Concept of Artificial Intelligence (AI) and Its Use in Orthopaedic Practice: Applications and Pitfalls: A Narrative Review

Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review is to assess and analyze the use of AI and its use in orthopedic practice, as well as its applications, limitations, and pitfalls. Methods: A review of all relevant databases such as EMBASE, Cochrane Database of Systematic Reviews, MEDLINE, Science Citation Index, Scopus, and Web of Science with keywords of AI, orthopedic surgery, applications, and drawbacks. All related articles on AI and orthopaedic practice were reviewed. A total of 3210 articles were included in the review. Results: The data from 351 studies were analyzed where in orthopedic surgery. AI is being used for diagnostic procedures, radiological diagnosis, models of clinical care, and utilization of hospital and bed resources. AI has also taken a chunk of share in assisted robotic orthopaedic surgery. Conclusions: AI has now become part of the orthopedic practice and will further increase its stake in the healthcare industry. Nonetheless, clinicians should remain aware of AI’s serious limitations and pitfalls and consider the drawbacks and errors in its use.

教育数字化赋能乡村教师高质量发展的时代意涵、现实隐忧与推进路径

为了顺应数字化社会的发展趋势,实施教育数字化战略行动,推动教育数字化转型势在必行。教育数字化赋能乡村教师高质量发展意指依托数字技术的核心支撑与创新应用,推动数字技术与乡村教师发展各维度的深度整合,助力乡村教师的教育空间、教学范式、知识储备、能力结构与乡村教师队伍管理等多方面的转型与变革,打造适应教育数字化发展趋势的高质量乡村教师队伍。同时教育数字化赋能乡村教师高质量发展也面临着数字技术焦虑,压制乡村教师高质量发展动力;数字素养薄弱,制约乡村教师高质量发展行动;数字资源不均,加剧乡村教师高质量发展鸿沟;数字成本繁重,加重乡村教师高质量发展负担等现实问题。基于文化路径、素养路径、资源路径与管理路径等推进逻辑,通过培养乡村教师数字文化自觉观念、实施乡村教师数字素养提升工程、构建乡村教师数字资源共享群落与完善乡村教师数字负担管理体系等路径,促进乡村教师高质量发展。

克拉通内盆地走滑断层地震判识的若干陷阱

克拉通盆地内走滑断层位移量小、变形微弱且构造复杂,深层地震低分辨率识别走滑断层困难且受诸多假象影响。通过剖析塔里木和四川盆地克拉通内走滑断层的典型地震现象,结合地质因素综合分析辨别走滑断层是否发育,总结了典型的地震假象并建立三大类陷阱模式,主要包括:①基底陡崖、阶梯状断裂与断垒结构可能误判为“花状构造”,基底盖层垂向发育的相似褶皱也可能成为走滑构造假象;②喷发岩、蒸发岩厚度、岩性的横向变化,可能造成地震层速度横向突变,导致下伏岩体在地震剖面上产生似走滑断层的高陡假象;③垂向规模发育的沟谷地形、岩溶地貌、岩相相变等地质现象可能出现似走滑断层的地震响应。为避免这些地震解释陷阱,在提高走滑断层地震分辨率的基础上,排除蒸发岩和火成岩的速度影响,剔除地形地貌与岩相变化的影响,并基于以地震平面属性为主的典型走滑构造识别,排除地震走滑断层的假象,建立合理的走滑断层地震地质解释模式。

Artificial Intelligence for Global Health: Difficulties and Challenges: A Narrative Review

Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improving patient outcomes by shuffling enormous volumes of health data—from health records and clinical studies to genetic information analyzing it much faster than humans. AI also helps in the improvement of medical imaging and medical diagnosis. There is an increased optimism regarding the use of applications of AI locally but can these facets be translated globally in the advancement and delivery of healthcare with the help of AI. At present majority of AI developments and applications in health care provide to the needs of developed countries and there is little effort to develop programs which could help to improve healthcare delivery globally. We performed this narrative review to assess the difficulties and discrepancies in implementing AI in global health delivery and find ways to improve.

