The applications of electrokinetics in the development of microfluidic devices have been widely attractive in the past decade. Electrokinetic devices generally require no external mechanical moving parts and can be made portable by replacing the power supply by small battery. Therefore, electrokinetic-based microfluidic systems can serve as a viable tool in creating a lab-on-a-chip (LOC) or micro-total analysis system (TAS) for use in biological and chemical assays. Mixing of analytes and reagents is a critical step in realizing lab-on-a-chip. This step is difficult due to the flow in microscale devices which are typically limited to low Reynolds numbers, turbulence does not readily occur. The mixing of two or more fluid streams in a simple microchannel is dominated by the molecular diffusion effect. The diffusive mixing time is given by t m ~ w 2 /D and the mixing length (l m ) along the downstream channel increases linearly with the Péclet number (i.e. l m ~ Pe×w), where w and D are the channel width and molecular diffusivity. However, the rate of diffusive mixing in microscale channels is very slow compared to the convection of the fluid along the channel since the Péclet number of typical microchannel flows is very high due to biomolecules (e.g. DNA and protein) with relatively low molecular diffusivities. To reduce the mixing time and length, various schemes to enhance micro-mixing have been proposed in the past years. This review reports recent developments in the micro-mixing schemes based on DC and AC electrokinetics. The overview given in this article provides a potential user or researcher of electrokinetic-based technology to select the most favorable mixing scheme for applications in the field of micro-total analysis systems. Mixing principle and chaotic mixingAlthough it is difficult to induce turbulence (so-called Eulerian chaos) in microchannels, an effective mixing in low Reynolds number flow regimes can be obtained by the chaotic advection mechanism (or so-called Lagrangian chaos or laminar chaos), which provides an effective increase in the interfacial contact area and concentration gradient due to reduction of the striation thickness (i.e. diffusion length).In this way, mixing time and length can be considerably reduced. If an exponential reduction of striation thickness should occur, the mixing time and mixing length can be reduced down to t m ~ ln(Pe) and l m ~ ln(Pe), respectively, for chaotic flows in the limit of large Pe. An effective mixing always requires repeated stretching and folding of fluid elements, e.g blanking vortex models. Blinking vortex models are similar to the link twist map (LTM) strategy which is based on a dynamic system theory described in the literature [1]. An LTM is often obtained when the dynamic system has a structure such that the motion can be described by the repeated application of two twist maps. Over the past few years, many effective micromixers have been designed according to the LTM strategy. Micro-mixing based on electrokinetics

This paper presents a theoretical and experimental investigation into the hydrodynamic focusing effect in rectangular microchannels. Two theoretical models for two-dimensional hydrodynamic focusing are proposed. The first model predicts the width of the focused stream in symmetric hydrodynamic focusing in microchannels of various aspect ratios. The second model predicts the location and the width of the focused stream in asymmetric hydrodynamic focusing in microchannels with a low or high aspect ratio. In both models, the theoretical results are shown to be in good agreement with the experimental data. Hence, the models provide a useful means of performing a theoretical analysis of flow control in microfluidic devices using hydrodynamic focusing effects. The ability of the proposed models to control the focused stream within a micro flow cytometer is verified in a series of experimental trials performed using polystyrene microparticles with a diameter of 20 µm. The experimental data show that the width of the focused stream can be reduced to the same order of magnitude as that of the particle size. Furthermore, it is shown that the microparticles can be successfully hydrodynamically focused and switched to the desired outlet port of the cytometer. Hence, the models presented in this study provide sufficient control to support cell/particle counting and sorting applications.

In this work, we designed and fabricated a three-dimensional hydrodynamic focusing microfluidic device. The device comprises a two-layer PDMS microchannel structure. There are four inlet ports and one outlet port. The fluids are all injected by syringe pumps. A sample flow stream was first vertically constrained into a narrow stream, and then horizontally focused on one small core region from a cross-section perspective, which is useful for cell/particle counting. We showed the numerical and experimental images of the focused stream shape from a cross-section perspective; experimental images were captured using a confocal fluorescence microscope. We also investigated the effect of channel aspect ratio on the vertical focusing effect using CFD simulations. The results showed that the sample flow can be focused successfully in the lower aspect ratio of the main channel (slightly greater than 0.5) in our design. Furthermore, the effect of the Reynolds number on the vertical focusing effect was also investigated. The numerical results showed that the rectangular-like shape of the focused stream from the cross-section perspective was deformed as the Reynolds number was high due to stronger secondary flows produced in the vertical focusing unit. This phenomenon was also demonstrated experimentally. The device only works well at low Reynolds numbers (approximately less than 5). The device can be integrated into an on-chip flow cytometer.

