Learning and change are key elements of clinical governance and are responsible for the progression of our specialty.Although orthopaedics has been slow to embrace quality improvement,recent years have seen global dev...Learning and change are key elements of clinical governance and are responsible for the progression of our specialty.Although orthopaedics has been slow to embrace quality improvement,recent years have seen global developments in surgical education,quality improvement,and patient outcome research.This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered.Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure.Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data.With various organisations promoting centralisation of care,learning curve analysis is more important than ever before.The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide.Patient outcome research is rapidly changing,with an increased focus on quality of life measures.These are key to patients and their care.Costutility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care.Large-scale international,multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread.A global lack of surgeon equipoise will need to be addressed.Quality improvement projects frequently employ interrupted time-series analysis to evaluate change.This technique’s limitations must be acknowledged,and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur.Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability,validity,and importance of the conclusions drawn from orthopaedic research.展开更多
AIM To determine whether three-dimensional(3D) reconstruction from conventional magnetic resonance imaging(MRI) is able to accurately detect a meniscal tear, and define the configuration.METHODS Thirty-three patients&...AIM To determine whether three-dimensional(3D) reconstruction from conventional magnetic resonance imaging(MRI) is able to accurately detect a meniscal tear, and define the configuration.METHODS Thirty-three patients' 3T MRI scan data were collected and sagittal uni-planar 3D reconstructions performed from the preoperative MRI. There were 24 meniscal tears in 24 patients, and nine controls. All patients had arthroscopic corroboration of MRI findings. Two independent observers prospectively reported on all 33 reconstructions. Meniscal tear presence or absence was noted, and tear configuration subsequently categorised as either radial, bucket-handle, parrot beak, horizontal or complex.RESULTS Identification of control menisci or meniscal tear presence was excellent(Accuracy: observer 1 = 90.9%; observer 2 = 81.8%). Of the tear configurations, bucket handle tears were accurately identified(Accuracy observer 1 and 2 = 80%). The remaining tear configurations were notaccurately discernable.CONCLUSION Uni-planar 3D reconstruction from 3T MRI knee scan sequences are useful in identifying normal menisci and menisci with bucket-handle tears. Advances in MRI sequencing and reconstruction software are awaited for accurate identification of the remaining meniscal tear configurations.展开更多
AIM To characterise the role of substitutes for receptoractivator nuclear factor kappa-B ligand(RANKL) in rheumatoid arthritis(RA) joint destruction. METHODS Synovial fluid(SF) macrophages isolated from the knee joint...AIM To characterise the role of substitutes for receptoractivator nuclear factor kappa-B ligand(RANKL) in rheumatoid arthritis(RA) joint destruction. METHODS Synovial fluid(SF) macrophages isolated from the knee joint of RA patients were incubated with 25 ng/m L macrophage-colony stimulating factor(M-CSF) and 50 ng/mL LIGHT(lymphotoxin-like, exhibits inducible expression and competes with herpes simplex virus glycoprotein D for herpes virus entry mediator, a receptor expressed by T lymphocytes) in the presence and absence of 25 ng/mL RANKL and 100 ng/mL osteoprotegerin(OPG) on glass coverslips and dentine slices. Osteoclastogenesis was assessed by the formation of multinucleated cells(MNCs) expressing tartrate-resistant acid phosphatase(TRAP) on coverslips and the extent of lacunar resorption pit formation on dentine slices. The concentration of LIGHT in RA and osteoarthritis(OA) synovial fluid was measured by an enzyme-linked immunosorbent assay(ELISA) and the expression of LIGHT in RA and OA synovium was determined by immunohistochemistry using an indirect immunoperoxidase technique. RESULTS In cultures of RA SF macrophages treated with LIGHT and M-CSF, there was significant formation of TRAP + MNCs on coverslips and extensive lacunar resorption pit formation on dentine slices. SF-macrophage-osteoclast differentiation was not inhibited by the addition of OPG, a decoy receptor for RANKL. Resorption pits were smaller and less confluent than in RANKL-treated cultures but the overall percentage area of the dentine slice resorbed was comparable in LIGHT-and RANKL-treated cultures. LIGHT significantly stimulated RANKL-induced lacunar resorption compared with RA SF macrophages treated with either RANKL or LIGHT alone. LIGHT was strongly expressed by synovial lining cells, subintimal macrophages and endothelial cells in RA synovium and the concentration of LIGHT was much higher in RA compared with OA SF.CONCLUSION LIGHT is highly expressed in RA synovium and SF, stimulates RANKL-independent/dependent osteoclastogenesis from SF macrophages and may contribute to marginal erosion formation.展开更多
In the dynamic landscape of generative artificial intelligence(GenAI),recent developments,such as the artificial research organisation OpenAI’s introduction of the text-to-video generation tool Sora,have again catapu...In the dynamic landscape of generative artificial intelligence(GenAI),recent developments,such as the artificial research organisation OpenAI’s introduction of the text-to-video generation tool Sora,have again catapulted GenAI into the limelight.Thus reigniting discussions on the swift march towards an era of future controlled usage of artificial general intelligence(AGI).Concurrently,in the realm of scientific research,the use of GenAI tools like DALL·E to generate inaccurate scientific illustrations for publication and the skepticism surrounding findings published in Nature from the AI-driven automated laboratory,A-Lab,have sparked widespread scientific controversy1.展开更多