地铁空间施工中基坑降水对渗流场的影响模拟预测研究

为了对地下水层结构稳定性进行模拟预测,从而保障地铁施工过程的安全,研究利用构建的地质水文模型分析测试三种基坑降水方案的性能。研究结果表明,隔水帷幕下辐射井降水方案在辐射管管径为0.1~0.3 m时,疏降时间维持在5~12 d,最大总抽水量为291279.124 m^(3)。实践结果证明隔水帷幕下辐射井降水方案降水效果较好,应用价值更高,对地铁空间施工中地下地质水文结果的稳定性提升有帮助。

5-Bromo-2'-deoxyuridine labeling:historical perspectives,factors infiuencing the detection,toxicity,and its implications in the neurogenesis

The halopyrimidine 5-bromo-2′-deoxyuridine(BrdU)is an exogenous marker of DNA synthesis.Since the introduction of monoclonal antibodies against BrdU,an increasing number of methodologies have been used for the immunodetection of this synthesized bromine-tagged base analogue into replicating DNA.BrdU labeling is widely used for identifying neuron precursors and following their fate during the embryonic,perinatal,and adult neurogenesis in a variety of vertebrate species including birds,reptiles,and mammals.Due to BrdU toxicity,its incorporation into replicating DNA presents adverse consequences on the generation,survival,and settled patterns of cells.This may lead to false results and misinterpretation in the identification of proliferative neuroblasts.In this review,I will indicate the detrimental effects of this nucleoside during the development of the central nervous system,as well as the reliability of BrdU labeling to detect proliferating neuroblasts.Moreover,it will show factors influencing BrdU immunodetection and the contribution of this nucleoside to the study of prenatal,perinatal,and adult neurogenesis.Human adult neurogenesis will also be discussed.It is my hope that this review serves as a reference for those researchers who focused on detecting cells that are in the synthetic phase of the cell cycle.

评价赋能高校教育高质量发展的基本路径与实施策略

高等教育高质量发展的落点是高校。高校教育高质量发展是高等教育高质量发展的基础,是高校高质量发展的内核和真义所在。教育评价是确立、判断和影响教育质量的实践活动,对质量发展既有正向作用也有负向作用。当前高校教育评价存在质量发展标准制定不够合理、质量发展水平判断不够科学、提升质量发展措施不够有效、防范评价负向效应不够自觉等问题,有必要基于质量与评价的内在关系逻辑,按照确立标准体系、开展科学评判、优化提质措施、严防评价陷阱的基本路径,实施标准系统化、评判立体化、提质多向化、防患分层化策略,通过明确合理方位、把准水平状态、促进有效发力、消减负面干扰,不断提升评价赋能高校教育高质量发展水平,继而助推高等教育高质量发展,为教育强国建设注入动力和活力。

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

Chronic Subdural Hematoma: Pitfalls to Avoid for Better Outcome

Introduction: Chronic subdural hematoma is one of the commonest intracranial haemorrhages that affect elderly. Headache and focal neurological deficits are among the commonest presentations. It carries excellent prognosis especially when evacuated probably on right timing. Recurrence rate ranging from 8% - 37% in literatures, we will highlight tricks during peri-operative period to have better outcome and decrease recurrence. Patients and methods: We operated 45 cases of chronic subdural hematoma in Cairo university emergencyhospital, during the period from November 2016 to December 2017;CT brain was done for all cases;clinical data were reported;burr hole evacuation was the standard technique. Suction drain with mild suction pressure was applied and hospital stay was 3 - 4 days after surgery. Patients were followed up to three months. Results: Forty-five patients were operated with 27 cases (60%) having their ages between 5th and 7th decades. Among Twenty-nine males and 16 females, eleven patients (25%) were confused;headache was observed in 12 patients, weakness in 31 cases (69%), dysphasia in two cases and two patients were on renal dialysis. Hypertension was associated as a comorbidity in 18 patients, diabetes mellitus in 11 patients, and smoking in 11 patients. Forty-two patients were discharged home within 3 - 4 days;two cases developed small-sized intra-cerebral hematoma, one case of wound infection, and excellent outcome for all cases on three months follow up visit. Conclusions: Chronic subdural hematoma is one of the commonest intra-cranial haemorrhages in elderly with excellent outcome if managed meticulously in right timing. Good control of co-morbidities, insuring slow clearing of hematoma fluid and staged closure technique are factors linked with better outcome. But larger studies are needed.

Pitfalls in Positron Emission Tomography/Computed Tomography Imaging:Causes and Their Classifications

