Modelling towards a more holistic medicine: The Virtual Physiological Human (VPH).

The Virtual Physiological Human (VPH) is a European initiative, rooted in the international Physiome initiative, focusing on establishing a methodological and technological framework, enabling the collaborative investigation of the human body as a single complex system. This collective framework will facilitate the sharing of resources and observations formed by different institutions and organizations, and the creation of disparate but integrated computer models of the mechanical, physical and biochemical functions of a living human body. The VPH initiative has laid the foundation for integrating heterogeneous data sources into mechanistic computer models of most anatomical systems

Structural behaviour and strain distribution of the long bones of the human lower limbs

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Use of embedded strain gages for the in-vitro study of proximal tibial cancellous bone deformation during knee flexion-extension movement: development, reproducibility and preliminary results of feasibility after frontal low femoral osteotomy

<p>Abstract</p> <p>Background</p> <p>This paper reports the development of an in-vitro technique allowing quantification of relative (not absolute) deformations measured at the level of the cancellous bone of the tibial proximal epiphysis (CB_TPE) during knee flexion-extension. This method has been developed to allow a future study of the effects of low femoral osteotomies consequence on the CB_TPE.</p> <p>Methods</p> <p>Six strain gages were encapsulated in an epoxy resin solution to form, after resin polymerisation, six measurement elements (ME). The latter were inserted into the CB_TPEof six unembalmed specimens, just below the tibial plateau. Knee motion data were collected by three-dimensional (3D) electrogoniometry during several cycles of knee flexion-extension. Intra- and inter-observer reproducibility was estimated on one specimen for all MEs. Intra-specimen repeatability was calculated to determine specimen's variability and the error of measurement. A varum and valgum chirurgical procedure was realised on another specimen to observed CB_TPEdeformation after these kind of procedure.</p> <p>Results</p> <p>Average intra-observer variation of the deformation ranged from 8% to 9% (mean coefficient of variation, MCV) respectively for extension and flexion movement. The coefficient of multiple correlations (CMC) ranged from 0.93 to 0.96 for flexion and extension. No phase shift of maximum strain peaks was observed. Inter-observer MCV averaged 23% and 28% for flexion and extension. The CMC were 0.82 and 0.87 respectively for extension and flexion. For the intra-specimen repeatability, the average of mean RMS difference and the mean ICC were calculated only for flexion movement. The mean RMS variability ranged from 7 to 10% and the mean ICC was 0.98 (0.95 - 0.99). A Pearson's correlation coefficient was calculated showing that RMS was independent of signal intensity. For the chirurgical procedure, valgum and varum deviation seems be in agree with the frontal misalignment theory.</p> <p>Conclusions</p> <p>Results show that the methodology is reproducible within a range of 10%. This method has been developed to allow analysis the indirect reflect of deformation variations in CB_TPEbefore and after distal femoral osteotomies. The first results of the valgum and varum deformation show that our methodology allows this kind of measurement and are encourageant for latter studies. It will therefore allow quantification and enhance the understanding of the effects of this kind of surgery on the CB_TPEloading.</p

A novel contact interaction formulation for voxel-based micro-finite-element models of bone

Voxel-based micro-finite-element (μFE) models are used extensively in bone mechanics research. A major disadvantage of voxel-based μFE models is that voxel surface jaggedness causes distortion of contact-induced stresses. Past efforts in resolving this problem have only been partially successful, ie, mesh smoothing failed to preserve uniformity of the stiffness matrix, resulting in (excessively) larger solution times, whereas reducing contact to a bonded interface introduced spurious tensile stresses at the contact surface. This paper introduces a novel "smooth" contact formulation that defines gap distances based on an artificial smooth surface representation while using the conventional penalty contact framework. Detailed analyses of a sphere under compression demonstrated that the smooth formulation predicts contact-induced stresses more accurately than the bonded contact formulation. When applied to a realistic bone contact problem, errors in the smooth contact result were under 2%, whereas errors in the bonded contact result were up to 42.2%. We conclude that the novel smooth contact formulation presents a memory-efficient method for contact problems in voxel-based μFE models. It presents the first method that allows modeling finite slip in large-scale voxel meshes common to high-resolution image-based models of bone while keeping the benefits of a fast and efficient voxel-based solution scheme

A Patient-Specific Foot Model for the Estimate of Ankle Joint Forces in Patients with Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the leading cause of childhood disability from a musculoskeletal disorder. It generally affects large joints such as the knee and the ankle, often causing structural damage. Different factors contribute to the damage onset, including altered joint loading and other mechanical factors, associated with pain and inflammation. The prediction of patients' joint loading can hence be a valuable tool in understanding the disease mechanisms involved in structural damage progression. A number of lower-limb musculoskeletal models have been proposed to analyse the hip and knee joints, but juvenile models of the foot are still lacking. This paper presents a modelling pipeline that allows the creation of juvenile patient-specific models starting from lower limb kinematics and foot and ankle MRI data. This pipeline has been applied to data from three children with JIA and the importance of patient-specific parameters and modelling assumptions has been tested in a sensitivity analysis focused on the variation of the joint reaction forces. This analysis highlighted the criticality of patient-specific definition of the ankle joint axes and location of the Achilles tendon insertions. Patient-specific detection of the Tibialis Anterior, Tibialis Posterior, and Peroneus Longus origins and insertions were also shown to be important