Novel roles of vibration transmittance in fracture testing.

This letter re-assesses a publication in the Journal of Cardiothoracic Surgery entitled 'Vibration transmittance measures sternotomy stability - a preliminary study in human cadavers.' The roles of ultrasound in testing for sternotomy stability and that of stress vibration transmittance in cases of fracture of the posterior table of the sternum or in hairline undisplaced fractures are examined in view of their differing sound wave frequency ranges.

Pathophysiological mechanism of post-lobectomy air leaks.

Background: Air leak post-lobectomy continues to remain a significant clinical problem, with upper lobectomy associated with higher air leak rates. This paper investigated the pathophysiological role of pleural stress in the development of post-lobectomy air leak.

Methods: Preoperative characteristics and postoperative data from 367 consecutive video assisted thoracic surgery (VATS) lobectomy resections from one centre were collected prospectively between January 2014 and March 2017.

A mathematical model for pressure-based organs behaving as biological pressure vessels.

We introduce a mathematical model that describes the allometry of physical characteristics of hollow organs behaving as pressure vessels based on the physics of ideal pressure vessels. The model was validated by studying parameters such as body and organ mass, systolic and diastolic pressures, internal and external dimensions, pressurization energy and organ energy output measurements of pressure-based organs in a wide range of mammals and birds. Seven rules were derived that govern amongst others, lack of size efficiency on scaling to larger organ sizes, matching organ size in the same species, equal relative efficiency in pressurization energy across species and direct size matching between organ mass and mass of contents.

Physiological rules for the heart, lungs and other pressure-based organs.

Background: The adherence of the heart to physical laws, such as Laplace's Law, may act as a measure of the organ's relative efficiency. Allometric relationships were investigated to assess the heart's efficiency concerning end-diastolic and end-systolic volumes, cardiac pressurization energy, cardiac output and mass.

Methods: Data to generate allometric relationships was obtained using a literature search, identifying heart and lung data across different mammalian and bird species.

Pleural pressure theory revisited: a role for capillary equilibrium.

Background: Theories elucidating pleural pressures should explain all observations including the equal and opposite recoil of the chest wall and lungs, the less than expected pleural hydrostatic gradient and its variation at lobar margins, why pleural pressures are negative and how pleural fluid circulation functions.

Methods: A theoretical model describing equilibrium between buoyancy, hydrostatic forces, and capillary forces is proposed. The capillary equilibrium model described depends on control of pleural fluid volume and protein content, powered by an active pleural pump.

A biomechanical hypothesis for the pathophysiology of apical lung disease.

Objective: A hypothesis is presented suggesting that the pathogenesis of apical lung disease is due to progression of subclinical congenital apical bullae in people with low Body Mass Index (BMI), a combination present in 15% of the population, due to high pleural stress levels present in the antero-posteriorly flattened chests of these individuals.

Design: The hypothesis was tested for validity in two apical lung pathologies with widespread epidemiological literature, namely tuberculosis (TB) and primary spontaneous pneumothorax (PSP), assessing whether the hypothesis could identify high-risk populations, explain exceptional cases like apical lower lobe disease and confirm predictions.

Results: The biomechanical hypothesis can explain the high-risk factors of apical location, age, gender and low-BMI build, as well as the occurrence of disease in the apex of the lower lobe, in both TB and PSP patients.

Internal rib structure can be predicted using mathematical models: An anatomic study comparing the chest to a shell dome with application to understanding fractures.

The human rib cage resembles a masonry dome in shape. Masonry domes have a particular construction that mimics stress distribution. Rib cortical thickness and bone density were analyzed to determine whether the morphology of the rib cage is sufficiently similar to a shell dome for internal rib structure to be predicted mathematically.

External rib structure can be predicted using mathematical models: An anatomical study with application to understanding fractures and intercostal muscle function.

As ribs adapt to stress like all bones, and the chest behaves as a pressure vessel, the effect of stress on the ribs can be determined by measuring rib height and thickness. Rib height and thickness (depth) were measured using CT scans of seven rib cages from anonymized cadavers. A Finite Element Analysis (FEA) model of a rib cage was constructed using a validated approach and used to calculate intramuscular forces as the vectors of both circumferential and axial chest wall forces at right angles to the ribs.

A novel method of personnel cooling in an operating theatre environment.

An optimized theatre environment, including personal temperature regulation, can help maintain concentration, extend work times and may improve surgical outcomes. However, devices, such as cooling vests, are bulky and may impair the surgeon's mobility. We describe the use of a low-cost, low-energy 'bladeless fan' as a personal cooling device.

Mechanism of sternotomy dehiscence.

Objectives: Biomechanical modelling of the forces acting on a median sternotomy can explain the mechanism of sternotomy dehiscence, leading to improved closure techniques.

Methods: Chest wall forces on 40 kPa coughing were measured using a novel finite element analysis (FEA) ellipsoid chest model, based on average measurements of eight adult male thoracic computerized tomography (CT) scans, with Pearson's correlation coefficient used to assess the anatomical accuracy. Another FEA model was constructed representing the barrel chest of chronic obstructive pulmonary disease (COPD) patients.

Is there a biomechanical cause for spontaneous pneumothorax?

Objectives: Primary spontaneous pneumothorax has long been explained as being without apparent cause. This paper deals with the effect of chest wall shape and explains how this may lead to the pathogenesis of primary spontaneous pneumothorax.

Methods: Rib cage measurements were taken from chest radiographs in 12 male pneumothorax patients and 12 age-matched controls.

Placement of trans-sternal wires according to an ellipsoid pressure vessel model of sternal forces.

Dehiscence of median sternotomy wounds remains a clinical problem. Wall forces in thin-walled pressure vessels can be calculated by membrane stress theory. An ellipsoid pressure vessel model of sternal forces is presented together with its application for optimal wire placement in the sternum.