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Kriener K, Whiting H, Storr N, Homes R, Lala R, Gabrielyan R, Kuang J, Rubin B, Frails E, Sandstrom H, Futter C, Midwinter M. Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review. JBI Evid Synth 2023; 21:2309-2405. [PMID: 37732940 DOI: 10.11124/jbies-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research. INTRODUCTION Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests. INCLUSION CRITERIA Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review. METHODS This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats. RESULTS Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values. CONCLUSIONS This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards. REVIEW REGISTRATION Open Science Framework https://osf.io/fgb34.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Harrison Whiting
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Royal Brisbane Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Storr
- Gold Coast University Hospital, Southport, QLD Australia
| | - Ryan Homes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Raushan Lala
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Robert Gabrielyan
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Jasmine Kuang
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Bryn Rubin
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Edward Frails
- Department of Chemical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hannah Sandstrom
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Christopher Futter
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Anaesthesia and Intensive Care Program, Herston Biofabrication institute, Brisbane, QLD, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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崔 泽, 陈 增, 黄 赛, 杨 洪, 雷 静, 朱 丹. [Development of on-line lateral stiffness measurement system for anterior cruciate ligament and its influence on anterior cruciate ligament reconstruction]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2021; 38:145-153. [PMID: 33899439 PMCID: PMC10307570 DOI: 10.7507/1001-5515.202006060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/12/2020] [Indexed: 11/03/2022]
Abstract
The anterior cruciate ligament (ACL) reconstruction mostly relies on the experience of surgeons. To improve the effectiveness and adaptability of the tension after ACL reconstruction in knee joint rehabilitation, this paper establishes a lateral force measurement model with relaxation characteristics and designs an on-line stiffness measurement system of ACL. In this paper, we selected 20 sheep knee joints as experimental material for the knee joint stability test before the ACL reconstruction operation, which were divided into two groups for a comparative test of single-bundle ACL reconstruction through the anterolateral approach. The first group of surgeons carried out intraoperative detection with routine procedures. The second group used ACL on-line stiffness measurement system for intraoperative detection. After that, the above two groups were tested for postoperative stability. The study results show that the tension accuracy is (- 2.3 ± 0.04)%, and the displacement error is (1.5 ± 1.8)%. The forward stability, internal rotation stability, and external rotation stability of the two groups were better than those before operation ( P < 0.05). But the data of the group using the system were closer to the preoperative knee joint measurement index, and there was no significant difference between them ( P > 0.05). The system established in this paper is expected to help clinicians judge the ACL reconstruction tension in the operation process and effectively improve the surgical effect.
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Affiliation(s)
- 泽 崔
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
| | - 增昊 陈
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
| | - 赛帅 黄
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
| | - 洪鑫 杨
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
| | - 静桃 雷
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
| | - 丹杰 朱
- 上海大学 机电工程与自动化学院(上海 200444)School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P.R.China
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Vaghela KR, Trockels A, Carobene M. Active vs passive haptic feedback technology in virtual reality arthroscopy simulation: Which is most realistic? J Clin Orthop Trauma 2021; 16:249-256. [PMID: 33717962 PMCID: PMC7920125 DOI: 10.1016/j.jcot.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/04/2020] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Virtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism. PURPOSE To assess the difference in face validity between two high fidelity VR simulators employing passive and active haptic feedback technology respectively. METHOD 38 participants were recruited and divided into intermediate and expert groups based on orthopaedic training grade. Each participant completed a 12-point diagnostic knee arthroscopy VR module using the active haptic Simbionix ARTHRO Mentor and passive haptic VirtaMed ArthroS simulators. Subsequently, each participant completed a validated simulator face validity questionnaire. RESULTS The ARTHRO Mentor active haptic system failed to achieve face validity with mean scores for external appearance (6.61), intra-articular appearance (4.78) and instrumentation (4.36) falling below the acceptable threshold (≥7.0). The ArthroS passive haptic simulator demonstrated satisfactory scores in all domains: external appearance (8.42), intra-articular appearance (7.65), instrumentation (7.21) and was significantly (p < 0.001) more realistic than ARTHRO Mentor for all metrics. 61% of participants gave scores ≥7.0 for questions pertaining to haptic feedback realism from intra-articular structures such as menisci and ACL/PCL for the ArthroS vs. 12% for ARTHRO Mentor. There was no difference in face-validity perception between intermediate and expert groups for either simulator (p > 0.05). CONCLUSION Current active haptic technology which employs motors to simulate tactile feedback fails to demonstrate sufficient face-validity or match the sophistication of passive haptic systems in high fidelity arthroscopy simulators. Textured rubber phantoms that mirror the anatomy and haptic properties of the knee joint provide a significantly more realistic training experience for both intermediate and expert arthroscopists.
