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Artifical intelligence in surgery: ethical considerations in the light of social trends in the perception of health and medicine. 外科手术中的人工智能：从健康和医学观念的社会趋势看伦理问题。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0029
Heiner Fangerau
{"title":"Artifical intelligence in surgery: ethical considerations in the light of social trends in the perception of health and medicine.","authors":"Heiner Fangerau","doi":"10.1530/EOR-24-0029","DOIUrl":"10.1530/EOR-24-0029","url":null,"abstract":"<p><p>The use of artificial intelligence (AI) in medicine and surgery is currently predicted to be very promising. However, AI has the potential to change the doctor's role and the doctor-patient relationship. It has the potential to support people's desires for health, along with the potential to nudge or push people to behave in a certain way. To understand these potentials, we must see AI in the light of social developments that have brought about changes in how medicine's role, in a given society, is understood. The trends of 'privatisation of medicine' and 'public-healthisation of the private' are proposed as a contextual backdrop to explain why AI raises ethical concerns different from those previously caused by new medical technologies, and which therefore need to be addressed specifically for AI.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long bone uninfected non-union: grafting techniques. 未感染的长骨非连接：移植技术。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0032
Enrique Gómez-Barrena, Christian Ehrnthaller
{"title":"Long bone uninfected non-union: grafting techniques.","authors":"Enrique Gómez-Barrena, Christian Ehrnthaller","doi":"10.1530/EOR-24-0032","DOIUrl":"10.1530/EOR-24-0032","url":null,"abstract":"<p><p>Long bone non-unions represent a serious clinical and socioeconomical problem due to the prolonged episodes, frequent sequelae, and variable treatment effectiveness. Bone grafts, classically involving the autologous iliac crest graft as the 'gold standard' bone graft, enhance bone regeneration and fracture healing incorporating osteoconductive and/or osteoinductive/osteogenic capacity to the non-union under treatment. Structural alternatives to autologous bone grafts include allografts and bone substitutes, expanding the available stock but loosing biological properties associated with cells in the graft. Biological alternatives to autologous bone grafts include bone marrow concentration from iliac crest aspiration, bone marrow aspiration from reaming of the diaphyseal medullary canal in the long bones, and isolated, expanded mesenchymal stem cells under investigation. When the combination with natural and synthetic bone substitutes allows for larger volumes of structural grafts, the enhancement of the biological regenerative properties through the incorporation of cells and their secretoma permits to foresee new bone grafting solutions and techniques.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bacteriophage therapy in musculoskeletal infections: from basic science to clinical application. 噬菌体疗法在肌肉骨骼感染中的应用：从基础科学到临床应用。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0042
Tristan Ferry, Jolien Onsea, Tiphaine Roussel-Gaillard, Cécile Batailler, Thomas Fintan Moriarty, Willem-Jan Metsemakers
{"title":"Bacteriophage therapy in musculoskeletal infections: from basic science to clinical application.","authors":"Tristan Ferry, Jolien Onsea, Tiphaine Roussel-Gaillard, Cécile Batailler, Thomas Fintan Moriarty, Willem-Jan Metsemakers","doi":"10.1530/EOR-24-0042","DOIUrl":"10.1530/EOR-24-0042","url":null,"abstract":"<p><p>The treatment of musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracture-related infection (FRI), is often complicated by biofilm-related challenges necessitating multiple revision surgeries and incurring substantial costs. The emergence of antimicrobial resistance (AMR) adds to the complexity of the problem, leading to increased morbidity and healthcare expenses. There is an urgent need for novel antibacterial strategies, with the World Health Organization endorsing non-traditional approaches like bacteriophage (phage) therapy. Phage therapy, involving the targeted application of lytic potent phages, shows promise in the treatment of MSIs. Although historical clinical trials and recent case studies present significant milestones in the evolution of phage therapy over the past century, challenges persist, including variability in study designs, administration protocols and phage selection. Efforts to enhance treatment efficacy consist of personalized phage therapy and combination with antibiotics. Future perspectives entail addressing regulatory barriers, standardizing treatment protocols, and conducting high-quality clinical trials to establish phage therapy's efficacy for the treatment of MSIs. Initiatives like the PHAGEFORCE study and the PHAGEinLYON Clinic programme aim to streamline phage therapy, facilitating personalized treatment approaches and systematic data collection to advance its clinical utility in these challenging infections.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Individualized megaimplants in acetabular revision arthroplasty: what have we learned in the last 15 years? 髋臼翻修关节置换术中的个性化巨型植入物：过去 15 年我们学到了什么？
