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Objective: To elucidate ethnic variations in the practice of oral cancer risk habits in a selected Malaysian population. Methods: This retrospective case–control study involves 790 cases of cancers of the oral cavity and 450 controls presenting with non‐malignant oral diseases, recruited from seven hospital‐based centres nationwide. Data on risk habits (smoking, drinking, chewing) were obtained using a structured questionnaire via face‐to‐face interviews. Multiple logistic regression was used to determine association between risk habits and oral cancer risk; chi‐square test was used to assess association between risk habits and ethnicity. Population attributable risks were calculated for all habits. Results: Except for alcohol consumption, increased risk was observed for all habits; the highest risk was for smoking + chewing + drinking (aOR 22.37 95% CI 5.06, 98.95). Significant ethnic differences were observed in the practice of habits. The most common habit among Malays was smoking (24.2%); smoking + drinking were most common among Chinese (16.8%), whereas chewing was the most prevalent among Indians (45.2%) and Indigenous people (24.8%). Cessation of chewing, smoking and drinking is estimated to reduce cancer incidence by 22.6%, 8.5% and 6.9%, respectively. Conclusion: Ethnic variations in the practice of oral cancer risk habits are evident. Betel quid chewing is the biggest attributable factor for this population. [ABSTRACT FROM AUTHOR]

Background: The ability to predict patients' functional outcomes will add value to preoperative counseling. The purpose of this study was to evaluate predictors of good outcomes following total knee arthroplasty (TKA) among Asian patients.Methods: Registry data from 2006 to 2010 were extracted. The Oxford Knee Score (OKS) and the Short Form (SF)-36 physical component summary (PCS) were used to evaluate outcomes. A "good outcome" was defined as an improvement in scores of greater than or equal to the minimal clinically important difference (MCID) in the primary analysis. The MCID for the OKS was 5, and the MCID for the PCS was 10. For the sensitivity analyses, a "good outcome" was defined as an OKS of <30 and a PCS score of >50. Clinical variables were used to develop a multiple logistic regression model for a good outcome following total knee arthroplasty at 5 years.Results: Follow-up data were available for 3,062 patients who underwent primary TKA (mean age of 66.4 years; 79.5% female). Eighty-five percent had a good outcome on the basis of the OKS and 83%, on the basis of the SF-36 PCS. Age and preoperative Knee Society score (KSS) were found to be significant predictors. When outcomes were assessed by the MCID, lesser age and lower (worse) preoperative KSS predicted a good outcome at 5 years. When outcomes were assessed by absolute criteria (postoperative scores measured against OKS and PCS thresholds), a higher (better) preoperative KSS predicted a good outcome at 5 years. Body mass index, preoperative flexion range, SF-36 mental component summary (MCS) score, mechanical alignment, sex, education level, ethnicity, operative side, number of comorbidities, type of anesthesia, and type of implant were found not to be significant predictors.Conclusions: The majority of Asian patients with osteoarthritis had good outcomes according to the MCID criterion and benefitted from primary TKA. On the basis of our findings, we believe that older patients with a lower (worse) preoperative KSS can be informed that they have a high likelihood of improvement but a lower likelihood of achieving as good a functional outcome as those with better scores.Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The article focuses on COVID-19 pandemic has placed the whole world and the medical profession in an unprecedented situation. Topics include the medical specialty has had to develop protocols within the local context to cope with this crisis, evolving situation in orthopaedic departments in Singapore and share insights, and the recommendations for the consideration of orthopaedic surgeons worldwide.

