Ultramarathon is an outstanding model for the study of adaptive responses to extreme load and stress.

ABSTRACT: Ultramarathons comprise any sporting event involving running longer than the traditional marathon length of 42.195 km (26.2 miles). Studies on ultramarathon participants can investigate the acute consequences of ultra-endurance exercise on inflammation and cardiovascular or renal consequences, as well as endocrine/energetic aspects, and examine the tissue recovery process over several days of extreme physical load. In a study published in BMC Medicine, Schütz et al. followed 44 ultramarathon runners over 4,487 km from South Italy to North Cape, Norway (the Trans Europe Foot Race 2009) and recorded daily sets of data from magnetic resonance imaging, psychometric, body composition and biological measurements. The findings will allow us to better understand the timecourse of degeneration/regeneration of some lower leg tissues such as knee joint cartilage, to differentiate running-induced from age-induced pathologies (for example, retropatelar arthritis) and finally to assess the interindividual susceptibility to injuries. Moreover, it will also provide new information about the complex interplay between cerebral adaptations/alterations and hormonal influences resulting from endurance exercise and provide data on the dose-response relationship between exercise and brain structure/function. Overall, this study represents a unique attempt to investigate the limits of the adaptive response of human bodies.Please see related article: http://www.biomedcentral.com/1741-7015/10/78.

Biomechanical wall properties of human intracranial aneurysms resected following surgical clipping (IRRAs Project)

Background and purpose: Individual rupture risk assessment of intracranial aneurysms is a major issue in the clinical management of asymptomatic aneurysms. Aneurysm rupture occurs when wall tension exceeds the strength limit of the wall tissue. At present, aneurysmal wall mechanics are poorly understood and thus, risk assessment involving mechanical properties is inexistent. Aneurysm computational hemodynamics studies make the assumption of rigid walls, an arguable simplification. We therefore aim to assess mechanical properties of ruptured and unruptured intracranial aneurysms in order to provide the foundation for future patient-specific aneurysmal risk assessment. This work also challenges some of the currently held hypotheses in computational flow hemodynamics research. Methods: A specific conservation protocol was applied to aneurysmal tissues following clipping and resection in order to preserve their mechanical properties. Sixteen intracranial aneurysms (11 female, 5 male) underwent mechanical uniaxial stress tests under physiological conditions, temperature, and saline isotonic solution. These represented 11 unruptured and 5 ruptured aneurysms. Stress/strain curves were then obtained for each sample, and a fitting algorithm was applied following a 3-parameter (C(10), C(01), C(11)) Mooney-Rivlin hyperelastic model. Each aneurysm was classified according to its biomechanical properties and (un)rupture status.Results: Tissue testing demonstrated three main tissue classes: Soft, Rigid, and Intermediate. All unruptured aneurysms presented a more Rigid tissue than ruptured or pre-ruptured aneurysms within each gender subgroup. Wall thickness was not correlated to aneurysmal status (ruptured/unruptured). An Intermediate subgroup of unruptured aneurysms with softer tissue characteristic was identified and correlated with multiple documented risk factors of rupture. Conclusion: There is a significant modification in biomechanical properties between ruptured aneurysm, presenting a soft tissue and unruptured aneurysms, presenting a rigid material. This finding strongly supports the idea that a biomechanical risk factor based assessment should be utilized in the to improve the therapeutic decision making.

Biomechanical characterization and in vitro mechanical injury of elderly human femoral head cartilage: comparison to adult bovine humeral head cartilage.

OBJECTIVES: In vitro mechanical injury of articular cartilage is useful to identify events associated with development of post-traumatic osteoarthritis (OA). To date, many in vitro injury models have used animal cartilage despite the greater clinical relevance of human cartilage. We aimed to characterize a new in vitro injury model using elderly human femoral head cartilage and compare its behavior to that of an existing model with adult bovine humeral head cartilage. DESIGN: Mechanical properties of human and bovine cartilage disks were characterized by elastic modulus and hydraulic permeability in radially confined axial compression, and by Young's modulus, Poisson's ratio, and direction-dependent radial strain in unconfined compression. Biochemical composition was assessed in terms of tissue water, solid, and glycosaminoglycan (GAG) contents. Responses to mechanical injury were assessed by observation of macroscopic superficial tissue cracks and histological measurements of cell viability following single injurious ramp loads at 7 or 70%/s strain rate to 3 or 14 MPa peak stress. RESULTS: Confined compression moduli and Young's moduli were greater in elderly human femoral cartilage vs adult bovine humeral cartilage whereas hydraulic permeability was less. Radial deformations of axially compressed explant disks were more anisotropic (direction-dependent) for the human cartilage. In both cartilage sources, tissue cracking and associated cell death during injurious loading was common for 14 MPa peak stress at both strain rates. CONCLUSION: Despite differences in mechanical properties, acute damage induced by injurious loading was similar in both elderly human femoral cartilage and adult bovine humeral cartilage, supporting the clinical relevance of animal-based cartilage injury models. However, inherent structural differences such as cell density may influence subsequent cell-mediated responses to injurious loading and affect the development of OA.

