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Background context High-grade dysplastic spondylolisthesis (HGDS) is a rare pediatric spinal deformity characterized by severe lumbosacral dysplasia and sagittal malalignment. The optimal surgical strategy for achieving deformity correction while minimizing neurological risk remains controversial. Purpose To evaluate radiographic and clinical outcomes of sacral dome osteotomy combined with complete L5 reduction and single-level posterior L5–S1 fusion in pediatric patients with HGDS, and to explore factors associated with residual postoperative sagittal imbalance. Study design A multicenter retrospective case-series study. Patient sample Thirty-one patients (30 females, 1 male; mean age 9.66 ± 2.27 years) with L5 high-grade dysplastic spondylolisthesis who underwent sacral dome osteotomy, complete L5 reduction, and posterior L5–S1 single-level fusion between 2008 and 2023. Outcome measures The primary outcome was residual sagittal imbalance at the latest follow-up, defined as sagittal vertical axis (SVA) > 5.0 cm or pelvic tilt to sacral slope ratio (PT/SS) > 1. These criteria represented global and regional malalignment, respectively. Methods Clinical and radiographic data were retrospectively reviewed. Patients were categorized according to the presence of residual sagittal imbalance at the final follow-up. Univariable and multivariable logistic regression analyses were performed in an exploratory manner to examine associations between selected clinical and radiographic variables and residual sagittal imbalance. Receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminatory ability of preoperative sagittal vertical axis within this cohort. Results Mean follow-up was 3.05 ± 2.01 years. Slip percentage improved from 61.0 ± 11.0 preoperatively to 13.0 ± 10.0 postoperatively (p < 0.001) and remained stable at 9.0 ± 12.0 at the latest follow-up. Lumbosacral and global sagittal alignment parameters demonstrated significant correction that was largely maintained over time. Seven patients (22.6%) demonstrated residual sagittal imbalance (SVA > 5.0 cm or PT/SS > 1). Greater preoperative SVA values were associated with residual postoperative sagittal imbalance (OR 1.04, 95% CI 1.00–1.08, p = 0.037). Exploratory ROC analysis identified a preoperative SVA value of 4.0 cm with high sensitivity (100%) and moderate specificity (75%) for residual imbalance in this cohort. Transient neurological complications occurred in 12.9% of patients, and radiographic adjacent segment degeneration requiring revision occurred in 9.7%. Conclusions Sacral dome osteotomy with complete L5 reduction and single-level posterior L5–S1 fusion achieved durable radiographic correction of sagittal and coronal deformities in pediatric patients with high-grade dysplastic spondylolisthesis. Exploratory analyses suggested that greater preoperative sagittal vertical axis values were associated with residual postoperative sagittal imbalance, highlighting the importance of careful postoperative follow-up.

Background Endoscopic transforaminal lumbar interbody fusion (endo-TLIF) with bilateral percutaneous pedicle screw fixation is an emerging option for low-grade spondylolisthesis. However, uniportal full endo-TLIF with a complete reduction for high-grade spondylolisthesis is challenging. Methods We attempted uniportal endo-TLIF for L5 isthmic grade 2 spondylolisthesis with a complete reduction, and have described the procedures, with a discussion of the indications, limitations, potential complications, and ways to avoid complications. Conclusion We had successfully completed a perfect reduction of L5 isthmic grade 2 spondylolisthesis via uniportal endo-TLIF with bilateral pedicle screw fixation. Uniportal endo-TLIF is suitable for isthmic grade 2 spondylolisthesis.

In this paper we introduce a general theory for nonlinear sufficient dimension reduction, and explore its ramifications and scope. This theory subsumes recent work employing reproducing kernel Hilbert spaces, and reveals many parallels between linear and nonlinear sufficient dimension reduction. Using these parallels we analyze the properties of existing methods and develop new ones. We begin by characterizing dimension reduction at the general level of σ-fields and proceed to that of classes of functions, leading to the notions of sufficient, complete and central dimension reduction classes. We show that, when it exists, the complete and sufficient class coincides with the central class, and can be unbiasedly and exhaustively estimated by a generalized sliced inverse regression estimator (GSIR). When completeness does not hold, this estimator captures only part of the central class. However, in these cases we show that a generalized sliced average variance estimator (GSAVE) can capture a larger portion of the class. Both estimators require no numerical optimization because they can be computed by spectral decomposition of linear operators. Finally, we compare our estimators with existing methods by simulation and on actual data sets.