Robot-assisted Total Knee Arthroplasty (TKA) improves the accuracy and precision of component implantation and mechanical axis (MA) alignment. Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of>5mm results in mid-flexion instability and poor outcomes. We prospectively randomised 60 patients into two groups: 31 patients (robot-assisted), 29 patients (conventional). No MA outliers (>±3° from neutral) or notching was noted in the robot-assisted group as compared with 19.4% (P=0.049) and 10.3% (P=0.238) respectively in the conventional group. The robot-assisted group had 3.23% joint-line outliers (>5mm) as compared to 20.6% in the conventional group (P=0.049). Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers. [ABSTRACT FROM AUTHOR]

Introduction: There is considerable controversy regarding the best method to prevent venous thromboembolism. In 2008, the American College of Chest Physicians (ACCP) published specific guidelines recommending the use of ow-molecular-weight heparin or warfarin, and a target international normalised ratio of 2.0-3.0 for a duration of at least 7-10 days, after elective knee arthroplasties. Many orthopaedic surgeons believe that these recommendations are biased toward reducing deep venous thrombosis (DVT), but neglect the implicated possibility of a higher incidence of wound complications. In order to enable an objective evaluation of the fit of the ACCP recommendations to the needs of our local cohort of patients, we aimed to look at the incidence of DVT in our local population.Methods: This study was a prospective observational study involving existing local patients in Singapore General Hospital, Singapore, who underwent total knee arthroplasty (TKA) and were on a short course of chemothromboprophylaxis (< 7 days) after the operation. The incidence of DVT in patients was evaluated using DVT imaging 4-6 days after the operation and at one month after the operation.Results: In our study cohort, the prevalence of DVT during the period between postoperative Days 4 and 6 was 12% (11% were distal DVT and 1% was proximal DVT). Only 9% of the patients had DVT one month after the operation. Using chi-square analysis, we found that there was no significant increase in the number of DVT and pulmonary embolism cases 4-6 days and 1 month after the operation (p > 0.05).Conclusion: Contrary to the ACCP guidelines, a short course of chemothromboprophylaxis post TKA, lasting no more than 7 days, is safe and adequate in the low-risk Asian population. [ABSTRACT FROM AUTHOR]

Over the past decade, significant advances have been made in the field of subarachnoid haemorrhage (SAH). Prompt diagnosis with high-resolution CT and intensive critical care support remain key aspects of good patient management. Early identification and definitive treatment of underlying ruptured aneurysms is generally advocated to reduce the risk of re-bleeding, a complication with high mortality and morbidity. Although intra-arterial digital subtraction angiography (DSA) is still considered the gold standard for sourcing aneurysms, CT angiography, especially with the evolution of multi-slice technology, is slowly gaining acceptance as a rapid, accessible and minimally invasive method which appears likely to replace DSA as first-line modality in the future. Furthermore, the advent of Guglielmi detachable coils and the ISAT trial have revolutionised the treatment of ruptured aneurysms, with a significant trend towards endovascular coiling away from operative clipping. Improvements in clinical experience, coiling technology and assistive devices now allow interventionalists to potentially treat the majority of aneurysms, including wide-necked or complex lesions. The uncertain long-term results of coiling, however, still fuel strong debate and controversy. This review summarises current diagnostic approaches to SAH from a radiological perspective, with an emphasis on aneurysmal SAH and an evidence-based approach to the role of imaging and interventional radiology in diagnosis, treatment and follow-up. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)-based models have become a growing area of interest in predictive medicine and have the potential to aid physician decision-making to improve patient outcomes. Imaging and radiomics play an increasingly important role in these models. This review summarizes recent developments in the field of radiomics for AI in head and neck cancer. Prediction models for oncologic outcomes, treatment toxicity, and pathological findings have all been created. Exploratory studies are promising; however, validation studies that demonstrate consistency, reproducibility, and prognostic impact remain uncommon. Prospective clinical trials with standardized procedures are required for clinical translation. [ABSTRACT FROM AUTHOR]

This study aims to review the quality of life and physical improvement achieved by total joint arthroplasty surgery, namely unilateral TKA, bilateral TKA and THA. We hypothesize that patients who undergo bilateral TKA should have greater improvement in patient-reported outcome measures, as compared to patients who had unilateral TKA, and their outcomes may be comparable to that of THA. We analyzed prospectively collected data of all patients who underwent unilateral TKA, bilateral TKA and THA (5291, 187 and 529 patients respectively) for end-stage osteoarthritis at a tertiary hospital during the 5-year period. Patients who underwent bilateral TKA had a greater degree of improvement in SF-36 and Knee Society Scores as compared to unilateral TKA at 6 months and 2 years follow-up. Bilateral TKA had the highest proportion of patients who were satisfied and had expectations met by surgery.