Changes in leg spring behaviour, plantar loading and foot mobility magnitude induced by an exhaustive treadmill run in adolescent middle-distance runners.

OBJECTIVES: This study aimed to determine adjustments in spring-mass model characteristics, plantar loading and foot mobility induced by an exhaustive run. DESIGN: Within-participants repeated measures. METHODS: Eleven highly-trained adolescent middle-distance runners ran to exhaustion on a treadmill at a constant velocity corresponding to 95% of velocity associated with VO₂max (17.8 ± 1.4 kmh(-1), time to exhaustion=8.8 ± 3.4 min). Contact time obtained from plantar pressure sensors was used to estimate spring-mass model characteristics, which were recorded (during 30 s) 1 min after the start and prior to exhaustion using pressure insoles. Foot mobility magnitude (a composite measure of vertical and medial-lateral mobility of the midfoot) was measured before and after the run. RESULTS: Mean contact area (foot to ground), contact time, peak vertical ground reaction force, centre of mass vertical displacement and leg compression increased significantly with fatigue, while flight time, leg stiffness and mean pressure decreased. Leg stiffness decreased because leg compression increased to a larger extent than peak vertical ground reaction forces. Step length, step frequency and foot mobility magnitude did not change at exhaustion. CONCLUSIONS: The stride pattern of adolescents when running on a treadmill at high constant velocity deteriorates near exhaustion, as evidenced by impaired leg-spring behaviour (leg stiffness) and altered plantar loading.

Biomechanical analysis of alpine skiers performing giant slalom turns

Over the past few years, technological breakthroughs have helpedcompetitive sports to attain new levels. Training techniques, athletes' management and methods to analyse specific technique and performancehave sharpened, leading to performance improvement. Alpine skiing is not different. The objective of the present work was to study the technique of highy skilled alpine skiers performing giant slalom, in order to determine the quantity of energy that can be produced by skiers to increase their speed. To reach this goal, several tools have been developed to allow field testing on ski slopes; a multi cameras system, a wireless synchronization system, an aerodynamic drag model and force plateforms have especially been designed and built. The analyses performed using the different tools highlighted the possibility for several athletes to increase their energy by approximately 1.5 % using muscular work. Nevertheless, the athletes were in average not able to use their muscular work in an efficient way. By offering functional tools such as drift analysis using combined data from GPS and inertial sensors, or trajectory analysis based on tracking morphological points, this research makes possible the analysis of alpine skiers technique and performance in real training conditions. The author wishes for this work to be used as a basis for continued knowledge and understanding of alpine skiing technique. - Le sport de compétition bénéficie depuis quelques années des progrès technologiques apportés par la science. Les techniques d'entraînement, le suivi des athlètes et les méthodes d'analyse deviennent plus pointus, induisant une nette amélioration des performances. Le ski alpin ne dérogeant pas à cette règle, l'objectif de ce travail était d'analyser la technique de skieurs de haut niveau en slalom géant afin de déterminer la quantité d'énergie fournie par les skieurs pour augmenter leur vitesse. Pour ce faire, il a été nécessaire de developer différents outils d'analyse adaptés aux contraintes inhérentes aux tests sur les pistes de skis; un système multi caméras, un système de synchronisation, un modèle aérodynamique et des plateformes de force ont notamment été développés. Les analyses effectuées grâce à ces différents outils ont montré qu'il était possible pour certains skieur d'augmenter leur énergie d'environ 1.5 % grâce au travail musculaire. Cependant, les athlètes n'ont en moyenne pas réussi à utiliser leur travail musculaire de manière efficace. Ce projet a également rendu possible des analyses adaptées aux conditions d'entraînement des skieurs en proposant des outils fonctionnels tels que l'analyse du drift grâce à des capteurs inertiels et GPS, ainsi que l'analyse simplifiée de trajectoires grâce au suivi de points morphologiques. L'auteur espère que ce travail servira de base pour approfondir les connaissances de la technique en ski alpin.

