Alignment in total knee arthroplasty : what’s in a name?

Dissatisfaction following total knee arthroplasty is a well-documented phenomenon. Although many factors have been implicated, including modifiable and nonmodifiable patient factors, emphasis over the past decade has been on implant alignment and stability as both a cause of, and a solution to, this problem. Several alignment targets have evolved with a proliferation of techniques following the introduction of computer and robotic-assisted surgery. Mechanical alignment targets may achieve mechanically-sound alignment while ignoring the soft tissue envelope; kinematic alignment respects the soft tissue envelope while ignoring the mechanical environment. Functional alignment is proposed as a hybrid technique to allow mechanically-sound, soft tissue-friendly alignment targets to be identified and achieved

Arthroscopic simulation using a knee model can be used to train speed and gaze strategies in knee arthroscopy

Purpose This study aimed to determine the effect of a simulation course on gaze fixation strategies of participants performing arthroscopy. Methods Participants (n = 16) were recruited from two one-day simulation-based knee arthroscopy courses, and were asked to undergo a task before and after the course, which involved identifying a series of arthroscopic landmarks. The gaze fixation of the participants was recorded with a wearable eye-tracking system. The time taken to complete the task and proportion of time participants spent with their gaze fixated on the arthroscopic stack, the knee model, and away from the stack or knee model were recorded. Results Participants demonstrated a statistically decreased completion time in their second attempt compared to the first attempt (P = 0.001). In their second attempt, they also demonstrated improved gaze fixation strategies, with a significantly increased amount (P = 0.008) and proportion of time (P = 0.003) spent fixated on the screen vs. knee model. Conclusion Simulation improved arthroscopic skills in orthopaedic surgeons, specifically by improving their gaze control strategies and decreasing the amount of time taken to identify and mark landmarks in an arthroscopic task

Towards video-based surgical workflow understanding in open orthopaedic surgery

Safe and efficient surgical training and workflow management play a critical role in clinical competency and ultimately, patient outcomes. Video data in minimally invasive surgery (MIS) have enabled opportunities for vision-based artificial intelligence (AI) systems to improve surgical skills training and assurance through post-operative video analysis and development of real-time computer-assisted interventions (CAI). Despite the availability of mounted cameras for the operating room (OR), similar capabilities are much more complex to develop for recording open surgery procedures, which has resulted in a shortage of exemplar video-based training materials. In this paper, we present a potential solution to record open surgical procedures using head-mounted cameras. Recorded videos were anonymised to remove patient and staff identifiable information using a machine learning algorithm that achieves state-of-the-art results on the OR Face dataset. We then propose a CNN-LSTM-based model to automatically segment videos into different surgical phases, which has never been previously demonstrated in open procedures. The redacted videos, along with the automatically predicted phases, are then available for surgeons and their teams for post-operative review and analysis. To our knowledge, this is the first demonstration of the feasibility of deploying camera recording systems and developing machine learning-based workflow analysis solutions for open surgery, particularly in orthopaedics

Small Interfering RNA Targeted to IGF-IR Delays Tumor Growth and Induces Proinflammatory Cytokines in a Mouse Breast Cancer Model

Insulin-like growth factor I (IGF-I) and its type I receptor (IGF-IR) play significant roles in tumorigenesis and in immune response. Here, we wanted to know whether an RNA interference approach targeted to IGF-IR could be used for specific antitumor immunostimulation in a breast cancer model. For that, we evaluated short interfering RNA (siRNAs) for inhibition of in vivo tumor growth and immunological stimulation in immunocompetent mice. We designed 2′-O-methyl-modified siRNAs to inhibit expression of IGF-IR in two murine breast cancer cell lines (EMT6, C4HD). Cell transfection of IGF-IR siRNAs decreased proliferation, diminished phosphorylation of downstream signaling pathway proteins, AKT and ERK, and caused a G0/G1 cell cycle block. The IGF-IR silencing also induced secretion of two proinflammatory cytokines, TNF- α and IFN-γ. When we transfected C4HD cells with siRNAs targeting IGF-IR, mammary tumor growth was strongly delayed in syngenic mice. Histology of developing tumors in mice grafted with IGF-IR siRNA treated C4HD cells revealed a low mitotic index, and infiltration of lymphocytes and polymorphonuclear neutrophils, suggesting activation of an antitumor immune response. When we used C4HD cells treated with siRNA as an immunogen, we observed an increase in delayed-type hypersensitivity and the presence of cytotoxic splenocytes against wild-type C4HD cells, indicative of evolving immune response. Our findings show that silencing IGF-IR using synthetic siRNA bearing 2′-O-methyl nucleotides may offer a new clinical approach for treatment of mammary tumors expressing IGF-IR. Interestingly, our work also suggests that crosstalk between IGF-I axis and antitumor immune response can mobilize proinflammatory cytokines

Peer review

The maintenance of quality and integrity in clinical and basic science research depends upon peer review. This process has stood the test of time and has evolved to meet increasing work loads, and ways of detecting fraud in the scientific community. However, in the 21st century, the emphasis on evidence-based medicine and good science has placed pressure on the ways in which the peer review system is used by most journals. This paper reviews the peer review system and the problems it faces in the digital age, and proposes possible solutions. Cite this article: Bone Joint J 2014;96-B:436-41

Alternative flight route generator by genetic algorithms

This paper presents a new air traffic route generator based on genetic algorithms. Due to traffic growth, direct (and near direct) routes are becoming increasingly congested and there is a real need for spreading traffic on new alternative routes. Those routes have to be different from several operational criteria and must not generate too much extra distance compared to the direct route. To reach this goal, a GA has been implemented with efficient sharing which automatically allows the emergence of different alternative routes. This algorithm has been tried on French air space and gives realistic operational results