Tools to Improve Scientific Research

The mission of Arthroscopy is to provide authoritative, current, peer-reviewed clinical and basic science information regarding arthroscopic and related surgery. In addition, with a goal of improving the quality of the scientific research published in our journal and others, we develop and publish research pearls, statistical guides, article checklists and templates, and related tools. In sum, this effort allows our cadre of editors, reviewers, authors, and readers to strive to improve in our ability to create and critically analyze medical literature of the greatest merit. Our ultimate ambition is to publish more perfect articles with conclusions on which readers can rely.     

“Publish or Perish” Promotes Medical Literature Quantity Over Quality

When it comes to medical research, incentives align to promote “publish or perish.” This results in quantity over quality. A solution is to change the goal of medical scientist and clinician training from bolstering a curriculum vitae to mastering scientific research methods. In addition, the metric for scholarly authorship should be quality, for which validated measurement tools exist, rather than number of publications.     

Editorial Commentary: Adoption of New Medical Technology Requires Replication of Consistent Results Across Multiple Studies: Biologic Injections for Knee Osteoarthritis

Determining when to adopt new treatment methods in a clinical practice is a challenging undertaking. Uncertain outcomes of emerging technology can undermine the impartial assessment of risk and benefit. “Optimism bias” can lead to premature adoption of technology. An additional risk is that influential colleagues often persuade clinicians to innovate. “Replicability” or obtaining consistent results across studies aimed at answering the same scientific question must be a goal prior to adoption of innovative devices and treatments. The ability to replicate the results by a separate research group in a similar population with different input data is critical to gaining acceptance from providers without a personal stake in the development of technology.     

Editorial Commentary: Infographics Engage a Broader Audience Than Traditional Scientific Articles in the Medical Literature: The Latest Social Media Influencer?

Infographics are an evolving medium within the orthopaedic literature and support engagement of a broad audience than traditional scientific articles. Arthroscopy infographics have been published monthly since January 2019 on a range of topics relevant to the readership. Citation numbers have long been used as a metric for quality and relevance of a scientific article, although alternative metrics (altmetrics) are now available to quantify the online activity related to scholarly content. Altmetrics are defined as “metrics and qualitative data that are complementary to traditional, citation-based metrics,” and the altmetric attention score depends on 3 main factors: volume (number of “mentions”), sources (e.g. newspaper, blog, tweet), and author (source of the “mention”, e.g. physician vs journal). Recent research links altmetric scores to citation gains. Infographics are a tool for expanding, educating, and increasing the breadth of medical journal readership.     

Editorial Commentary: A Model for Shoulder Rotator Cuff Repair and for Basic Science Investigations

“Breaking the fourth wall” is a theater convention where the narrator or character speaks directly to the audience. As an Assistant Editor-in-Chief, as I comment on a recent basic science study investigating rotator cuff repair, I break the fourth wall and articulate areas of basic science research excellence that align with the vision that we hold for our journal. Inclusion of a powerful video strengthens the submission. We prefer to publish clinical videos in our companion journal, Arthroscopy Techniques, and encourage basic science video submissions to Arthroscopy. Basic science research requires step-by-tedious-step analogous to climbing a mountain. Establishment of a murine rotator cuff repair model was rigorous and research intensive, biomechanically, radiographically, histologically, and genetically documented, a huge step toward the bone-to-tendon healing research summit. This research results in a model for both rotator cuff repair and the pinnacle of quality, basic science research.     