Measurement of multi-segment foot joint angles during gait using a wearable system.

Usually the measurement of multi-segment foot and ankle complex kinematics is done with stationary motion capture devices which are limited to use in a gait laboratory. This study aimed to propose and validate a wearable system to measure the foot and ankle complex joint angles during gait in daily conditions, and then to investigate its suitability for clinical evaluations. The foot and ankle complex consisted of four segments (shank, hindfoot, forefoot, and toes), with an inertial measurement unit (3D gyroscopes and 3D accelerometers) attached to each segment. The angles between the four segments were calculated in the sagittal, coronal, and transverse planes using a new algorithm combining strap-down integration and detection of low-acceleration instants. To validate the joint angles measured by the wearable system, three subjects walked on a treadmill for five minutes at three different speeds. A camera-based stationary system that used a cluster of markers on each segment was used as a reference. To test the suitability of the system for clinical evaluation, the joint angle ranges were compared between a group of 10 healthy subjects and a group of 12 patients with ankle osteoarthritis, during two 50-m walking trials where the wearable system was attached to each subject. On average, over all joints and walking speeds, the RMS differences and correlation coefficients between the angular curves obtained using the wearable system and the stationary system were 1 deg and 0.93, respectively. Moreover, this system was able to detect significant alteration of foot and ankle function between the group of patients with ankle osteoarthritis and the group of healthy subjects. In conclusion, this wearable system was accurate and suitable for clinical evaluation when used to measure the multi-segment foot and ankle complex kinematics during long-distance walks in daily life conditions.

The Dynamic Analysis of a Human Skeleton Using the Flexile Multibody Simulation Approach

The human motion study, which relies on mathematical and computational models ingeneral, and multibody dynamic biomechanical models in particular, has become asubject of many recent researches. The human body model can be applied to different physical exercises and many important results such as muscle forces, which are difficult to be measured through practical experiments, can be obtained easily. In the work, human skeletal lower limb model consisting of three bodies in build using the flexible multibody dynamics simulation approach. The floating frame of reference formulation is used to account for the flexibility in the bones of the human lower limb model. The main reason of considering the flexibility inthe human bones is to measure the strains in the bone result from different physical exercises. It has been perceived the bone under strain will become stronger in order to cope with the exercise. On the other hand, the bone strength is considered and important factors in reducing the bone fractures. The simulation approach and model developed in this work are used to measure the bone strain results from applying raising the sole of the foot exercise. The simulation results are compared to the results available in literature. The comparison shows goof agreement. This study sheds the light on the importance of using the flexible multibody dynamic simulation approach to build human biomechanical models, which can be used in developing some exercises to achieve the optimalbone strength.

Biomechanical Changes During a 50-minute Run in Different Footwear and on Various Slopes.

The effects of footwear and inclination on running biomechanics over short intervals are well documented. Although recognized that exercise duration can impact running biomechanics, it remains unclear how biomechanics change over time when running in minimalist shoes and on slopes. Our aims were to describe these biomechanical changes during a 50-minute run and compare them to those observed in standard shoes. Thirteen trained recreational male runners ran 50 minutes at 65% of their maximal aerobic velocity on a treadmill, once in minimalist shoes and once in standard shoes, 1 week apart in a random order. The 50-minute trial was divided into 5-minute segments of running at 0%, +5%, and -5% of treadmill incline sequentially. Data were collected using photocells, high-speed video cameras, and plantar-pressure insoles. At 0% incline, runners exhibited reduced leg stiffness and plantar flexion angles at foot strike and lower plantar pressure at the forefoot and toes in minimalist shoes from minute 34 of the protocol onward. However, only reduced plantar pressure at the toes was observed in standard shoes. Overall, similar biomechanical changes with increased exercise time were observed on the uphill and downhill inclines. The results might be due to the unfamiliarity of subjects to running in minimalist shoes.

