Advantages and pitfalls in computer assisted orthopedic surgery planning using rapid-prototyped guides

Durch die von Rapid Prototyping gebotenen Möglichkeiten können computergestützte 3D Operationsplanungen präzise in der Operation umgesetzt werden. An der Universitätsklinik Balgrist wurden in den letzten 3 Jahren nahezu 100 Patienten erfolgreich behandelt, deren Operation in 3D geplant und mit patienten-spezifischen Schablonen umgesetzt wurde. Wir beschreiben die Genauigkeit dieser Methode und berichten über die hierbei gesammelten Erfahrungen. Aufgrund der Flexibilität der Rapid Prototyping Technologie, gibt es nicht immer nur einen Weg wie eine 3D geplante Operation umgesetzt werden kann. Wir zeigen daher anhand von Fallbeispielen unterschiedliche Strategien auf und beschreiben deren Vor- und Nachteile. Ausserdem präsentieren wir die Weiterentwicklung der Methode zur Anwendung an kleinerer Anatomie wie Knochen des Handgelenkes oder der Finger.

Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse

CASE DESCRIPTION A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain. CLINICAL FINDINGS Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain. TREATMENT AND OUTCOME Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully. CLINICAL RELEVANCE HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.

Endoscopically assisted decompression of the median nerve in the pronator and Kiloh-Nevin syndrome: Surgical technique

STATE OF THE ART The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. MATERIAL AND SURGICAL TECHNIQUE Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. RESULTS Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. CONCLUSION Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.

[Collagenase injection in Dupuytren's disease, evaluation of the ultrasound assisted technique].

Since October 2011, the enzymatic lysis of Dupuytren's cord was introduced in Switzerland (Xiapex(®), Auxilium Pharmaceuticals, Pfizer). Here we present our first university experience and underline the major role of ultrasound during the injection. Between December 2011 and February 2013, 52 injections were performed to eliminate 43 Dupuytren's cords in 33 patients. The mean age of the patients was 64.4 ± 8.5 years. Complications were documented for each patient. Before, directly after and after a minimum of 6 months post-injection, the contracture of the treated joint was measured with use of a goniometer. The DASH score was evaluated after a minimum of 6 months and the patients were asked to subjectively evaluate the outcome of the treatment (very good, good, mild, poor) and whether they would reiterate it if necessary. Four skin defects, one lymphangitis, and one CRPS were responsible for a complication rate of 18%. There was no infection and no tendon rupture in the series. The mean MCP joint contracture was respectively 36.8 ± 27.4°, 3.5 ± 7.8° (gain of mobility compared to the preoperative situation 33.3°, P<0.001), and 8.4 ± 13.9° (gain 28.4°, P<0.001) respectively before, just after and at the long-term clinical control. The mean PIP joint contracture was respectively 36.5 ± 29.1°, 5.9 ± 6.7° (gain 30.6°, P<0.001), and 15.1 ± 13.8° (gain 21.4°, P<0.001) respectively before injection, just after and at the long-term clinical control. The DASH score decreased from 24 ± 14 to 7 ± 9 (P<0.001). Eighty-one per cent of the patients were satisfied or very satisfied of the treatment. All but two would reiterate the treatment if necessary. Ultrasound is able to target the injection of collagenase in order to reduce complications. The short-term results of this non-invasive therapy are very promising however comparison with conventional procedures is difficult as the long-term results are lacking.

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

OBJECTIVES To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement. METHODS Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot). SETTING Single Level 1 University Hospital Trauma Center. MAIN OUTCOME MEASUREMENTS The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy. RESULTS Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25-88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40-103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4-16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6-28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 μGy (range, 51-660 μGy; SD, 0.17 μGy) compared with 690.27 μGy (range, 200-2310 μGy; SD, 0.52 μGy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888). CONCLUSIONS The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique. LEVEL OF EVIDENCE Therapeutic level II.

Computational Tools for Stereo and Light Field Photography

This thesis covers a broad part of the field of computational photography, including video stabilization and image warping techniques, introductions to light field photography and the conversion of monocular images and videos into stereoscopic 3D content. We present a user assisted technique for stereoscopic 3D conversion from 2D images. Our approach exploits the geometric structure of perspective images including vanishing points. We allow a user to indicate lines, planes, and vanishing points in the input image, and directly employ these as guides of an image warp that produces a stereo image pair. Our method is most suitable for scenes with large scale structures such as buildings and is able to skip the step of constructing a depth map. Further, we propose a method to acquire 3D light fields using a hand-held camera, and describe several computational photography applications facilitated by our approach. As the input we take an image sequence from a camera translating along an approximately linear path with limited camera rotations. Users can acquire such data easily in a few seconds by moving a hand-held camera. We convert the input into a regularly sampled 3D light field by resampling and aligning them in the spatio-temporal domain. We also present a novel technique for high-quality disparity estimation from light fields. Finally, we show applications including digital refocusing and synthetic aperture blur, foreground removal, selective colorization, and others.