Objective To describe the pitfalls in positron emission tomography/computed tomography (PET/CT) imaging and classify them according to the principles of their generation. Methods We summarized retrospectively the 18F-fluorodeoxyglucose (FDP) PET/CT imaging pit-falls through reviewing the PET/CT images of 872 patients. The pitfalls were divided into artifacts and infrequent physiological uptake, and the artifacts were further classified according to their causes. Meanwhile, we calculated the incidences of various pitfalls. Whether the PET/CT pitfalls influenced the diagnostic decision was analyzed. The appearances of pitfalls in PET were also described. Results Pitfalls could be found in PET/CT images of 684 (78.4%) patients. Artifacts were found in 664 (76.15%) patients, and could be classified into self-factor artifacts and equipment-or technology-related artifacts. Among self-factor artifacts, respiratory motion (57.5%), postprandial or hyperglycemia artifacts (2.41%), and metal or high density matter artifacts (1.38%) were frequent. As for equipment- or technology-related factors, injection point outleakage or radiotracer contamination (13.88%) and truncation artifacts (1.83%) were most common ones. Infrequent physiological FDG uptakes, including fatty uptake, endometrial uptake, and bilateral breast feeding period uptake, were found in 20 (2.29%) patients. Among all pitfalls, the artifacts in 92 (13.4%) patients and infrequent physiological uptakes in 6 (0.88%) patients affected the diagnostic results. Artifact images in PET could be described as hot or cold area and the images of infrequent physiological uptake were always shown as hot area. Conclusions The incidence of pitfall in PET/CT imaging was high and the causes of pitfalls are various. Among all causes that artifacts generated, respiratory motion is the most common. Some pitfalls may disturb clinical physicians' decision, so it is important to recognize artifacts and physiological uptake, and distinguish them from pathological uptakes.

Pitfalls and optimal approaches to diagnose melioidosis

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melidoidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review

We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature. FDG PET, CT, MRI, ultrasound and histology were performed according to standardized protocols in our case. The literature search was performed on PubMed.gov. The literature search revealed 29 relevant publications starting with 2002. The high metabolic activity of hibernomas is a precarious pitfall in the staging of patients with a high pretest probability of malignancy and an increasing number of published cases indicate a possibly underestimated problem necessitating histological work-up in most cases. In our experience and in accordance with the literature unusually high uptake of a lesion and fat equivalent density in the CT should raise the suspicion for a hibernoma. The differential diagnosis between hibernomas and liposarcoma is often impossible without biopsy and histological work-up to prevent unnecessary treatment.

Epithelioid Angiosarcoma of Bone: A Neoplasm with Potential Pitfalls in Diagnosis

Angiosarcoma of bone is an exceedingly rare primary bone malignancy that can present as an aggressive osteolytic lesion. This subset can radiologically mimic non-vascular neoplasms and impose serious challenges in reaching the correct diagnosis. Meanwhile histological diagnosis can be extremely challenging too, as the pathological features often resemble that of aneurysmal bone cysts. We present an unusual case of a 22-year-old woman who presented with a rapidly growing humeral tumor of 8 months’ duration. The case of intraosseous angiosarcoma presented as a diagnostic dilemma and the relevant radiological and pathologic findings were discussed. We describe the clinical, radiological and pathological features of this unique case, and review the literature concerning Angiosarcoma of bone. Our case highlights the diagnostic difficulties for such very rare tumours and clinico-pathological correlation is of paramount importance to differential diagnosis.

The pitfalls in electrocatalytic nitrogen reduction for ammonia synthesis

Ammonia synthesis by electrocatalytic nitrogen reduction reaction(EC-NRR)has gained momentum in recent years fueled by its potential to operate at ambient conditions,unlike the highly energyintensive yet long-standing Haber-Bosch process.However,the large disparity of the yields and Faradic efficiencies reported for EC-NRR raises serious concerns about the reliability of the experimental results.In this perspective,we elaborate on the potential sources of error when assessing EC-NRR and update the testing protocols to circumvent them,and more importantly,we pose a general call for consensus on ammonia production analysis and reporting to lay the solid foundations that this burgeoning field requires to thrive.

Pitfalls in Assessing Risks from Carcinogens

The decision to classify a chemical as a human carcinogen must depend upon agreed conclusions from epidemiology, bioassays, and some short-term corroborating tests; information from only one of these disciplines is inadequate. Most pitfalls appear in interpreting the results from animal bioassays; this report will concentrate on them. Often the conclusion is accepted that a chemical is an animal carcinogen without a critical appraisal of the experimental design. By manipulating the experiment, 90 + % of all chemicals can induce some tumor in a rodent. Pitfalls encountered in bioassays result from not specifying the exact agent under test and how it relates to human exposure, using inappropriate routes of administration unrelated to humans, administering illogically high doses, or concluding that a cancer was induced without adequate histopathological description of the lesion. Importance of animal husbandry is often overlooked. Pitfalls are also related to short-term tests. Finally, a major pitfall in assessing carcinogenic risk from chemicals is drawing global conclusions about the carcinogenicity of an agent after the detection of only one or two tumors in the treated group.