Wood as a model material for medical biomaterials. In vivo and in vitro studies with bone and Betula pubescens Ehrh

Novel biomaterials are needed to fill the demand of tailored bone substitutes required by an ever‐expanding array of surgical procedures and techniques. Wood, a natural fiber composite, modified with heat treatment to alter its composition, may provide a novel approach to the further development of hierarchically structured biomaterials. The suitability of wood as a model biomaterial as well as the effects of heat treatment on the osteoconductivity of wood was studied by placing untreated and heat‐treated (at 220 C , 200 degrees and 140 degrees for 2 h) birch implants (size 4 x 7mm) into drill cavities in the distal femur of rabbits. The follow‐up period was 4, 8 and 20 weeks in all in vivo experiments. The flexural properties of wood as well as dimensional changes and hydroxyl apatite formation on the surface of wood (untreated, 140 degrees C and 200 degrees C heat‐treated wood) were tested using 3‐point bending and compression tests and immersion in simulated body fluid. The effect of premeasurement grinding and the effect of heat treatment on the surface roughness and contour of wood were tested with contact stylus and non‐contact profilometry. The effects of heat treatment of wood on its interactions with biological fluids was assessed using two different test media and real human blood in liquid penetration tests. The results of the in vivo experiments showed implanted wood to be well tolerated, with no implants rejected due to foreign body reactions. Heat treatment had significant effects on the biocompatibility of wood, allowing host bone to grow into tight contact with the implant, with occasional bone ingrowth into the channels of the wood implant. The results of the liquid immersion experiments showed hydroxyl apatite formation only in the most extensively heat‐treated wood specimens, which supported the results of the in vivo experiments. Parallel conclusions could be drawn based on the results of the liquid penetration test where human blood had the most favorable interaction with the most extensively heat‐treated wood of the compared materials (untreated, 140 degrees C and 200 degrees C heat‐treated wood). The increasing biocompatibility was inferred to result mainly from changes in the chemical composition of wood induced by the heat treatment, namely the altered arrangement and concentrations of functional chemical groups. However, the influence of microscopic changes in the cell walls, surface roughness and contour cannot be totally excluded. The heat treatment was hypothesized to produce a functional change in the liquid distribution within wood, which could have biological relevance. It was concluded that the highly evolved hierarchical anatomy of wood could yield information for the future development of bulk bone substitutes according to the ideology of bioinspiration. Furthermore, the results of the biomechanical tests established that heat treatment alters various biologically relevant mechanical properties of wood, thus expanding the possibilities of wood as a model material, which could include e.g. scaffold applications, bulk bone applications and serving as a tool for both mechanical testing and for further development of synthetic fiber reinforced composites.

Repair of segmental bone defects with fiber-reinforced composite: a study of material development and an animal model on rabbits

The Repair of segmental defects in load-bearing long bones is a challenging task because of the diversity of the load affecting the area; axial, bending, shearing and torsional forces all come together to test the stability/integrity of the bone. The natural biomechanical requirements for bone restorative materials include strength to withstand heavy loads, and adaptivity to conform into a biological environment without disturbing or damaging it. Fiber-reinforced composite (FRC) materials have shown promise, as metals and ceramics have been too rigid, and polymers alone are lacking in strength which is needed for restoration. The versatility of the fiber-reinforced composites also allows tailoring of the composite to meet the multitude of bone properties in the skeleton. The attachment and incorporation of a bone substitute to bone has been advanced by different surface modification methods. Most often this is achieved by the creation of surface texture, which allows bone growth, onto the substitute, creating a mechanical interlocking. Another method is to alter the chemical properties of the surface to create bonding with the bone – for example with a hydroxyapatite (HA) or a bioactive glass (BG) coating. A novel fiber-reinforced composite implant material with a porous surface was developed for bone substitution purposes in load-bearing applications. The material’s biomechanical properties were tailored with unidirectional fiber reinforcement to match the strength of cortical bone. To advance bone growth onto the material, an optimal surface porosity was created by a dissolution process, and an addition of bioactive glass to the material was explored. The effects of dissolution and orientation of the fiber reinforcement were also evaluated for bone-bonding purposes. The Biological response to the implant material was evaluated in a cell culture study to assure the safety of the materials combined. To test the material’s properties in a clinical setting, an animal model was used. A critical-size bone defect in a rabbit’s tibia was used to test the material in a load-bearing application, with short- and long-term follow-up, and a histological evaluation of the incorporation to the host bone. The biomechanical results of the study showed that the material is durable and the tailoring of the properties can be reproduced reliably. The Biological response - ex vivo - to the created surface structure favours the attachment and growth of bone cells, with the additional benefit of bioactive glass appearing on the surface. No toxic reactions to possible agents leaching from the material could be detected in the cell culture study when compared to a nontoxic control material. The mechanical interlocking was enhanced - as expected - with the porosity, whereas the reinforcing fibers protruding from the surface of the implant gave additional strength when tested in a bone-bonding model. Animal experiments verified that the material is capable of withstanding load-bearing conditions in prolonged use without breaking of the material or creating stress shielding effects to the host bone. A Histological examination verified the enhanced incorporation to host bone with an abundance of bone growth onto and over the material. This was achieved with minimal tissue reactions to a foreign body. An FRC implant with surface porosity displays potential in the field of reconstructive surgery, especially regarding large bone defects with high demands on strength and shape retention in load-bearing areas or flat bones such as facial / cranial bones. The benefits of modifying the strength of the material and adjusting the surface properties with fiber reinforcement and bone-bonding additives to meet the requirements of different bone qualities are still to be fully discovered.

