Improving the accuracy of digital templating: achieving success through stakeholder management

The use of a marker ball in digital templating for hip arthroplasty is a well-established method of preoperative planning and is used to overcome the inherent magnification in plain film radiographs. Our hospital policy is to place a marker ball in all anteroposterior pelvic films taken in the emergency department (ED) which have been requested for suspected neck of femur fractures. We carried out a baseline measurement followed by three Plan-Do-Study-Act cycles for all pelvic films taken in ED during July 2016, November 2016, February 2017 and November 2017. Interventions between the baseline measurement and cycle 1 were to educate the lead radiographer and publish the results in the radiology newsletter, and between cycles 1 and 2 was to run a teaching session for radiographers, display posters in the X-ray department and place an electronic prompt on the X-ray machine to alert them of the need to place a marker ball in the X-ray field. Cycle 3 looked to see if improvements were sustained. 16/81 (20%) radiographs complied with the policy in our baseline measurement; 25/51 (46%, p=0.002) in cycle 1; 40/54 (74%, p=0.0056) in cycle 2; and 48/63 (76%) in cycle 3. Our quality improvement project led to large improvements in clinical practice through straightforward, small, but appropriately targeted interventions. Stakeholder management is key to successfully implementing change. The next step is to switch from the VoyantMark to the KingMark marker ball, as it has greater accuracy of templating and is also easier to place within the field of an X-ray.

Prospective Validation of a Demographically Based Primary Total Knee Arthroplasty Size Calculator

BACKGROUND

Preoperative planning for total knee arthroplasty (TKA) is essential for streamlining operating room efficiency and reducing costs. Digital templating and patient-specific instrumentation have shown some value in TKA but require additional costs and resources. The purpose of this study was to validate a previously published algorithm that uses only demographic variables to accurately predict TKA tibial and femoral component sizes.

METHODS

Four hundred seventy-four consecutive patients undergoing elective primary TKA were prospectively enrolled. Four surgeons were included, three of which were unaffiliated with the retrospective cohort study. Patient sex, height, and weight were entered into our published Arthroplasty Size Prediction mobile application. Accuracy of the algorithm was compared with the actual sizes of the implanted femoral and tibial components from 5 different implant systems. Multivariate regression analysis was used to identify independent risk factors for inaccurate outliers for our model.

RESULTS

When assessing accuracy to within ±1 size, the accuracies of tibial and femoral components were 87% (412/474) and 76% (360/474). When assessing accuracy to within ±2 sizes of predicted, the tibial accuracy was 97% (461/474), and the femoral accuracy was 95% (450/474). Risk factors for the actual components falling outside of 2 predicted sizes include weight less than 70 kg (odds ratio = 2.47, 95% confidence interval [1.21-5.06], P = .01) and use of an implant system with <2.5 mm incremental changes between femoral sizes (odds ratio = 5.50, 95% confidence interval [3.33-9.11], P < .001).

CONCLUSIONS

This prospective series of patients validates a simple algorithm to predict component sizing for TKA with high accuracy based on demographic variables alone. Surgeons can use this algorithm to simplify the preoperative planning process by reducing unnecessary trays, trials, and implant storage, particularly in the community or outpatient setting where resources are limited. Further assessment of components with less than 2.5-mm differences between femoral sizes is required in the future to make this algorithm more applicable worldwide.

Air Templated Macroporous Epoxy Foams with Silica Particles as Property-Defining Additive

Nonaqueous foams were successfully produced by mechanically beating air into liquid epoxy resin, surfactant, and silica particle mixtures and used as templates to produce macroporous polymers. The air bubbles introduced into the epoxy formulations served as templates for the pores of the cured epoxy foams. The addition of silica particles into the resin mixture resulted in an increased viscosity of the formulation, thus enhancing the stability of the liquid epoxy froths, which could then be thermally cured at 60 °C. Increasing the silica loading in the formulation resulted in an increase of the foam density and decrease of the average pore size of the epoxy foams. The epoxy foams containing silica exhibited a hierarchical pore structure, where large pores were surrounded by smaller pores, and enhanced stiffness as compared to the control epoxy foams with a monomodal pore size distribution.

