YM) 1221.7 MPa, piezoelectric coefficient 19.3pC/N and dielectric constant 6.5). The results have been supported by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), current-voltage-resistance (I-V-R), and Fourier transformed infrared (FTIR) analysis. Graphical Abstract

Workflow assessing the effect of Achilles tendon rupture on gait function and metatarsal stress: Combined musculoskeletal modeling and finite element analysis

Abstract: Achilles tendon rupture (ATR) incidence has increased among badminton players in recent years. The foot internal stress was hard to obtain through experimental testing. The purpose of the current research is to develop a methodology that could improve the finite element model derived foot internal stress prediction for ATR clinical and rehabilitation applications. A subject-specific musculoskeletal model was combined with a 3D finite element model to predict the metatarsal stress. The 80% point during the push-off phase of walking was selected for the comparing between injured and uninjured sides. The surgical repaired Achilles tendon (AT) after 12 months was elongated by 5.5% than the uninjured tendon. At 80% point of stance phase, the ankle plantarflexion angle and AT force decreased by 39.6% and 21.9% on the injured side, respectively. The foot inversion degree increased by 22.9% and was accompanied by the redistribution of metatarsals von Mises stress. The stresses on the fourth and fifth metatarsals were increased by 59.5% and 85.9% on the injured side. The workflow is available to assess musculoskeletal disorders and obtain foot internal stress after ATR. The decreased ankle plantar flexor force may be affected by triceps surae muscle atrophy and weakened force transmission ability of elongated AT. The increased von Mises stress on fourth and fifth metatarsals accompanied by higher foot inversion may increase the ankle lateral sprain injury risk.

Automated evaluation of rheumatoid arthritis from hand radiographs using Machine Learning and deep learning techniques

Abstract: The aim and objectives of the study are as follows: (i) to implement automated patch-based classification of hand X-ray images using modified pre-trained convolutional neural network (CNN) models; (ii) to develop a customized CNN model for automated feature extraction and classification of hand X-ray images and to compare the performance of customized CNN models with non-linear and linear kernels; (iii) to construct the hand crafted feature fusion (SIFT+ Customized CNN features) and categorize the normal and RA using Machine Learning classifiers. The model was trained on 75 images (10,000 patches) of hand radiographs and tested using 25 images (500 patches) that were not included in the training set. The accuracy of the modified pre-trained model GoogLeNet was 89% and the proposed custom model three achieved an accuracy of 95%. The sensitivity and specificity of GoogLeNet were 84% and 90% respectively. The custom model three attained the sensitivity and specificity as 95% and 94% respectively. Furthermore, when compared to the features extracted (SIFT + CNN) from the customized models, the custom3 model outperformed well for the classification of RA compared to ML classifiers. Thus a custom CNN-based computer-aided diagnostic tool can be used as an effective method for the detection of RA. Graphical Abstract

COVID-19: Current challenges regarding medical healthcare supplies and their implications on the global additive manufacturing industry

Abstract: The covid-19 outbreak has caused a shortage of masks and other healthcare products for the general public around the globe. In addition, it has also affected the supply of personal protective equipment (PPE) used by healthcare services because of a sudden increase in their demand. This significant disruption in the global supply chain of these products resulted in, leaving many staff and patients without protection. The additive manufacturing (AM) industry is going through extraordinary times and can provide emergency responses to help deal with the global crisis caused by the COVID-19 pandemic. The objective of the present work is therefore to perform an up-to-date review to determine the capacity of AM to provide exclusive benefits for the medical healthcare supplies sector to fight this current situation. In this review, it is found that AM technology has proved that it can be used as a volume manufacturing technology for the ongoing crisis. However, the standardization and certification are appeared to represent the main challenges for adopting the AM in healthcare against COVID-19. Furthermore, additively manufactured materials for medical applications must be developed for medical environments. Most printed medical products for COVID-19 require biocompatibility evaluation and shall prove their ability to sterilize. Finally, this review concluded that AM technology can fulfill the requirements of face masks and ventilator parts for healthcare systems for proper controlling and treating of COVID-19 patients when the safety and efficacy of these devices are ensured.