Numerical study of the laser-tip coupling in surface plasmon assisted stacked-double-gate field emitter arrays

Recently, sub-wavelength-pitch stacked double-gate metal nanotip arrays have been proposed to realize high current, high brightness electron bunches for ultrabright cathodes for x-ray free-electron laser applications. With the proposed device structure, ultrafast field emission of photoexcited electrons is efficiently driven by vertical incident near infrared laser pulses, via near field coupling of the surface plasmon polariton resonance of the gate electrodes with the nanotip apex. In this work, in order to gain insight in the underlying physical processes, the authors report detailed numerical studies of the proposed device. The results indicate the importance of the interaction of the double-layer surface plasmon polariton, the position of the nanotip, as well as the incident angle of the near infrared laser pulses.

Training-induced changes in drag-flick technique in female field hockey players

The penalty corner is one of the most important goal plays in field hockey. The drag-flick is used less by women than men in a penalty corner. The aim of this study was to describe training-induced changes in the drag-flick technique in female field hockey players. Four female players participated in the study. The VICON optoelectronic system (Oxford Metrics, Oxford, UK) measured the kinematic parameters of the drag-flick with six cameras sampling at 250 Hz, prior to and after training. Fifteen shots were captured for each subject. A Wilcoxon test assessed the differences between pre-training and post-training parameters. Two players received specific training twice a week for 8 weeks; the other two players did not train. The proposed drills improved the position of the stick at the beginning of the shot (p<0.05), the total distance of the shot (p<0.05)and the rotation radius at ball release (p<0.01). It was noted that all players had lost speed of the previous run. Further studies should include a larger sample, in order to provide more information on field hockey performance.

A reflection suppression technique for far field antenna measurements

This paper presents a reflection suppression technique for far field antenna measurements. The technique is based on a source reconstruction over a surface greater than the antenna itself. To be able to perform the reflection construction the next steps are required: the complete far field antenna pattern is obtained through interpolation of the acquired cuts, the currents are obtained through a holographic technique, the field out of the antenna area is filtered, and the pattern is reconstructed. The algorithm is used with measurements in the LEHA-UPM antenna measurement facilities and in the outdoor far field facility of LIT INPE in Brazil.

High-field magnetic resonance imaging with reduced field/tissue RF artefacts - A modeling study using hybrid MoM/FEM and FDTD technique

Due to complex field/tissue interactions, high-field magnetic resonance (MR) images suffer significant image distortions that result in compromised diagnostic quality. A new method that attempts to remove these distortions is proposed in this paper and is based on the use of transceiver-phased arrays. The proposed system uses, in the examples presented herein, a shielded four-element transceive-phased array head coil and involves performing two separate scans of the same slice with each scan using different excitations during transmission. By optimizing the amplitudes and phases for each scan, antipodal signal profiles can be obtained, and by combining both the images together, the image distortion can be reduced several fold. A combined hybrid method of moments (MoM)/finite element method (FEM) and finite-difference time-domain (FDTD) technique is proposed and used to elucidate the concept of the new method and to accurately evaluate the electromagnetic field (EMF) in a human head model. In addition, the proposed method is used in conjunction with the generalized auto-calibrating partially parallel acquisitions (GRAPPA) reconstruction technique to enable rapid imaging of the two scans. Simulation results reported herein for 11-T (470-MHz) brain imaging applications show that the new method with GRAPPA reconstruction theoretically results in improved image quality and that the proposed combined hybrid MoM/FEM and FDTD technique is. suitable for high-field magnetic resonance imaging (MRI) numerical analysis.

Liquid core fibre Bragg grating based refractive index sensor formed by femtosecond assisted chemical etching technique

We report the fabrication of a refractive index (RI) sensor based on a liquid core fibre Bragg grating (FBG). A micro-slot FBG was created in standard telecom optical fibre employing the tightly focused femtosecond laser inscription aided chemical etching. A micro-slot with dimensions of 5.74(h) × 125(w) × 1388.72(l) μm was engraved across the whole fibre and along 1mm long FBG which gives advantage of a relatively robust liquid core waveguide. The device performed the refractive index sensitivity up to about 742.72 nm/RIU. © 2011 Copyright Society of Photo-Optical Instrumentation Engineers (SPIE).