The external obturator footprint as a landmark in total hip arthroplasty through a direct anterior approach: a CT-based analysis

BACKGROUND:

Anatomical landmarks for templating of total hip arthroplasty (THA) that are visible both during surgery and on radiographs are rare. If surgery is performed through a direct anterior approach the external obturator tendon (EO) is consistently visible. To use this point as a reference the exact position and dimensions of the footprint need to be known.

AIM:

To determine the location and dimension of the EO footprint on pelvic radiographs by correlating the EO anatomy in CT scans with conventional radiographs.

METHODS:

CT scans and radiographs of 200 patients were analysed. The EO tendon was identified on CT scans; the height of its footprint, and its distance to the tip of the greater trochanter and to the anatomical axis of the femur was measured. The accuracy and inter-rater reliability in the identification of the EO footprint was determined.

RESULTS:

The EO tendon was visible on all CT scans and it's footprint was identifiable on all corresponding radiographs. It's cranio-caudal dimension was 6.4 ± 1.4 mm. It's distance to the tip of the greater trochanter was 16.0 ± 3.1 mm. The EO footprint was located 5.2 ± 3.7 mm lateral to the femoral anatomical axis. There was no significant difference regarding the accuracy of EO footprint localisation on radiographs among the 2 readers.

CONCLUSION:

The EO footprint on the greater trochanter is consistently visible on CT scans and radiographs. As the variability of the footprint dimension is small, this structure may serve as a useful landmark in THA, particularly when performed through a direct anterior approach.

Synthesis and Formation Mechanism of All-Organic Block Copolymer-Directed Templating of Laser-Induced Crystalline Silicon Nanostructures

This report describes the generation of three-dimensional (3D) crystalline silicon continuous network nanostructures by coupling all-organic block copolymer self-assembly-directed resin templates with low-temperature silicon chemical vapor deposition and pulsed excimer laser annealing. Organic 3D mesoporous continuous-network resin templates were synthesized from the all-organic self-assembly of an ABC triblock terpolymer and resorcinol-formaldehyde resols. Nanosecond pulsed excimer laser irradiation induced the transient melt transformation of amorphous silicon precursors backfilled in the organic template into complementary 3D mesoporous crystalline silicon nanostructures with high pattern fidelity. Mechanistic studies on laser-induced crystalline silicon nanostructure formation revealed that the resin template was carbonized during transient laser-induced heating on the milli- to nanosecond timescales, thereby imparting enhanced thermal and structural stability to support the silicon melt-crystallization process at temperatures above 1250 °C. Photoablation of the resin material under pulsed excimer laser irradiation was mitigated by depositing an amorphous silicon overlayer on the resin template. This approach represents a potential pathway from organic block copolymer self-assembly to alternative functional hard materials with well-ordered 3D morphologies for potential hybrid photovoltaics, photonic, and energy storage applications.

Multiferroic nanocomposite fabrication via liquid phase using anodic alumina template

We report a novel and inexpensive fabrication process of multiferroic nanocomposite via liquid phase using an anodic alumina template. The sol-gel spin-coating technique was used to coat the template with ferrimagnetic CoFe₂O₄. By dissolving the template with NaOH aqueous solution, a unique nanotube array structure of CoFe₂O₄ was obtained. The CoFe₂O₄ nanotube arrays were filled with, and sandwiched in, ferroelectric BaTiO₃ layers by a sol-gel spin-coating method to obtain the composite. Its multiferroicity was confirmed by measuring the magnetic and dielectric hysteresis loops.

Using Patient Demographics and Statistical Modeling to Predict Knee Tibia Component Sizing in Total Knee Arthroplasty

BACKGROUND

Preoperative planning is important to achieve successful implantation in primary total knee arthroplasty (TKA). However, traditional TKA templating techniques are not accurate enough to predict the component size to a very close range.