Impingement in total hip arthroplasty: A geometric model

Abstract: Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0–1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete or permanent, and partial or temporary loss of contact between the bearing surfaces respectively. This study comprises the development of a geometric model of bone and an in situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that anterior-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and inclination. Posterior-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased cup anteversion and inclination. A component impingement-free range was identified, running from when the cup was positioned with 45° inclination and 25° anteversion to 70° inclination and 15°–20° anteversion.

Nitinol: From historical milestones to functional properties and biomedical applications

Abstract: Isoatomic NiTi alloy (Nitinol) has become an important biomaterial due to its unique characteristics, including shape memory effect, superelasticity, and high damping. Nitinol has been widely used in the biomedical field, including orthopedics, vascular stents, orthodontics, and other medical devices. However, there have been convicting views about the biocompatibility of Nitinol. Some studies have shown that Nitinol has extremely low cytotoxicity, indicating Nitinol has good biocompatibility. However, some studies have shown that the in-vivo corrosion resistance of Nitinol significantly decreases. This comprehensive paper discusses the historical developments of Nitinol, its biomedical applications, and its specific functional property. These render the suitability of Nitinol for such biomedical applications and provide insights into its in vivo and in vitro biocompatibility in the physiological environment and the antimicrobial strategies that can be applied to enhance its biocompatibility. Although 3D metal printing is still immature and Nitinol medical materials are difficult to be processed, Nitinol biomaterials have excellent potential and commercial value for 3D printing. However, there are still significant problems in the processing of Nitinol and improving its biocompatibility. With the deepening of research and continuous progress in surface modification and coating technology, a series of medical devices made from Nitinol are expected to be released soon.

Validation of wearable inertial sensor-based gait analysis system for measurement of spatiotemporal parameters and lower extremity joint kinematics in sagittal plane

Abstract: Wearable inertial sensor-based motion analysis systems are promising alternatives to standard camera-based motion capture systems for the measurement of gait parameters and joint kinematics. These wearable sensors, unlike camera-based gold standard systems, find usefulness in outdoor natural environment along with confined indoor laboratory-based environment due to miniature size and wireless data transmission. This study reports validation of our developed (i-Sens) wearable motion analysis system against standard motion capture system. Gait analysis was performed at self-selected speed on non-disabled volunteers in indoor (n = 15) and outdoor (n = 8) environments. Two i-Sens units were placed at the level of knee and hip along with passive markers (for indoor study only) for simultaneous 3D motion capture using a motion capture system. Mean absolute percentage error (MAPE) was computed for spatiotemporal parameters from the i-Sens system versus the motion capture system as a true reference. Mean and standard deviation of kinematic data for a gait cycle were plotted for both systems against normative data. Joint kinematics data were analyzed to compute the root mean squared error (RMSE) and Pearson’s correlation coefficient. Kinematic plots indicate a high degree of accuracy of the i-Sens system with the reference system. Excellent positive correlation was observed between the two systems in terms of hip and knee joint angles (Indoor: hip 3.98° ± 1.03°, knee 6.48° ± 1.91°, Outdoor: hip 3.94° ± 0.78°, knee 5.82° ± 0.99°) with low RMSE. Reliability characteristics (defined using standard statistical thresholds of MAPE) of stride length, cadence, walking speed in both outdoor and indoor environment were well within the “Good” category. The i-Sens system has emerged as a potentially cost-effective, valid, accurate, and reliable alternative to expensive, standard motion capture systems for gait analysis. Further clinical trials using the i-Sens system are warranted on participants across different age groups.

Electro-osmotic peristaltic flow and heat transfer in an ionic viscoelastic fluid through a curved micro-channel with viscous dissipation