Introduction: The use of robotics in total knee arthroplasty (TKA) has been shown to minimise human error, as well as improve the accuracy and precision of component implantation and mechanical axis alignment. The present study aimed to demonstrate that robot-assisted TKA using ROBODOC® is safe and capable of producing a consistent and accurate postoperative mechanical axis., Methods: We prospectively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012. Two patients were excluded from the study due to intraoperative technical problems with the robot. Long-leg radiography and computed tomography were performed prior to surgery, and used for mechanical axis measurements and component sizing. DigiMatch™ ROBODOC® Surgical System software version 4.3.6 (Curexo Technology Corp, Fremont, CA, USA) was used in all cases to perform bone cuts in accordance with the preoperative plan., Results: The postoperative coronal mechanical alignment was within 3 degrees, with a mean alignment of -0.4 ± 1.7 degrees, confirming the accuracy of the preoperative surgical plan and bone cuts. The mean operating time was 96 ± 15 min, and preoperative planning yielded 100% implant sizing accuracy., Conclusion: Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment. The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC® by minimising errors. However, the role of the surgeon in TKA is still vital, as the surgeon is ultimately in charge of planning the surgery, its execution and ensuring soft tissue balance during TKA.

Background: Modern radiation oncology demands a thorough understanding of gross and cross-sectional anatomy for diagnostic and therapeutic applications. Complex anatomic sites present challenges for learners and are not well-addressed in traditional postgraduate curricula. A multidisciplinary team (MDT) based head-and-neck gross and radiologic anatomy program for radiation oncology trainees was developed, piloted, and empirically assessed for efficacy and learning outcomes., Methods: Four site-specific MDT head-and-neck seminars were implemented, each involving a MDT delivering didactic and case-based instruction, supplemented by cadaveric presentations. There was no dedicated contouring instruction. Pre- and post-testing were performed to assess knowledge, and ability to apply knowledge to the clinical setting as defined by accuracy of contouring. Paired analyses of knowledge pretests and posttests were performed by Wilcoxon matched-pair signed-rank test., Results: Fifteen post-graduate trainees participated. A statistically significant (p < 0.001) mean absolute improvement of 4.6 points (17.03%) was observed between knowledge pretest and posttest scores. Contouring accuracy was analyzed quantitatively by comparing spatial overlap of participants' pretest and posttest contours with a gold standard through the dice similarity coefficient. A statistically significant improvement in contouring accuracy was observed for 3 out of 20 anatomical structures. Qualitative and quantitative feedback revealed that participants were more confident at contouring and were enthusiastic towards the seminars., Conclusions: MDT seminars were associated with improved knowledge scores and resident satisfaction; however, increased gross and cross-sectional anatomic knowledge did not translate into improvements in contouring accuracy. Further research should evaluate the impact of hands-on contouring sessions in addition to dedicated instructional sessions to develop competencies.

Matrix metalloproteinase 13 (MMP13) plays a central role in the MMP activation cascade that enables degradation of the extracellular matrix and basement membranes, and it is identified as a potential driver in oral carcinogenesis. Therefore, this study aims to determine the copy number, mRNA, and protein expression of MMP13 in oral squamous cell carcinoma (OSCC) and to associate these expressions with clinicopathological parameters. Copy number, mRNA, and protein expression analysis of MMP13 were determined using real-time quantitative PCR and immunohistochemistry methods in OSCC samples. The correlations between MMP13 expressions and clinicopathological parameters were evaluated, and the significance of MMP13 as a prognostic factor was determined. Despite discrepancies between gene amplification and mRNA and protein overexpression rates, OSCC cases showed high amplification of MMP13 and overexpression of MMP13 at both mRNA and protein levels. High level of MMP13 protein expression showed a significant correlation with lymph node metastasis (P = 0.011) and tumor staging (P = 0.002). Multivariate Cox regression model analysis revealed that high level of mRNA and protein expression of MMP13 were significantly associated with poor prognosis (P < 0.050). Taken together, these observations indicate that the MMP13 protein overexpression could be considered as a prognostic marker of OSCC.