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Design of personalized scoliosis braces based on differentiable biomechanics-Synthetic study.

ABSTRACT: This work describes a computational methodology for the design of braces for adolescent idiopathic scoliosis. The proposed methodology relies on a personalized simulation model of the patient's trunk, and automatically searches for the brace geometry that optimizes the trade-off between clinical improvement and patient comfort. To do this, we introduce a formulation of differentiable biomechanics of the patient's trunk, the brace, and their interaction. We design a simulation model that is differentiable with respect to both the deformation state and the brace design parameters, and we show how this differentiable model is used for the efficient update of brace design parameters within a numerical optimization algorithm. To evaluate the proposed methodology, we have obtained trunk models with personalized geometry for five patients of adolescent idiopathic scoliosis, and we have designed Boston-type braces. In a simulation setting, the designed braces improve clinical metrics by 45% on average, under acceptable comfort conditions. In the future, the methodology can be extended beyond synthetic validation, and tested with physical braces on the actual patients.

SUBMITTER: Kardash K

PROVIDER: S-EPMC9684303 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Design of personalized scoliosis braces based on differentiable biomechanics-Synthetic study.

Kardash Kateryna K Koutras Christos C Otaduy Miguel A MA

Frontiers in bioengineering and biotechnology 20221110

This work describes a computational methodology for the design of braces for adolescent idiopathic scoliosis. The proposed methodology relies on a personalized simulation model of the patient's trunk, and automatically searches for the brace geometry that optimizes the trade-off between clinical improvement and patient comfort. To do this, we introduce a formulation of differentiable biomechanics of the patient's trunk, the brace, and their interaction. We design a simulation model that is diffe ...[more]

PMID: 36440444

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Project description:The implementation of intracorneal ring segments (ICRS) is one of the successfully applied refractive operations for the treatment of keratoconus (kc) progression. The different selection of ICRS types along with the surgical implementation techniques can significantly affect surgical outcomes. Thus, this study aimed to investigate the influence of ICRS implementation techniques and design on the postoperative biomechanical state and keratometry results. The clinical data of three patients with different stages and patterns of keratoconus were assessed to develop a three-dimensional (3D) patient-specific finite-element model (FEM) of the keratoconic cornea. For each patient, the exact surgery procedure definitions were interpreted in the step-by-step FEM. Then, seven surgical scenarios, including different ICRS designs (complete and incomplete segment), with two surgical implementation methods (tunnel incision and lamellar pocket cut), were simulated. The pre- and postoperative predicted results of FEM were validated with the corresponding clinical data. For the pre- and postoperative results, the average error of 0.4% and 3.7% for the mean keratometry value ([Formula: see text]) were predicted. Furthermore, the difference in induced flattening effects was negligible for three ICRS types (KeraRing segment with arc-length of 355, 320, and two separate 160) of equal thickness. In contrast, the single and double progressive thickness of KeraRing 160 caused a significantly lower flattening effect compared to the same type with constant thickness. The observations indicated that the greater the segment thickness and arc-length, the lower the induced mean keratometry values. While the application of the tunnel incision method resulted in a lower [Formula: see text] value for moderate and advanced KC, the induced maximum Von Mises stress on the postoperative cornea exceeded the induced maximum stress on the cornea more than two to five times compared to the pocket incision and the preoperative state of the cornea. In particular, an asymmetric regional Von Mises stress on the corneal surface was generated with a progressive ICRS thickness. These findings could be an early biomechanical sign for a later corneal instability and ICRS migration. The developed methodology provided a platform to personalize ICRS refractive surgery with regard to the patient's keratoconus stage in order to facilitate the efficiency and biomechanical stability of the surgery.