Abstract: Emerging systems in microfluidics are embracing bio-inspired designs in which boundaries are flexible and mimic peristaltic propulsion mechanisms encountered in nature. These devices utilize electro-kinetic body forces to manipulate very precisely ionic biofluids for a range of medical applications including. Motivated by exploring in more detail electro-hemorheological micro-pumping, in the current article, a mathematical model is developed for peristalsis propulsion of a viscoelastic biofluid in a curved microchannel with electro-osmotic effect and thermal transport under static axial electrical field and with viscous heating. The third grade Reiner-Rivlin model is deployed for blood rheology. The novelty of the current work is therefore the simultaneous consideration of electrokinetics, viscoelastic behavior with the third grade Reiner-Rivlin model and coupled flow and heat transport with viscous dissipation in peristaltic pumping in a curved micro-channel. A Poisson-Boltzmann formulation is adopted to simulate the charge number density associated with the electrical potential. Asymmetric zeta potential (25 mV) is prescribed and mobilizes an electric double layer (EDL). The governing conservation equations for mass, energy, momentum and electrical potential with associated boundary conditions are simplified using lubrication approximations and rendered dimensionless via appropriate scaling transformations. Analytical solutions are derived in the form of Bessel functions and numerical evaluations are conducted via the ND solver command in MATHEMATICA symbolic software. The simulations show that with stronger viscoelastic effect, boluses are eliminated and there is relaxation in streamlines in the core and peripheral regions of the micro-channel. Increasing Brinkman number (dissipation parameter) elevates temperatures. An increase in electrical double layer thickness initially produces a contraction in the upper bolus and an expansion (lateral) in the lower bolus in the micro-channel. With modification in zeta potential ratio parameter from positive to negative values, in the lower half of the micro-channel, axial flow deceleration is generated.

Thermal entrance problem for blood flow inside an axisymmetric tube: The classical Graetz problem extended for Quemada’s bio-rheological fluid with axial conduction

Abstract: The heat-conducting nature of blood is critical in the human circulatory system and features also in important thermal regulation and blood processing systems in biomedicine. Motivated by these applications, in the present investigation, the classical Graetz problem in heat transfer is extended to the case of a bio-rheological fluid model. The Quemada bio-rheological fluid model is selected since it has been shown to be accurate in mimicking physiological flows (blood) at different shear rates and hematocrits. The steady two-dimensional energy equation without viscous dissipation in stationary regime is tackled via a separation of variables approach for the isothermal wall temperature case. Following the introduction of transformation variables, the ensuing dimensionless boundary value problem is solved numerically via MATLAB based algorithm known as bvp5c (a finite difference code that implements the four-stage Lobatto IIIa collocation formula). Numerical validation is also presented against two analytical approaches namely, series solutions and Kummer function techniques. Axial conduction in terms of Péclet number is also considered. Typical values of Reynolds number and Prandtl number are used to categorize the vascular regions. The graphical representation of mean temperature, temperature gradient, and Nusselt numbers along with detail discussions are presented for the effects of Quemada non-Newtonian parameters and Péclet number. The current analysis may also have potential applications for the development of microfluidic and biofluidic devices particularly which are used in the diagnosis of diseases in addition to blood oxygenation technologies.

Techniques to determine knee joint contact forces during squatting: A systematic review

Abstract: This review article provides an overview of techniques used to determine human knee joint contact forces during squatting. The main two approaches are experimental and theoretical. Thigh calf contact has a significant effect on knee forces and should not be neglected. In this study, data were searched electronically and organized by techniques to find knee joint contact force during squatting theoretically and experimentally. There was a large variation in peak tibiofemoral (CV = 0.45) and patellofemoral (CV = 0.38) contact forces predicted theoretically. However, very little variation was observed between peak tibiofemoral contact forces (CV = 0.12) measured in vivo experimentally but measured knee joint force is available up to a limited knee flexion angle. There was a reduction in knee joint contact forces due to thigh calf contact. Literature of knee joint contact force prediction theoretically during squatting incorporating thigh calf contact force is very limited.

Improving the corrosion behavior of magnesium alloys with a focus on AZ91 Mg alloy intended for biomedical application by microstructure modification and coating

Abstract: Magnesium alloys such as AZ91 have received much attention due to their attractive properties, including biocompatibility and lightness. Although magnesium is a potential candidate for implant application, due to its rapid degradation in the physiological environment, there are still some challenges to using it as biocompatible implants. In this regard, various techniques such as microstructure modification and coating are utilized to moderate the degradation rate of magnesium alloys. Therefore, efforts are being made to conduct more extensive research to produce magnesium implants with acceptable corrosion resistance. In this literature review, an overview of the history of research on the corrosion behavior, biodegradability, microstructure deformation mechanisms, crystallographic texture in magnesium alloys with a focus on AZ91 Mg alloy, is provided. In addition, the necessity of improving the properties of AZ91 Mg alloy by the two methods of improving microstructure and coating, and existing innovations in these methods are investigated.