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Affiliation(s)
- Kalpesh R. Vaghela
- Department of Trauma and Orthopaedics, The Royal London Hospital, Percivall Pott Rotation, London, UK
| | - Amaury Trockels
- Department of Elderly Medicine, Southend University Hospital, Southend-On-Sea, UK,Corresponding author.
| | - Marco Carobene
- Department of Computer Science, University College London, London, UK
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Mason EM, Deal MJ, Richey BP, Baker A, Zeini IM, Service BC, Osbahr DC. Innate Arthroscopic & Laparoscopic Surgical Skills: A Systematic Review of Predictive Performance Indicators Within Novice Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2021; 78:178-200. [PMID: 32591323 DOI: 10.1016/j.jsurg.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To query the literature for predictive factors for performance on arthroscopic and laparoscopic surgical simulators in novice surgical trainees. These predictive factors may prove a valuable tool in identifying certain innate potential to becoming a future skilled surgeon that could benefit both surgical residency candidates and program directors alike, while also improving patient care. DESIGN Systematic Review. RESULTS The initial searches yielded 249 articles. After screening titles/abstracts and implementing inclusion and exclusion criteria, 36 studies were included in the final systematic review. CONCLUSIONS Current literature suggests that video game experience/frequency, psychomotor and visuospatial aptitude, and perceptual ability are among the most promising predictive indicators of baseline simulator performance. Study limitations include utilization of different standards for characterizing predictive factors. Future studies should aim to utilize standard guidelines for accurate quantification of innate predictive factors. Future research should also focus on utilizing standardized simulator platforms and aptitude tests to allow for more accurate cross-study comparisons and meta-analyses with larger sample sizes.
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Affiliation(s)
- Eric M Mason
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Bradley P Richey
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alexandra Baker
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Benjamin C Service
- Sports Medicine Division, Orlando Health Orthopedic Institute, Orlando, Florida
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Richey BP, Deal MJ, Baker A, Mason EM, Zeini IM, Osbahr DC, Service BC. Predictors of Performance on the Arthrobox Arthroscopy Simulator for Medical Students. Arthrosc Sports Med Rehabil 2020; 2:e829-e837. [PMID: 33376998 PMCID: PMC7754603 DOI: 10.1016/j.asmr.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/22/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study was to analyze the effects of past participation in athletics, the playing of musical instruments and video games and other variables on medical students’ performance on an arthroscopic simulator task as well as other assessments of visuospatial ability. Methods We assessed 50 medical students by using previously validated tests of manual dexterity and spatial reasoning as well as performance on an arthroscopic surgical simulator. Inclusion criteria were to be 18 years of age or older and to be a student studying in the M.D. program at a single public state university. Exclusion criteria were previous use of an arthroscopic surgery training device or active participation in an actual arthroscopic surgery, defined as participating as a surgeon, resident trainee, physician’s assistant, or other similarly credentialed professional. Students were also assessed by the use of a high-fidelity ultrasound simulator as a marker of visuospatial capacity. Students were then surveyed about lifestyle characteristics and personal attributes hypothesized to predict surgical skill, such as playing sports, instruments or video games. Results A total of 49 participants were included in this study. High levels of athletic experience were significantly associated with improved performance on the arthroscopic