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0064
Thorsten Gehrke, Mustafa Citak, Mustafa Akkaya
{"title":"Individualized megaimplants in acetabular revision arthroplasty: what have we learned in the last 15 years?","authors":"Thorsten Gehrke, Mustafa Citak, Mustafa Akkaya","doi":"10.1530/EOR-24-0064","DOIUrl":"10.1530/EOR-24-0064","url":null,"abstract":"<p><p>Acetabular revision arthroplasty, a demanding field of reconstructive hip surgery, calls for innovative strategies to deal with challenging bone defects and implant failure seen in revision cases. Conventional implant solutions might fall short of adequately addressing severe bone loss and ensuring stable fixation, highlighting the necessity of customized strategies. Personalized megaimplants, distinguished by their tailor-made design and large-scale construction, present a viable option to overcome these challenges. The present article provides an elaborate analysis of custom-made megaimplants in acetabular revision arthroplasty, shedding light on the underlying principles, design complexities, manufacturing methods, applications in the clinical setting, and outcome assessment. The aim of this review is to present a comprehensive insight into personalized megaimplants and their contribution to the advancement of orthopedic surgery.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Joint line and knee osteotomy. 关节线和膝关节截骨术
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0037
Andrea Pratobevera, Romain Seil, Jacques Menetrey
{"title":"Joint line and knee osteotomy.","authors":"Andrea Pratobevera, Romain Seil, Jacques Menetrey","doi":"10.1530/EOR-24-0037","DOIUrl":"10.1530/EOR-24-0037","url":null,"abstract":"<p><p>This review explores the intricate relationship between knee osteotomy and frontal plane joint line orientation, emphasizing the dynamic nature of the joint line's influence on knee forces and kinematics. Consideration of coronal alignments, knee phenotypes, and associated angles (medial proximal tibial angle (MTPA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA)) becomes crucial in surgical planning to avoid joint line deformities. The double-level osteotomy is to be considered a valid option, especially for severe deformities; however, the target patient cannot be selected solely based on high predicted postoperative joint line obliquity (JLO) and MPTA.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Which radial head fractures are best treated surgically? 哪些桡骨头骨折最适合手术治疗？
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0035
Anna E van der Windt, Lisette C Langenberg, Joost W Colaris, Denise Eygendaal
{"title":"Which radial head fractures are best treated surgically?","authors":"Anna E van der Windt, Lisette C Langenberg, Joost W Colaris, Denise Eygendaal","doi":"10.1530/EOR-24-0035","DOIUrl":"10.1530/EOR-24-0035","url":null,"abstract":"<p><p>Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically. The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus-valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow. The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries. Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery. Mechanical block to pronation/supination and comminution of the fracture are indications for surgery. The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How to distinguish a benign from a malignant tumour in children and when should a biopsy be done and by whom. 如何区分儿童良性肿瘤和恶性肿瘤，以及何时和由谁进行活组织检查。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0031
Marta Salom, Inês Balacó