Pro-Con Debate: Interdisciplinary Perspectives on Industry-Sponsored Research

ProNearly all new devices and drugs come from industry that provides two-thirds of the funding for medical research, and a much higher fraction of clinical research. Realistically, without corporate-funded studies, perioperative research would stagnate with little innovation and few new products. Opinions are ubiquitous and normal but do not constitute epidemiologic bias. Competent clinical research includes many protections against selection and measurement bias, and the publication process provides at least moderate protection against misinterpretation of results. Trial registries largely prevent selective data presentation. Sponsored trials are particularly protected against inappropriate corporate influence because they are usually codesigned with the US Food and Drug Administration, and analyses are based on formal predefined statistical plans, as well as being conducted with rigorous external monitoring. Novel products, which are essential for advances in clinical care, largely come from industry, and industry appropriately funds much of the required research. We should celebrate industry’s contribution to improvements in clinical care.ConWhile industry funding contributes to research and discovery, examples of industry-funded research demonstrate bias. In the setting of financial pressures and potential conflict of interest, bias can influence the type of study design, hypotheses being tested, rigor and transparency in data analysis, interpretation, as well as reporting of the results. Unlike public granting agencies, industry does not necessarily provide funding based on unbiased peer review following an open call for proposals. The focus on success can influence the choice of a comparator, which might not be ideal among the possible alternatives, the language used in the publication, and even the ability to publish. Unpublished negative trials can result in selected information being withheld from the scientific community and the public. Appropriate safeguards are needed to ensure that research addresses the most important and relevant questions, that results are available even when they do not support the use of a product produced by the funding company, that populations studied reflect the relevant patients, that the most rigorous approaches are applied, that studies have the appropriate power to address the question posed, and that conclusions are presented in an unbiased manner.     

转化医学时代的肝胆外科

转化医学是一种新兴的医学研究模式,其内涵包括有效地将医学基础研究的最新成果转化为可用的临床医学技术和产品,并把临床医疗中的实际问题反馈到实验室开展研究的双向过程,即“从实验室到病房” 和“从病房到实验室” 的双向研究。肝胆外科与转化医学是医学科学的尖端领域。近年来肝胆外科领域研究成果的临床转化应用得到世界各国科学家的共同关注,政府领导的相关法律、法规已开始制订。肝胆外科的进步离不开转化医学的贡献。在不远的将来,中国有望在肝胆外科与转化医学领域走在世界前列。中国外科界应放眼世界,集世界发展之大成,加快转化医学理念的传播与深入,努力改进技术理念并提升疗效。     

Medical Students’ Views on Cadaver and Organ Donation

BackgroundOrgan and cadaver donation are 2 important issues that contribute to the future of medicine. Organ donation is a miraculous gift and enables the donor to continue to “live” in others. Cadavers are usually part of medical students’ first encounters with clinical work and play a very important role in medical education. The attitudes of medical students toward both organ and cadaver donation were evaluated in the current study.MethodsSixteen phrases about cadaver and organ donation were presented to the fourth-, fifth-, and sixth-year students of the Kafkas University Faculty of Medicine. The answers were compared between male and female students using the χ² test.ResultsThere was a significant difference between the answers of the male and female students only to the first item (P = .043). Very important data were also obtained from the answers given to the other items in the study. Although many students, both male and female, agreed with the item “I would donate my organs,” the rate of agreement with “I would donate my body as a cadaver” was low for both sexes.ConclusionsThe results obtained from the study regarding organ and cadaver donation awareness are significant. It is extremely important to deal with the reluctance regarding this matter, starting from the medical students, to inform society in the appropriate manner.     

Editorial Commentary: The Power of Interpretation: Utilizing the P Value as a Spectrum,in Addition to Effect Size,Will Lead to Accurate Presentation of Results

Statistics have helped develop evidence-based medicine. Comparing groups and rejecting (or not) a null hypothesis is a main principle of the scientific method. Many studies have demonstrated that drawing conclusions based on the statistical result of a dichotomic P value instead of a spectrum can mislead us to conclude that there is “no difference” between two groups, or two treatments. In addition to the P value, the utilization of effect size (magnitude of difference between studied groups), may help us obtain a better global understanding of the statement “no effect”. Although statistical significance does not mean clinical significance, by learning to adequately interpret data, we can disclose transparent results and conclusions, as we ward off our own bias. After all, without appropriate interpretation, we may be blinded from the truth.     

