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Thoracospinal deformities in early onset scoliosis (EOS) patients often lead to thoracic insufficiency syndrome, in which respiration or lung growth is impaired. Pulmonary function tests (PFTs) are used to assess pulmonary deficits but are challenging to comply with for EOS patients, who typically are between 5 and 10 years old. Thus, the objective was to predict PFT values in EOS patients directly from deformity parameters measured on routine radiographs. Corresponding preoperative radiographs and PFT values were retrospectively obtained from 47 EOS patients (13M/34F; mean age: 9.8 ± 3.0 years), and 19 literature-based deformity parameters were measured. Multiple linear regression (MLR) analyses using an exhaustive search feature selection method were used to estimate percent predicted forced vital capacity (%FVC) and forced expiratory volume in one second (%FEV1). Ten percent of the dataset was set aside to validate the predictive accuracy of the MLR models. The additive contributions of multiple thoracospinal deformity parameters successfully yielded significant (p < 0.001) MLR models that predicted %FVC (R2 = 0.54) and %FEV1 (R2 = 0.59) in EOS patients. For the validation test, no significant differences (p > 0.05) in prediction error magnitudes were found. The developed MLR models provide the highest reported precision for predicting PFT values in EOS patients from radiographic deformity parameters. Additionally, a key subset of deformity parameters was identified, and their relative contributions to predicting PFT values provide quantitative metrics to guide surgical treatment.

Purpose of Review In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research. Recent Findings Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. Summary With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders.

Anterior vertebral body tethering (AVBT), or spinal growth tethering, is an emerging technology that recently received Food and Drug Administration (FDA) approval through a humanitarian device exemption designation to treat idiopathic scoliosis patients with remaining growth. This study compared patients who underwent AVBT with those treated with standard-of-care posterior spinal fusion (PSF) to determine inherent differences in patients and families who seek cutting-edge treatments. The authors reviewed 62 PSF patients from a multicenter registry and 20 AVBT patients from an FDA-approved investigational clinical trial. The authors examined demographics, preoperative clinical and radiographic variables, and health-related quality of life (HRQOL). All included patients preoperatively were classified as Lenke type 1 or 2 with a thoracic curve of 35° to 60°, a lumbar curve less than 35°, and a skeletal maturity score of Risser sign 0 or Sanders bone age of 4 or less. Idiopathic scoliosis patients treated with surgical intervention were primarily White females who were 12 years old. No differences in demographics, clinical variables, and radiographic measures were detected between the PSF and AVBT cohorts. The AVBT group showed more thoracic flexibility on bending radiographs, correcting on average 59% compared with 43% for PSF patients (P=.005). Patients had similar HRQOL total scores and scores across each of the 5 domains of the Scoliosis Research Society Questionnaire Version 22. The percentage of patients scoring below 4.0 within each domain was comparable between cohorts. Scoliosis patients who underwent vertebral tethering at a level of deformity magnitude and maturity similar to those who underwent posterior fusion did not differ at baseline regarding demographics, clinical variables, and HRQOL. [Orthopedics. 2021;44(1):24–28.]

The number, extent, diversity, and global reach of submerged static artificial structures (SSAS) in the marine environment is increasing. These structures are prone to the accumulation of biofouling that can result in unwanted impacts, both immediate and long-term. Therefore, management of biofouling on SSAS has a range of potential benefits that can improve structure functions, cost-efficiency, sustainability, productivity, and biosecurity. This review and synthesis collates the range of methods and tools that exist or are emerging for managing SSAS biofouling for a variety of sectors, highlighting key criteria and knowledge gaps that affect development, and uptake to improve operational and environmental outcomes. The most common methods to manage biofouling on SSAS are mechanical and are applied reactively to manage biofouling assemblages after they have developed to substantial levels. Effective application of reactive methods is logistically challenging, occurs after impacts have accumulated, can pose health and safety risks, and is costly at large scales. Emerging technologies aim to shift this paradigm to a more proactive and preventive management approach, but uncertainty remains regarding their long-term efficacy, feasibility, and environmental effects at operational scales. Key priorities to promote more widespread biofouling management of SSAS include rigorous and transparent independent testing of emerging treatment systems, with more holistic cost-benefit analyses where efficacy is demonstrated.

Purpose Although adolescent idiopathic scoliosis (AIS) is known to impact the 3D orientation of the spine and pelvis, the impact of the vertebral position relative to the X-ray scanner on the agreement between 2D and 3D measurements of a curve has not been evaluated. The purpose of this study was to investigate the agreement between 2D and 3D measurements of the scoliotic curve as a function of the 3D spinal parameters in AIS. Methods Three independent observers measured the thoracic and lumbar Cobb angles, Kyphosis, and lordosis on the posterior–anterior and lateral X-rays of AIS patients. The 3D reconstructions were created from bi-planar X-rays and the 3D spinal parameters were calculated in both radio and patient planes using SterEOS software. The degree of agreement between the 2D and 3D measurements was tested and its relationship with the curve axial rotation was determined. Results 2D and 3D measurements of the sagittal plane spinal parameters were significantly different ( p  < 0.05). The differences between the 2D and 3D measurements were related to the apical vertebrae rotation, the orientation of the plane of maximum curvature, pelvic axial rotation, and the curve magnitude. Differences between the radio plane and patient plane measurements were related to the pelvic axial rotation, Cobb angles, and apical vertebrae rotation, p  < 0.05. Conclusion Clinically and statistically significant differences were observed between the 2D and 3D measurements of the scoliotic spine. The differences between the 2D and 3D techniques were significant in sagittal plane and were related to the spinal curve and pelvic rotation in transverse plane.

