This theses discusses thoracic surgeries and their effect on thoracic kinematics since those patients aren't usually indicated for outpatients physiotherapy. Theses observes the changes of thoracic kinematice in time withnout the interference of outpatient physiotherapy. Patients were acquainted during their hospitalization and they received a flyer. The theoretical part focuses on thoracic surgeries, options of respiratory physiotherapy and effects of thoracic surgeries on patients. The practical part observers the effect of thoracic surgery on chest expansion, development of pain (using Visual pain scale and Questionnaire of pain interference with daily activities) and effect of the surgery on quality of life using WHOQOL BREF questionnaire.

Ewing's sarcoma family of tumors (ESFTs) contains multiple tumors with similar histological and immunohistochemical features. ESFTs are small, round cell, highly malignant tumors that arise from the neuroectoderm of bone and extraskeletal soft tissue. Ewing's sarcoma is the second most common primary malignant bone cancer in children and adolescents, with the second decade of life being the most common age of diagnosis. In this article, we present a case of a young male who presented to the emergency department complaining of shortness of breath and cough and was later diagnosed with Ewing's sarcoma of the chest wall, which is also called Askin's tumor, and it is an extremely rare disease with only 17 cases reported in the literature.

Insurance is a vital factor in the billed cost to the patient, but to what degree does insurance explain the amount a patient is left to pay? Also, does obesity further influence patient’s billed cost? This thesis assesses the type of thoracic trauma patient, insurance status, and their billed cost. Database variables were analyzed in IBM SPSS 25. Table 1 characteristics were evaluated based on demographics and systematic hospital factors. Linear regressions used Private0_Government1 and BMI Obese n_y_ as independent variables while Total Patient Cost was the dependent variable. Private0_Government1 insurance explained .03% of Total Patient Charges. Private0_Government1 and BMI Obese n_y_ explained 1.4% of Total Patient Charges. Private0_Government1 and BMI Obese n_y_ explained a low percentage of Total Patient Charges. This shows that there are factors other than insurance type and obesity that are influential upon patient charges.

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Lung cancer currently has the greatest mortality rate of cancer patients of all sexes in the United States (Torre et al., 2016). Low-dose CT scans are utilized for lung cancer screening in patients who fall within the NLST entry criteria (Sanchez-Salcedo et al., 2015). The original criteria for screening were age over 55 and pack-year over 30, which were recently changed to age 50 and pack-year over 20 in 2021. The study population in this paper utilized the original criteria. A system developed and copyrighted by the American College of Radiology (ACR) referred to as the Lung CT Screening Reporting and Data System (Lung-RADS) has implemented a standardized method of classifying and interpreting lung cancer chest CT screening results. Lung-RADS has a scoring system which is scaled 1 – 4x (Pinsky et al., 2015) The likelihood of malignancy based on nodule appearance, diameter, and presence of growth comprise the components of which score is given (Chung et al., 2017). Lung-RADS 2 scored nodules are benign nodules and patients follow up for another CT in a year. Lung-RADS 3 nodules are probably benign nodules; however, they do have a low-risk of malignancy. It is known that a select few of these relatively benign appearing nodules will turn out to be malignant. Lung-RADS 4 nodules have a >5% chance of malignancy and can be confirmed through pathology. In this project, a retrospective chart review analyzing patient demographics and pulmonary health history will be correlated to lung-RADS risk likelihood of malignancy. Machine learning will also be utilized to study and analyze radiographic factors associated with the sample. The CT scans of patients who previously scored in an intermediate category will be compiled and analyzed to determine potential common demographical, clinical and radiomic factors which will hopefully allow intermediately categorized nodule indicators to be used to detect cancers earlier and to more accurately classify lesions into benign or malignant categories. In all, the goal of this research is to determine common clinical, demographic and radiomic factors of patients who were deemed intermediate risk and then progressed to a higher categorization. The importance of expanding current risk factors for discrimination of benign from malignant will also be analyzed, along with those specific risk-factors within Lung-RADS intermediately categorized nodules. The characteristics and baseline co-morbidities of RADS 2 and 3 lung cancer patients by follow-up CT results, progression to RADS-4 on follow-up CT and lung cancer diagnosis will be compiled and exemplified.