surgical simulator (P = .008). Participants with higher levels of athletic experience were more likely to achieve competence on the arthroscopic surgical simulator (P = .006). Scores on the arthroscopic simulator task were significantly correlated with both ultrasound simulator shape-identification task scores and masked mirror-tracing task scores, as independent measures of visuospatial ability (P = .015 and P = .013, respectively). Conclusions This study provides evidence of a statistically significant correlation between increased experience in athletics and single-use test performance on an arthroscopic surgical simulator. Subjects who reported higher levels of experience in athletics were significantly more likely to achieve competence in the arthroscopic surgical simulator task. Finally, statistically significant correlations were found between subjects’ performance scores on tasks assessed by the surgical simulator, masked mirror-trace assessment and ultrasound simulator. Clinical Relevance Simulator-based training and education allow for the development of arthroscopic skills prior to operating on a live patient in a clinical situation. This is an area of great interest in orthopaedic education. Our study evaluates parameters in a trainee that may relate to a higher performance level in technical skills on an arthroscopic surgical simulator.
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Affiliation(s)
- Bradley P. Richey
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | | | - Alexandra Baker
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | - Eric M. Mason
- University of Central Florida, College of Medicine, Orlando, Florida, U.S.A
| | - Ibrahim Mamdouh Zeini
- Orlando Health Orthopedics and Sports Medicine, Orlando, Florida, U.S.A
- Address correspondence to Ibrahim Mamdouh Zeini, Ph.D. P.M.P., S.A., C.C.R.P., Sports Medicine Division, Orlando Health, 22 Lake Beauty Drive, MP 141, Orlando, Florida 32806, U.S.A.
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Hartmann B, Marchi G, Alberton P, Farkas Z, Aszodi A, Roths J, Clausen-Schaumann H. Early Detection of Cartilage Degeneration: A Comparison of Histology, Fiber Bragg Grating-Based Micro-Indentation, and Atomic Force Microscopy-Based Nano-Indentation. Int J Mol Sci 2020; 21:ijms21197384. [PMID: 33036285 PMCID: PMC7582717 DOI: 10.3390/ijms21197384] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 12/27/2022] Open
Abstract
We have determined the sensitivity and detection limit of a new fiber Bragg grating (FBG)-based optoelectronic micro-indenter for biomechanical testing of cartilage and compared the results to indentation-type atomic force microscopy (IT-AFM) and histological staining. As test samples, we used bovine articular cartilage, which was enzymatically degraded ex vivo for five minutes using different concentrations of collagenase (5, 50, 100 and 500 µg/mL) to mimic moderate extracellular matrix deterioration seen in early-stage osteoarthritis (OA). Picrosirius Red staining and polarization microscopy demonstrated gradual, concentration-dependent disorganization of the collagen fibrillar network in the superficial zone of the explants. Osteoarthritis Research Society International (OARSI) grading of histopathological changes did not discriminate between undigested and enzymatically degraded explants. IT-AFM was the most sensitive method for detecting minute changes in cartilage biomechanics induced by the lowest collagenase concentration, however, it did not distinguish different levels of cartilage degeneration for collagenase concentrations higher than 5 µg/mL. The FBG micro-indenter provided a better and more precise assessment of the level of cartilage degeneration than the OARSI histological grading system but it was less sensitive at detecting mechanical changes than IT-AFM. The FBG-sensor allowed us to observe differences in cartilage biomechanics for collagenase concentrations of 100 and 500 µg/mL. Our results confirm that the FBG sensor is capable of detecting small changes in articular cartilage stiffness, which may be associated with initial cartilage degeneration caused by early OA.
