Aims To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. Methods This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. Results Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. Conclusion Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375–1383.

3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.

Study Design Systematic review and meta-analysis Objectives The present review aimed to summarize the evidence regarding differences in proprioception between children with and without adolescent idiopathic scoliosis (AIS). Methods Seven electronic databases were searched from their inception to April 10, 2021. Articles were included if they involved: (1) AIS patients aged between 10 and 18 years, (2) measurements of proprioceptive abilities, and (3) comparisons with non-AIS controls. Animal studies, case reports, commentaries, conference proceedings, research protocols, and reviews were excluded. Two reviewers independently conducted literature screening, data extraction, risks of bias assessments, and quality of evidence evaluations. Relevant information was pooled for meta-analyses. Results From 432 identified citations, 11 case-control studies comprising 1121 participants were included. The meta-analyses showed that AIS participants displayed proprioceptive deficits as compared to non-AIS controls. Moderate evidence supported that AIS participants showed significantly larger repositioning errors than healthy controls (pooled mean difference = 1.27 degrees, P < .01). Low evidence substantiated that AIS participants had significantly greater motion detection threshold (pooled mean difference = 1.60 degrees, P < .01) and abnormal somatosensory evoked potentials (pooled mean difference = .36 milliseconds, P = .01) than non-AIS counterparts. Conclusions Consistent findings revealed that proprioceptive deficits occurred in AIS patients. Further investigations on the causal relationship between AIS and proprioception, and the identification of the subgroup of AIS patients with proprioceptive deficit are needed.

Purpose Although it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS. Methods Participants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC). Results Fifty-nine patients with AIS were recruited. Regarding the trunk flexion–extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59). Conclusion This is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.

Bracing is the most common non-operative treatment option for patients with adolescent idiopathic scoliosis (AIS). However, existing brace designs have deficiencies, including a long production lead time and low patient compliance caused by the negative impacts of bracing on quality of life (QoL). The aim of this study was to address these problems by developing a new textile-based scoliosis brace in accordance with the biomechanics used in the existing braces for spinal correction. A case study of interface pressure had been carried out to determine the optimum combination of pads to be used in the proposed brace to correct a scoliotic spine. AIS patients who were undergoing hard brace treatment were recruited to complete a questionnaire (BrQ) on hard braces and on the proposed brace. The BrQ scores of the two types of braces were compared to assess their respective impacts on the QoL. The findings show that the proposed brace can address the issue of patient compliance by reducing the impact of bracing on QoL, and shorten the production lead time through incorporation of the mass customization concept into the design. Similar to most of the commonly-used scoliosis braces, the selected combination of pads used in the proposed brace for spinal correction shows a sufficient amount of exerted pressure and a similar function of active spinal correction.

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, and affects up to 4% of adolescents in early stages. The deformity can develop during any of the rapid periods of growth in children, and the time of pubertal growth spurt also plays a role in spinal curve progression. Hence it is crucial to detect the disease early, to provide timely intervention. Detection of scoliosis when it is mild or before the growth spurt can be conducted via various screening methods. Adam's forward bend test (FBT) and scoliometer measurement of the angle of trunk rotation (ATR) are commonly used, to observe lateral bending and rotation of the spine, causing a visible rib hump. Moire topography can also be used, but is reserved for second tier due to some degree of ambiguity. X-rays (XR) remain the best way to diagnose scoliosis, as it provides a clear image of the spine and allows measurement of Cobb angle; however it has risks associated including requirement of the use of ionising radiation. Infrared (IR) thermography can be used to measure surface temperature and is performed with an IR camera. The temperature distribution and data matrix can be visualised into a thermal map, which has previously been studied and associated with the thermal asymmetry in paraspinal muscles, as well as significant temperature differences between the convex and concave side of the spinal curvature for idiopathic scoliotic patients. We hypothesize that such asymmetry and temperature differences may produce a detectable pattern on IR thermography, which would prompt further confirmatory investigations to reach a fast and non-radiation screening of AIS.

