Miracle-dz/UniFAR-FTUs huggingface dataset:
Conservative Treatment for Bony Healing in Pediatric Lumbar Spondylolysis

Study Design. A retrospective review of prospectively collected data. Objective. The aim of this study was to investigate recent outcomes of conservative treatment for bony healing in pediatric patients with lumbar spondylolysis (LS) and to identify the problems that need to be resolved. Summary of Background Data. Several diagnostic and therapeutic techniques for LS have been developed recently, leading to better outcomes for bony healing. Methods. Overall, 63 consecutive pediatric patients (53 boys and 10 girls) with LS (average age: 13.8 years; range: 6–17 years) were analyzed. Diagnosis and staging (very early, early, progressive, and terminal) were based on multidetector computed tomography (CT) scans and magnetic resonance imaging (MRI). For all patients except those with terminal-stage pars defect, conservative treatment included rest, avoidance of sports, and the use of a thoraco-lumbo-sacral-type trunk brace. Follow-up MRI was performed monthly. When the signal changes resolved, CT scans were obtained to assess bony healing. Results. Three patients dropped out during the study period. A total of 60 patients were included (50 boys and 10 girls) in this study (follow-up rate: 95.2%), with 86 instances of LS (very early: 36, early: 16, progressive: 15, terminal: 19) in 65 laminae. In the very early stage, the bony healing rate was 100%, and average treatment period was 2.5 months (range: 1–7 months). In the early stage, the bony healing rate was 93.8%, and the average treatment period was 2.6 months (range: 1–6 months). In the progressive stage, the bony healing rate was 80.0%, and the average treatment period was 3.6 months (range: 3–5 months). The average overall recurrence rate was 26.1%. All patients showing recurrence eventually achieved bony healing. Conclusion. High bony healing rates and short treatment periods were observed with conservative treatment in pediatric patients with LS. However, the recurrence rates were relatively high. This issue should be targeted in future studies. Level of Evidence: 2
Fuzzy Direct Adaptive Control for a Class of Decentralized Nonlinear Systems

In this paper, a stable fuzzy direct control scheme is presented for a class of interconnected nonlinear systems with unknown nonlinear subsystems and unknown nonlinear interconnections. In this control algorithm, fuzzy logic systems are employed to approximate the optimal controllers, which are designed on the assumption that all dynamics for each subsystem are known; then the fuzzy controllers and adaptation mechanisms for each subsystem depend only on local measurements to provide asymptotic tracking of a reference trajectory. In addition, a fuzzy sliding mode controller is developed to compensate for the fuzzy approximating errors and attenuate the interactions between subsystems. Global asymptotic stability is established in the Lyapunov sense, with the tracking errors converging to a neighborhood of zero. A simulation example is given to illustrate the performance of the proposed method.
Overproduction of L‐tryptophan via simultaneous feed of glucose and anthranilic acid from recombinant Escherichia coli W3110: Kinetic modeling and process scale‐up

L‐tryptophan is an essential amino acid widely used in food and pharmaceutical industries. However, its production via Escherichia coli fermentation suffers severely from both low glucose conversion efficiency and acetic acid inhibition, and to date effective process control methods have rarely been explored to facilitate its industrial scale production. To resolve these challenges, in the current research an engineered strain of E. coli was used to overproduce L‐tryptophan. To achieve this, a novel dynamic control strategy which incorporates an optimized anthranilic acid feeding into a dissolved oxygen‐stat (DO‐stat) glucose feeding framework was proposed for the first time. Three original contributions were observed. Firstly, compared to previous DO control methods, the current strategy was able to inhibit completely the production of acetic acid, and its glucose to L‐tryptophan yield reached 0.211 g/g, 62.3% higher than the previously reported. Secondly, a rigorous kinetic model was constructed to simulate the underlying biochemical process and identify the effect of anthranilic acid on both glucose conversion and L‐tryptophan synthesis. Finally, a thorough investigation was conducted to testify the capability of both the kinetic model and the novel control strategy for process scale‐up. It was found that the model possesses great predictive power, and the presented strategy achieved the highest glucose to L‐tryptophan yield (0.224 g/g) ever reported in large scale processes, which approaches the theoretical maximum yield of 0.227 g/g. This research, therefore, paves the way to significantly enhance the profitability of the investigated bioprocess.
Late‐life insomnia: A review