Near-field diffraction-based focal length determination technique

An accurate and simple technique for determining the focal length of a lens is presented. It consists of measuring the period of the fringes produced by a diffraction grating at the near field when it is illuminated with a beam focused by the unknown lens. In paraxial approximation, the period of the fringes varies linearly with the distance. After some calculations, a simple extrapolation of data is performed to obtain the locations of the principal plane and the focal plane of the lens. Thus, the focal length is obtained as the distance between the two mentioned planes. The accuracy of the method is limited by the collimation degree of the incident beam and by the algorithm used to obtain the period of the fringes. We have checked the technique with two commercial lenses, one convergent and one divergent, with nominal focal lengths (+100±1) mm and (−100±1) mm respectively. We have experimentally obtained the focal lengths resulting into the interval given by the manufacturer but with an uncertainty of 0.1%, one order of magnitude lesser than the uncertainty given by the manufacturer.

Plasma diagnostics and ITO film deposition by RF-assisted closed-field dual magnetron system

Deposition of indium tin oxide (ITO) among various transparent conductive materials on flexible organic substrates has been intensively investigated among academics and industrials for a whole new array of imaginative optoelectronic products. One critical challenge coming with the organic materials is their poor thermal endurances, considering that the process currently used to produce industry-standard ITO usually involves relatively high substrate temperature in excess of 200°C and post-annealing. A lower processing temperature is thus demanded, among other desires of high deposition rate, large substrate area, good uniformity, and high quality of the deposited materials. For this purpose, we developed an RF-assisted closed-field dual magnetron sputtering system. The “prototype” system consists of a 3-inch unbalanced dual magnetron operated at a closed-field configuration. An RF coil was fabricated and placed between the two magnetron cathodes to initiate a secondary plasma. The concept is to increase the ionization faction with the RF enhancement and utilize the ion energy instead of thermal energy to facilitate the ITO film growth. The closed-field unbalanced magnetrons create a plasma in the intervening region rather than confine it near the target, thus achieving a large-area processing capability. An RF-compensated Langmuir probe was used to characterize and compare the plasmas in mirrored balanced and closed-field unbalanced magnetron configurations. The spatial distributions of the electron density ne and electron temperature Te were measured. The density profiles reflect the shapes of the plasma. Rather than intensively concentrated to the targets/cathodes in the balanced magnetrons, the plasma is more dispersive in the closed-field mode with a twice higher electron density in the substrate region. The RF assistance significantly enhances ne by one or two orders of magnitude higher. The effect of various other parameters, such as pressure, on the plasma was also studied. The ionization fractions of the sputtered atoms were measured using a gridded energy analyzer (GEA) combined with a quartz crystal microbalance (QCM). The presence of the RF plasma effectively increases the ITO ionization fraction to around 80% in both the balanced and closed-field unbalanced configurations. The ionization fraction also varies with pressure, maximizing at 5-10 mTorr. The study of the ionization not only facilitates understanding the plasma behaviors in the RF-assisted magnetron sputtering, but also provides a criterion for optimizing the film deposition process. ITO films were deposited on both glass and plastic (PET) substrates in the 3-inch RF-assisted closed-field magnetrons. The electrical resistivity and optical transmission transparency of the ITO films were measured. Appropriate RF assistance was shown to dramatically reduce the electrical resistivity. An ITO film with a resistivity of 1.2×10-3 Ω-cm and a visible light transmittance of 91% was obtained with a 225 W RF enhancement, while the substrate temperature was monitored as below 110°C. X-ray photoelectron spectroscopy (XPS) was employed to confirm the ITO film stoichiometry. The surface morphology of the ITO films and its effect on the film properties were studied using atomic force microscopy (AFM). The prototype of RF-assisted closed-field magnetron was further extended to a larger rectangular shaped dual magnetron in a flat panel display manufacturing system. Similar improvement of the ITO film conductivities by the auxiliary RF was observed on the large-area PET substrates. Meanwhile, significant deposition rates of 25-42 nm/min were achieved.

Critique groups : a technique for the author’s toolbox?

With a lack of places to gain an education in the craft of romance writing, novelists have few places to turn to gain real feedback. This paper investigates an alternative to textbooks, conferences, and workshops through an examination of the role provided to the writer by critique groups. How these groups work, how they benefit an author, and the critique groups as a whole are discussed. This work studies the form of Peer Assessment and Learning (PAL) and compares the technique used by educational institutions all over the world with the practice of author groups critiquing their own work. The research shows how a critique group can assist a writer to learn, grow and develop, helping to enhance the writer’s skills through constructive feedback, which gives them confidence to sell their work.