METHODS

With the goal of developing a general predictive statistical model using patient demographic information, ordinal logistic regression was applied to build a proportional odds model to predict the tibia component size. The study retrospectively collected the data of 1992 primary Persona Knee System TKA procedures. Of them, 199 procedures were randomly selected as testing data and the rest of the data were randomly partitioned between model training data and model evaluation data with a ratio of 7:3. Different models were trained and evaluated on the training and validation data sets after data exploration.

RESULTS

The final model had patient gender, age, weight, and height as independent variables and predicted the tibia size within 1 size difference 96% of the time on the validation data, 94% of the time on the testing data, and 92% on a prospective cadaver data set.

CONCLUSION

The study results indicated the statistical model built by ordinal logistic regression can increase the accuracy of tibia sizing information for Persona Knee preoperative templating. This research shows statistical modeling may be used with radiographs to dramatically enhance the templating accuracy, efficiency, and quality. In general, this methodology can be applied to other TKA products when the data are applicable.

Tissue-engineered 3D microvessel and capillary network models for the study of vascular phenomena

Advances in tissue engineering, cell biology, microfabrication, and microfluidics have led to the development of a wide range of vascular models. Here, we review platforms based on templated microvessel fabrication to generate increasingly complex vascular models of (i) the tumor microenvironment, (ii) occluded microvessels, and (iii) perfused capillary networks. We outline fabrication guidelines and demonstrate a number of experimental methods for probing vascular function such as permeability measurements, tumor cell intravasation, flow characterization, and endothelial cell morphology and proliferation.

Graphene Inks as Versatile Templates for Printing Tiled Metal Oxide Crystalline Films

There is great interest in exploiting van der Waals gaps in layered materials as confinement reaction vessels to template the synthesis of new nanosheet structures. The gallery spaces in multilayer graphene oxide, for example, can intercalate hydrated metal ions that assemble into metal oxide films during thermal oxidation of the sacrificial graphene template. This approach offers limited control of structure, however, and does not typically lead to 2D atomic-scale growth of anisotropic platelet crystals, but rather arrays of simple particles directionally sintered into porous sheets. Here, a new graphene-directed assembly route is demonstrated that yields fully dense, space-filling films of tiled metal oxide platelet crystals with tessellated structures. The method relies on colloidal engineering to produce a printable "metallized graphene ink" with accurate control of metal loading, grain size/porosity, composition, and micro/nanomorphologies, and is capable of achieving higher metal-carbon ratio than is possible by intercalation methods. These tiled structures are sufficiently robust to create free standing papers, complex microtextured films, 3D shapes, and metal oxide replicas of natural biotextures.

Prospective, Randomized, Surgeon-Blinded Comparison of Standard Magnification Assumption vs Magnification Marker Usage for Preoperative Templating in Total Hip Arthroplasty

BACKGROUND

We undertook this prospective, randomized, surgeon-blinded study to compare the accuracy of using of a magnification marker on preoperative radiographs for templating vs using a standard 21% magnification.

METHODS

One hundred consecutive total hip arthroplasties were randomized to preoperative templating using a 25-mm magnification marker (50 patients) or a standard 21% magnification (50 patients). Intraoperative data were collected regarding the actual and predicted size of the femoral and acetabular components.

RESULTS

The 2 groups were found to be comparable with respect to body mass index (28.9 vs 27.9, P = .26) and gender (P = .69). In the magnification marker group, we predicted the femoral size within 1 size in 80% of the cases and the acetabular component in 94%. In the group of a standard 21% magnification, we predicted the femoral size within 1 size in 90% of the cases and the acetabular component in 96%. These proportions did not statistically differ (femur: χ²P = .16, odds ratio = 2.3, 95% confidence interval = 0.7-7.1; acetabulum: χ²P = .65, odds ratio = 1.5, 95% confidence interval = 0.3-9.6).

CONCLUSION

We did not detect a statistically significant difference in accuracy by using one method over the other when comparing the accuracy of component size selection. As the use of the magnification marker adds to the time and expense of preoperative radiographic acquisition, we feel using a standard 21% magnification is an equally accurate technique.