Tissues and organ printing: An evolution of technology and materials

Abstract: Since its beginnings, three-dimensional printing (3DP) technology has been successful because of ongoing advances in operating principles, the range of materials and cost-saving measures. However, the 3DP technological progressions in the biomedical sector have majorly taken place in the last decade after the evolution of novel 3DP systems, generally categorised as bioprinters and biomaterials to provide a replacement, transplantation or regeneration of the damaged organs and tissue constructs of the human body. There is now substantial scientific literature accessible to support the benefits of digital healthcare procedures with the help of bioprinters. It is of the highest significance to know the fundamental principles of the available printers and the compatibility of biomaterials as their feedstock, notwithstanding the huge potential of bioprinting systems to manufacture organs and other human body components. This paper provides a precise and helpful reading of the different categories of bioprinters, suitable biomaterials, numerical simulations and modelling and examples of much acknowledged clinical practices. The paper will also cite the prominent issues that still have not received desired solutions. Overall, the article will be of great use for all the professionals, scholars and engineers concerned with the 3DP, bioprinting and biomaterials.

Modelling, design and control of a new seat-cushion for pressure ulcers prevention

Abstract: Pressure ulcers are a frequent complication in patients having limited activity and mobility (e.g., elderly people, spinal cord injury patients, people with disabilities, etc.). The aim of this work is the conceptual design, modelling and control of a new seat cushion for pressure ulcers prevention. The whole system (constituted by the seat cushion equipped with a real-time pressure mapping with closed-loop control) is designed to identify the critical points on the human skin, before pressure ulcers creation, and to be able to distribute the contact pressure between the human and cushion avoiding wound creation. The seat cushion is constituted by soft air-cells actuated by air flow. To define the shape and size of the soft air-cells, finite element simulations are carried out, analysing the internal volume reduction with external loads application to reproduce the variable stiffness. The data obtained by finite element analysis are used to simulate inflation and deflation of the soft bubble air-cells. Finally, the control systems of a single air-cell and of the whole cushion are designed and simulated. The novelty of our work consists in the conception of a seat cushion able to recognise higher and lower risk zones of pressure ulcer generation on the human skin and to provide compensation automatically. This work can therefore be considered in line with the sustainable development goals recently launched by the EU Commission.

Design optimization of functionally graded lattice infill total hip arthroplasty stem for stress shielding reduction

Abstract: Reducing stress shielding of stem-inserted femurs in total hip arthroplasty caused by the high stiffness of the stem is an emerging medical engineering issue. In this study, a numerical design optimization methodology lattice infill stem was developed to realize a stem, balancing the low stiffness and strength requirements. Two pairs of models and loading conditions were introduced for the stress shielding and strength criteria. The objective function was set as the weighted sum of the criteria. Its effective density distribution was optimized by handling the representative size of the lattice as a design variable, assuming that the so-called body-centered cubic lattice was the base shape of the lattice. In the optimization, the approximated model of the lattice was handled as a solid material with the effective physical properties of the lattice derived by the homogenization method. After optimization, the detailed lattice stem geometry was modeled based on the obtained optimal lattice distribution, and the actual performance was numerically evaluated. The developed stem increased the stress applied to the remaining femur by 32.4% compared with the conventional stem.