We study the relationship between postulation and reduction vectors of admissible multigraded filtrations F = { F ( n _ ) } n _ ∈ ℤ s of ideals in Cohen-Macaulay local rings of dimension at most two. This is enabled by a suitable generalization of the Kirby-Mehran complex. An analysis of its homology leads to an analogue of Huneke's fundamental lemma which plays a crucial role in our investigations. We also clarify the relationship between the Cohen-Macaulay property of the multigraded Rees algebra of F and reduction vectors with respect to complete reductions of F .

Pathologic complete response to neoadjuvant chemotherapy without trastuzumab in hormone receptor-negative/HER2+ tumors is seen in 27–45% of cases. In contrast, estrogen receptor (ER)+/HER2+ tumors demonstrate pathologic complete response in ∼8% of cases and is generally limited to weak-to-moderate ER+/HER2+ tumors. It is speculated that addition of trastuzumab to neoadjuvant chemotherapy regimen will increase the pathologic complete response rates in all HER2+ tumors. A list of HER2+ patients who received neoadjuvant chemotherapy (with trastuzumab) in the years 2007–2010 was obtained from our hospital database. The 104 HER2+ tumors were classified into three groups based on semiquantitative hormone receptor and HER2 results as follows: ERBB2 (ER–/PR–[H-score ≤10]/HER2+), Luminal B-HER2 Hybrid (LBHH; weak to moderate ER+ [H-score 11–199]/HER2+), and Luminal A-HER2 Hybrid (LAHH; strong ER+[H-score ≥200]/HER2+). Pathologic complete response was defined as absence of invasive carcinoma in the resection specimen and in the lymph nodes. Percentage tumor volume reduction was also calculated based on pretherapy size and detailed evaluation of the resection specimen. In all, 52% (25 of 48 cases) of ERBB2 tumors showed pathologic complete response, which was significantly higher than the pathologic complete response rate in LBHH (33%; 10 of 30) and LAHH (8%; 2 of 26) tumors. Average percentage tumor volume reduction was also highest in ERBB2 tumors (86%), followed by LBHH (74%) and LAHH (64%) tumors. We conclude that addition of trastuzumab to neoadjuvant chemotherapy regimen significantly increases the pathologic complete response rates in all HER2+ tumors. However, the benefit of trastuzumab is highest in ER-negative tumors and progressively decreases with increase in tumor ER expression. This information can be utilized to counsel patients considered for neoadjuvant chemotherapy and the same principle could be applied in the adjuvant setting.

Generative deep learning methods have recently been proposed for generating 3D molecules using equivariant graph neural networks (GNNs) within a denoising diffusion framework. However, such methods are unable to learn important geometric properties of 3D molecules, as they adopt molecule-agnostic and non-geometric GNNs as their 3D graph denoising networks, which notably hinders their ability to generate valid large 3D molecules. In this work, we address these gaps by introducing the Geometry-Complete Diffusion Model (GCDM) for 3D molecule generation, which outperforms existing 3D molecular diffusion models by significant margins across conditional and unconditional settings for the QM9 dataset and the larger GEOM-Drugs dataset, respectively. Importantly, we demonstrate that GCDM’s generative denoising process enables the model to generate a significant proportion of valid and energetically-stable large molecules at the scale of GEOM-Drugs, whereas previous methods fail to do so with the features they learn. Additionally, we show that extensions of GCDM can not only effectively design 3D molecules for specific protein pockets but can be repurposed to consistently optimize the geometry and chemical composition of existing 3D molecules for molecular stability and property specificity, demonstrating new versatility of molecular diffusion models. Code and data are freely available on GitHub . Geometric deep learning methods have the advantage of being expressive, while denoising diffusion probabilistic models have great generative power. Here, the authors introduce a geometry-complete diffusion model for effective 3D molecule generation for specific protein pockets that can also consistently optimize the geometry and chemical composition of existing 3D molecules for molecular stability and property specificity