增长转型最后的机会——城市更新的财务陷阱

随着城市化1.0阶段进入尾声,“城市更新”正在取代“成片开发”成为助推经济增长的新一级火箭。由于独特的财税制度,中国城市更新的背后是城市化从资本增长阶段向运营增长阶段的转型,必须从一个更高的维度讨论城市更新的财务问题。当下更新模式所面对的财务陷阱,正让许多城市挥霍了其城市化的“最后一桶金”,损失了跨越增长鸿沟实现增长转型最后的资本。城市更新更根本的目标是创造可持续的财务现金流,“好的城市更新”可以帮助地方政府完成从房地产市场向股票市场的迁移,实现城市化从高速度向高质量的转换。

Potential Economic Pitfalls Call for Removal of Institutional Drawbacks——An Interview with Mr. FAN Gang (樊纲), Ph.D. of Economics, Doctoral Advisor, Director of National Research Institute of Economics

The continuous rise of consumer price index (CPI) has increased concern over China's macroeconomic situation. Will inflation have a disastrous impact on the Chinese economy? What risks are brewing behind the booming real estate and stock markets? Have bubbles already occurred in the Chinese economy? From his office in Guohong Building, Beijing, Dr. Fan Gang gave his views on these questions in an exclusive interview with China Economist.

Sclerotic marginal zone lymphoma:A case report

BACKGROUND Marginal zone lymphoma(MZL)is an indolent non-Hodgkin B cell lymphoma with various architectural pattern including perifollicular,follicular colonization,nodular,micronodular,and diffuse patterns.A sclerotic variant has not been previously reported and represents a diagnostic pitfall.CASE SUMMARY A 66-year-old male developed left upper extremity swelling.Chest computed tomography(CT)in September 2020 showed 14 cm mass in left axilla.Needle core biopsy of axillary lymph node showed sclerotic tissue with atypical B lymphoid infiltrate but was non-diagnostic.Excisional biopsy was performed for diagnosis and showed extensive fibrosis and minor component of infiltrating B cells.Flow cytometry showed a small population of CD5-,CD10-,kappa restricted B cells.Monoclonal immunoglobulin heavy chain and light chain gene rearrangement were identified.Upon being diagnosed with MZL,patient was treated with rituximab,cyclophosphamide,doxorubicin,vincristine,and prednisone and achieved complete remission by positron emission tomography/CT.CONCLUSION This is an important case report because by morphology this case could have easily been overlooked as non-specific fibrosis with chronic inflammation representing a significant diagnostic pitfall.Moreover,this constitutes a new architectural pattern.While sclerotic lymphomas have rarely been described(often misdiagnosed as retroperitoneal fibrosis),we do not know of any cases describing this architectural presentation of MZL.

椎体成形术治疗骨质疏松性压缩骨折中病椎的选择及常见的误区和预防策略

[目的]骨质疏松性椎体压缩骨折往往是多发的,本文旨在探讨如何选择造成症状的骨折椎体(病椎)以及常见的误区和预防方法。[方法]回顾性分析48例78个椎体经皮穿刺椎体成形术治疗的骨质疏松性压缩骨折患者,男15例,女33例,年龄67～82岁,平均77.3岁,椎体骨折部位T8～L5,术前均行胸腰椎正侧位X线片及T1W1,T2W1及STIR像MRI检查,结合患者的疼痛及叩痛部位来确定病椎。其中单侧注射36例,双侧注射12例,骨水泥注射量3～7ml。临床疗效采用VAS评分和Oswestry功能障碍指数(ODI)评分进行评价并对并发症进行分析。[结果]所有患者随访1年以上,平均15.6个月(12～26个月),VAS评分由术前9.1到术后2.2和最终随访时2.5(P<0.001)。Oswestry评分由术前63到术后25和最终随访时28(P<0.01)。所有患者腰背疼痛均有不同程度缓解,其中30例疼痛完全消失,2例经右侧穿刺的患者右侧疼痛缓解,但左侧疼痛未缓解。1例T8椎体骨折的患者术后背部疼痛基本缓解,但双侧肋骨疼痛未缓解。1例术中穿刺时神经损伤,术后遗留下肢疼痛,1例患者术后即刻出现骨水泥单体中毒症状,3例胸片示肺栓塞但无临床症状,20例出现不同程度骨水泥渗漏,但无神经压迫症状,无死亡等严重并发症发生。[结论]骨质疏松性压缩骨折中病椎的选择要综合考虑,不仅根据X线片,更重要的是要结合MRI上T1W1像病椎表现为低信号,T2W1像上表现为高信号,而STIR像上仍表现为高信号;陈旧骨折没有必要穿刺;穿刺尽可能达到骨折最重的部位,必要时采用双侧穿刺;为避免肺栓塞,一定要等骨水泥较为粘稠即面团状时再注射。