{"title":"How to distinguish a benign from a malignant tumour in children and when should a biopsy be done and by whom.","authors":"Marta Salom, Inês Balacó","doi":"10.1530/EOR-24-0031","DOIUrl":"10.1530/EOR-24-0031","url":null,"abstract":"<p><p>Bone tumours are frequent in children but most of them are benign. Moreover, the incidence and type of tumours differ from those of adults. As an orthopaedic surgeon, we will likely encounter a bone lesion in a child and we must be able to distinguish if it is a benign lesion or has malignant characteristics and it is necessary to refer it to a centre specialized in tumours. We will discuss the key points we would have to ask in the medical history, look at the physical examination and the radiological characteristics that will allow us to distinguish between a benign and a malignant bone lesion in a child. When there are doubts about the malignancy of a bone lesion or if the diagnosis is not clear, a biopsy should be performed following certain rules in a specialized centre.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
WALANT surgery of the hand: state of the art. 手部 WALANT 手术：最新技术。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0033
Ilse Degreef, Donald H Lalonde
{"title":"WALANT surgery of the hand: state of the art.","authors":"Ilse Degreef, Donald H Lalonde","doi":"10.1530/EOR-24-0033","DOIUrl":"10.1530/EOR-24-0033","url":null,"abstract":"<p><p>Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancing spine care through AI and machine learning: overview and applications. 通过人工智能和机器学习推进脊柱护理：概述与应用。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0019
Andrea Cina, Fabio Galbusera
{"title":"Advancing spine care through AI and machine learning: overview and applications.","authors":"Andrea Cina, Fabio Galbusera","doi":"10.1530/EOR-24-0019","DOIUrl":"10.1530/EOR-24-0019","url":null,"abstract":"<p><p>Machine learning (ML), a subset of artificial intelligence, is crucial for spine care and research due to its ability to improve treatment selection and outcomes, leveraging the vast amounts of data generated in health care for more accurate diagnoses and decision support. ML's potential in spine care is particularly notable in radiological image analysis, including the localization and labeling of anatomical structures, detection and classification of radiological findings, and prediction of clinical outcomes, thereby paving the way for personalized medicine. The manuscript discusses ML's application in spine care, detailing supervised and unsupervised learning, regression, classification, and clustering, and highlights the importance of both internal and external validation in assessing ML model performance. Several ML algorithms such as linear models, support vector machines, decision trees, neural networks, and deep convolutional neural networks, can be used in the spine domain to analyze diverse data types (visual, tabular, omics, and multimodal).</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modern treatment of unicameral and aneurysmatic bone cysts. 单腔骨囊肿和动脉瘤性骨囊肿的现代治疗方法。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0027
Elisa Pala, Giulia Trovarelli, Andrea Angelini, Maria Chiara Cerchiaro, Pietro Ruggieri
{"title":"Modern treatment of unicameral and aneurysmatic bone cysts.","authors":"Elisa Pala, Giulia Trovarelli, Andrea Angelini, Maria Chiara Cerchiaro, Pietro Ruggieri","doi":"10.1530/EOR-24-0027","DOIUrl":"10.1530/EOR-24-0027","url":null,"abstract":"<p><p>The best treatment of unicameral bone cyst and aneurismatic bone cyst (ABC) is debated in the literature. For simple bone cysts, multiple treatments were proposed from observation only to open curettage. The historical treatment with intraosseous injection of methylprednisolone acetate into the bone cysts nowadays is reduced due to the morbidity of multiple injections and the risk of multiple pathologic fractures until the healing. Different types of treatments for ABC are reported, including surgery, percutaneous treatments, and medical treatments; however, there is currently no consensus on the best approach. The association of curettage, bone graft, and elastic stable intramedullary nail (ESIN) had a success rate of over 85%. Decompressing the cyst wall is more critical for increasing the healing rate than the type of graft used to fill the cavity. In ABC, sclerotherapy offers the advantages of lower invasiveness and morbidity, associated with better functional scores and faster return to full weight-bearing. Moreover, they can be used in challenging locations. Selective arterial embolization is a complex procedure and often requires association with other treatments. Further studies are needed to confirm the effectiveness of denosumab and its side effects on skeletally immature patients. Curettage with adjuvants and autogenous bone grafting still shows promising results and can be used in larger, aggressive defects or superficial lesions. For simple bone cysts, the combination of curettage, bone graft, and ESIN showed the best results. Sclerotherapy for ABC also shows promising results.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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