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Evaluating learning and change in orthopaedics: What is the evidence-base?
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作者 Epaminondas Markos Valsamis Mohamed Sukeik 《World Journal of Orthopedics》 2019年第11期378-386,共9页
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
关键词 LEARNING CHANGE Quality improvement ORTHOPAEDICS SURGICAL education
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Three-dimensional reconstructed magnetic resonance scans:Accuracy in identifying and defining knee meniscal tears 被引量:1
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作者 Neil Kruger Eugene Mc Nally +3 位作者 Sami Al-Ali Raj Rout Jonathan L Rees Andrew J Price 《World Journal of Orthopedics》 2016年第11期731-737,共7页
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
关键词 KNEE MENISCUS ARTHROSCOPY Magnetic RESONANCE imaging THREE-DIMENSIONAL reconstruction Materialise Interactive Medical Control System TEAR
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Role of LIGHT in the pathogenesis of joint destruction in rheumatoid arthritis 被引量:1
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作者 Afsie Sabokbar Sara Afrough +3 位作者 David J Mahoney Yoshinobu Uchihara Catherine Swales Nicholas A Athanasou 《World Journal of Experimental Medicine》 2017年第2期49-57,共9页
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
关键词 Receptor-activator nuclear factor KAPPA-B ligand OSTEOCLAST RHEUMATOID arthritis RESORPTION LIGHT
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Generation artificial intelligence(GenAI)and Biomaterials Translational:steering innovation without misdirection
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作者 Long Bai Zhidao Xia +1 位作者 James T.Triffitt Jiacan Su 《Biomaterials Translational》 2024年第1期1-2,共2页
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
关键词 artificial ILLUSTRATION discussions
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牛津单髁膝关节置换:长期结果(英文) 被引量:9
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作者 DW Murray BE Marks +2 位作者 L Kontochristos CAF Dodd HG Pandit 《中华关节外科杂志(电子版)》 CAS 2013年第4期74-78,共5页
牛津膝置换是使用最广泛的膝关节单髁置换(UKR)。牛津膝在37年前开始应用,拥有一个全匹配的活动衬垫,因而磨损率非常低。牛津膝最主要的使用指征是膝关节前内侧骨关节炎,这种病人至少占所有需要行膝关节置换术患者的50%。由于这一系统... 牛津膝置换是使用最广泛的膝关节单髁置换(UKR)。牛津膝在37年前开始应用,拥有一个全匹配的活动衬垫,因而磨损率非常低。牛津膝最主要的使用指征是膝关节前内侧骨关节炎,这种病人至少占所有需要行膝关节置换术患者的50%。由于这一系统的设计特点,传统UKR的反指征,如年龄、活动量、肥胖、髌股关节损害和软骨钙质沉着症等对于牛津膝均不是反指征。与全膝关节置换(TKR)相比,牛津膝提供更快的康复、更好的功能、更大的活动度和更好的术后满意度,发生并发症更少、程度更轻,病残率和死亡率更低。一个持续超过30年的研究显示在90%的病例中,牛津膝为患者终生提供了优或良的临床结果,且不需要翻修。在最近15年,牛津膝通过微创手术入路植入,涉及6000多例使用该入路牛津膝置换的9个研究报道显示,10年生存率约95%。在许多这样的研究中,医生们在拟行膝关节置换的患者中约50%使用了牛津单髁膝置换。 展开更多
关键词 膝关节置换 单髁 牛津膝 长期结果
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全肘关节置换术治疗类风湿性关节炎的疗效评价——三种假体的比较研究