Development of finite elements for analysis of biomechanical structures using flexible multibody formulations

The absolute nodal coordinate formulation was originally developed for the analysis of structures undergoing large rotations and deformations. This dissertation proposes several enhancements to the absolute nodal coordinate formulation based finite beam and plate elements. The main scientific contribution of this thesis relies on the development of elements based on the absolute nodal coordinate formulation that do not suffer from commonly known numerical locking phenomena. These elements can be used in the future in a number of practical applications, for example, analysis of biomechanical soft tissues. This study presents several higher-order Euler–Bernoulli beam elements, a simple method to alleviate Poisson’s and transverse shear locking in gradient deficient plate elements, and a nearly locking free gradient deficient plate element. The absolute nodal coordinate formulation based gradient deficient plate elements developed in this dissertation describe most of the common numerical locking phenomena encountered in the formulation of a continuum mechanics based description of elastic energy. Thus, with these fairly straightforwardly formulated elements that are comprised only of the position and transverse direction gradient degrees of freedom, the pathologies and remedies for the numerical locking phenomena are presented in a clear and understandable manner. The analysis of the Euler–Bernoulli beam elements developed in this study show that the choice of higher gradient degrees of freedom as nodal degrees of freedom leads to a smoother strain field. This improves the rate of convergence.

A new model for the immobilization of the rat hind limb

An alternative device for the immobilization of the hind limb of the rat was developed to study the effects of chronic disuse on the soleus and tibialis anterior muscles, maintained for 3 weeks in the shortening and the stretching positions, respectively. The proposed device is made of steel mesh and cotton materials, and has some advantages when compared to cast or plaster cast: it is cheaper, lighter (12 g or 4% of the body weight of the rat) and the same unit can be easily adjusted and used several times in the same animal or in animals of similar size. Immobilization is also useful to restrain the movements of the hip, knee, and ankle joints. Male rats (291 ± 35 g and aged 14 ± 2 weeks) were used to develop and test the model. The soleus muscle of 18 rats was maintained in a shortened position for 21 consecutive days and lost 19 ± 7% of its length (P = 0.008) and 44 ± 6% of its weight (P = 0.002) compared to the contralateral intact muscle. No difference (P = 0.67) was found in the stretched tibialis anterior of the same hind limb when compared to the contralateral muscle. No ulcer, sore or foot swelling was observed in the animals. Immobilization was effective in producing chronic muscle disuse in the hind limbs of rats and is an acceptable alternative to the traditional methods of immobilization such as cast or plaster cast.