Investigation of mechanical behaviors and improved design of V-shaped braid stents

Abstract: Graphical abstract V-shaped braid stents (VBSs), as highly retrievable and flexible nitinol stents, are extensively applied in endovascular diseases. They also cause less damage to vessel wall compared to tube-cutting stents. However, poor performance of VBS or suboptimal operation can give rise to unwanted clinical situations such as thrombosis and intimal hyperplasia. Therefore, research on designing factors affecting the performance of these devices is of great significance. Furthermore, simulation of stenting process can help designers understand the interactions of stents and vessel wall to reduce time to market. Thus, finite element analysis (FEA) and bench test are performed taking into account both designing factors and stenting process of VBS, including development of parametric modeling tool, research on the relationships among structural parameters and radial force, exploration of the interactions of VBS and vessel wall and pulsating load effect. This research was performed using a commercial solver Abaqus/standard with a user material subroutine (UMAT/nitinol). Structural parameters of VBS, unit-cell height and wire diameter have significant impacts on radial force, unit-cell number has slight influence on radial force, and arc diameter has almost negligible impact on radial force. Without pulsatile load, maximum stress and strain always occur in arc position; however, in pulsatile load, maximum stress and strain are gradually transformed to strut position. The stress created near vessel wall and VBS interface is higher than interaction stress due to pulsating load. The obtained result provided valuable information on the structural design of stents as well as the effects of stent on vessel wall and that vessel wall on stent deformation.

Assessment and selection of filler compounds for radiopaque PolyJet multi-material 3D printing for use in clinical settings

Abstract: The aim of this research was to assess a selection of radiopaque filler compounds for increasing radiopacity in a resin suitable for Polyjet multi-material 3D printing. A radiopaque resin has potential applications in medicine to produce patient-specific anatomical models with realistic radiological properties, training aids, and skin contacting components such as surgical or procedural guides that require visibility under fluoroscopy. The desirable filler would have a high level of radiopacity under ionising imaging modalities, such as X-ray, CT, fluoroscopy or angiography. Nine potential filler compounds were selected based on atomic number and handling risk: barium sulphate, bismuth oxide, zirconium oxide, strontium oxide, strontium fluoride, strontium carbonate, iodine, niobium oxide and tantalum oxide. The fillers were evaluated using selected criteria. A weighted material selection matrix was developed to prioritise and select a filler for future 3D printing on a multi-material 3D printer. Zirconium oxide was the highest scoring filler compound in the material selection matrix, scoring 4.4 out of a maximum of 5. MED610TM resin doped with zirconium oxide was shown to be UV curable, and when cured is non-toxic, environmentally friendly, and has the ability to display antimicrobial properties. In terms of radiopacity, a sample with thickness 1.5 mm of MED610™ resin doped with 20 wt.% zirconium oxide produced X-ray radiopacity equivalent to 3 mm of aluminium. Zirconium oxide was selected using the material selection matrix. This radiopaque resin can be used to produce anatomical models with accurate radiological properties, training aids or skin contacting devices that require visibility under ionising imaging modalities. The 3D printing validation run successfully demonstrated that the material selection matrix prioritised a filler suitable for radiopaque multi-material 3D printing.

Comparison of the design maps of TPMS based bone scaffolds using a computational modeling framework simultaneously considering various conditions

Abstract: In recent years, the triply periodic minimal surface (TPMS)-based scaffolds have been served as one of the crucial types of structures for biological replacements, the energy absorber, etc. Meanwhile, the development of additive manufacturing (AM) has facilitated the production of TPMS scaffolds with complex microstructures. However, the design maps of TPMS scaffolds, especially considering the AM constraints, remain unclear, which has hindered the design and application of TPMS scaffolds. The aims of the present study were to develop an efficient computational modeling framework for investigating the design maps of TPMS scaffolds simultaneously considering the AM constraints, the biological requirements, and the structural anisotropy. To demonstrate the computational framework, five widely-used topologies of the TPMS-based scaffolds (i.e. the Diamond, the Gyroid, the Fischer-Koch S, the F-RD, and the Schwarz P) were used, whose design maps for the surface-to-volume ratio and the effective elastic modulus were also investigated. The results showed that as the porosities increase, the design ranges of the surface-to-volume ratios decreases for all the structures. Compared with the effect of the constraint for the pore size, the minimal structural thickness for AM constraint has a greater effect on the surface-to-volume ratio. Regarding the elastic modulus, in the region of low porosity (approximately 0.5–0.7), the range for the effective elastic modulus of Schwarz P is the widest (approximately 2.24–32.6 GPa), but the Gyroid can achieve both high porosity and low effective elastic modulus (e.g. 0.61 GPa at the porosity of 0.90). These results and the method developed in the present study provided important basis and guidance for the design and application of the TPMS-based porous structures.