Can Demographic Variables Accurately Predict Component Sizing in Primary Total Knee Arthroplasty?

BACKGROUND

As health care reform drives providers to reduce costs and improve efficiencies without compromising patient care, preoperative planning has become imperative. The purpose of this study is to determine whether height, weight, and gender can accurately predict total knee arthroplasty (TKA) sizing.

METHODS

A consecutive series of 3491 primary TKAs performed by 2 surgeons was reviewed. Height, weight, gender, implant, preoperative templating sizes, and final implant sizes were collected. Implant-specific dimensions were collected from vendors. Using height, weight, and gender, a multivariate linear regression was performed with and without the inclusion of preoperative templating. Accuracy of the model was reported for commonly used implants.

RESULTS

There was a significant linear correlation between height, weight, and gender for femoral (R² = 0.504; P < .001) and tibial sizes (R² = 0.610; P < .001). Adding preoperative templating to the regression analysis increased the overall model fit for both the femoral (R² = 0.756; P < .001) and tibial sizes (R² = 0.780; P < .001). Femoral and tibial sizes were accurately predicted within 1 size of the final implant 71%-92% and 81%-97% using demographics alone or 85%-99% and 90%-99% using both templating and demographics, respectively.

CONCLUSION

This novel TKA templating model allows final implants to be predicted to within 1 size. The model allows for simplified preoperative planning and potential implementation into a cost-savings program that limits inventory and trays required for each case.

Advances in 3D Modeling: Preoperative Templating for Revision Wrist Surgery

BACKGROUND

Three-dimensional (3D) printing is a computer-directed process leading to the layered synthesis of scaled models. The popularity and availability of the technique has exponentially increased over the last decade, and as such is seeing a greater number of medical and surgical applications.

METHODS

We report 3 cases involving the use of 3D printing as an aid to operative planning in the revision of wrist surgery.

RESULTS

All patients underwent successful operative interventions with a £34 average cost of model creation.

CONCLUSIONS

A growing number of reports are emerging in reconstructive surgical specialities including maxillofacial, orthopedic, and plastic surgery; from our experience, we advocate the economically viable use of 3D printing for preoperative templating.

Transcription of Nanofibrous Cerium Phosphate Using a pH-Sensitive Lipodipeptide Hydrogel Template

A novel and simple transcription strategy has been designed for the template-synthesis of CePO₄·xH₂O nanofibers having an improved nanofibrous morphology using a pH-sensitive nanofibrous hydrogel (glycine-alanine lipodipeptide) as structure-directing scaffold. The phosphorylated hydrogel was employed as a template to direct the mineralization of high aspect ratio nanofibrous cerium phosphate, which in-situ formed by diffusion of aqueous CeCl₃ and subsequent drying (60 °C) and annealing treatments (250, 600 and 900 °C). Dried xerogels and annealed CePO₄ powders were characterized by conventional thermal and thermogravimetric analysis (DTA/TG), and Wide-Angle X-ray powder diffraction (WAXD) and X-ray powder diffraction (XRD) techniques. A molecular packing model for the formation of the fibrous xerogel template was proposed, in accordance with results from Fourier-Transformed Infrarred (FTIR) and WAXD measurements. The morphology, crystalline structure and composition of CePO₄ nanofibers were characterized by electron microscopy techniques (Field-Emission Scanning Electron Microscopy (FE-SEM), Transmission Electron Microscopy/High-Resolution Transmission Electron Microscopy (TEM/HRTEM), and Scanning Transmission Electron Microscopy working in High Angle Annular Dark-Field (STEM-HAADF)) with associated X-ray energy-dispersive detector (EDS) and Scanning Transmission Electron Microscopy-Electron Energy Loss (STEM-EELS) spectroscopies. Noteworthy, this templating approach successfully led to the formation of CePO₄·H₂O nanofibrous bundles of rather co-aligned and elongated nanofibers (10⁻20 nm thick and up to ca. 1 μm long). The formed nanofibers consisted of hexagonal (P6₂22) CePO₄ nanocrystals (at 60 and 250 °C), with a better-grown and more homogeneous fibrous morphology with respect to a reference CePO₄ prepared under similar (non-templated) conditions, and transformed into nanofibrous monoclinic monazite (P21/n) around 600 °C. The nanofibrous morphology was highly preserved after annealing at 900 °C under N₂, although collapsed under air conditions. The nanofibrous CePO₄ (as-prepared hexagonal and 900 °C-annealed monoclinic) exhibited an enhanced UV photo-luminescent emission with respect to non-fibrous homologues.

