COVID-19: How the Quarantine could lead to the Depreobesity.

This is the author accepted manuscript. The final version is available from Wolters Kluwer Health via the DOI in this record

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Translational medicine: challenges and new orthopaedic vision (Mediouni-Model)

Introduction: Many orthopaedic procedures require drilling of bone, especially fracture repair cases. Bone drilling results in heat generation due to the friction between the bone and the drill bit. A high-level of heat generation kills bone cells. Bone cell death results in resorption of bone around bone screws.Methods: We searched in the literature for data on parameters that influence drilling bone and could lead to thermal necrosis. The points of view of many orthopaedists and neurosurgeons based upon on previous practices and clinical experience are presented.Results: Several potential complications that lead to thermal necrosis are discussed and highlighted.Discussion: Even in the face of growing evidence as to the negative effects of heat induction during drilling, simple and effective methods for monitoring and cooling in real-time are not in widespread usage today. For that purpose, we propose some suggestions for the future of bone drilling, taking note of recent advances in autonomous robotics, intelligent systems and computer simulation techniques.Conclusions: These advances in prevention of thermal necrosis during bone drilling surgery are expected to reduce the risk of patient injury and costs for the health service.

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An overview of thermal necrosis: present and future

The making of a competent surgeon has always been a priority for the orthopaedic community. Although assessed skills can contribute to safer, more effective patient care, a precise definition has been deemed rather unattainable. In his article entitled “Creating the educated surgeon in the 21st century,” Gawande explains that “great surgeons” require several competencies including technical skills, safe judgment, decision-making skills, and communication with the patient. In 1982, Howell noted that a novice migrates through three phases: (1) “unconscious incompetence,” (2) “conscious incompetence,” and (3) “unconscious competence.” In 1990, Miller defined his triangle based on four steps: “Knows,” “Knows how,” “Shows how,” and “Does.” The surgeons progress toward each step based on the previous step. The main drawback of those models is that there is no distinction between competence and performance. In order to overcome this dilemma, “The Cambridge Model” has been proposed by Rethans et al. This model explains the difference between the assessment situation and real practice. For that purpose, the performance is based on competence. In their article entitled “Surgical experts: Born or made?” According to Sadideen et al. the trainee should develop and improve his or her surgical skills. Therefore, it appears that innate abilities play important roles in surgical expertise. The literature moves in one direction in the development of expertise: improving surgical practices. Therefore, this aspect still needs to be explored in greater depth. According to this, we can call this strategy “I-model,” that is to say, a deeper understanding of performance and its development will help the trainee to progress in practice (Figure 1). The success of this model depends on three criteria: (1) individual ability, with the trainee understanding that surgery is not just coordination between hands and eyes, but a practical-minded obsession; (2) repetitive performance that could be a benefit for surgeons faced with complex procedures; and (3) physical greatness, which is defined by Gladwell as “vision” to be able to react faced with novel practice situations. A deeper understanding of surgical competencies is good but not enough. Today, with complicated new orthopaedic practices, the question we should ask is how can orthopaedic surgeons integrate new sciences and discoveries into orthopaedic practice? To answer this question there needs to be interconnection between basic sciences and clinical sciences. Therefore, we can talk about a “T-model” that aims to bridge the gap between basic science and clinical results and the impact on surgical competencies (Figure 2). In his article, “A review of translational medicine. The future paradigm: how can we connect the orthopedic dots better?” Mediouni et al. proposed the concept of a “translational orthopaedist” who can move an idea all the way from basic research to clinical application. The success of this model is based on multidisciplinary teams who are involved in translational orthopaedics. The communication between surgeons with other scientists in many fields such as biology, chemistry, mathematics, and computer science have many benefits in terms of understanding solutions for complex clinical S P E C I A L F O C U S

A new generation of orthopaedic surgeons: “T-model”

Circular RNAs (circRNAs) are associated with rheumatoid arthritis (RA) development. The purpose of this study is to explore the function and mechanism of circRNA fragile mental retardation 2 (circ-AFF2) in the processes of rheumatoid arthritis fibroblast-like synoviocytes (RAFLSs). Circ-AFF2, microRNA (miR)-650, and 2′,3′-cyclic nucleotide 3′-phosphodiesterase (CNP) levels were determined in synovial tissues of RA and RAFLSs by quantitative reverse transcription polymerase chain reaction or Western blotting. Cell proliferation, inflammatory response, apoptosis, caspase3 activity, migration, invasion, and epithelial-mesenchymal transition (EMT) were investigated using Cell Counting Kit-8 (CCK-8), enzyme-linked immunosorbent assay (ELISA), flow cytometry, Transwell, and Western blotting analyses. Dual-luciferase reporter, RNA immunoprecipitation (RIP), and pull-down assays were performed to assess the binding relationship. Circ-AFF2 expression level was enhanced in synovial tissues of RA and RAFLSs. Circ-AFF2 overexpression facilitated cell proliferation, inflammatory response, migration, invasion, and EMT and repressed apoptosis in RAFLSs. Circ-AFF2 downregulation played an opposite role. Circ-AFF2 targeted miR-650, and miR-650 downregulation reversed the effect of circ-AFF2 interference on RAFLS processes. CNP was targeted by miR-650, and circ-AFF2 increased CNP expression by regulating miR-650. MiR-650 overexpression constrained cell proliferation, inflammatory response, migration, invasion, and EMT and contributed to apoptosis by decreasing CNP in RAFLSs. Circ-AFF2 promoted proliferation, inflammatory response, migration, and invasion of RAFLSs by modulating the miR-650/CNP axis.

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Circ-AFF2/miR-650/CNP axis promotes proliferation, inflammatory response, migration, and invasion of rheumatoid arthritis synovial fibroblasts.

Introduction: Patients with complex medical and surgical problems often travel great distances to prestigious university medical centers in search of solutions and in some cases for nothing more th

Balwant Rai

Papers

A review of translational medicine. The future paradigm: how can we connect the orthopedic dots better?