There are many nonsurgical treatment options from adolescent idiopathic scoliosis (AIS) to control the progression of the spinal curvature. However, the existing studies are so diverse and diffuse that it is challenging to find potential trends for further studies without a more comprehensive review in place for reference purposes. Thus, the objective of this review article is to conduct a systematic literature review on the noninvasive treatment of AIS with a citation network analysis. The Web of Science (WoS) was searched using 9 reference keywords to collect published articles in English on nonsurgical treatment options for AIS from 1979 to 2019. Each eligible article focused on the nonsurgical options for treating AIS. In addition, the HistCite and the UCINet softwares were referred to for article distribution and citation network analysis. Only non-invasive treatment options of AIS were included. Studies that estimated the amount of spinal curvature, causes of or risk factors for AIS and any invasive treatments, such as surgery, were not focused on. The articles were independently extracted by 3 authors based on the predefined eligibility criteria. The title, authors, year of publication, country or region of publication, reference list, keywords and other bibliographic information from each article was extracted and analyzed purely based on the data with the HistCite and UCINet programs. At last, a total of 146 articles out of 1594 articles were selected for the literature review after the exclusion of 1357 irrelevant articles and 91 inappropriate studies, such as letters and proceedings papers. Of these 146 articles, the majority were empirical studies (74.0%). There was also a lack of meta-analyses in this research field. Based on the results of the citation network analysis, most of the top 10 articles with the highest local citation scores (LCSs) focused on bracing as a treatment. The popularity of bracing as a research topic was also supported by the citation network structure, as brace treatment was in the largest of the five research clusters; this cluster also included posture training through exercise, managing the corrective forces of braces, 3D analysis of braces and quality of life during brace treatment. However, most of these studies focused on rigid braces. A few studies on non-rigid braces and other types of nonsurgical treatment were available in the current literature, which might indicate potential research areas for future studies. To conclude, noninvasive treatment for AIS has been on the academic radar recently; but there are still research gaps, such as the lack of research on semi-rigid and flexible braces or posture training exercises with biofeedback systems. Further studies could explore these research directions.

The mission of the Transmutation Research Program (TRP) at University of Nevada, Las Vegas (UNLV) is to establish a nuclear engineering test bed that can carry out effective transmutation and advanced reactor research and development effort. TRPSEMPro package, developed from previous project period, integrated a chemical separation code from the Argonne National Laboratories (ANL). Current research focus has two folds: development of simulation system processes applied to Spent Fuel Treatment Facility (SFTF) using ASPEN-plus and further interaction of ASPEN+ program from TRPSEMPro interface. More details will be discussed below. ANL has identified three processes simulations using their separation technologies. The first process is to separate aqueous acid streams of acetic acid, nitric acid, water and a variety of fission product nitric salts. Distillation separation method is used to remove the desired components from the streams. The second simulation is to convert plutonium nitrate to plutonium metal. Steps used for the process simulation are precipitation, calcinations, fluorination and reduction. The third process currently under development is vitrification of fission product of raffinate streams. During the process, various waste streams from the plant are mixed and fed to a process that converts them to a solid state glass phase. The vitrification process used by the Hanford and Savannah River facilities was selected as a guideline to develop the prototype simulation process using ASPEN-Plus. Current research is focusing on identifying unit operations required to perform the vitrification of the waste streams. The first two processes are near completion stage. Microsoft Visual Basic (MS VB) has been used to develop the entire system engineering model package, TRPSEMPro. Currently a user friendly interface is under development to facilitate direct execution of ASPEN-plus within TRPSEMPro. The major purpose for the implementation is to create iterative interaction among system engineering modeling, ANL separation model and ASPEN-Plus process that outputs optimized separation/process simulation results. The ASPEN-plus access interface from TRPSEMPro allows users to modify and execute process parameters derived from the ASPEN Plus simulations without navigating through ASPEN-Plus. All ASPEN-plus simulation results can be also accessible by the interface. Such integration provide a single interaction gateway for researchers interested in SFTF process simulation without struggling with complicate data manipulation and joggling among various software packages.