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.

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.

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 pitfalls 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 tectmology-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 up-take, 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.

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.

A Discussion of Usefulness and Pitfall of Elicitation and Introspection

Nowadays, many scholars would like to use evidence derived from elicitation and introspection in their research. Both elicitation and introspection are common methods of data collection. The essay discusses the usefulness and pitfall of elicitation and introspection. It finds out that both elicitation and introspection have their own advantages and disadvantages.

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.

Pitfalls in interpretation of shallow seismic data

High-resolution shallow seismic methods are the most widely used geophysical methods in near surface characterization. However, in many cases interpreting the seismic images can be misleading. In this article, we present three case studies where results from P-wave seismic reflection, SH-wave seismic reflection, and multi-channel analysis of surface wave （MASW） surveys were incorrectly interpreted because of inadequate constraints on either the surveyed sites surface or subsurface conditions. A P-wave reflection survey feature was first interpreted as a shallow fault zone but it was later determined to result from a high level of background noise as the acquisition passed through a road intersection. A SH-wave seismic reflection survey feature was interpreted to be a reverse dip-slip fault but targeted drilling showed it was deep local erosion into the bedrock surface. Finally, in an MASW survey, a steeply dipping feature was first interpreted as a bedrock valley. However, later exploratory drilling showed the feature to be a shallow layer of very soft lake sediment that severely damped most of the applied surface wave frequency band. Although initial interpretations were incorrect, they stimulated discussions among geophysicists and geologists and underscored the need for meaningful cooperation and discourse between the scientists before, during, and after geophysical data acquisition.

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.

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.

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.

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.

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.

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.

Pitfalls of restriction enzyme analysis in identifying, characterizing,typing, and naming viral pathogens in the era of whole genome data, as illustrated by HAdV type 55

Restriction endonuclease analysis(REA),or restriction fragment length polymorphism(RFLP),was useful for identifying and determining the relatedness and putative identities of microbial strains(Tang et al.,1997)and for characterizing and discriminating large numbers of samples inexpensively in the past。

Loss of HER2 in breast cancer: biological mechanisms and technical pitfalls

Loss of HER2 in previously HER2-positive breast tumors is not rare, occurring in up to 50% of breast cancers;however, clinical research and practice underestimate this issue. Many studies have reported the loss of HER2 afterneoadjuvant therapy and at metastatic relapse and identified clinicopathological variables more frequentlyassociated with this event. Nevertheless, the biological mechanisms underlying HER2 loss are still poorlyunderstood. HER2 downregulation, intratumoral heterogeneity, clonal selection, and true subtype switch have beensuggested as potential causes of HER2 loss, but translational studies specifically investigating the biology behindHER2 loss are virtually absent. On the other side, technical pitfalls may justify HER2 loss in some of these samples.The best treatment strategy for patients with HER2 loss is currently unknown. Considering the prevalence of thisphenomenon and its apparent correlation with worse outcomes, we believe that correlative studies specificallyaddressing HER2 loss are warranted.

Pitfalls of Using Chinese or Expatriate Staff to Run Your Company

Chinese staff The question needs to be asked-is it normal business practice, anywhere, to have one person in control of all aspects of your country operations? No, it isn't. And with very good reason:

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.

Composition and Distribution of Soil Spider Assemblages in Three Natural Secondary Forests in Ziwuling, Gansu

Soil spiders were pitfall-trapped once every month in three forest vegetation types of Ziwuling natural secondary forest region, Gansu Province from April to October, 2004. A total of 2 164 spiders were collected, belonging to 43 species in 19 families, captured in 630 pitfall trap collections. Linyphiidae, Gnaphosidae and Lycosodae were found to be the dominant families in all habitat types, and the composition of soil spider assemblages was different between the three habitats. Ecological indices of diversity, richness and evenness were significantly different between the three habitats （ P 〈 0.05）. The relative abundance of guilds （based on numbers of individuals） varied greatly （P 〈 0.01）, which may releet resource availability within habitat types. The existence of different patterns within the assemblages reflects the importance of maintaining habitat heterogeneity and vegetation types in order to preserve soil spider biodiversity.