Aging is associated with substantial changes in sleep patterns, which are almost always negative in nature. Typical findings in the elderly include a reduction in the deeper stages of sleep and a profound increase in the fragmentation of nighttime sleep by periods of wakefulness. The prevalence of specific sleep disorders increases with age, such as a phase advance in the normal circadian sleep cycle, restless legs syndrome, and obstructive sleep apnea, which is increasingly seen among older individuals and is significantly associated with cardio‐ and cerebrovascular disease as well as cognitive impairment. Elderly patients with sleep disturbances are often considered difficult to treat; yet, they are among the groups with the greatest need of treatment. Management of sleep disturbances begins with recognition and adequate assessment. Hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in short‐term situations, but their role in chronic insomnia still remains to be further defined by research evidence. Non‐pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with a stable, long‐term improvement in sleep. This review delineates the common causes of disordered sleep in older individuals, and effective diagnostic approaches and treatments for these conditions.
CRISPRi repression of nonhomologous end‐joining for enhanced genome engineering via homologous recombination in Yarrowia lipolytica

In many organisms of biotechnological importance precise genome editing is limited by inherently low homologous recombination (HR) efficiencies. A number of strategies exist to increase the effectiveness of this native DNA repair pathway; however, most strategies rely on permanently disabling competing repair pathways, thus reducing an organism's capacity to repair naturally occurring double strand breaks. Here, we describe a CRISPR interference (CRISPRi) system for gene repression in the oleochemical‐producing yeast Yarrowia lipolytica. By using a multiplexed sgRNA targeting strategy, we demonstrate efficient repression of eight out of nine targeted genes to enhance HR. Strains with nonhomologous end‐joining repressed were shown to have increased rates of HR when transformed with a linear DNA fragment with homology to a genomic locus. With multiplexed targeting of KU70 and KU80, and enhanced repression with Mxi1 fused to deactivated Cas9 (dCas9), rates of HR as high as 90% were achieved. The developed CRISPRi system enables enhanced HR in Y. lipolytica without permanent genetic knockouts and promises to be a potent tool for other metabolic engineering, synthetic biology, and functional genomics studies.
Directed evolution of polypropylene and polystyrene binding peptides

Surface functionalization of biological inert polymers (e.g., polypropylene PP; polystyrene PS) with material binding peptides facilitates an efficient immobilization of enzymes, bioactive peptides or antigens at ambient temperature in water. The developed robust directed evolution protocol enables to tailor polymer binding anchor peptides (PBPs) for efficient binding under application conditions. Key for a successful directed evolution campaign was to develop an epPCR protocol with a very high mutation frequency (60 mutations/kb) to ensure sufficient diversity in PBPs (47 aas LCI: “liquid chromatography peak I”; 44 aas TA2: “Tachystatin A2”). LCI and TA2 were genetically fused to the reporter egfp to quantify peptide binding on PP and PS by fluorescence analysis. The Peptide‐Polymer evolution protocol (PePevo protocol) was validated in two directed evolution campaigns for two PBPs and polymers (LCI: PP; TA2: PS). Surfactants were used as selection pressure for improved PBP binders (non‐ionic surfactant Triton X‐100; 1 mM for LCI‐PP // anionic surfactant LAS; 0.5 mM for TA2‐PS). PePevo yielded an up to three fold improved PP‐binder (LCI‐M1‐PP: I24T, Y29H, E42 K and LCI‐M2‐PP: D31V, E42G) and an up to six fold stronger PS‐binder (TA2‐M1‐PS: R3S, L6P, V12 K, S15P, C29R, R30L, F33S, Y44H and TA2‐M2‐PS: F9C, C24S, G26D, S31G, C41S, Y44Q).
A fast and simple method to estimate relative, hyphal tensile‐strength of filamentous fungi used to assess the effect of autophagy