Variance in predicted cup size by 2-dimensional vs 3-dimensional computerized tomography-based templating in primary total hip arthroplasty

Background

Preoperative total hip arthroplasty templating can be performed with radiographs using acetate prints, digital viewing software, or with computed tomography (CT) images. Our hypothesis is that 3D templating is more precise and accurate with cup size prediction as compared to 2D templating with acetate prints and digital templating software.

Methods

Data collected from 45 patients undergoing robotic-assisted total hip arthroplasty compared cup sizes templated on acetate prints and OrthoView software to MAKOplasty software that uses CT scan. Kappa analysis determined strength of agreement between each templating modality and the final size used. t tests compared mean cup-size variance from the final size for each templating technique. Interclass correlation coefficient (ICC) determined reliability of digital and acetate planning by comparing predictions of the operating surgeon and a blinded adult reconstructive fellow.

Results

The Kappa values for CT-guided, digital, and acetate templating with the final size was 0.974, 0.233, and 0.262, respectively. Both digital and acetate templating significantly overpredicted cup size, compared to CT-guided methods (P < .001). There was no significant difference between digital and acetate templating (P = .117). Interclass correlation coefficient value for digital and acetate templating was 0.928 and 0.931, respectively.

Conclusions

CT-guided planning more accurately predicts hip implant cup size when compared to the significant overpredictions of digital and acetate templating. CT-guided templating may also lead to better outcomes due to bone stock preservation from a smaller and more accurate cup size predicted than that of digital and acetate predictions.

Intricate Hollow Structures: Controlled Synthesis and Applications in Energy Storage and Conversion

Intricate hollow structures garner tremendous interest due to their aesthetic beauty, unique structural features, fascinating physicochemical properties, and widespread applications. Here, the recent advances in the controlled synthesis are discussed, as well as applications of intricate hollow structures with regard to energy storage and conversion. The synthetic strategies toward complex multishelled hollow structures are classified into six categories, including well-established hard- and soft-templating methods, as well as newly emerging approaches based on selective etching of "soft@hard" particles, Ostwald ripening, ion exchange, and thermally induced mass relocation. Strategies for constructing structures beyond multishelled hollow structures, such as bubble-within-bubble, tube-in-tube, and wire-in-tube structures, are also covered. Niche applications of intricate hollow structures in lithium-ion batteries, Li-S batteries, supercapacitors, Li-O₂ batteries, dye-sensitized solar cells, photocatalysis, and fuel cells are discussed in detail. Some perspectives on the future research and development of intricate hollow structures are also provided.

Spontaneous emergence of catalytic cycles with colloidal spheres

Colloidal particles endowed with specific time-dependent interactions are a promising route for realizing artificial materials that have the properties of living ones. Previous work has demonstrated how this system can give rise to self-replication. Here, we introduce the process of colloidal catalysis, in which clusters of particles catalyze the creation of other clusters through templating reactions. Surprisingly, we find that simple templating rules generically lead to the production of huge numbers of clusters. The templating reactions among this sea of clusters give rise to an exponentially growing catalytic cycle, a specific realization of Dyson's notion of an exponentially growing metabolism. We demonstrate this behavior with a fixed set of interactions between particles chosen to allow a catalysis of a specific six-particle cluster from a specific seven-particle cluster, yet giving rise to the catalytic production of a sea of clusters of sizes between 2 and 11 particles. The fact that an exponentially growing cycle emerges naturally from such a simple scheme demonstrates that the emergence of exponentially growing metabolisms could be simpler than previously imagined.