Design of patient specific basal dental implant using Finite Element method and Artificial Neural Network technique

Abstract: The bone conditions of mandibular bone vary from patient to patient, and as a result, a patient-specific dental implant needs to be designed. The basal dental implant is implanted in the cortical region of the bone since the top surface of the bone narrows down because of aging. Taguchi designs of experiments technique are used in which 25 optimum solid models of basal dental implants are modeled with variable geometrical parameters, viz. thread length, diameter, and pitch. In the solid models the implants are placed in the cortical part of the 3D models of cadaveric mandibles, that are prepared from CT data using image processing software. Patient-specific bone conditions are varied according to the strong, weak, and normal basal bone. A compressive force of 200 N is applied on the top surface of these implants and using finite element analysis software, the microstrain on the peri-implant bone ranges from 1000 to 4000 depending on the various bone conditions. According to the finite element data, it can be concluded that weak bone microstrain is comparatively high compared with normal and strong bone conditions. A surrogate artificial neural network model is prepared from the finite element analysis data. Surrogate model assisted genetic algorithm is used to find the optimum patient-specific basal dental implant for a better osseointegration-friendly mechanical environment.

A developed multibody knee model for unloading knee with cartilage penetration depth control

Abstract: Unloader knee braces could relieve pain by decreasing the medial knee loading. Particularly for knee osteoarthritis (KOA) patients, this study investigates the relevance of the knee model after identifying the most influential parameter. Since KOA causes the cartilage in a joint to lose its elasticity and thickness, the lack of normal bone-to-bone separation can be painful. We believe that cartilage penetration depth control is an impactful strategy in this research. Moreover, the knee contact force in KOA is fewer than in healthy knees, confirming that the contact force control cannot be a straight factor. Therefore, a biomechanical human knee model is developed, and a generic procedure for dynamic analysis of contact problems in combination with the musculoskeletal model is introduced. The developed model includes the geometric expression of collision curves and an algorithm for determining collision points. This presentation addresses cartilage penetration depth and contact force calculation through nonlinear discontinuous contact law. In view of this, femur and tibia’s relative motion is analyzed through the combined collision reactions of cartilage and bone in the knee. In the simulation, maximum penetration depth in a healthy knee is reported to be 0.795 mm, while in a 75% KOA is 0.521 mm, including 0.5 mm cartilage-cartilage contact and 0.021 mm bone-bone contact. The top unloading 852 N is achieved, reducing penetration depth to 0.45 mm, avoiding bone-bone contact. This proposed procedure with low computation gives us a suitable analysis method for designing knee assistive devices.

Effects of plate contouring quality on the biomechanical performance of high tibial osteotomy fixation: A parametric finite element study

Abstract: Locking plates have threaded holes, in which threaded-head screws are affixed. Hence, they do not need to be in intimate contact with underlying bone to provide fixation. There are, however, reports that a large distance between the plate and the bone might cause clinical complications such as delayed union or nonunion, screw pull out, and screw and plate breakage. Considering the diversity in the capabilities and costs of different plate customization techniques, the purpose of this study was to investigate the effect of the plate contouring quality on the biomechanical performance of high tibial osteotomy (HTO) fixation. A finite element model of proximal tibia was developed in Abaqus, using the QCT data of a cadaver. The model was then subjected to open-wedge HTO (correction angle 12°) with TomoFix plate fixation. The sagittal curvature of the plate was changed parametrically to provide certain levels of geometrical fit, and the biomechanical performance parameters of fixation were assessed. Results indicated 5%, 9% and 38% increase in the stiffness of the construct, and the von Mises stress in the plate and locking screw just above the osteotomy site, respectively, when the level of fit of plate changed from 0% (initial non-contoured initial shape) to 100% (fully adapted shape). The same change decreased the pressure at the lateral hinge of the osteotomy by 61%, and the mean of the tensile stress on the screw shaft by 12%. It was concluded that the level of fit has conflicting effects on the biomechanical parameters of the HTO fixation system, that is, the structural stiffness, the pressure at the lateral hinge, the stresses in the plate and screws, and the pull out resistance of the screws. In particular, for HTO patients with high quality bone, the optimal level of fit should provide a tradeoff between these parameters.

