Virtual interactive musculoskeletal system (VIMS) in orthopaedic research, education and clinical patient care

The ability to combine physiology and engineering analyses with computer sciences has opened the door to the possibility of creating the "Virtual Human" reality. This paper presents a broad foundation for a full-featured biomechanical simulator for the human musculoskeletal system physiology. This simulation technology unites the expertise in biomechanical analysis and graphic modeling to investigate joint and connective tissue mechanics at the structural level and to visualize the results in both static and animated forms together with the model. Adaptable anatomical models including prosthetic implants and fracture fixation devices and a robust computational infrastructure for static, kinematic, kinetic, and stress analyses under varying boundary and loading conditions are incorporated on a common platform, the VIMS (Virtual Interactive Musculoskeletal System). Within this software system, a manageable database containing long bone dimensions, connective tissue material properties and a library of skeletal joint system functional activities and loading conditions are also available and they can easily be modified, updated and expanded. Application software is also available to allow end-users to perform biomechanical analyses interactively. Examples using these models and the computational algorithms in a virtual laboratory environment are used to demonstrate the utility of these unique database and simulation technology. This integrated system, model library and database will impact on orthopaedic education, basic research, device development and application, and clinical patient care related to musculoskeletal joint system reconstruction, trauma management, and rehabilitation

Deleted in Liver Cancer 2 (DLC2) Was Dispensable for Development and Its Deficiency Did Not Aggravate Hepatocarcinogenesis

DLC2 (deleted in liver cancer 2), a Rho GTPase-activating protein, was previously shown to be underexpressed in human hepatocellular carcinoma and has tumor suppressor functions in cell culture models. We generated DLC2-deficient mice to investigate the tumor suppressor role of DLC2 in hepatocarcinogenesis and the function of DLC2 in vivo. In this study, we found that, unlike homologous DLC1, which is essential for embryonic development, DLC2 was dispensable for embryonic development and DLC2-deficient mice could survive to adulthood. We also did not observe a higher incidence of liver tumor formation or diethylnitrosamine (DEN)-induced hepatocarcinogenesis in DLC2-deficient mice. However, we observed that DLC2-deficient mice were smaller and had less adipose tissue than the wild type mice. These phenotypes were not due to reduction of cell size or defect in adipogenesis, as observed in the 190B RhoGAP-deficient mouse model. Together, these results suggest that deficiency in DLC2 alone does not enhance hepatocarcinogenesis

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Chinese nationalism and democracy during the war period 1937-1945 : a critique of the Jiuwang-Qimeng dichotomy

200

Socialism, capitalism, and democracy in Republican China : the political thought of Zhang Dongsun

Literacy contributions of Zhang Dongsun, a leading scholar of Western philosophy in the Republican period, are presented. His significant contributions to the studies of philosophy and culture, especially the theory of knowledge is discussed along with his views on socialism, capitalism, and democracy

The idea of freedom on modern China revisited : plural conceptions and dual responsibilities

Western historiography on the idea of freedom in modern China has tended to focus on its conception as service to the state and social ends, as illustrated by studies of Liang Qichao’s democratic thought; as a result, many other interpretations have been overlooked. This article locates Chinese notions of liberty in a broader context as a fusion of personal, national, social, civic, and moral freedoms. After revisiting Liang Qichao’s conception of freedom, it posits six others that are mutually interactive—freedom as liberation; as self-development, independent personality, and responsibility; as democracy and human rights; as a spiritual cultural necessity; as a private realm; and as autonomy and self-mastery. The article offers a more nuanced understanding of the issue of the primacy of collective interests over individual interests by developing the notion of dual responsibilities, or the dualism between the sanctity of personal liberty and the public morality of service to society and state

Chinese nationalism, conservatism and modernity (Nationalism in modern China)

200

New confucianism and chinese democratization : the thought and predicament of Zhang Junmai

This article probes Zhang Junmai's New Confucian political thought that evolved over time in different contexts. My argument is briefly as follows. Despite his early traditional Chinese education, Zhang came to Confucian philosophy via a Western route, his New Confucian political thought being a mix of "New Song Learning," German idealism, constitutionalism, and democratic socialism (or variably state socialism). Though already known as a New Confucian of the first generation during the Republican era, Zhang's major works on Confucianism did not appear until the contemporary PRC period. His views on Chinese culture and politics changed over time and space. An advocate of cultural assimilation and synthesis, Zhang considered Western learning essential for a renewal of Confucianism and a reconstruction of Chinese culture. But in the end, he was, consciously or unconsciously, entrapped in a predicament. On one level, he profoundly appreciated the strengths of modem Western thought and political institutions. Yet, on another, he insisted on Chinese culture being the core, or the foundation on which to build Western learning and institutions, thus unwittingly succumbing to the familiar ti-yong (spiritual essence-material function) dichotomy. For all his attempts, he failed also to reconcile, theoretically or practically, the claims of inner sagehood with those of the outer world, or the Lebenswelt. The project of making the new outer king out of inner sagehood was a forlorn hope, in spite of the availability of modem political thought, modern science, and new forms of economic and political organizations. Its failure demonstrated with a rare clarity that the New Confucians had neither the power nor the resources to change the outer realm of the sociopolitical order to fulfill Confucian moral goals. In this, they fared no better than their Song-Ming predecessors. In the twilight of his life, out of politics and living in exile in the United States, Zhang could only maintain that Confucianism was an important intellectual resource for Chinese democratization and modernization; he was left with many questions unanswered. Notwithstanding his striving, he found no escape from the kind of predicament on which Thomas Metzger has written.

State building, capitalist development, and social justice : social democracy in China's modern transformation, 1921-1949

This article explores social democracy in China as an intellectual current and political movement, seeking to demonstrate, on one hand, its similarities to European classical social democracy and, on the other, its Chinese peculiarities. It revises the earlier historiography that viewed liberalism in China as irrelevant to the crisis of Chinese society at the time. Instead, it argues that social democracy, linked to state building, capitalist development, and social justice, was a dominant feature of Chinese liberalism and politics, which provided an impetus to China’s modern transformation. Many intellectuals, such as Hu Shi, Zhang Junmai, and Zhang Dongsun, were simultaneously liberal, democratic, and socialist. Their frustrations in the end had much to do with the dominant mainstream political culture, represented by the GMD and the CCP, and little to do with the liberal, democratic, or socialist creed itself

In search of Chinese democracy : civil opposition in nationalist China 1929-1949/ Fung

xviii, 407 hal.; 23 cm