Fungal hyphal strength is an important phenotype which can have a profound impact on bioprocess behavior. Until now, there is not an efficient method which allows its characterization. Currently available methods are very time consuming, thus, compromising their applicability in strain selection and process development. To overcome this issue, a method for fast and easy, statistically verified quantification of relative hyphal tensile strength was developed. It involves off‐line fragmentation in a high shear mixer followed by quantification of fragment size using laser diffraction. Particle size distribution (PSD) is determined, with analysis time on the order of minutes. Plots of PSD 90th percentile versus time allow estimation of the specific fragmentation rate. This novel method is demonstrated by estimating relative hyphal strength during growth in control conditions and rapamycin‐induced autophagy for Aspergillus nidulans (parental strain) and a mutant strain (ΔAnatg8) lacking an important autophagy gene. Both strains were grown in shake flasks and relative hyphal tensile strength was compared. The mutant strain grown in control conditions appears to be weaker than the parental strain, suggesting that Anatg8 may play a role in other processes involving cell wall biosynthesis. Furthermore, rapamycin‐induced autophagy resulted in apparently weaker cells even for the mutant strain. These findings confirm the utility of the developed method in strain selection and process development.
Meta‐analysis of antibiotics for simple hand injuries requiring surgery

Simple hand trauma is very common, accounting for 1·8 million emergency department visits annually in the USA alone. Antibiotics are used widely as postinjury prophylaxis, but their efficacy is unclear. This meta‐analysis assessed the effect of antibiotic prophylaxis versus placebo or no treatment on wound infection rates in hand injuries managed surgically.
Intrathecal Morphine and Oral Analgesics Provide Safe and Effective Pain Control After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Study Design. Retrospective comparative study. Objective. The aim of this study was to demonstrate that intrathecal morphine (ITM) and oral analgesics provide effective pain control after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), and this protocol has a low complication rate so patients can be admitted to a general care floor. Summary of Background Data. Previous studies have shown that ITM combined with intravenous patient-controlled analgesia or epidural infusion (EPI) provides effective pain control after PSF for AIS. Owing to concerns for respiratory depression, ITM patients were routinely admitted to the intensive care unit (ICU) postoperatively. There are little data on ITM combined with oral analgesics. Methods. We identified AIS patients aged 10 to 17 years who had undergone PSF. Twenty-eight patients who received ITM were matched to 28 patients who received a hydromorphone EPI. The ITM group received oral oxycodone starting at 16 hours postinjection. The EPI group received oxycodone after the epidural catheter was removed on postoperative day 2. Pain scores, adverse events, and length of stay were recorded. Results. A higher number of EPI patients received fentanyl (11 vs. 3, P = 0.014) in the post-anesthesia care unit (PACU). The ITM group had lower pain scores between PACU discharge and midnight (mean 2.9 vs. 4.2, P = 0.034). Pain scores were similar during the remaining postoperative periods. All ITM patients transitioned to oxycodone without intravenous opioids. Time to ambulation (19.9 vs. 26.5 hours, P = 0.010) and Foley catheter removal (21.3 vs. 41.9 hours, P < 0.001) were earlier in the ITM patients. Length of hospital stay was shorter in the ITM group (3.1 vs. 3.5 days, P = 0.043). Adverse events occurred at similar rates in both groups. Conclusion. ITM and oral analgesics provide safe and effective pain control after PSF for AIS. Routine postoperative admission to the ICU is not necessary. Level of Evidence: 3
Prediction of survival in patients with oesophageal or junctional cancer receiving neoadjuvant chemoradiotherapy and surgery

The value of conventional prognostic factors is unclear in the era of multimodal treatment for oesophageal cancer. This study aimed to quantify the impact of neoadjuvant chemoradiotherapy (nCRT) and surgery on well established prognostic factors, and to develop and validate a prognostic model.
Propensity score‐based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases