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作者 CHRISTOPHER P. LITTLE ALASTAIR J. GRAHAM +3 位作者 GEORGIOS KARATZAS DAVID A. WOODS ANDREW J. CARR 卫小春(译) 《骨科动态》 2006年第1期6-13,共8页
背景:据我们所知,英文文献中只有两篇关于当前所用的肘关节假体的比较研究,因假体效果的比较是非常困难的。更好的了解不同假体的疗效对于指导选择合适的假体是很有意义的。 方法:我们将采用肘关节置换治疗的风湿性关节炎患者根据... 背景:据我们所知,英文文献中只有两篇关于当前所用的肘关节假体的比较研究,因假体效果的比较是非常困难的。更好的了解不同假体的疗效对于指导选择合适的假体是很有意义的。 方法:我们将采用肘关节置换治疗的风湿性关节炎患者根据假体类型的不同分为三组,即Souter—Strathclyde组、Kudo组和Coonrad—Morrey组。每组包括33个肘关节。所有手术均由一名医生或由他指导下完成。术后随访没有进行翻修手术的病例,随访时间Souter—Strathclyde组平均为61个月,Kud0组为67个月,Coonrad—Morrey组为68个月。临床功能评价包括疼痛缓解程度和屈曲程度。用生命曲线表评价假体生存率,翻修手术和假体松动的影像学表现作为终结点。 结果:各组在年龄、性别和随访时间方面有可比性。三组病例疼痛均得到缓解。三组中肘关节活动度的改善程度也很相似,但固定屈曲畸形和最大屈曲角度并未有显著改变。翻修术的原因主要有感染、脱位和无菌性松动。Coonrad—Morrey假体比其他二组生存率高。以翻修手术或影像学显示假体松动分别作为终结点,假体五年生存率Souter-Strathclyde组为85%和81%,Kudo组为93%和82%,Coonrad-Morrey组为90%和86%。而Coonrad—Morrey组影像学显示假体松动率较低。此组中16%的尺骨假体周围出现局灶型骨溶解,而其中一半的病例能发展为真正的松动。 结论:这三种假体在缓解疼痛和提高肘关节活动范围方面是相似的。我们相信Coonrad—Morrey假体的铰链装置可预防脱位,并不增加松动的危险。 可信水平:治疗性研究,Ⅲ级,进一步可信度参见作者介绍。 展开更多
关键词 全肘关节置换术 类风湿性关节炎 关节假体 疗效评价 置换治疗 影像学表现 五年生存率 假体松动 翻修手术 肘关节活动度
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A brief history of the development of stromal stem cells (stem cells of the skeleton) 被引量:3
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作者 James T.Triffitt 《Biomaterials Translational》 2021年第4期287-293,共7页
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
关键词 WORDS MEANINGS SKELETON
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改进和评估复合干预措施:医学研究委员会的新指南
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作者 Peter Craig Paul Dieppe +5 位作者 Sally Macintyre Susan Mitchie Irwin Nazareth Mark Petticrew 安伟(译) 武阳丰(校) 《英国医学杂志中文版》 2009年第1期43-47,共5页
评估复合的干预措施很复杂。医学研究委员会的评估框架(2000)因能使我们清晰了解如何完成这项复杂的任务,而受到欢迎。现在该研究会更新了他们的指南。
关键词 医学研究 干预措施 新指南 委员会 评估 复合
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合理的影像学检查——急性膝关节损伤的检查
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作者 James Teh Gregoris Kambouroglou +1 位作者 Julia Newton 王英民(译) 《英国医学杂志中文版》 2012年第5期314-316,共3页
普通x线片对于膝关节损伤的评估可能是不适当的;可能还需要其他的影像学技术,特别是核磁共振。
关键词 急性膝关节损伤 影像学检查 普通X线片 影像学技术 核磁共振
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Stem cell fate and microenvironment 被引量:1
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作者 James T.Triffitt Qian Wang 《Biomaterials Translational》 2022年第1期1-2,共2页
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
关键词 MICROENVIRONMENT MEDICINE entitled
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Application of stem cells in translational medicine
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作者 James T.Triffitt Qian Wang 《Biomaterials Translational》 2021年第4期285-286,共2页
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
关键词 ORGANS FIGURE JOURNAL
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