Trends in Intraoperative Assessment of Spinal Alignment: A Survey of Spine Surgeons in the United States.

STUDY DESIGN: Survey. OBJECTIVES: To characterize national practices of and shortcomings surrounding intraoperative assessments of spinal alignment. METHODS: Spine surgeons in the US were surveyed to analyze their experience with assessing spinal alignment intraoperatively. RESULTS: 108 US spine surgeons from 77 surgical centers with an average of 19.2 + 8.8 years of surgical experience completed the survey. To assess alignment intraoperatively, 84% (91/108) use C-arm or spot radiographs, 40% (43/108) use full-length radiographs, and 20% utilize the T-bar (22/108). 88% of respondents' surgical centers (93/106) possessed a navigation camera and 63% of respondents (68/108) report using surgical navigation for 40% of their deformity cases on average. Reported deterrents for using current technology to assess alignment were workflow interruption (54%, 58/108), expense (33%, 36/108), and added radiation exposure (26%, 28/108). 87% of respondents (82/94) reported a need for improvement in current capabilities of making intraoperative assessments of spinal alignment. CONCLUSIONS: Corrective surgery for spinal deformity is a complex procedure that requires a high level of expertise to perform safely. The majority of surveyed surgeons primarily rely on radiographs for intraoperative assessments of alignment. Despite the majority of surveyed surgical practices possessing navigation cameras, they are utilized only for a minority of spinal deformity cases. With the majority of surveyed surgeons reporting a need for improvement in technology to assess spinal alignment intraoperatively, 3 of the top design considerations should include workflow interruption, expense, and radiation exposure.

Breath Acetone Sensing Based on Single-Walled Carbon Nanotube-Titanium Dioxide Hybrids Enabled by a Custom-Built Dehumidifier.

Acetone is a metabolic byproduct found in the exhaled breath and can be measured to monitor the metabolic degree of ketosis. In this state, the body uses free fatty acids as its main source of fuel because there is limited access to glucose. Monitoring ketosis is important for type I diabetes patients to prevent ketoacidosis, a potentially fatal condition, and individuals adjusting to a low-carbohydrate diet. Here, we demonstrate that a chemiresistor fabricated from oxidized single-walled carbon nanotubes functionalized with titanium dioxide (SWCNT@TiO2) can be used to detect acetone in dried breath samples. Initially, due to the high cross sensitivity of the acetone sensor to water vapor, the acetone sensor was unable to detect acetone in humid gas samples. To resolve this cross-sensitivity issue, a dehumidifier was designed and fabricated to dehydrate the breath samples. Sensor response to the acetone in dried breath samples from three volunteers was shown to be linearly correlated with the two other ketone bodies, acetoacetic acid in urine and ß-hydroxybutyric acid in the blood. The breath sampling and analysis methodology had a calculated acetone detection limit of 1.6 ppm and capable of detecting up to at least 100 ppm of acetone, which is the dynamic range of breath acetone for someone with ketosis. Finally, the application of the sensor as a breath acetone detector was studied by incorporating the sensor into a handheld prototype breathalyzer.

Tetrahydrocannabinol Detection Using Semiconductor-Enriched Single-Walled Carbon Nanotube Chemiresistors.

Semiconductor-enriched single-walled carbon nanotubes (s-SWCNTs) have potential for application as a chemiresistor for the detection of breath compounds, including tetrahydrocannabinol (THC), the main psychoactive compound found in the marijuana plant. Herein we show that chemiresistor devices fabricated from s-SWCNT ink using dielectrophoresis can be incorporated into a hand-held breathalyzer with sensitivity toward THC generated from a bubbler containing analytical standard in ethanol and a heated sample evaporator that releases compounds from steel wool. The steel wool was used to capture THC from exhaled marijuana smoke. The generation of the THC from the bubbler and heated breath sample chamber was confirmed using ultraviolet-visible absorption spectroscopy and mass spectrometry, respectively. Enhanced selectivity toward THC over more volatile breath components such as CO2, water, ethanol, methanol, and acetone was achieved by delaying the sensor reading to allow for the desorption of these compounds from the chemiresistor surface. Additionally, machine learning algorithms were utilized to improve the selective detection of THC with better accuracy at increasing quantities of THC delivered to the chemiresistor.