Internal seawater systems (ISS) are critical to the proper functioning of maritime vessels. Sea water is pumped on board ships for a broad array of uses, primarily for temperature control (e.g., engine and electrical systems), cooling capacity (e.g., air conditioners and refrigeration), and water provision (e.g., drinking, firefighting, steam, and ballast). Although sea water may spend only a brief period within ISS of a vessel, it can carry microorganisms and larval stages of macroorganisms throughout the system leading to biofouling accumulation that can impair system function or integrity. ISS can also act as a sub-vector of species translocations, potentially facilitating biological invasions. This review describes ships’ ISS with a focus on operational impacts of biofouling and current drivers and barriers associated with ISS biofouling management. As ISS internal components are difficult to access, reports and studies of ISS biofouling are uncommon and much of the dedicated literature is decades old. The impact of biofouling on ISS and vessel operations is based on increased surface roughness of pipework and equipment, restricted water flow, corrosion and subsequent component impingement, reduced surface functional efficiency, and potential contamination by pathogens that can affect human and aquatic animal health. Biofouling management is primarily achieved using antifouling coatings and marine growth prevention systems, but independent and accessible data on their efficacy in ISS remain limited. Further research is required to resolve the extent to which biofouling occurs in ISS of the modern commercial fleet and the efficacy of preventive systems. Such information can ultimately inform decisions to improve operational efficiency for vessel operators and ensure any biosecurity risks are appropriately managed.

Thoracic insufficiency syndrome (TIS) and early-onset scoliosis (EOS) are complex pediatric conditions involving deformities of the spine and chest wall, which can significantly impact respiratory function and overall development. Managing these conditions requires a comprehensive approach that combines precise diagnosis and innovative treatment strategies. This opinion article provides a critical discussion of the diagnosis and treatment of TIS and EOS and reflects upon the advancement of methods that are crucial for assessing these conditions and guiding treatment decisions.

Thoracic insufficiency syndromes are a genetically and phenotypically heterogeneous group of disorders characterized by congenital abnormalities or progressive deformation of the chest wall and/or vertebrae that result in restrictive lung disease and compromised respiratory capacity. We performed whole exome sequencing on a cohort of 42 children with thoracic insufficiency to elucidate the underlying molecular etiologies of syndromic and non-syndromic thoracic insufficiency and predict extra-skeletal manifestations and disease progression. Molecular diagnosis was established in 24/42 probands (57%), with 18/24 (75%) probands having definitive diagnoses as defined by laboratory and clinical criteria and 6/24 (25%) probands having strong candidate genes. Gene identified in cohort patients most commonly encoded components of the primary cilium, connective tissue, and extracellular matrix. A novel association between KIF7 and USP9X variants and thoracic insufficiency was identified. We report and expand the genetic and phenotypic spectrum of a cohort of children with thoracic insufficiency, reinforce the prevalence of extra-skeletal manifestations in thoracic insufficiency syndromes, and expand the phenotype of KIF7 and USP9X -related disease to include thoracic insufficiency.

Antibodies' protective, pathological, and therapeutic properties result from their considerable diversity. This diversity is almost limitless in potential, but actual diversity is still poorly understood. Here we use deep sequencing to characterize the diversity of the heavy-chain CDR3 region, the most important contributor to antibody binding specificity, and the constituent V, D, and J segments that comprise it. We find that, during the stepwise D-J and then V-DJ recombination events, the choice of D and J segments exert some bias on each other; however, we find the choice of the V segment is essentially independent of both. V, D, and J segments are utilized with different frequencies, resulting in a highly skewed representation of VDJ combinations in the repertoire. Nevertheless, the pattern of segment usage was almost identical between two different individuals. The pattern of V, D, and J segment usage and recombination was insufficient to explain overlap that was observed between the two individuals' CDR3 repertoires. Finally, we find that while there are a near-infinite number of heavy-chain CDR3s in principle, there are about 3-9 million in the blood of an adult human being.

There is a lack of cost-effective, environmentally-friendly tools available to manage marine biofouling accumulation on static artificial structures such as drilling rigs, wind turbines, marine farms, and port and marina infrastructure. For there to be uptake and refinement of tools, emerging technologies need to be tested and proven at an operational scale. This study aimed to see whether biofouling accumulation could be suppressed on marine infrastructure under real-world conditions through the delivery of continuous bubble streams. Submerged surfaces of a floating marina pontoon were cleaned in-situ by divers, and the subsequent colonisation by biofouling organisms was monitored on treated (bubbles applied) and untreated sections. Continuous bubble streams proved highly effective (>95%) in controlling macrofouling accumulation on the underside surface of the marina pontoon for the first 2 months after deployment, but efficacy dropped off rapidly once bubble stream delivery was partially obscured due to biofouling accumulation on the diffuser itself. Although extensive macrofouling cover by mussels, bryozoans and hydroids was observed on treated surfaces by 4 months (27.5%, SE = 4.8%), biofouling % cover and diversity was significantly higher on untreated surfaces (79.6%, SE = 2.9%). While this study demonstrates that continuous bubble streams greatly restrict biofouling accumulation over short-to-medium timescales, improved system design, especially the incorporation of diffusers resistant to fouling, is needed for the approach to be considered a viable long-term option for biofouling management on static artificial structures.