In all aspects of communication the meanings of words and definitions are of paramount importance for clear understanding and transmission of ideas.However,these meanings may change with time so that words and phrases...In all aspects of communication the meanings of words and definitions are of paramount importance for clear understanding and transmission of ideas.However,these meanings may change with time so that words and phrases take on different interpretations.Furthermore,the way words are used in writing significantly affects the conveyance of ideas from one mind to another.1 In the long history of the study of the histogenesis of bone we see some of these changes in meaning and understanding of concepts that have perhaps contributed to serious misinterpretation of the ideas of some investigators in the field.It is hoped that this brief historical perspective may explain and clarify at least some of the problems that have resulted.展开更多
For successful translational use of stem cells in biomedicine,knowledge of the quality of the cells,the presence of bioactive factors,and the nature of the microenvironmental niches is paramount.They may be regarded a...For successful translational use of stem cells in biomedicine,knowledge of the quality of the cells,the presence of bioactive factors,and the nature of the microenvironmental niches is paramount.They may be regarded as the Three Musketeers as they unite“All for one,one for all”1 to control the trafficking,survival,proliferation,and differentiation of stem cells.In this second themed issue of Biomaterials Translational,entitled“Application of Stem Cells in Translational Medicine:Stem Cells Part II”.展开更多
We are pleased to devote the following two issues of Biomaterials Translational to the important subject of the potential translation of stem cells for regenerative medicine and disease treatment.Stem cells with capac...We are pleased to devote the following two issues of Biomaterials Translational to the important subject of the potential translation of stem cells for regenerative medicine and disease treatment.Stem cells with capacities to renew their own tissue are now considered present in all tissues and organs of the body.Such cells have been of great interest to biologists and clinicians over the past century,since Haeckel in his‘Natural history of creation’first coined the term in 1868.1 The nature of the definition of what constitutes a stem cell has changed with time,but since the 1970s there has been an explosion of research publications on stem cells(Figure 1).This has involved increasing consideration of these primitive cells,that exist in the embryo and postnatally,for translation to the clinic for medical use and significant public health benefit.The trend in research output continues to increase exponentially with almost 72,000 publications on stem cells being recorded in the past year alone(searched using Web of Science databases).Hence there is great urgency and adequate justification for dedication of appreciable journal emphasis to this topic.In this issue,Stem Cells-Part I,there are a variety of topics within this theme that are covered either as viewpoint,review or research papers.展开更多
文摘Learning and change are key elements of clinical governance and are responsible for the progression of our specialty.Although orthopaedics has been slow to embrace quality improvement,recent years have seen global developments in surgical education,quality improvement,and patient outcome research.This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered.Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure.Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data.With various organisations promoting centralisation of care,learning curve analysis is more important than ever before.The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide.Patient outcome research is rapidly changing,with an increased focus on quality of life measures.These are key to patients and their care.Costutility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care.Large-scale international,multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread.A global lack of surgeon equipoise will need to be addressed.Quality improvement projects frequently employ interrupted time-series analysis to evaluate change.This technique’s limitations must be acknowledged,and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur.Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability,validity,and importance of the conclusions drawn from orthopaedic research.
文摘AIM To determine whether three-dimensional(3D) reconstruction from conventional magnetic resonance imaging(MRI) is able to accurately detect a meniscal tear, and define the configuration.METHODS Thirty-three patients' 3T MRI scan data were collected and sagittal uni-planar 3D reconstructions performed from the preoperative MRI. There were 24 meniscal tears in 24 patients, and nine controls. All patients had arthroscopic corroboration of MRI findings. Two independent observers prospectively reported on all 33 reconstructions. Meniscal tear presence or absence was noted, and tear configuration subsequently categorised as either radial, bucket-handle, parrot beak, horizontal or complex.RESULTS Identification of control menisci or meniscal tear presence was excellent(Accuracy: observer 1 = 90.9%; observer 2 = 81.8%). Of the tear configurations, bucket handle tears were accurately identified(Accuracy observer 1 and 2 = 80%). The remaining tear configurations were notaccurately discernable.CONCLUSION Uni-planar 3D reconstruction from 3T MRI knee scan sequences are useful in identifying normal menisci and menisci with bucket-handle tears. Advances in MRI sequencing and reconstruction software are awaited for accurate identification of the remaining meniscal tear configurations.
