Artificial Intelligence: Impact and Challenges to Authors, Journals and Medical Publishing.

Artificial intelligence (AI)-assisted technologies are here to stay and cannot be ignored. These tools are able to generate highly-realistic human-like text and perform a wide range of useful language tasks with a wide range of applications. They have the potential to expedite innovation in health care and can aid in promoting equity and diversity in research by overcoming language barriers. When using these AI tools, authors must take responsibility for the output and originality of their work, as publishers expect all content to be generated by human authors unless there is a declaration to the contrary. Authors must disclose how AI tools have been used, and ensure appropriate attribution of all the text, images, and audio-visual material. The responsible use of AI language models and transparent reporting of how these tools were used in the creation of information and publication are vital to promote and protect the credibility and integrity of medical research, and trust in medical knowledge. Educating postgraduate and undergraduate students, researchers and authors on the applications and best usage of AI-assisted technologies, together with the importance of critical thinking, integrity and strict adherence to ethical principles, are key steps that need to be undertaken.

Identifying canonical and replicable multi-scale intrinsic connectivity networks in 100k+ resting-state fMRI datasets.

Despite the known benefits of data-driven approaches, the lack of approaches for identifying functional neuroimaging patterns that capture both individual variations and inter-subject correspondence limits the clinical utility of rsfMRI and its application to single-subject analyses. Here, using rsfMRI data from over 100k individuals across private and public datasets, we identify replicable multi-spatial-scale canonical intrinsic connectivity network (ICN) templates via the use of multi-model-order independent component analysis (ICA). We also study the feasibility of estimating subject-specific ICNs via spatially constrained ICA. The results show that the subject-level ICN estimations vary as a function of the ICN itself, the data length, and the spatial resolution. In general, large-scale ICNs require less data to achieve specific levels of (within- and between-subject) spatial similarity with their templates. Importantly, increasing data length can reduce an ICN's subject-level specificity, suggesting longer scans may not always be desirable. We also find a positive linear relationship between data length and spatial smoothness (possibly due to averaging over intrinsic dynamics), suggesting studies examining optimized data length should consider spatial smoothness. Finally, consistency in spatial similarity between ICNs estimated using the full data and subsets across different data lengths suggests lower within-subject spatial similarity in shorter data is not wholly defined by lower reliability in ICN estimates, but may be an indication of meaningful brain dynamics which average out as data length increases.

Artificial Intelligence: Impact and Challenges to Authors, Journals and Medical Publishing

@#Artificial intelligence (AI)-assisted technologies are here to stay and cannot be ignored. These tools are able to generate highly-realistic human-like text and perform a wide range of useful language tasks with a wide range of applications. They have the potential to expedite innovation in health care and can aid in promoting equity and diversity in research by overcoming language barriers. When using these AI tools, authors must take responsibility for the output and originality of their work, as publishers expect all content to be generated by human authors unless there is a declaration to the contrary. Authors must disclose how AI tools have been used, and ensure appropriate attribution of all the text, images, and audio-visual material. The responsible use of AI language models and transparent reporting of how these tools were used in the creation of information and publication are vital to promote and protect the credibility and integrity of medical research, and trust in medical knowledge. Educating postgraduate and undergraduate students, researchers and authors on the applications and best usage of AI-assisted technologies, together with the importance of critical thinking, integrity and strict adherence to ethical principles, are key steps that need to be undertaken.

Foot Arch Changes after Endoscopic Plantar Fascia Release for Recalcitrant Plantar Fasciitis.

Introduction: Endoscopic plantar fascia release (EPFR) is a minimally invasive surgical intervention for recalcitrant plantar fasciitis. Its efficacy has been convincing but the in vivo effect on medial longitudinal foot arch and footprint has not been studied. Our objective is to evaluate the changes of foot posture using radiographs and footprints following endoscopic plantar fascia release in recalcitrant plantar fasciitis. Materials and methods: This prospective cohort involved patients with recalcitrant plantar fasciitis who failed six months of conservative treatment. Two-portal endoscopic release of not more than 50% of plantar fascia width was performed. Footprint and standard weight-bearing anteroposterior and lateral radiographs of the foot were taken pre-operatively and at 12 months post-surgery. Arch index, normalised navicular height truncated, calcaneal inclination angle, calcano-1st metatarsal angle, talonavicular coverage angle and talus-2nd metatarsal angle were measured. Results: Sixteen patients (18 feet) were reported. Patients' follow-up ranged from 14 to 31 months after surgery (mean±SD: 23.44±5.76). The increase of arch index, calcano-1st metatarsal angle and reduction of calcaneal inclination angle were found statistically significant (p<0.05). Two normal arch patients progressed to asymptomatic flat arch feet. Three complications were noted between three to nine months post-surgery, one with medial column and two with lateral column symptoms. Conclusion: There is evidence of reduction in medial longitudinal arch of the foot after EPFR. Although the reduction remains asymptomatic, post-operative complications related to changes in biomechanics of the foot can occur between three to nine months. Patients should be monitored at least for 12 months and longer for those who are symptomatic.

Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome.

INTRODUCTION: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. MATERIALS AND METHODS: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). RESULTS: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. CONCLUSION: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.

Pre-operative Halo-Pelvic Traction for Neurofibromatosis Patients with Severe Proximal Thoracic Spinal Deformity: Indications and Early Treatment Outcome

@#Introduction: To report the indications and early treatment outcomes of pre-operative halo-pelvic traction in patients with neurofibromatosis associated with severe proximal thoracic (PT) spinal deformity. Materials and methods: We reviewed four patients with neurofibromatosis with severe PT spinal deformity. Case 1, a 16-year-old male presented with severe PT kyphoscoliosis (scoliosis: 89°, kyphosis: 124°) and thoracic myelopathy. Case 2 was a 14-year-old, skeletally immature male who presented with a PT lordoscoliosis (scoliosis: 85°). Case 3, a 13-year-old male, presented with severe PT kyphoscoliosis (scoliosis: 100°, kyphosis: 95°). Case 4, a 35-year-old gentleman, presented with severe PT kyphoscoliosis (scoliosis: 113°, kyphosis: 103°) and thoracic myelopathy. All patients underwent pre-operative halo-pelvic traction. After a period of traction, all patients underwent posterior spinal fusion (PSF) with autologous bone grafts (local and fibula bone grafts) and recombinant human bone morphogenetic protein-2 (rhBMP-2). Results: Both patients with thoracic myelopathy regained near normal neurological status after halo-pelvic traction. Following traction, the scoliosis correction rate (CR) ranged from 18.0% to 38.9%, while the kyphosis CR ranged from 14.6% to 37.1%. Following PSF, the scoliosis CR ranged from 24.0% to 58.8%, while the kyphosis CR ranged from 29.1% to 47.4%. The total distraction ranged from 50-70mm. Duration of distraction ranged from 26-95 days. The most common complication encountered during halo-pelvic traction was pin-related e.g. pin tract infection, pin loosening and migration, osteomyelitis, and halo-pelvic strut breakage. No patients had cranial nerve palsies or neurological worsening. Conclusion: Pre-operative correction of severe PT spinal deformities could be performed safely and effectively with the halo-pelvic device prior to definitive surgery.

Ponseti method of treating clubfoot - Is there difference if treatment is started before or after one month of age?

INTRODUCTION: Most of the authors currently agree that congenital talipes equinovarus (CTEV) or idiopathic clubfoot can be effectively treated with the Ponseti method instead of extensive soft tissue surgery. This study was conducted to investigate whether there is a difference in the outcome between starting treatment before one month of age or after that age. METHODS: This is a retrospective study on babies with CTEV treated in University Malaya Medical Centre from 2013 to 2017. The 54 babies (35 boys and 19 girls) were divided into two cohorts, Group 1 that had treatment before the age of one month, and Group 2 that had treatment after one month old. The number of cast changes, rate of full correction, and rate of relapse after treatment were compared between the two groups. RESULTS: Of the 54 babies, with 77 CTEV treated during the period, our outcome showed that the mean number of cast change was 5.9 for Group 1 and 5.7 for Group 2. The difference was not statistically significant. All the affected feet (100%) achieved full correction. One foot in the Group 1 relapsed, while three feet in Group 2 relapsed, but the difference was also not statistically significant. All of the relapsed feet were successfully treated with repeated Ponseti method. CONCLUSIONS: Treating CTEV using Ponseti method starting after one month was not associated with more casting change of higher rate of relapse.

The Perils of Predatory Journals and Conferences.

Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.

COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic.

With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.

COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic

@#With the increasing number of COVID-19 cases and related deaths worldwide, we decided to share the development of this condition in Singapore and Malaysia. First few cases were diagnosed in the two countries at the end of January 2020, and the numbers have surged to thousands by end of March 2020. We will focus on strategies adopted by the government and also the Orthopaedic community of the two countries up till the beginning of April 2020. We hope that by sharing of relevant information and knowledge on how we are managing the COVID-19 condition, we can help other communities, and health care workers to more effectively overcome this pandemic.

The Perils of Predatory Journals and Conferences

@#Predatory journals and conferences have little or no peer review. Their raison d'être is for making money through the article processing charges and the conference registration fees. Without a critical evaluation, predatory journals publishing flawed results and conclusions would cloud the existing scientific literature. Predatory conferences are the offshoots of predatory publishing. The conferences are not organised by learned societies, but by profit-making event organisers. There is a need for awareness among researchers and clinicians regarding predatory publishing. The scourge of predatory publishing and conferencing should be more often highlighted during scientific meetings and publication courses.

Spike-shape dependence of the spike-timing dependent synaptic plasticity in ferroelectric-tunnel-junction synapses.

Resistive switching (RS) devices have attracted increasing attention for artificial synapse applications in neural networks because of their nonvolatile and analogue resistance changes. Among the neural networks, a spiking neural network (SNN) based on spike-timing-dependent plasticity (STDP) is highly energy efficient. To implement STDP in resistive switching devices, several types of voltage spikes have been proposed to date, but there have been few reports on the relationship between the STDP characteristics and spike types. Here, we report the STDP characteristics implemented in ferroelectric tunnel junctions (FTJs) by several types of spikes. Based on simulated time evolutions of superimposed spikes and taking the nonlinear current-voltage (I-V) characteristics of FTJs into account, we propose equations for simulating the STDP curve parameters of a magnitude of the conductance change (ΔGmax) and a time window (τC) from the spike parameters of a peak amplitude (Vpeak) and time durations (tp and td) for three spike types: triangle-triangle, rectangular-triangle, and rectangular-rectangular. The power consumption experiments of the STDP revealed that the power consumption under the inactive-synapse condition (spike timing |Δt| > τC) was as large as 50-82% of that under the active-synapse condition (|Δt| < τC). This finding indicates that the power consumption under the inactive-synapse condition should be reduced to minimize the total power consumption of an SNN implemented by using FTJs as synapses.

Probing ultrafast spin-relaxation and precession dynamics in a cuprate Mott insulator with seven-femtosecond optical pulses.

A charge excitation in a two-dimensional Mott insulator is strongly coupled with the surrounding spins, which is observed as magnetic-polaron formations of doped carriers and a magnon sideband in the Mott-gap transition spectrum. However, the dynamics related to the spin sector are difficult to measure. Here, we show that pump-probe reflection spectroscopy with seven-femtosecond laser pulses can detect the optically induced spin dynamics in Nd2CuO4, a typical cuprate Mott insulator. The bleaching signal at the Mott-gap transition is enhanced at ~18 fs. This time constant is attributable to the spin-relaxation time during magnetic-polaron formation, which is characterized by the exchange interaction. More importantly, ultrafast coherent oscillations appear in the time evolution of the reflectivity changes, and their frequencies (1400-2700 cm-1) are equal to the probe energy measured from the Mott-gap transition peak. These oscillations can be interpreted as the interference between charge excitations with two magnons originating from charge-spin coupling.

A New Approach to Body Donation for Medical Education: The Silent Mentor Programme.

Cadaveric dissection is an integral component of medical education. There had been concerns about negative impact on medical students exposed to deceased donors before their clinical years, but most studies reported overall positive outcome following this form of teaching. Due to reducing number of body donations in most parts of the world, many institutions are adopting alternative models especially for the teaching of gross anatomy. A new body donation programme that incorporate humanistic values in the procurement process was initiated by Tsu Chi University of Taiwan in 1996. Early observations following teaching with the so-called "silent mentors" noted less negative emotional impact on the students. With increasing number of body donation following the initiation of the silent mentor programme as reported in some regions, we will be able to continue the time-honoured cadaveric dissection for anatomy teaching, at the same time promoting humanistic values on junior doctors.