Reliability of pre-resection ligament tension assessment in imageless robotic assisted total knee replacement.

BACKGROUND: Ligament tension balance is a major determinant for the success of total knee replacement (TKR). The present study aimed at determining the inter-rater and intra-rater reliability in performing ligament tension assessment using an imageless robotic-assisted TKR. METHODS: Twenty-four knees in 21 patients who received robotic-assisted TKR for end-stage varus osteoarthritis were examined. Three orthopedic specialists and six orthopedic trainees participated in the operations. Data from the ligament tension assessment were collected during the operations. RESULTS: For the inter-rater reliability, "extension medial" and "flexion medial" had excellent reliability whilst "extension lateral" and "flexion lateral" had good-to-excellent reliability. For the intra-rater reliability, "extension medial" showed excellent reliability, "extension lateral" and "flexion medial" showed good-to-excellent reliability, and "flexion lateral" showed moderate-to-excellent reliability. CONCLUSIONS: Robotic-assisted technology provides a reliable solution to improve ligament tension assessment. All ligament tension assessments with the use of the technology could demonstrate at least good-to-excellent reliability except for the intra-rater reliability of "flexion lateral".

Comparison of the in vivo kinematics between robotic-assisted Bi-cruciate retaining and Bi-cruciate stabilised total knee arthroplasty.

BACKGROUND: Up to 20% of patients remain unsatisfied after total knee arthroplasty (TKA), prompting the development of new implants. Bi-Cruciate Retaining (BCR) TKA preserves both the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), with the ACL beneficial for its proprioceptive qualities. The Bi-Cruciate Stabilised (BCS) TKA substitutes the ACL and PCL with a unique dual cam-post mechanism. Robotics improve accuracy and facilitate technically demanding TKA. METHODS: This was a retrospective case-control study recruited from two centres. Measured outcomes included kinematic analysis, proprioception, and functional outcomes. RESULTS: There was a significantly larger maximum flexion angle and range of flexion to extension in sit-to-stand and stairs in BCR when compared to BCS. Further analysis revealed more similarities between BCR and normal native knees. Proprioception and functional scores did not have any statistical difference. CONCLUSION: BCR TKA demonstrated better knee flexion in weight-bearing active range of motion and showed similarities with normal knee kinematics.

Surgical accuracy of image-free versus image-based robotic-assisted total knee arthroplasty.

BACKGROUND: This study investigated the accuracy in achieving proper lower limb alignment and component positions after total knee replacement (TKR) with image-free and image-based robotic-assisted TKR. METHODS: A total of 129 patients (166 knees) suffering from end-stage knee arthritis who underwent TKA operated by robotic-assisted surgery between the years 2018 and mid-2021 were recruited. Radiological outcomes were compared between image-free and image-based robotic-assisted surgical systems. RESULTS: There were significant differences between the two robotic systems when comparing the mean planned component alignment and the mean measured alignment on radiographs, in which the image-free robotic-assisted system was more varus, whereas the image-based robotic-assisted system was more valgus for both the mean femoral and tibial component coronal alignment (p < 0.001). For tibial component sagittal alignment, the image-based group had a larger deviation from the planned posterior slope (p < 0.001). CONCLUSION: Image-free and image-based robotic assisted TKR had differing accuracy in femoral and tibial alignment.

Epithelial cell transforming 2 is regulated by Yes-associated protein 1 and mediates pancreatic cancer progression and metastasis.

Pancreatic ductal adenocarcinoma (PDAC) is highly metastatic and represents one of the deadliest forms of human cancers. Previous studies showed that activation of Yes-associated protein 1 (YAP1) plays a key role in malignant transformation in the pancreas. In this study, we found that YAP1 regulates the expression of epithelial cell transforming 2 (ECT2), a guanine nucleotide exchange factor for Rho-like GTPases. By immunohistochemistry analysis of human tissues, we show that ECT2 is highly expressed in primary PDAC and liver metastasis but not in normal pancreas. These correlations were also observed in a mouse model of PDAC, where pancreatic transformation is driven by mutants of Kras and Trp53. Notably, nuclear ECT2 is upregulated in the transition from preneoplastic lesions to PDAC. High levels of YAP1 or ECT2 expression correlates with the poor overall survival rate of patients with PDAC. We further demonstrate that ECT2 is required for pancreatic cancer cell proliferation and migration in vitro. Finally, using a syngeneic orthotopic xenograft mouse model for pancreatic cancer, we found that ablation of ECT2 expression reduces pancreatic cancer growth and dissemination to the liver. These findings highlight the critical role of ECT2 in promoting pancreatic cancer growth and metastasis and provides insights into the development of novel methods for early detection and treatment.NEW & NOTEWORTHY Pancreatic ductal adenocarcinoma is one of the deadliest forms of human cancers. In this study, we identified a novel signaling mechanism involved in PDAC progression and metastasis. Yes-associated protein 1 mediates the expression of epithelial cell transforming 2, which is elevated in PDAC and correlates with poor survival. Epithelial cell transforming 2 is required for PDAC growth and metastasis. This study provides insights into the development of novel methods for early detection and treatment of PDAC.