Comparison of axial-rotational postoperative periprosthetic fracture of the femur in composite osteoporotic femur versus human cadaveric specimens: A validation study

Abstract: Postoperative periprosthetic femoral fracture following hip replacement has been the subject of many varied experimental approaches. Cadaveric samples offer realistic fit and fracture patterns but are subject to large between-sample variation. Composite femurs have not yet been validated for this purpose. We compared the results of composite femurs to cadaveric femurs using an established methodology. In vitro postoperative periprosthetic fracture results using axial-rotational loading were compared between 12 composite femurs and nine fresh frozen femurs, which were implanted with an otherwise identical collarless (6 composite vs 4 cadaveric) or collared (6 composite vs 5 cadaveric) cementless femoral stem using identical methodology. Fracture torque and rotational displacement were measured and torsional stiffness and rotational work prior to fracture were estimated. Fractures patterns were graded according to the Unified Classification System. Fracture torque, displacement, torsional stiffness and fracture patterns for cadaveric and composite femurs were similar between groups. There was a trend for a greater rotational displacement in the cadaveric groups, which lead to a decrease in torsional stiffness and a significantly greater rotational work prior to fracture for all cadaveric specimens (collarless stems: 10.51 [9.71 to 12.57] vs 5.21 [4.25 to 6.04], p = 0.01 and for collared stems: 15.38 [14.01 to 17.05] vs 5.76 [4.92 to 6.64], p = 0.01). Given comparable fracture torque and the similarity in fracture patterns for fracture trials using composite samples versus cadaveric femurs, the use of composite femur models may be a reasonable choice for postoperative periprosthetic femoral fracture studies within certain limitations.

Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair

Abstract: Synthetic implants were used for repair of anterior compartment prolapses, which can be caused by direct trauma resulting in damaged pelvic structures. The mechanical properties of these implants may cause complications, namely erosion of the mesh through the vagina. In this study, we evaluated, by modeling, the behavior of implants, during Valsalva maneuver, used to replace damaged uterosacral ligaments (USLs), mimicking a sacrocolpopexy repair. For this purpose, two synthetic implants (A, for prolapse repair and B, for Hernia repair) were uniaxially tested, and the mechanical properties obtained were incorporated in the computational models of the implants. The computational model for the implant was incorporated into the model of the female pelvic cavity, in order to mimic the USLs after its total rupture and with 90% and 50% impairment. The total rupture and impairments of the USLs, caused a variation of the supero-inferior displacement and displacement magnitude of the vagina, with higher values for the total rupture. With total rupture of the USLs, when compared to healthy USLs, supero-inferior displacement and displacement magnitude of the vagina increased by 4.98 mm (7.69 mm vs 12.67 mm) and 6.62 mm (9.38 mm vs 16.00 mm), respectively. After implantation (A and B) a reduction of the supero-inferior displacements of the anterior vaginal wall occurred, to values found in the case of the model without any impairment or rupture of the ligaments. The simulation was able to mimic the biomechanical response of the USLs, in response to different implants stiffnesses, which can be used in the development of novel meshes.

Human-robot-robot cooperative control using positioning robot and 1-DOF traction device for robot-assisted fracture reduction system

Abstract: While performing musculoskeletal long bone fracture reduction surgery, assistant surgeons can often suffer from physical fatigue as they provide resistance against the tension from surrounding muscles pulling on the patient’s broken bones. These days, robotic systems are being actively developed to mitigate this physical workload by realigning and holding these fractured bones for surgeons. This has led to one consortium proposing the development of a robot-assisted fracture reduction system consisting of a 6-DOF positioning robot along with a 1-DOF traction device. With the introduction of the 1-DOF traction device, the positioning robot does not have to fight these contraction forces so can be compact improving its maneuverability and overall convenience; however, considering surgeon-robot interactions, this approach adds the requirement of controlling two different types of robots simultaneously. As such, an advanced cooperative control methodology is required to control the proposed bone fracture reduction robot system. In this paper, a human-robot-robot cooperative control (HRRCC) scheme is proposed for collaboration between the surgeon, the positioning robot, and the traction device. First, the mathematical background of this HRRCC scheme is provided. Next, we describe a series of experiments that show how the proposed scheme facilitates a reduction in the load placed on the positioning robot from strong muscular contraction forces making it possible to conduct fracture reduction procedures more safely despite the muscular forces.