Natural language processing to facilitate breast cancer research and management

The medical literature has been growing exponentially, and its size has become a barrier for physicians to locate and extract clinically useful information. As a promising solution, natural language processing (NLP), especially machine learning (ML)‐based NLP is a technology that potentially provides a promising solution. ML‐based NLP is based on training a computational algorithm with a large number of annotated examples to allow the computer to “learn” and “predict” the meaning of human language. Although NLP has been widely applied in industry and business, most physicians still are not aware of the huge potential of this technology in medicine, and the implementation of NLP in breast cancer research and management is fairly limited. With a real‐world successful project of identifying penetrance papers for breast and other cancer susceptibility genes, this review illustrates how to train and evaluate an NLP‐based medical abstract classifier, incorporate it into a semiautomatic meta‐analysis procedure, and validate the effectiveness of this procedure. Other implementations of NLP technology in breast cancer research, such as parsing pathology reports and mining electronic healthcare records, are also discussed. We hope this review will help breast cancer physicians and researchers to recognize, understand, and apply this technology to meet their own clinical or research needs.     

Animal models of spontaneous renal carcinoma: A possible rebirth?

Introduction and Objectives The animal models for renal carcinogenesis have allowed researchers to better understand the physiopathological, genetic, molecular, and immunological mechanisms underlying the development of human renal cancers from the induction of precancerous lesions to the metastatic process. Our study aimed to review and discuss the characteristics of all the spontaneous animal models of renal carcinogenesis described in scientific literature to date and see how they could address future challenges in the field of personalized medicine. Methods and Materials We reviewed all the papers on PubMed which focus on spontaneous animal models of renal carcinogenesis. To do so, we used the keywords “spontaneous” AND “animal model” AND “renal cancer” in the PubMed search engine. We also conducted a search using the keywords “spontaneous” AND “animal model” AND “kidney cancer.” PRISMA recommendations were used for the literature review. Results A total of 213 publications were found on PubMed with the keywords “spontaneous” AND “animal model” AND “kidney cancer.” 219 publications were found on PubMed with the keywords “spontaneous” AND “animal model” AND “renal cancer.” After pooling these 2 searches and removing the duplicate publications, 233 publications remained. Among these, 220 full-text articles were assessed for eligibility; 160 were removed because they were irrelevant to our topic, and the remaining 60 studies were included in our qualitative synthesis. Conclusions Many spontaneous animal models have been developed to study renal cancer. So far, these models have enabled the understanding of pathophysiological mechanisms underlying renal cancer. Though less appropriate than patient xenografts from the perspective of personalized medicine, we believe animal models can help medical professionals better understand the hows and whys of the genetic events underlying the intratumoral heterogeneity and spatial distribution of metastatic subclones.     

August Gottlieb Richter (1742–1812)

August Gottlieb Richter (1742–1812) is regarded as one of the most important surgeons and medical writers of the second half of the eighteenth century. In this publication his path through life and his scientific career in a period of permanent war are described. This is why the diagnosis and therapy of injuries played an important role in his work. The different aspects of thoracic injuries were presented by him in detail in his scientific practical journal Chirurgische Bibliothek (“Surgical library”) as well as in the fourth volume of his late work Anfangsgründe der Wundarzneykunst (“Elements of the art of surgery”). This article reports on and assesses these aspects and compares them with the work of other contemporary authors. Richter’s views on tracheotomy as well as first experience reports and case studies from the developing field of cardiology are considered. Particular emphasis is given to his critical and self-critical approach based on experience and reflection.     

Three-dimensional ultrasound

Laparoendoscopic surgery is fueled by technology, and advances in medical imaging may bring about further progress. The application of three-dimensional ultrasound to minimally invasive surgery represents technology “just over the horizon.” This article describes the scientific basis of three-dimensional ultrasound and its ability “to see” anatomy not readily visualized laparoscopically. Three-dimensional ultrasound may offer a more intuitive, accurate assessment of hidden anatomic structures in real time, using a safe, non-ionizing and cost-effecitve technology.     