MSP-RON Signaling Is Activated in the Transition From Pancreatic Intraepithelial Neoplasia (PanIN) to Pancreatic Ductal Adenocarcinoma (PDAC).

Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest epithelial malignancies and remains difficult to treat. Pancreatic intraepithelial neoplasias (PanINs) represent the majority of the pre-cancer lesions in the pancreas. The PDAC microenvironment consists of activated pancreatic stellate cells (PSCs) and immune cells, which are thought to contribute to neoplastic transformation. However, the signaling events involved in driving the transition from the neoplastic precursor to the more advanced and aggressive forms in the pancreas are not well understood. Recepteur d'Origine Nantais (RON) is a c-MET family receptor tyrosine kinase that is implicated in playing a role in cell proliferation, migration and other aspects of tumorigenesis. Macrophage stimulating protein (MSP) is the ligand for RON and becomes activated upon proteolytic cleavage by matriptase (also known as ST14), a type II transmembrane serine protease. In the current study, by immunohistochemistry (IHC) analysis of human pancreatic tissues, we found that the expression levels MSP and matriptase are drastically increased during the transition from the preneoplastic PanIN stages to the more advanced and aggressive PDAC. Moreover, RON is highly expressed in both PDAC and in cancer-associated stellate cells. In contrast, MSP, RON, and matriptase are expressed at low levels, if any, in normal pancreas. Our study underscores an emerging role of MSP-RON autocrine and paracrine signaling events in driving malignant progression in the pancreas.

Evaluating the Chinese Revised Controlling Behaviors Scale.

The present study evaluated the utility of the Chinese version of the Revised Controlling Behaviors Scale (C-CBS-R) as a measure of controlling behaviors in violent Chinese intimate relationships. Using a mixed-methods approach, in-depth, individual interviews were conducted with 200 Chinese women survivors to elicit qualitative data about their personal experiences of control in intimate relationships. The use of controlling behaviors was also assessed using the C-CBS-R. Interview accounts suggested that the experiences of 91 of the women were consistent with the description of coercive control according to Dutton and Goodman's conceptualization of coercion. Using the split-half validation procedure, a receiver operating characteristics (ROC) curve analysis was conducted with the first half of the sample. The area under the curve (AUC) for using the C-CBS-R to identify high control was .99, and the cutoff score of 1.145 maximized both sensitivity and specificity. Applying the cutoff score to the second half gave a sensitivity of 96% and a specificity of 95%. Overall, the C-CBS-R has demonstrated utility as a measure of controlling behaviors with a cutoff score for distinguishing high from low levels of control in violent Chinese intimate relationships.

Intimate partner sexual aggression against Chinese women: a mixed methods study.

BACKGROUND: Although intimate partner sexual aggression has been shown to be associated with adverse mental health outcomes, there is scant information about sexual aggression in Chinese intimate relationships in general and about its mental health impact in particular. This article aimed to investigate sexual aggression in Chinese intimate relationships, including the use of force or threat of force and non-physical coercive tactics in unwanted sex. METHODS: The quantitative and qualitative data used in this paper were drawn from a prospective cohort study conducted in Hong Kong between September 2010 and September 2012. A total of 745 Chinese women aged 18 or older who had been in an intimate relationship in the preceding 12 months were recruited from sites in all districts of Hong Kong. Multiple logistic regression analysis, ordinary linear regression, and t-tests were used in quantitative analysis. Directed content analysis was used to analyze the transcripts of 59 women who revealed experiences of intimate partner sexual aggression in individual in-depth interviews. RESULTS: Of the 745 Chinese women in the study, 348 (46.7%) had experienced intimate partner physical violence in the past year, and 179 (24%) had experienced intimate partner physical violence and sexual aggression in the past year. Intimate partner sexual aggression significantly predicted PTSD and depressive symptoms after controlling for intimate partner physical violence. Among the 179 women reporting intimate partner physical violence and sexual coercion in the past year, 75 indicated that their partners used force or threat of force to make them have sex, and 104 of them reported that they gave in to sex because of non-physical coercive tactics used by their partners. Qualitative data revealed a variety of non-physical coercive tactics with different degrees of subtlety used to coerce women into unwanted sex with their partners. Chinese women experiencing physically forced sex had significantly more depressive symptoms and PTSD symptoms. CONCLUSIONS: Our findings indicate that sexual aggression in Chinese intimate relationships has specific mental health consequences over and above those associated with physical violence. Assessment of partner violence in Chinese relationships should include screening for sexual aggression in order to provide appropriate interventions. TRIAL REGISTRATION: ClinicalTrials gov NCT01206192.