There is a need for high‐level evidence regarding the added value of laparoscopic (LLR) compared with open (OLR) liver resection. The aim of this study was to compare the surgical and oncological outcomes of patients with colorectal liver metastases (CRLM) undergoing LLR and OLR using propensity score matching to minimize bias.
The Lumbar Pelvic Angle, the Lumbar Component of the T1 Pelvic Angle, Correlates With HRQOL, PI-LL Mismatch, and it Predicts Global Alignment

Study Design. Prospective multicenter analysis of adult spinal deformity (ASD) patients. Objective. The aim of this study was to introduce the lumbar pelvic angle (LPA), a novel parameter of spinopelvic alignment. Summary of Background Data. The T1 pelvic angle (TPA), a measure of global spinopelvic alignment, correlates with health-related quality of life (HRQOL), but it may not be measureable on all intraoperative x-rays. In patients with previous interbody fusion at L5-S1, the plane of the S1 endplate can be blurred, creating error in pelvic incidence and lumbar lordosis (PI-LL) measure. The LPA is more readily measured on intraoperative imaging than the TPA. Methods. ASD patients were included with either coronal Cobb angle >20°, sagittal vertical axis (SVA) >5 cm, thoracic kyphosis >60°, or pelvic tilt (PT) >25°. Measures of disability included Oswestry Disability Index (ODI), Scoliosis Research Society (SRS), and Short Form (SF)-36. Baseline and 2-year follow-up radiographic and HRQOL outcomes were evaluated. Linear regressions compared LPA with radiographic parameters and HRQOL. Results. A total of 852 ASD patients (407 operative) were enrolled (mean age 53.7). Baseline LPA correlated with PI-LL (r = 0.79), PT (r = 0.78), TPA (r = 0.82), and SVA (r = 0.61) (all P < 0.001). PI-LL, LPA, and TPA correlated with ODI (r = 0.42/0.29/0.45), SF-36 physical component score (−0.43/−0.28/−0.45) SRS (−0.354/−0.23/−0.37) with all P < 0.001. At 2 years’ follow-up, LPA correlated with PI-LL (r = 0.77), PT (r = 0.78), TPA (r = 0.83), and SVA (r = 0.57) (all P < 0.001). Categorizing patients by increasing LPA (<7°; 7°–15°; >15°) revealed progressive increases in all HRQOL, PI-LL (−3.2°/12.7°/32.4°), and TPA (9.7°/20.1°/34.6°) with all P < 0.001. Moderate disability (ODI = 40) corresponded to LPA 10.1°, PI-LL 12.6°, and TPA 20.6°. Mild disability (ODI = 20) corresponded to LPA 7.2°, PI-LL 4.2°, and TPA 14.7°. Conclusion. LPA correlates with TPA, PI-LL, and HRQOL in ASD patients. LPA can be used as an intraoperative tool to gauge correction with a target LPA of <7.2°. LPA predicts global alignment, as it correlates with baseline and 2-year TPA and SVA. Along with the cervical-thoracic pelvic angle and TPA, LPA completes the fan of spinopelvic alignment. Level of Evidence: 3
Tai chi and reduction of depressive symptoms for older adults: A meta‐analysis of randomized trials

The aim of the present article was to systematically review the effectiveness of tai chi for reducing depressive symptoms among older adults. Electronic databases were searched through January 2011. Reference lists of systematic reviews and identified studies from the search strategy were also screened. Randomized controlled trials of tai chi compared with waiting list controls in older adults with depressive symptoms measured by a self‐report depression rating scale were included. Two authors independently identified eligible studies, extracted data and assessed the included studies for risk of bias. Estimates of depressive symptoms reduction used a random effects model, and the I2 statistic was applied to examine heterogeneity. Four trials with a total of 253 participants met the inclusion criteria. Two studies were assessed as being of high quality; the remaining two studies were rated as moderate quality. All four studies compared tai chi with a waiting list control group. The pooled standard mean difference for these studies was −0.27 (95% CI −0.52 to −0.02, P = 0.03). Tai chi appeared to have a significant impact on reducing depressive symptoms compared with the waiting list control groups. Further research is recommended with larger sample sizes, more clarity on trial design and the intervention, longer‐term follow up, and concomitant economic evaluations. Geriatr Gerontol Int 2013; 13: 3–12.
Poorer Fusion Outcomes in Diabetic Cervical Spondylotic Myelopathy Patients Undergoing Single-level Anterior Cervical Discectomy and Fusion Does Not Compromise Functional Outcomes and Quality of Life