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Affiliation(s)
- Bastian Hartmann
- Center for Applied Tissue Engineering and Regenerative Medicine–CANTER, Munich University of Applied Sciences, 80335 Munich, Germany; (B.H.); (A.A.)
- Laboratory of Experimental Surgery and Regenerative Medicine (ExperiMed), Clinic for General, Trauma and Reconstructive Surgery, University of Munich, 82152 Planegg, Germany; (P.A.); (Z.F.)
- Center for Nanoscience (CeNS), University of Munich, 80331 Munich, Germany
| | - Gabriele Marchi
- Photonics Laboratory, Department of Applied Sciences and Mechatronics, Munich University of Applied Sciences, 80335 Munich, Germany; (G.M.); (J.R.)
| | - Paolo Alberton
- Laboratory of Experimental Surgery and Regenerative Medicine (ExperiMed), Clinic for General, Trauma and Reconstructive Surgery, University of Munich, 82152 Planegg, Germany; (P.A.); (Z.F.)
| | - Zsuzsanna Farkas
- Laboratory of Experimental Surgery and Regenerative Medicine (ExperiMed), Clinic for General, Trauma and Reconstructive Surgery, University of Munich, 82152 Planegg, Germany; (P.A.); (Z.F.)
| | - Attila Aszodi
- Center for Applied Tissue Engineering and Regenerative Medicine–CANTER, Munich University of Applied Sciences, 80335 Munich, Germany; (B.H.); (A.A.)
- Laboratory of Experimental Surgery and Regenerative Medicine (ExperiMed), Clinic for General, Trauma and Reconstructive Surgery, University of Munich, 82152 Planegg, Germany; (P.A.); (Z.F.)
| | - Johannes Roths
- Photonics Laboratory, Department of Applied Sciences and Mechatronics, Munich University of Applied Sciences, 80335 Munich, Germany; (G.M.); (J.R.)
| | - Hauke Clausen-Schaumann
- Center for Applied Tissue Engineering and Regenerative Medicine–CANTER, Munich University of Applied Sciences, 80335 Munich, Germany; (B.H.); (A.A.)
- Center for Nanoscience (CeNS), University of Munich, 80331 Munich, Germany
- Correspondence: ; Tel.: +49-89-1265-1682
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El-Monajjed K, Driscoll M. Analysis of Surgical Forces Required to Gain Access Using a Probe for Minimally Invasive Spine Surgery via Cadaveric-Based Experiments Towards Use in Training Simulators. IEEE Trans Biomed Eng 2020; 68:330-339. [PMID: 32746011 DOI: 10.1109/tbme.2020.2996980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Virtual Reality haptic-based surgical simulators for training purposes have recently been receiving increased traction within the medical field. However, its future adoption is contingent on the accuracy and reliability of the haptic feedback. GOAL This study describes and analyzes the implementation of a set of haptic-tailored experiments to extract the force feedback of a medical probe used in minimally invasive spinal lumbar interbody fusion surgeries. METHODS Experiments to extract linear, lateral and rotational insertion, relaxation and extraction of the tool within the spinal muscles, intervertebral discs and lumbar nerve on two cadaveric torsos were conducted. RESULTS Notably, mean force-displacement and torque-angular displacement curves describing the different tool-tissue responses were reported with a maximum force of 6.87 (±1.79) N at 40 mm in the muscle and an initial rupture force through the Annulus Fibrosis of 20.550 (±7.841) N at 6.441 mm in the L4/L5 disc. CONCLUSION The analysis showed that increasing the velocity of the probe slightly reduced and delayed depth of the muscle punctures but significantly lowered the force reduction due to relaxation. Decreasing probe depth resulted with a reduction to the force relaxation drop. However, varying the puncturing angle of attack resulted with a significant effect on increasing force intensities. Finally, not resecting the thoracolumbar fascia prior to puncturing the muscle resulted with a significant increase in the force intensities. SIGNIFICANCE These results present a complete characterization of the input required for probe access for spinal surgeries to provide an accurate haptic response in training simulators.