OBJECTIVEPotential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established. The authors aimed to compare the long-term radiographic outcomes of expandable versus static TLIF cages.METHODSA retrospective review of 1- and 2-level TLIFs over a 10-year period with expandable and static cages was performed at the University of California, San Francisco. Patients with posterior column osteotomy (PCO) were subdivided. Fusion assessment, cage subsidence, anterior and posterior disc height, foraminal dimensions, pelvic incidence (PI), segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence–lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA) were assessed.RESULTSA consecutive series of 178 patients (with a total of 210 levels) who underwent TLIF using either static (148 levels) or expandable cages (62 levels) was reviewed. The mean patient age was 60.3 ± 11.5 years and 62.8 ± 14.1 years for the static and expandable cage groups, respectively. The mean follow-up was 42.9 ± 29.4 months for the static cage group and 27.6 ± 14.1 months for the expandable cage group. Within the 1-level TLIF group, the SL and PI-LL improved with statistical significance regardless of whether PCO was performed; however, the static group with PCOs also had statistically significant improvement in LL and SVA. The expandable cage with PCO subgroup had significant improvement in SL only. All of the foraminal parameters improved with statistical significance, regardless of the type of cages used; however, the expandable cage group had greater improvement in disc height restoration. The incidence of cage subsidence was higher in the expandable group (19.7% vs 5.4%, p = 0.0017). Within the expandable group, the unilateral facetectomy-only subgroup had a 5.6 times higher subsidence rate than the PCO subgroup (26.8% vs 4.8%, p = 0.04). Four expandable cages collapsed over time.CONCLUSIONSExpandable TLIF cages may initially restore disc height better than static cages, but they also have higher rates of subsidence. Unilateral facetectomy alone may result in more subsidence with expandable cages than using bilateral PCO, potentially because of insufficient facet release. Although expandable cages may have more power to induce lordosis and restore disc height than static cages, subsidence and endplate violation may negate any significant gains compared to static cages.

OBJECTIVEA consequence of anterior cervical discectomy and fusion (ACDF) is graft subsidence, potentially leading to kyphosis, nonunion, foraminal stenosis, and recurrent pain. Bone density, as measured in Hounsfield units (HUs) on CT, may be associated with subsidence. The authors evaluated the association between HUs and subsidence rates after ACDF.METHODSA retrospective study of patients treated with single-level ACDF at the University of California, San Francisco, from 2008 to 2017 was performed. HU values were measured according to previously published methods. Only patients with preoperative CT, minimum 1-year follow-up, and single-level ACDF were included. Patients with posterior surgery, tumor, infection, trauma, deformity, or osteoporosis treatment were excluded. Changes in segmental height were measured at 1-year follow-up compared with immediate postoperative radiographs. Subsidence was defined as segmental height loss of more than 2 mm.RESULTSA total of 91 patients met inclusion criteria. There was no significant difference in age or sex between the subsidence and nonsubsidence groups. Mean HU values in the subsidence group (320.8 ± 23.9, n = 8) were significantly lower than those of the nonsubsidence group (389.1 ± 53.7, n = 83, p < 0.01, t-test). There was a negative correlation between the HU values and segmental height loss (Pearson’s coefficient −0.735, p = 0.01). Using receiver operating characteristic curves, the area under the curve was 0.89, and the most appropriate threshold of HU value was 343.7 (sensitivity 77.1%, specificity 87.5%). A preoperative lower HU is a risk factor for postoperative subsidence (binary logistic regression, p < 0.05). The subsidence rate and distance between allograft and polyetheretherketone (PEEK) materials were not significantly different (PEEK 0.9 ± 0.7 mm, allograft 1.0 ± 0.7 mm; p > 0.05).CONCLUSIONSLower preoperative CT HU values are associated with cage subsidence in single-level ACDF. Preoperative measurement of HUs may be useful in predicting outcomes after ACDF.

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Background For laminectomy and posterior spinal fusion (LPSF) surgery for cervical spondylotic myelopathy (CSM), the evidence is unclear as to whether fusions should cross the cervicothoracic junction (CTJ). Objective To compare LPSF outcomes between those with and without lower instrumented vertebrae (LIV) crossing the CTJ. Methods A consecutive series of adults undergoing LPSF for CSM from 2012 to 2018 with a minimum of 12-mo follow-up were identified. LPSF with subaxial upper instrumented vertebrae and LIV between C6 and T2 were included. Clinical and radiographic outcomes were compared. Results A total of 79 patients were included: 46 crossed the CTJ (crossed-CTJ) and 33 did not. The mean follow-up was 22.2 mo (minimum: 12 mo). Crossed-CTJ had higher preoperative C2-7 sagittal vertical axis (cSVA) (33.3 ± 16.0 vs 23.8 ± 12.4 mm, P = .01) but similar preoperative cervical lordosis (CL) and CL minus T1-slope (CL minus T1-slope) (P &gt; .05, both comparisons). The overall reoperation rate was 3.8% (crossed-CTJ: 2.2% vs not-crossed: 6.1%, P = .37). In adjusted analyses, crossed-CTJ was associated with superior cSVA (β = –9.7; P = .002), CL (β = 6.2; P = .04), and CL minus T1-slope (β = –6.6; P = .04), but longer operative times (β = 46.3; P = .001). Crossed- and not-crossed CTJ achieved similar postoperative patient-reported outcomes [Visual Analog Scale (VAS) neck pain, VAS arm pain, Nurick Grade, Modified Japanese Orthopedic Association Scale, Neck Disability Index, and EuroQol-5D] in adjusted multivariable analyses (adjusted P &gt; .05). For the entire cohort, higher postoperative CL was associated with lower postoperative arm pain (adjusted Pearson's r –0.1, P = .02). No postoperative cervical radiographic parameters were associated with neck pain (P &gt; .05). Conclusion Subaxial LPSF for CSM that crossed the CTJ were associated with superior radiographic outcomes for cSVA, CL, and CL minus T1-slope, but longer operative times. There were no differences in neck pain or reoperation rate.

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