The focus of this dissertation was the biomechanics of blast-induced traumatic brain injury (bTBI). This study had three specific aims. One of the specific aims was to investigate the thoracic mechanism of bTBI by characterizing the cerebral blood pressure change during local blast exposure to head or chest in a rat model. This model utilized a shock tube to simulate the blast wave. The results showed that there is a blood pressure rise with high amplitude and short duration during both Head-Only and Chest-Only exposure conditions. It was shown that cerebral blood pressure rise was significantly higher in Chest-Only exposure, and resulted in astrocyte reactivation, and infiltration of blood-borne macrophages into the brain. It was concluded that due to chest exposure to a blast wave, high amplitude pressure waves that transfer from thoracic large vessels to cerebrovasculature can lead to blood-brain barrier disruption or perivascular injury and consequently trigger secondary neuronal damage. The second and third aims were related to the viscoelasticity and heterogeneity of brain tissue respectively for blast rate loading conditions. For the second specific aim, a novel test method was developed to apply shear deformation to samples of brain tissue with strain rates in the range of 300 to 1000 s-1. The results of shear tests on cylindrical samples of bovine brain showed that the instantaneous shear modulus (about 6 kPa) increased about 3 times compared to the values reported in the literature. For the third specific aim, local viscoelastic behavior of rat brain was characterized using a micro-indentation setup with the spatial resolution of 350 mm. The results of micro-indentation tests showed that the heterogeneity of brain tissue was more pronounced in long-term shear moduli. Moreover, the inner anatomical regions were generally more compliant than the outer regions and the gray matter generally exhibited a stiffer response than the white matter. The results of this study can enhance the prediction of brain injury in finite element models of TBI in general and models of bTBI in particular. These results contribute to development of more biofidelic models that can determine the extent and severity of injury in blast loadings. Such predictions are essential for designing better injury mitigation devices for soldiers and also for improving neurosurgical procedures among other applications. / Mechanical Engineering / Accompanied by one .pdf file.

Materials which exhibit non-linear mechanical behaviors under large deformations are generally classified as “soft matter”. Elastomers represent an important class of soft materials which have wide commercial applications and isotropic non-linear behavior. In contrast, biological materials have anisotropic responses due to their heterogeneous and composite architectures. The underlying microstructure determines the arterial macroscopic behavior and is represented through constitutive models to describe the stress-strain relationships. Mechanical characterization and development of constitutive models that describe these non-linear and anisotropic properties are essential to our understanding of the structure-property relationships in these materials. In this study, we use two model systems to link the local microstructure to the overall macroscopic behaviors of soft matter. First, we delineate the roles of individual network topological factors in determining the overall macroscopic behavior of isotropic silicone elastomers using specimens fabricated with differential amounts of crosslinking. We performed mechanical experiments, within a theoretically motivated continuum mechanical framework, using a custom made planar biaxial testing instrument. These experiments demonstrate the contributions of physical entanglements and chemical crosslinks to the overall mechanical properties of silicone elastomers. Further, we show that the slip-link form of strain energy function is better suited to describe the material properties in the low to moderate regions of the stress-strain behavior. However, this model does not predict the stiffening response of elastomers at higher deformations, which is better captured using the Arruda-Boyce form of strain energy function. To explore the effects of individual topological factors on the overall network properties, we performed swelling experiments of silicone specimens in xylene and quantified variations in the polymer-solvent interaction parameter, χ, given by the Frenkel-Flory-Rehner (FFR) model. Further, we characterized the viscoelastic properties using dynamic mechanical analysis. Our results show that χ is not a constant, as assumed in the FFR model, but bears a linear relation to the equilibrium polymer volume fraction. To characterize the contribution of trapped entanglements to the overall mechanical behaviors, we use scaling laws in polymer physics and investigate the dependence of equilibrium volume fraction and experimentally obtained elastic moduli. Further, dynamic mechanical analysis demonstrated an increase in complex modulus with increase in the cross linking density. Finally, we examined variations in the uniaxial and the dynamical mechanical properties of silicone elastomers with storage time. Our results show that the time dependent increase in the modulus correlated with the formation of slip-links in the samples aged for a significantly long time in air. Together, these comprehensive studies show the importance of individual network features which affect the overall macroscopic properties of elastomers. Second, we use a multilayered and composite arterial model system to explore the passive material properties of arteries due to anisotropic layouts of extracellular matrix proteins, collagen and elastin. We characterized the mechanical properties of diseased human ascending thoracic aortic dissected (TAD) tissues, obtained from consenting patients undergoing emergency surgical repair to replace the diseased region, using multiple biaxial tests. We fit these results to micro structurally motivated Holzapfel-Gasser-Ogden model which is frequently used in the arterial mechanics literature. Our results show a higher stiffness for TAD tissues as compared to control aorta, without the presence of atherosclerotic plaques or other arterial disease. To study the directional variation in the mechanical properties of TAD tissues, we compared the stiffness in circumferential longitudinal directions at high and low stress region of equibiaxial experimental data. We observed no differences in the stiffness of TAD tissues in the circumferential and longitudinal directions. Further, we do not see any directional variations in the ultimate tensile stress, maximum extensibility, and modulus calculated in the low stretch region of uniaxial stress-strain response in TAD tissues. Histological analysis of TAD tissues showed a decrease in elastin content and an increase in collagen content as compared to control tissues. Higher TAD tissue stiffness also correlated with reduced elastin content in the arterial walls. To investigate the strain rate dependence of measured mechanical properties we use high testing rates of 1mm/sec to show that the TAD tissues have higher stiffness in the circumferential direction as compared to longitudinal direction. Finally, we used peel experiments to quantify the rupture potential of aortic dissected tissues. Our results show that TAD tissues have reduced delamination strength between layers as compared to control aortic tissues. To the best of our knowledge, no previous study has reported the mechanical property of human TAD tissues and these are the only biomechanical results on TAD tissues reported in specimens from South Asian patients. We hope that such studies will be useful for researchers who rely on microstructure based constitutive models to accurately describe the mechanical environment of cells which are important in the remodeling of tissues and in numerical models to assess mechanical criteria which may lead to the growth or dissection of arterial tissues.