基金Supported by the Rosetrees Trust,No.242Arthritis Research Campaign(United Kingdom),No.18358.
文摘AIM To characterise the role of substitutes for receptoractivator nuclear factor kappa-B ligand(RANKL) in rheumatoid arthritis(RA) joint destruction. METHODS Synovial fluid(SF) macrophages isolated from the knee joint of RA patients were incubated with 25 ng/m L macrophage-colony stimulating factor(M-CSF) and 50 ng/mL LIGHT(lymphotoxin-like, exhibits inducible expression and competes with herpes simplex virus glycoprotein D for herpes virus entry mediator, a receptor expressed by T lymphocytes) in the presence and absence of 25 ng/mL RANKL and 100 ng/mL osteoprotegerin(OPG) on glass coverslips and dentine slices. Osteoclastogenesis was assessed by the formation of multinucleated cells(MNCs) expressing tartrate-resistant acid phosphatase(TRAP) on coverslips and the extent of lacunar resorption pit formation on dentine slices. The concentration of LIGHT in RA and osteoarthritis(OA) synovial fluid was measured by an enzyme-linked immunosorbent assay(ELISA) and the expression of LIGHT in RA and OA synovium was determined by immunohistochemistry using an indirect immunoperoxidase technique. RESULTS In cultures of RA SF macrophages treated with LIGHT and M-CSF, there was significant formation of TRAP + MNCs on coverslips and extensive lacunar resorption pit formation on dentine slices. SF-macrophage-osteoclast differentiation was not inhibited by the addition of OPG, a decoy receptor for RANKL. Resorption pits were smaller and less confluent than in RANKL-treated cultures but the overall percentage area of the dentine slice resorbed was comparable in LIGHT-and RANKL-treated cultures. LIGHT significantly stimulated RANKL-induced lacunar resorption compared with RA SF macrophages treated with either RANKL or LIGHT alone. LIGHT was strongly expressed by synovial lining cells, subintimal macrophages and endothelial cells in RA synovium and the concentration of LIGHT was much higher in RA compared with OA SF.CONCLUSION LIGHT is highly expressed in RA synovium and SF, stimulates RANKL-independent/dependent osteoclastogenesis from SF macrophages and may contribute to marginal erosion formation.
基金financially supported by Integrated Project of Major Research Plan of National Natural Science Foundation of China(No.92249303)Young Elite Scientist Sponsorship Program by China Association for Science and Technology(No.YESS20230049).
文摘In the dynamic landscape of generative artificial intelligence(GenAI),recent developments,such as the artificial research organisation OpenAI’s introduction of the text-to-video generation tool Sora,have again catapulted GenAI into the limelight.Thus reigniting discussions on the swift march towards an era of future controlled usage of artificial general intelligence(AGI).Concurrently,in the realm of scientific research,the use of GenAI tools like DALL·E to generate inaccurate scientific illustrations for publication and the skepticism surrounding findings published in Nature from the AI-driven automated laboratory,A-Lab,have sparked widespread scientific controversy1.
文摘In all aspects of communication the meanings of words and definitions are of paramount importance for clear understanding and transmission of ideas.However,these meanings may change with time so that words and phrases take on different interpretations.Furthermore,the way words are used in writing significantly affects the conveyance of ideas from one mind to another.1 In the long history of the study of the histogenesis of bone we see some of these changes in meaning and understanding of concepts that have perhaps contributed to serious misinterpretation of the ideas of some investigators in the field.It is hoped that this brief historical perspective may explain and clarify at least some of the problems that have resulted.
文摘For successful translational use of stem cells in biomedicine,knowledge of the quality of the cells,the presence of bioactive factors,and the nature of the microenvironmental niches is paramount.They may be regarded as the Three Musketeers as they unite“All for one,one for all”1 to control the trafficking,survival,proliferation,and differentiation of stem cells.In this second themed issue of Biomaterials Translational,entitled“Application of Stem Cells in Translational Medicine:Stem Cells Part II”.
文摘We are pleased to devote the following two issues of Biomaterials Translational to the important subject of the potential translation of stem cells for regenerative medicine and disease treatment.Stem cells with capacities to renew their own tissue are now considered present in all tissues and organs of the body.Such cells have been of great interest to biologists and clinicians over the past century,since Haeckel in his‘Natural history of creation’first coined the term in 1868.1 The nature of the definition of what constitutes a stem cell has changed with time,but since the 1970s there has been an explosion of research publications on stem cells(Figure 1).This has involved increasing consideration of these primitive cells,that exist in the embryo and postnatally,for translation to the clinic for medical use and significant public health benefit.The trend in research output continues to increase exponentially with almost 72,000 publications on stem cells being recorded in the past year alone(searched using Web of Science databases).Hence there is great urgency and adequate justification for dedication of appreciable journal emphasis to this topic.In this issue,Stem Cells-Part I,there are a variety of topics within this theme that are covered either as viewpoint,review or research papers.