Non-invasive technique to detect diabetic retinopathy based on Electrooculography signal using machine learning classifiers

Abstract: Single-channel Electrooculogram (EOG) is proposed for detecting diabetic retinopathy. The Corneal-retinal potential of the eyes plays a vital role in the acquisition of Electrooculography. Diabetes is the most prevalent disease and for one out of three people with diabetes above 40 years, diabetic retinopathy occurs. It is necessary for the early detection of diabetic retinopathy as it is one of the primary reasons for blindness in the population. The potential difference between cornea and retina leads to the acquisition of EOG signal. The proposed study aims to design a low-cost miniaturized hardware circuit to obtain EOG signal using second order filters without compromising in accuracy of the outcome signal and to classify the signal into normal and diabetic retinopathy subjects by extracting the statistical features like kurtosis, mean, median absolute deviation, standard deviation, and range from software filtered EOG signal. Among the classifiers used, Support vector machine (SVM) shows a higher accuracy of 93.33%. The sensitivity, specificity and Area Under Curve (AUC) values of SVM are 96.43%, 90.625%, 0.93% is considered as more favorable outcome for the proposed method and it supports the developed prototype and processing methodology. The novelty of the research is based on proposing and exploring a non-invasive methodology for Diabetic retinopathy diagnosis based on EOG signal. Thus, the designed hardware is simple in operation and cost effective, provides an affordable and non-invasive diagnostic tool for diabetic retinopathy patients

Skin cancer diagnosis based on a hybrid AlexNet/extreme learning machine optimized by Fractional-order Red Fox Optimization algorithm.

Abstract: Skin cancer is known as one of the most usual malignant cancer in the human body. Statistics show that each year above one million people are added to the who has this cancer. There are different types of skin cancer, where, the main difference is on the type of cell that is developing cancer. The best way to treat this cancer is to diagnose it early and to prevent the lesion from spreading with surgery. Early detection and treatment of skin cancer from skin images can significantly reduce mortality. Although skin cancer is very dangerous, early diagnosis and appropriate treatment, in most cases, prevent death. The present study introduces a new diagnostic technique for skin cancer based on deep learning and metaheuristics. At first, a pre-trained modified AlexNet based on batch normalization layers is used to train the skin dermoscopy images. Afterward, the last several layers are substituted by an Extreme Learning Machine (ELM). For providing higher efficiency in the ELM network, a newly amended metaheuristic, called Fractional-order Red Fox Optimization (FORFO) Algorithm is used. The final results of the proposed technique are compared with some various techniques and the results showed the effectiveness of the suggested method.

Biological and mechanical response of laser shock peening orthopaedic titanium alloy (Ti-6Al-7Nb)

Abstract: This paper focuses on the evaluation of mechanical and biological properties of laser shock peening (LSP) orthopaedic grade Ti-6Al-7Nb alloy. LSP surface treatment was conducted at laser energy of 3 to 7 J with overlaps of 33%–67%, and with a 3 mm laser spot size. Cell viability on laser shock peened surface was evaluated through in-vitro MTT assay, using osteoblast-like MG63 cells for the first-time. Residual stresses, microhardness, microstructure, sliding wear and wetting properties were investigated. Compressive residual stresses were found at various depths due to controlling the LSP parameters, compared to the as-received surface. The laser shock peened surfaces were hardened from 365HV0.05 to 405HV0.05, while the as-received surface was 320HV0.05. The average sub-grain size was refined from 14% to 36% after LSP. The wear resistance was also controllable by altering LSP parameters. The MTT results show that the cell viability on the laser shock peened surfaces was comparatively lower than that of the untreated surface after 24 h. However, after 72 h, the cell viability on modified surfaces were significantly improved. This work indicated that laser shock peened surfaces have a strong potential to decrease the pain from orthopaedic implant failures and promote the cytocompatibility between the bone and implant.