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Abstract
Virtual Reality (VR) in orthopedic surgery has significantly increased in popularity in the areas of preoperative planning, intraoperative usage, and for education and training; however, its utilization lags behind other surgical disciplines and industries. The use of VR in orthopedics is largely focused on education and is currently endorsed by North American and European training committees. The use of VR in shoulder and elbow surgery has varying levels of evidence, from I to IV, and typically involves educational randomized controlled trials. To date, however, the terms and definitions surrounding VR technology used in the literature are often redundant, confusing, or outdated. The purpose of this review, therefore, was to characterize previous uses of VR in shoulder and elbow surgery in preoperative, intraoperative, and educational domains including trauma and elective surgery. Secondary objectives were to provide recommendations for updated terminology of immersive VR (iVR) as well as provide a framework for standardized reporting of research surrounding iVR in shoulder and elbow surgery.
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Affiliation(s)
- Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Jon J P Warner
- The Harvard Shoulder Service, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
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Marchi G, Foehr P, Consalvo S, Javadzadeh-Kalarhodi A, Lang J, Hartmann B, Alberton P, Aszodi A, Burgkart R, Roths J. Fiberoptic microindentation technique for early osteoarthritis diagnosis: an in vitro study on human cartilage. Biomed Microdevices 2019; 21:11. [DOI: 10.1007/s10544-019-0359-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Guo ZH, Zhang W, Jia YYS, Liu QX, Li ZF, Lin JS. An Insight into the Difficulties in the Discovery of Specific Biomarkers of Limbal Stem Cells. Int J Mol Sci 2018; 19:ijms19071982. [PMID: 29986467 PMCID: PMC6073450 DOI: 10.3390/ijms19071982] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 12/13/2022] Open
Abstract
Keeping the integrity and transparency of the cornea is the most important issue to ensure normal vision. There are more than 10 million patients going blind due to the cornea diseases worldwide. One of the effective ways to cure corneal diseases is corneal transplantation. Currently, donations are the main source of corneas for transplantation, but immune rejection and a shortage of donor corneas are still serious problems. Graft rejection could cause transplanted cornea opacity to fail. Therefore, bioengineer-based corneas become a new source for corneal transplantation. Limbal stem cells (LSCs) are located at the basal layer in the epithelial palisades of Vogt, which serve a homeostatic function for the cornea epithelium and repair the damaged cornea. LSC-based transplantation is one of the hot topics currently. Clinical data showed that the ratio of LSCs to total candidate cells for a transplantation has a significant impact on the effectiveness of the transplantation. It indicates that it is very important to accurately identify the LSCs. To date, several putative biomarkers of LSCs have been widely reported, whereas their specificity is controversial. As reported, the identification of LSCs is based on the characteristics of stem cells, such as a nuclear-to-cytoplasm ratio (N/C) ≥ 0.7, label-retaining, and side population (SP) phenotype. Here, we review recently published data to provide an insight into the circumstances in the study of LSC biomarkers. The particularities of limbus anatomy and histochemistry, the limits of the current technology level for LSC isolation, the heterogeneity of LSCs and the influence of enzyme digestion are discussed. Practical approaches are proposed in order to overcome the difficulties in basic and applied research for LSC-specific biomarkers.
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Affiliation(s)
- Zhi Hou Guo
- School of Medicine, Huaqiao University, Quanzhou 362021, China.
| | - Wei Zhang
- School of Medicine, Huaqiao University, Quanzhou 362021, China.
| | | | - Qing Xiu Liu
- School of Medicine, Huaqiao University, Quanzhou 362021, China.
| | - Zhao Fa Li
- School of Medicine, Huaqiao University, Quanzhou 362021, China.
| | - Jun Sheng Lin
- School of Medicine, Huaqiao University, Quanzhou 362021, China.
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