Oil-in-Water-in-Oil Multinanoemulsions for Templating Complex Nanoparticles

Complex nanoemulsions involving nanodroplets with a defined inner structure have great potential for encapsulation and templating applications. We report a method to form novel complex oil-in-water-in-oil nanoemulsions using a combination of high-energy processing with mixed nonionic surfactants that simultaneously achieve ultralow interfacial tension and frustrated curvature of the water-oil interface. The method produces multinanoemulsions possessing morphologies resembling water-swollen reverse vesicles with core-shell and multicore-shell morphologies of water in cyclohexane. A combination of macroscopic and microscopic characterization conclusively verifies and quantifies the complex morphologies, which vary systematically and reproducibly with water content for water volume fractions between 0.01 and 0.10. The complex morphologies are stable tens of hours, providing a route for their use as liquid templates for internally structured nanoparticles. As a demonstration, we test the complex nanoemulsions' ability to template complex polymer nanogels.

Nanometer-Scale Chemistry of a Calcite Biomineralization Template: Implications for Skeletal Composition and Nucleation

Plankton, corals, and other organisms produce calcium carbonate skeletons that are integral to their survival, form a key component of the global carbon cycle, and record an archive of past oceanographic conditions in their geochemistry. A key aspect of the formation of these biominerals is the interaction between organic templating structures and mineral precipitation processes. Laboratory-based studies have shown that these atomic-scale processes can profoundly influence the architecture and composition of minerals, but their importance in calcifying organisms is poorly understood because it is difficult to measure the chemistry of in vivo biomineral interfaces at spatially relevant scales. Understanding the role of templates in biomineral nucleation, and their importance in skeletal geochemistry requires an integrated, multiscale approach, which can place atom-scale observations of organic-mineral interfaces within a broader structural and geochemical context. Here we map the chemistry of an embedded organic template structure within a carbonate skeleton of the foraminifera Orbulina universa using both atom probe tomography (APT), a 3D chemical imaging technique with Ångström-level spatial resolution, and time-of-flight secondary ionization mass spectrometry (ToF-SIMS), a 2D chemical imaging technique with submicron resolution. We quantitatively link these observations, revealing that the organic template in O. universa is uniquely enriched in both Na and Mg, and contributes to intraskeletal chemical heterogeneity. Our APT analyses reveal the cation composition of the organic surface, offering evidence to suggest that cations other than Ca2+, previously considered passive spectator ions in biomineral templating, may be important in defining the energetics of carbonate nucleation on organic templates.

Guided Folding of Nematic Liquid Crystal Elastomer Sheets into 3D via Patterned 1D Microchannels

Two-dimensional liquid-crystal elastomer (LCE) sheets with preprogrammed topological defects are prepared by aligning liquid-crystal monomers within micropatterned epoxy channels, followed by photopolymerization. Upon heating, the LCE films form various three-dimensional structures in agreement with theoretical design. The miniaturized LCE actuators offer large-area work capacities (≈1.05 J m^-2 ) to lift over 700 times their own weight.

Polymer Capsules for Plaque-Targeted In Vivo Delivery

Targeted polymer capsules can selectively bind to unstable plaques in mice after intravenous injection. Different formulations of the capsules are explored with a synthetic/biopolymer hybrid capsule showing the best stability and small-molecule drug retention. The synthetic polymer is composed of pH-sensitive blocks (PDPA), low-binding blocks (PEG), and click-groups for postfunctionalization with targeting peptides specific to plaques.

Magnetostatic Interactions in Self-Assembled CoxNi1-xFe2O4/BiFeO3 Multiferroic Nanocomposites

Self-assembled vertically aligned oxide nanocomposites consisting of magnetic pillars embedded in a ferroelectric matrix have been proposed for logic devices made from arrays of magnetostatically interacting pillars. To control the ratio between the nearest neighbor interaction field and the switching field of the pillars, the pillar composition CoxNi1-xFe2O4 was varied over the range 0 ≤ x ≤ 1, which alters the magnetoelastic and magnetocrystalline anisotropy and the saturation magnetization. Nanocomposites were templated into square arrays of pillars in which the formation of a "checkerboard" ground state after ac-demagnetization indicated dominant magnetostatic interactions. The effect of switching field distribution in disrupting the antiparallel nearest neighbor configuration was analyzed using an Ising model and compared with experimental results.