The terrestrial Gastropoda Megalobulimus abbreviatus as a useful model for nociceptive experiments: effects of morphine and naloxone on thermal avoidance behavior

We describe the behavior of the snail Megalobulimus abbreviatus upon receiving thermal stimuli and the effects of pretreatment with morphine and naloxone on behavior after a thermal stimulus, in order to establish a useful model for nociceptive experiments. Snails submitted to non-functional (22ºC) and non-thermal hot-plate stress (30ºC) only displayed exploratory behavior. However, the animals submitted to a thermal stimulus (50ºC) displayed biphasic avoidance behavior. Latency was measured from the time the animal was placed on the hot plate to the time when the animal lifted the head-foot complex 1 cm from the substrate, indicating aversive thermal behavior. Other animals were pretreated with morphine (5, 10, 20 mg/kg) or naloxone (2.5, 5.0, 7.5 mg/kg) 15 min prior to receiving a thermal stimulus (50ºC; N = 9 in each group). The results (means ± SD) showed an extremely significant difference in response latency between the group treated with 20 mg/kg morphine (63.18 ± 14.47 s) and the other experimental groups (P < 0.001). With 2.5 mg/kg (16.26 ± 3.19 s), 5.0 mg/kg (11.53 ± 1.64 s) and 7.5 mg/kg naloxone (7.38 ± 1.6 s), there was a significant, not dose-dependent decrease in latency compared to the control (33.44 ± 8.53 s) and saline groups (29.1 ± 9.91 s). No statistically significant difference was found between the naloxone-treated groups. With naloxone plus morphine, there was a significant decrease in latency when compared to all other groups (minimum 64% in the saline group and maximum 83.2% decrease in the morphine group). These results provide evidence of the involvement of endogenous opioid peptides in the control of thermal withdrawal behavior in this snail, and reveal a stereotyped and reproducible avoidance behavior for this snail species, which could be studied in other pharmacological and neurophysiological studies.

Comparative pathogenicity of Coxsackievirus A16 circulating and noncirculating strains in vitro and in a neonatal mouse model

An enterovirus 71 (EV71) vaccine for the prevention of hand, foot, and mouth disease (HMFD) is available, but it is not known whether the EV71 vaccine cross-protects against Coxsackievirus (CV) infection. Furthermore, although an inactivated circulating CVA16 Changchun 024 (CC024) strain vaccine candidate is effective in newborn mice, the CC024 strain causes severe lesions in muscle and lung tissues. Therefore, an effective CV vaccine with improved pathogenic safety is needed. The aim of this study was to evaluate the in vivo safety and in vitro replication capability of a noncirculating CVA16 SHZH05 strain. The replication capacity of circulating CVA16 strains CC024, CC045, CC090 and CC163 and the noncirculating SHZH05 strain was evaluated by cytopathic effect in different cell lines. The replication capacity and pathogenicity of the CC024 and SHZH05 strains were also evaluated in a neonatal mouse model. Histopathological and viral load analyses demonstrated that the SHZH05 strain had an in vitro replication capacity comparable to the four CC strains. The CC024, but not the SHZH05 strain, became distributed in a variety of tissues and caused severe lesions and mortality in neonatal mice. The differences in replication capacity and in vivo pathogenicity of the CC024 and SHZH05 strains may result from differences in the nucleotide and amino acid sequences of viral functional polyproteins P1, P2 and P3. Our findings suggest that the noncirculating SHZH05 strain may be a safer CV vaccine candidate than the CC024 strain.

The impact of topical prostaglandin analogs on the biomechanical properties of the cornea in patients with open angle glaucoma