The search for ideal hernia repair; mesh materials and types

Hernia surgery continues to draw the attention of surgeons, patients, and the industry. This strong interest has driven the establishment of professional medical societies with the sole purpose of furthering the understanding of hernias and hernia repair. In the more than 100 years of development, industry has played a major role in advancing the technology to perfect the performance of hernia repair with the hope of establishing the "best" technique and its associated technology. However, with the development of newer prosthetics and approaches to hernia repair, many surgeons do not fully understand the properties of the available prosthetics. The goal of this review is to highlight the different types of meshes in an effort to clarify to surgeons what types of materials are available to them and how to select an appropriate one for a given case.     

Evaluation of the Relationship Between Aspects of Medical Complexity and Work Relative Value Units (wRVUs) for Foot and Ankle Surgical Procedures

Work relative value units (wRVUs) have been assigned to current procedural terminology codes in an effort to help establish physician compensation. However, the ability of these to accurately and efficiently capture the time, technical, and perioperative managerial aspects required of various procedures has recently been called into question for several surgical subspecialties. Therefore, the objective of this investigation was to evaluate various measures of medical complexity against wRVUs for foot and ankle surgical procedures. The 2018 American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify and extract data related to the perioperative medical complexity of 16 foot and ankle surgical current procedural terminology codes. We observed a “weak” positive relationship between wRVUs and operation time as defined by a correlation coefficient of 0.234 (p < .001). Other variables associated with medical complexity in the perioperative period were found to significantly vary between wRVUs categories, but these differences were neither consistently nor directly associated with assigned relative values. We conclude that wRVUs might not always represent an efficient means for determining compensation for foot and ankle surgical procedures.     

Current guidelines regarding industry-sponsored continuing medical education

The importance of continuing medical education has been long recognized by the orthopaedic profession as vital in maintaining a current knowledge and skills base. There has been increasing concern over the expanding involvement of industry in sponsoring continuing medical education. Concomitant with rising costs of medical education is a decreasing source of funds from government and other sources; therefore industry has taken an active role in sponsoring continuing medical education, leading to a potential for serious conflict of interest. National and federal guidelines have been created to allow commercial sponsorship, yet leave the responsibility for the design, faculty, and content to the accredited provider. The guidelines are intended to prevent bias, keep commercial displays separate from educational presentations, and clearly state that industry-sponsored events should be primarily educational in nature and directly benefit the patient. Because of the potential conflict inherent within industry-sponsored continuing medical education, a cooperative relationship between educators, industry, and attendees of educational activities must be achieved to prevent bias and to keep the patient's best interest as paramount. Each orthopaedic surgeon has an ethical obligation to resolve any conflicts of interest in the best interest of the patient.     

Introducing the Orthoregeneration Network Foundation Review Articles: Guiding Tissue Regeneration and Biologic Therapies Into Practice

In this issue of Arthroscopy, readers will find the first of what are designed to be a series of peer-reviewed Orthoregeneration Network (ON) Foundation review articles. The ON Foundation is an independent, nonprofit, international foundation dedicated to promoting research and education in the field of orthopaedic tissue regeneration. ON defines “Orthoregeneration … as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration” making use of treatments, including “drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli.” The article is accessible and could be of interest to all readers, including clinicians, as well as basic scientists and researchers. It brings us great pleasure to collaborate with the ON Foundation and introduce the ON Foundation Reviews to the readers of Arthroscopy.     

医美科研课题查新与查新人员素质提升策略研究

医学美容科研查新及查新人员素质在医美行业中的地位日益提升，受到了广泛关注。随着科研 信息量的快速增长，查新工作越来越复杂，挑战明显增加，同时查新人员的素质直接影响到查新结果的质 量和效率。本文主要探讨医美科研查新质量以及查新人员素质的提升策略。为提高查新质量，提出了建立 医学美容查新体系和标准，包括规范查新流程、加强查新技术、确保查新结果的权威性和准确性。同时， 对于查新人员素质的提升，强调了文献检索、有效沟通和外语翻译能力的培养，以及服务意识、责任感、 成就导向意识和安全保密意识的重要性。本研究旨在为提升医美科研查新质量和查新人员素质提供理论 依据和实践建议，从而推动医美行业的持续发展。