Project description:BackgroundThe use of soft braces to treat scoliosis has been described by Fischer as early as 1876. With the help of elastic straps, as the authors suggested, a corrective movement for individual curve patterns should be maintained in order to inhibit curve progression. Today this concept has been revived besides soft 3 point pressure systems. Some shortcomings have been revealed in literature in comparison with hard braces, however the concept of improving quality of life of a patient while under brace treatment should furtherly be considered as valuable. Purpose of this review is to gather the body of evidence existent for the use of soft braces and to present recent developments.MethodA review of literature as available on Pub Med was performed using the key words 'scoliosis' and 'soft brace' at first. The search was expanded using 'scoliosis' and the known trademarks (1) 'scoliosis' and 'SpineCor', (2) 'scoliosis' and 'TriaC', (3) 'scoliosis' and 'St. Etienne brace', (4) 'scoliosis' and 'Olympe'. The papers considered for inclusion were new technical descriptions, preliminary results, cohort studies and controlled studies.ResultsWhen searching for the terms 'scoliosis' and 'SpineCor': 20 papers have been found, most of them investigating a soft brace, for 'scoliosis' and 'TriaC': 7 papers displayed, for 'scoliosis' and 'St. Etienne brace': one paper displayed but not meeting the topic and for 'scoliosis' and 'Olympe': No paper displayed. Four papers found on the SpineCor™ were of prospective controlled or prospective randomized design. These papers partly presented contradictory results. Two papers were on soft Boston braces used in patients with neuromuscular scoliosis.DiscussionThere is a small but consistent body of evidence for the use of soft braces in the treatment of scoliosis. Contradictory results have been published for samples treated during the pubertal growth spurt. In a biomechanical analysis the reason for the lack of effectiveness during this period has been elaborated. Improved materials and the implementation of corrective movements respecting also the sagittal correction of the scoliotic spine will hopefully contribute to an improvement of the results achievable.ConclusionsThe treatment of scoliosis using soft braces is supported by some papers providing a small body of evidence. During the growth spurt the use of soft braces is discussed contradictory. There is insufficient evidence to draw definite conclusions about effectiveness and safety of the intervention.

Project description:BackgroundReported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with bracesMethodsWe followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached.ResultsWe had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72% - 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up).ConclusionThe Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies.

Project description:Personalized cancer vaccines (PCVs) are receiving attention as an avenue for cancer immunotherapy. PCVs employ immunogenic peptide epitopes capable of stimulating the immune system to destroy cancer cells with great specificity. Challenges associated with effective delivery of these peptides include poor solubility of hydrophobic sequences, rapid clearance, and poor immunogenicity, among others. The incorporation of peptides into nanoparticles has the potential to overcome these challenges, but the broad range of functionalities found in amino acids presents a challenge to conjugation due to possible interferences and lack of reaction specificity. Herein, a facile and versatile approach to generating nanosized PCVs under mild nonstringent conditions is reported. Following a simple two-step semibatch synthetic approach, amphiphilic hyperbranched polymer-peptide conjugates were prepared by the conjugation of melanoma antigen peptides, either TRP2 (hydrophobic) or MUT30 (hydrophilic), to an alkyne functionalized core via strain-promoted azide-alkyne click chemistry. Self-assembly of the amphiphiles gave spherical nanovaccines (by transmission electron microscopy) with sizes in the range of 10-30 nm (by dynamic light scattering). Fluorescently labeled nanovaccines were prepared to investigate the cellular uptake by antigen presenting cells (dendritic cells), and uptake was confirmed by flow cytometry and microscopy. The TRP2 nanovaccine was taken up the most followed by MUT30 nanoparticles and, finally, nanoparticles without peptide. The nanovaccines showed good biocompatibility against B16-F10 cells, yet the TRP2 peptide showed signs of toxicity, possibly due to its hydrophobicity. A test for immunogenicity revealed that the nanovaccines were poorly immunogenic, implying the need for an adjuvant when administered in vivo. Treatment of mice with melanoma tumors showed that in combination with adjuvant, CpG, groups with the peptide nanovaccines slowed tumor growth and improved survival (up to 24 days, TRP2) compared to the untreated group (14 days).

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Design of personalized scoliosis braces based on differentiable biomechanics-Synthetic study.

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Design of personalized scoliosis braces based on differentiable biomechanics-Synthetic study.

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