Conformational Compatibility Is Essential for Heterologous Aggregation of α-Synuclein

Under aggregation-prone conditions, soluble amyloidogenic protein monomers can self-assemble into fibrils or they can fibrillize on preformed fibrillar seeds (seeded aggregation). Seeded aggregations are known to propagate the morphology of the seeds in the event of cross-seeding. However, not all proteins are known to cross-seed aggregation. Cross-seeding has been proposed to be restricted either because of differences in the protein sequences or because of conformations between the seeds and the soluble monomers. Here, we examine cross-seeding efficiency between three α-synuclein sequences, wild-type, A30P, and A53T, each varying in only one or two amino acids but forming morphologically distinct fibrils. Results from bulk Thioflavin-T measurements, monomer incorporation quantification, single fibril fluorescence microscopy, and atomic force microscopy show that under the given solution conditions conformity between the conformation of seeds and monomers is essential for seed elongation. Moreover, elongation characteristics of the seeds are defined by the type of seed.

One-Step Fabrication of Microchannels Lined with a Metal Oxide Coating

We demonstrate a simple, single-step method for metal/metal oxide coating on interior walls of microchannels in an elastomeric material like PDMS, which is the mainstay of microfluidic devices. The fabrication process involves electrodeposition of cuprous oxide on a metallic wire or a sheet, embedding it inside a PDMS matrix along with the cross-linker, curing and then swelling the PDMS elastomer, and finally pulling out the template metal wire or the metal sheet from the PDMS matrix. Stronger attachment of the metal oxide layer to PDMS allows the transfer of the metal oxide coating originally present on the template surface (wire or sheet) to the channel wall resulting in a microchannel/microslit lined with the metal/metal oxide layer. In view of the catalytic activity associated with transition metal oxides, this simple method offers a cost-effective and versatile technique to fabricate microfluidic and lab-on-a-chip devices which can be utilized as microcatalytic reactors or chemical filters. As a proof of concept, we have successfully tested the metal oxide coated microchannels and microslits as active sites for adsorption of iodide ions.

Calibration Marker Position in Digital Templating of Total Hip Arthroplasty

BACKGROUND

We report a mathematical method to assess the vertical and horizontal positions of spherical radiopaque objects of known size in conventional radiographs.

METHODS

The reliability and validity of the method were tested in an experimental setting and applied to 100 anteroposterior pelvic radiographs with external calibration markers and unilateral total hip arthroplasty (THA).

RESULTS

We found excellent reliabilities; intraclass correlation coefficients for interobserver and intraobserver reliabilities were 0.999-1.000 (P = .000). The mean normal height of THA was 198 mm (range: 142-243 mm, standard deviation: 18 mm) above the detector. Vertical and horizontal external marker positions differed significantly from the true hip center (THA; P < .001 and P = .017).

CONCLUSION

This method could enhance patient safety by enabling automated detection of malpositioned calibration markers by templating software.

Measuring the Femoral Head Size--An Additional Real-Time Intraoperative Monitoring Tool for the Accuracy of the Preoperative Process and Implant Selection

The purpose of this study was to examine the correlation between the implanted cup's outer diameter and the actual femoral head diameter removed during surgery. Seventy-five patients with primary total hip arthroplasty were evaluated. The difference between the implanted cup diameter and the femoral head diameter was calculated for each patient. The mean±SD actual femoral head diameter that was removed and measured during surgery was 48.5±3.7 mm. The mean±SD cementless implanted cup outer diameter was 51.8±3.5 mm. A high correlation was found between the implanted cup diameter and the actual femoral head diameter (r=0.923). A cut-off point of 4mm of the measured femoral head diameter should be considered as an additional monitoring indicator.