Justification: Le glaucome entraîne une perte progressive de la vision causée par la détérioration du nerf optique. Le glaucome est répandu dans le monde et cause la cécité dans environ sept millions de personnes. Le glaucome touche plus de 400 000 Canadiens et sa prévalence augmente avec le vieillissement de la population.1,2 Il s'agit d'une maladie chronique surnoise dont les symptômes se manifestent uniquement lors des stades avancés et qui peuvent mener à la cécité. Présentement, le seul moyen possible d’arrêter la progression du glaucome au stade initial est de diminuer la pression intra-oculaire (PIO). Les analogues de prostaglandines (APG) topiques sont fréquemment utilisées comme traitement de première ligne. Cependant, la recherche démontre que cette classe de médicaments peut changer certaines propriétés de la cornée, et possiblement influencer la mesure de la PIO.3 Objectif: À déterminer si l'utilisation d'APG affecte les propriétés biomécaniques de la cornée. La conclusion sera basée sur l'analyse intégrée des résultats obtenus de l'analyseur Reichert oculaire Réponse (ORA), la tonométrie par applanation de Goldmann (TAG) et la pachymétrie ultrasonographique. Le deuxième objectif potentiel de cette étude est de déterminer la corrélation, le cas échéant, entre les propriétés biomécaniques de la cornée, l'épaisseur de la cornée centrale (ECC) et la PIO chez les patients subissant un traitement d’APG topique. L'hypothèse principale de cette étude est que l’APG influence les propriétés de la cornée telles que l'épaisseur centrale, l'élasticité et la résistance. Patients et méthodes : Soixante-dix yeux de 35 patients, âgés de 50-85 ans, atteints de glaucome à angle ouvert (GAO) et traités avec APG topique ont été examinés. Seulement les sujets avec une réfraction manifeste entre -6,00 D et +4,25 D ont été inclus. Les critères d'exclusion sont: patients avec n'importe quelle autre maladie de la cornée de l’œil, telles que la dystrophie endothéliale de Fuch’s et kératocône, ou tout antécédent de traumatisme ou d'une chirurgie de la cornée, ainsi que le port de lentilles de contact. Nous avons demandé aux patients atteints du glaucome qui ont des paramètres stables et qui utilisent l’APG dans les deux yeux de cesser l’APG dans l'œil moins affecté par la PIO, et de continuer l’utilisation d’APG dans l'œil contralatéral. Le meilleur œil est défini comme celui avec moins de dommage sur le champ visuel (CV) (déviation moyenne (DM), le moins négatif) ou une PIO maximale historique plus basse si la DM est égale ou encore celui avec plus de dommage sur la tomographie par cohérence optique (TCO, Cirrus, CA) ou la tomographie confocale par balayage laser (HRT, Heidelberg, Allemagne). Toutes les mesures ont été prises avant la cessation d’APG et répétées 6 semaines après l’arrêt. Les patients ont ensuite recommencé l’utilisation d’APG et toutes les mesures ont été répétées encore une fois après une période supplémentaire de 6 semaines. Après commencer ou de changer le traitement du glaucome, le patient doit être vu environ 4-6 semaines plus tard pour évaluer l'efficacité de la goutte.4 Pour cette raison, on été décidé d'utiliser 6 semaines d'intervalle. Toutes les mesures ont été effectuées à l’institut du glaucome de Montréal par le même technicien, avec le même équipement et à la même heure de la journée. L'œil contralatéral a servi comme œil contrôle pour les analyses statistiques. La tonométrie par applanation de Goldmann a été utilisée pour mesurer la PIO, la pachymétrie ultrasonographique pour mesurer l'ECC, et l’ORA pour mesurer les propriétés biomécaniques de la cornée, incluant l'hystérèse cornéenne (HC). L’hypothèse de l'absence d'effet de l'arrêt de l’APG sur les propriétés biomécaniques a été examiné par un modèle linéaire à effets mixtes en utilisant le logiciel statistique R. Les effets aléatoires ont été définies à deux niveaux: le patient (niveau 1) et l'œil de chaque patient (niveau 2). Les effets aléatoires ont été ajoutés au modèle pour tenir compte de la variance intra-individuelle. L’âge a également été inclus dans le modèle comme variable. Les contrastes entre les yeux et les temps ont été estimés en utilisant les valeurs p ajustées pour contrôler les taux d'erreur internes de la famille en utilisant multcomp paquet dans R. Résultats: Une augmentation statistiquement significative due l 'HC a été trouvée entre les visites 1 (sur APG) et 2 (aucun APG) dans les yeux de l'étude, avec une moyenne (±erreur standard) des valeurs de 8,98 ± 0,29 mmHg et 10,35 ± 0,29 mmHg, respectivement, correspondant