Study Design. Retrospective matched pair cohort study using prospectively collected registry data. Objectives. The aim of this study was to determine whether patients with DM have poorer patient-reported outcomes and poorer fusion rates after undergoing a single-level anterior cervical discectomy and fusion (ACDF) for cervical myelopathy. Summary of Background Data. ACDF remains the most common procedure in the treatment of cervical spondylotic myelopathy (CSM); however, there is a paucity of literature with regards to patient-reported outcome measures (PROMs), health-related quality-of-life (HRQOL) scores, and fusion rates post-ACDF in diabetic patients with CSM. Methods. From 2002 to 2012, 29 diabetic patients were matched with 29 nondiabetic controls. Patient demographics, perioperative data, and validated spine-specific scores including the Numerical Pain Rating Scale on Neck Pain and Upper Limb Pain, American Academy of Orthopaedic Surgeons (AAOS) neck pain and disability scores, AAOS Neurogenic Symptoms Score, Neck Disability Index, Japanese Orthopaedic Association Cervical Myelopathy Score, and Short Form 36 Physical/Mental Component Summaries were recorded. Fusion rates based on Bridwell grading were assessed at 2 years. Results. After matching, there were no significant preoperative differences in patient demographics, clinical outcomes, PROMs or HRQoL measures between the DM and control group (P > 0.05). There was no difference in either length of hospital stay (P = 0.92) or length of surgery (P = 0.92) between the two groups. At 2 years postoperatively, there were no significant differences between validated spine-specific scores, PROMs, HRQoL scores, satisfaction rates, or fulfilment of expectations between the two groups. Significant poorer Bridwell fusion grades were noted in the DM group at 2 years postoperatively (P < 0.05). Subgroup analysis within the DM group demonstrated that glycated hemoglobin levels had no impact on functional outcomes, fulfilment of expectations, or patient satisfaction at 2 years (P > 0.05). Conclusion. Despite poorer fusion outcomes following single-level ACDF for symptomatic CSM, there was no significant difference in validated spine outcome scores, PROMs, HRQoL measures, or satisfaction levels when compared to nondiabetic controls at short-term follow-up. Level of Evidence: 3
Congenital Malformations in Four Siblings of a Mother Taking Anticonvulsant Drugs

• Four siblings have various congenital malformations attributable to the teratogenic effect of anticonvulsant drugs. Their mother has a 23-year history of continuous medication for seizures. Since the malformations noted in her four offspring are more extensive and severe in each subsequent child, the question arises as to the possible cumulative effect of antiepileptic drugs in producing congenital malformations. The observations in this family strongly support the need to carefully evaluate all offspring of mothers receiving anticonvulsant drugs. ( Am J Dis Child 130:884-887, 1976)
Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion

Study Design. Retrospective, economic analysis. Objective. To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. Summary of Background Data. Chronic opioid use is associated with poor outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with COT in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors is important. Methods. Commercial insurance data from 2007 to Q3–2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications, ED visits, readmissions, 1-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications and adverse events. Results. A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost associated with increase resource use in these patients has been reported. Conclusion. Preoperative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after one- or two-level PLF. Level of Evidence: 3
Neoadjuvant chemotherapy with MRI monitoring for breast cancer

Neoadjuvant chemotherapy (NACT) is increasingly being offered to patients with breast cancer. No survival benefit has been demonstrated for NACT, but it may serve to reduce tumour size and improve prognosis through the attainment of a pathological complete response (pCR). The role and mode of MRI monitoring during NACT remain unclear.