Automatic Early-Onset Free Flap Failure Detection for Implantable Biomedical Devices.

OBJECTIVE: Up to 10% of free flap cases are compromised, and without prompt intervention, amputation and even death can occur. Hourly monitoring improves salvage rates, but the gold standard for monitoring requires experienced personnel to operate and suffers from high false-positive rates as high as 31% that result in costly and unnecessary surgeries. In this paper, we investigate free flap patency monitoring using automatic hardware-only classification systems that eliminate the need for experienced personnel. The expected flow ranges of the antegrade and retrograde veins for breast reconstruction are studied using a syringe pump to create the laminar flow seen in veins. METHODS: Feature data extracted from the Doppler blood flow signals are analyzed for sensitivity, specificity, and false-positive rates. Hardware is built to perform the classification automatically in real-time and output a decision at the end of the observation period. RESULTS: Experimental results using the hardware-only classifier for a 50 ms window size show high sensitivity (96.75%), specificity (90.20%), and low false-positive rate (9.803%). The experimental and theoretical classification results show close agreement. CONCLUSION: This work indicates that automatic hardware-only classifiers can eliminate the need for experienced personnel to monitor free flap patency. SIGNIFICANCE: The hardware-only classification is amenable to a monolithic implementation and future studies should study a totally implantable wirelessly-powered blood flow classifier. The high classifier performance in a short window period indicates that duty-cycled powering can be used to extend the safe operational depth of an implant. This is particularly relevant for the difficult buried free flap applications.

A System for Simple Real-Time Anastomotic Failure Detection and Wireless Blood Flow Monitoring in the Lower Limbs.

Current totally implantable wireless blood flow monitors are large and cannot operate alongside nearby monitors. To alleviate the problems with the current monitors, we developed a system to monitor blood flow wirelessly, with a simple and easily interpretable real-time output. To the best of our knowledge, the implanted electronics are the smallest in reported literature, which reduces bio-burden. Calibration was performed across realistic physiological flow ranges using a syringe pump. The device's sensors connected directly to the bilateral femoral veins of swine. For each 1 min, blood flow was monitored, then, an occlusion was introduced, and then, the occlusion was removed to resume flow. Each vein of four pigs was monitored four times, totaling 32 data collections. The implant measured 1.70 cm3 without battery/encapsulation. Across its calibrated range, including equipment tolerances, the relative error is less than ±5% above 8 mL/min and between -0.8% and +1.2% at its largest calibrated flow rate, which to the best of our knowledge is the lowest reported in the literature across the measured calibration range. The average standard deviation of the flow waveform amplitude was three times greater than that of no-flow. Establishing the relative amplitude for the flow and no-flow waveforms was found necessary, particularly for noise modulated Doppler signals. Its size and accuracy, compared with other microcontroller-equipped totally implantable monitors, make it a good candidate for future tether-free free flap monitoring studies.

Innovation and translation efforts in wireless medical connectivity, telemedicine and eMedicine: a story from the RFID Center of Excellence at the University of Pittsburgh.

Translational research has recently been rediscovered as one of the basic tenants of engineering. Although many people have numerous ideas of how to accomplish this successfully, the fundamental method is to provide an innovative and creative environment. The University of Pittsburgh has been accomplishing this goal though a variety of methodologies. The contents of this paper are exemplary of what can be achieved though the interaction of students, staff, faculty and, in one example, high school teachers. While the projects completed within the groups involved in this paper have spanned other areas, the focus of this paper is on the biomedical devices, that is, towards improving and maintaining health in a variety of areas. The spirit of the translational research is discovery, invention, intellectual property protection, and the creation of value through the spinning off of companies while providing better health care and creating jobs. All but one of these projects involve wireless radio frequency (RF) energy for delivery. The remaining device can be wirelessly connected for data collection.