à une augmentation moyenne de 1,37 ± 0,18 mmHg (p <0,001). Une réduction significative de 1,25 ± 0,18 mmHg (p <0,001) a été observée entre les visites 2 et 3, avec une valeur moyenne HC finale de 9,09 ± 0,29 mmHg. En outre, une différence statistiquement significative entre l’oeil d’étude et le contrôle n'a été observée que lors de la visite 2 (1,01 ± 0,23 mmHg, p <0,001) et non lors des visites 1 et 3. Une augmentation statistiquement significative du facteur de résistance conréen (FRC) a été trouvée entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 10,23 ± 0,34 mmHg et 11,71 ± 0,34 mmHg, respectivement. Le FRC a ensuite été réduit de 1,90 ± 0,21 mmHg (p <0,001) entre les visites 2 et 3, avec une valeur moyenne FRC finale de 9,81 ± 0,34 mmHg. Une différence statistiquement significative entre l’oeil d’étude et le contrôle n'a été observée que lors de la visite 2 (1,46 ± 0,23 mmHg, p <0,001). Une augmentation statistiquement significative de l'ECC a été trouvée entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 541,83 ± 7,27 µm et 551,91 ± 7,27 µm, respectivement, ce qui correspond à une augmentation moyenne de 10,09 ± 0,94 µm (p <0,001). L'ECC a ensuite diminué de 9,40 ± 0,94 µm (p <0,001) entre les visites 2 et 3, avec une valeur moyenne finale de 542,51 ± 7,27 µm. Une différence entre l’étude et le contrôle des yeux n'a été enregistré que lors de la visite 2 (11,26 ± 1,79 µm, p <0,001). De même, on a observé une augmentation significative de la PIO entre les visites 1 et 2 dans les yeux de l'étude, avec des valeurs moyennes de 15,37 ± 0,54 mmHg et 18,37 ± 0,54 mmHg, respectivement, ce qui correspond à une augmentation moyenne de 3,0 ± 0,49 mmHg (p <0,001). Une réduction significative de 2,83 ± 0,49 mmHg (p <0,001) a été observée entre les visites 2 et 3, avec une valeur moyenne de la PIO finale de 15,54 ± 0,54 mmHg. L’oeil de contrôle et d’étude ne différaient que lors de la visite 2 (1,91 ± 0,49 mmHg, p <0,001), ce qui confirme l'efficacité du traitement de l’APG. Lors de la visite 1, le biais de la PIO (PIOcc - PIO Goldmann) était similaire dans les deux groupes avec des valeurs moyennes de 4,1 ± 0,54 mmHg dans les yeux de contrôles et de 4,8 ± 0,54 mmHg dans les yeux d’études. Lors de la visite 2, après un lavage de 6 semaines d’APG, le biais de la PIO dans l'œil testé a été réduit à 1,6 ± 0,54 mmHg (p <0,001), ce qui signifie que la sous-estimation de la PIO par TAG était significativement moins dans la visite 2 que de la visite 1. La différence en biais PIO moyenne entre l'étude et le contrôle des yeux lors de la visite 2, en revanche, n'a pas atteint la signification statistique (p = 0,124). On a observé une augmentation peu significative de 1,53 ± 0,60 mmHg (p = 0,055) entre les visites 2 et 3 dans les yeux de l'étude, avec une valeur de polarisation finale de la PIO moyenne de 3,10 ± 0,54 mmHg dans les yeux d'études et de 2,8 ± 0,54 mmHg dans les yeux de contrôles. Nous avons ensuite cherché à déterminer si une faible HC a été associée à un stade de glaucome plus avancé chez nos patients atteints du glaucome à angle ouvert traités avec l’APG. Lorsque l'on considère tous les yeux sur l’APG au moment de la première visite, aucune association n'a été trouvée entre les dommages sur le CV et l'HC. Cependant, si l'on considère seulement les yeux avec un glaucome plus avancé, une corrélation positive significative a été observée entre la DM et l'HC (B = 0,65, p = 0,003). Une HC inférieure a été associé à une valeur de DM de champ visuelle plus négative et donc plus de dommages liés au glaucome. Conclusions : Les prostaglandines topiques affectent les propriétés biomécaniques de la cornée. Ils réduisent l'hystérèse cornéenne, le facteur de résistance cornéen et l'épaisseur centrale de la cornée. On doit tenir compte de ces changements lors de l'évaluation des effets d’APG sur la PIO. Plus de recherche devrait être menées pour confirmer nos résultats. De plus, d’autres études pourraient être réalisées en utilisant des médicaments qui diminuent la PIO sans influencer les propriétés biomécaniques de la cornée ou à l'aide de tonomètre dynamique de Pascal ou similaire qui ne dépend pas des propriétés biomécaniques de la cornée. En ce qui concerne l'interaction entre les dommages de glaucome et l'hystérésis de la cornée, nous pouvons conclure qu' une HC inférieure a été associé à une valeur de DM de CV plus négative. Mots Clés glaucome - analogues de prostaglandines - hystérèse cornéenne – l’épaisseur de la cornée centrale - la pression intraoculaire - propriétés biomécaniques de la cornée.