Ammonia oxidation carried out by ammonia-oxidizing microorganisms (AOMs) is a central step in the global nitrogen cycle. Aerobic AOMs comprise conventional ammonia-oxidizing bacteria (AOB), novel ammonia-oxidizing archaea (AOA), which could exist in complex and extreme conditions, and complete ammonia oxidizers (comammox), which directly oxidize ammonia to nitrate within a single cell. Anaerobic AOMs mainly comprise anaerobic ammonia-oxidizing bacteria (AnAOB), which can transform NH4+-N and NO2−-N into N2 under anaerobic conditions. In this review, the unique metabolic characteristics, microbial community of AOMs and the influencing factors are discussed. Process applications of nitrification/denitrification, nitritation/denitrification, nitritation/anammox and partial denitrification/anammox in wastewater treatment systems are emphasized. The future development of nitrogen removal processes using AOMs is expected, enrichment of comammox facilitates the complete nitrification performance, inhibiting the activity of comammox and NOB could achieve stable nitritation, and additionally, AnAOB conducting the anammox process in municipal wastewater is a promising development direction.

Purpose To determine clinical outcomes and risks of various management strategies for mucoid degeneration of the anterior cruciate ligament (MD-ACL). Methods Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining clinical outcomes for various management strategies of MD-ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on satisfaction scores, visual analogue scale (VAS) scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, Knee Osteoarthritis and Outcome Scores (KOOS), range of motion and Lachman test were recorded. Results A total of 14 studies comprising 776 patients (782 knees) were included in this review. Partial debridement was reported in ten (71.4%) studies comprising 446 patients, showing significant improvements in VAS, Lysholm, IKDC scores and range of motion. Complete debridement was reported by two (14.2%) studies comprising 250 patients, and resulted in increases in Lysholm scores, KOOS, and range of motion. Reduction plasty was reported in two (14.2%) studies comprising 26 patients and showed improvements in VAS and Lysholm scores, and range of motion. Other methods of treatment included conservative management and ultrasound decompression. Complete debridement resulted in 10/23 (43%) patients with a positive Lachman test. This was followed by reduction plasty and partial debridement, with 5/26 (19.2%) and 45/340 (13.2%) patients respectively having positive Lachman or elevated knee arthrometer scores. Pivot shifting was only reported in studies on partial debridement and reduction plasty, with 14/93 (15.1%) and 1/21 (4.8%) patients have positive results, respectively. Conclusion The most commonly reported management strategy for MD-ACL is partial debridement with complete debridement, reduction plasty and conservative management as alternative options. Current operative management strategies place individuals at risk for ACL insufficiency. Information from this review can aid surgeons and clinicians in understanding what treatment options are best for this patient population, by understanding the reported clinical benefits and risks of each strategy. Level of evidence IV.

Background Pseudomonas stutzeri S116 is a sulfur-oxidizing bacteria isolated from marine sludge. It exhibited excellent electricity generation as bioanode and biocathode applied in microbial fuel cells (MFCs). Complete genome sequencing of P. stutzeri and cyclic voltammetry method were performed to reveal its mechanism in microbial fuel cells system. Results This study indicated that the MFCs generated a maximum output voltage of 254.2 mV and 226.0 mV, and maximum power density of 765 mW/m 2 and 656.6 mW/m 2 respectively. Complete genome sequencing of P. stutzeri S116 was performed to indicate that most function genes showed high similarities with P. stutzeri , and its primary annotations were associated with energy production and conversion (6.84%), amino acid transport and metabolism (6.82%) and inorganic ion transport and metabolism (6.77%). Homology of 36 genes involved in oxidative phosphorylation was detected, which suggests the strain S116 possesses an integrated electron transport chain. Additionally, many genes encoding pilus-assembly proteins and redox mediators (riboflavin and phenazine) were detected in the databases. Thiosulfate oxidization and dissimilatory nitrate reduction were annotated in the sulfur metabolism pathway and nitrogen metabolism pathway, respectively. Gene function analysis and cyclic voltammetry indicated that P. stutzeri probably possesses cellular machinery such as cytochrome c and redox mediators and can perform extracellular electron transfer and produce electricity in MFCs. Conclusion The redox mediators secreted by P. stutzeri S116 were probably responsible for performance of MFCs. The critical genes and metabolic pathways involved in thiosulfate oxide and nitrate reduction were detected, which indicated that the strain can treat wastewater containing sulfide and nitrite efficiently.