Dans le contexte actuel d’attentats et autres conflits armées, le risque lésionnel thoracique par explosion est exacerbé sans que pour autant l’on sache l’efficacité réelle des moyens actuels de protection thoracique individuelle face à une telle menace. Ce travail de thèse, combinant expérimentations et simulations numériques, a traité de front l’ensemble de la chaine physique entre la détonation d’une charge explosive et l’apparition de lésions pulmonaires. Un des premiers objectifs a été de comprendre les différents phénomènes physiques mis en jeu lors de la propagation de l’onde de choc en champ libre. Le large éventail de données expérimentales acquis a permis de développer des outils simples permettant la détermination des caractéristiques de la menace ainsi qu’une approche numérique robuste sous LS-DYNA. L’objectif suivant a été d’étudier l’interaction d’ondes de choc avec des cibles de géométries simples et de compositions différentes. L’analyse des données expérimentales acquises a permis, en plus de la validation numérique de l’interaction fluide-structure et des MEF des structures, de déterminer de possibles candidats pour la définition d’un critère de lésions thoraciques. Enfin, des essais sur réacteurs biologiques post-mortem ont été réalisés, permettant d’obtenir la réponse cinématique du thorax du modèle porcin sous blast. Tout ceci a permis d’aboutir à des voies d’amélioration et à des outils prometteurs pour permettre l’évaluation et l’évolution des systèmes de protection thoracique dans un futur assez proche afin de limiter les risques face à cette menace qui a gagné en importance ces dernières années. / With the increasing number of bombing attacks and armed conflicts, the risk of thoracic injuries caused by the blast threat is worsen, without knowing the efficiency of the current individual chest protection systems impacted by such a threat. This research, combining experiments and numerical simulations, dealt with the physics at play from the detonation of an explosive charge and the injury outcomes. One of the first objectives was to understand the different physical phenomena involved in the propagation of the shock wave in the open field. The huge set of data acquired allowed the development of simple tools for the determination of the blast characteristics as well as a robust numerical approach under LS-DYNA. The next objective was to study the interaction of shock waves with targets of simple geometries and different compositions. In addition to the numerical validation of the fluid-structure interaction and of the FEM of the structures, the analysis of the experimental data acquired allowed to determine possible candidates for the definition of a thoracic injury criterion. Finally, tests on biological post-mortem reactors have been carried out, which enabled to obtain the kinematic response of the swine’s thorax under blast. All this work has led to improvements and promising tools for the evaluation and the improvement of chest protection systems in the near future. The proposed tools should be used to limit the risks to this threat which has gained in importance in recent years.

Dans ce travail, le concept d'approche mini-invasive est décrit dans sa globalité. Pour les chirurgiens pédiatres le concept a été analysé de manière systématique en répondant aux problématiques cliniques des patients dans tous les champs d'application. La somme de ce travail a le tour de force de répondre à toutes les grandes questions qui ont été posées lors des premiers temps de la coelioscopie pédiatrique, mais aussi de répondre, pour les plus récents, à des interrogations concernant les perspectives. Cette Thèse a donc pour objectif de développer l'évolution de la vidéochirurgie chez l'enfant et de mettre en valeur certaines applications que nous avons travaillées dans les différents domaines de la coelioscopie pédiatrique : tout d'abord dans la tolérance et la sécurité de la vidéochirurgie; puis ses applications en Chirurgie Digestive et Thoracique, en Rétropéritonéoscopie, en Oncologie et en Urologie ; mais aussi ses applications dans des techniques avancées de chirurgie néonatale ainsi que l'introduction de techniques encore moins invasives comme la chirurgie assistée par aimant ou des techniques non opératoires utilisées dans le traitement de certaines malformations de la paroi thoracique, en démontrant leurs bénéfices et leur efficacité / In this work, the concept of minimal invasive approach is described in its entirety. For pediatric surgeons, the concept was analyzed systematically meeting the clinical problems of patients in all fields of application. The result of this work is to answer all the big questions that were asked during the early days of the pediatric laparoscopy but also to respond to the latest questions about the perspectives. The goal of this thesis is to describe the evolution of laparoscopy in pediatric, and to report some applications. We have worked in several fields such as: Tolerance and safety of laparoscopy in advanced neonatal surgery, and its applications in Digestive Surgery, Thoracic, Retroperitoneoscopy, Oncology and Urology. This also introduces the use of less invasive techniques, such as magnet-assisted surgery of non-operative techniques in the correction on chest wall deformities, demonstrating their efficacity and efficiency