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The growing number of people aging with HIV represents a group vulnerable to the symptom burdens of HIV-associated neurocognitive disorder (HAND). Among younger groups, Mindfulness-Based Stress Reduction (MBSR) has been shown to help people living with HIV manage HIV-related and other life stress, and although there is some theoretical and empirical evidence that it may be effective among those with cognitive deficits, the approach has not been studied in older populations with HAND. Participants (n = 180) 55 years or older with HIV and cognitive impairment were randomly assigned to either an 8-week MBSR arm or a waitlist control. We assessed the impact of MBSR compared to a waitlist control on psychological outcomes [stress, anxiety, depression, and quality of life (QOL)] and cognitive metrics (e.g., speed of information processing, working memory, attention, impulsivity) measured at baseline, immediately post intervention (8 weeks) and one month later (16 weeks). Intent to treat analyses showed significant improvement in the MBSR group compared to control on symptoms of depression from baseline to 8 weeks, however, the difference was not sustained at 16 weeks. The MBSR group also showed improvement in perceived QOL from baseline to 16 weeks compared to the waitlist control group. Cognitive performance did not differ between the two treatment arms. MBSR shows promise as a tool to help alleviate the symptom burden of depression and low QOL in older individuals living with HAND and future work should address methods to better sustain the beneficial impact on depression and QOL. [ABSTRACT FROM AUTHOR]

Pediatric pial arteriovenous shunts in the brain and spine are challenging to understand because of low incidence, variable presentation, and associations with genetic syndromes. What is known about their natural history comes from reviews of small series. To better understand the natural history and role for intervention, two cases are presented followed by a review of the literature. In the first case, an infant with a prior history of intracranial hemorrhage from a ruptured pial fistula returns for elective embolization for a second pial fistula which was found to be spontaneously thrombosed 2 weeks later. In the second case, a 5-year-old with a vertebro-vertebral fistula, identified on work up for a heart murmur and documented with diagnostic angiography, is brought for elective embolization 6 weeks later where spontaneous thrombosis is identified. In reviewing the literature on pediatric single-hole fistulae of the brain and spine, the authors offer some morphologic considerations for identifying which high-flow fistulae may undergo spontaneous thrombosis to decrease the potentially unnecessary risk associated with interventions in small children. [ABSTRACT FROM AUTHOR]

Purpose: Using ultrashort echo time (UTE) MRI, we determined prevalence of abnormal cartilaginous endplate (CEP), and the relationship between CEP and disc degeneration in human lumbar spines. Materials and methods: Lumbar spines from 71 cadavers (age 14–74 years) were imaged at 3 T using sagittal UTE and spin echo T2 map sequences. On UTE images, CEP morphology was defined as "normal" with linear high signal intensity or "abnormal" with focal signal loss and/or irregularity. On spin echo images, disc grade and T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) were determined. 547 CEPs and 284 discs were analysed. Effects of age, sex, and level on CEP morphology, disc grade, and T2 values were determined. Effects of CEP abnormality on disc grade, T2 of NP, and T2 of AF were also determined. Results: Overall prevalence of CEP abnormality was 33% and it tended to increase with older ages (p = 0.08) and at lower spinal levels of L5 than L2 or L3 (p = 0.001). Disc grades were higher and T2 values of the NP were lower in older spines (p < 0.001) and at lower disc level of L4-5 (p < 0.05). We found significant association between CEP and disc degeneration; discs adjacent to abnormal CEPs had high grades (p < 0.01) and lower T2 values of the NP (p < 0.05). Conclusion: These results suggest that abnormal CEPs are frequently found, and it associates significantly with disc degeneration, suggesting an insight into pathoetiology of disc degeneration. [ABSTRACT FROM AUTHOR]

Ni-based superalloys are promising materials for high-temperature molten salt (MS) energy generation and storage. Studying morphological and chemical evolution of pure Ni in MS provides fundamental knowledge for MS technologies and corrosion mitigation. Here, real-time 3D morphological changes of Ni microparticles in molten KCl-MgCl2 were studied by operando synchrotron X-ray nano-tomography at 700°C. Rapid Ni particle agglomeration occurred, without significant chemical reactions, such as oxide or chloride formation. The morphological growth evolved differently from classical coarsening or sintering behaviors and occurred nonuniformly, with other regions showing slight dissolution of Ni. Ni nanoparticles were found to be dispersed in many areas of the samples, either from microparticle dissolution or other radiation-induced nanoparticle formation mechanisms. This study discusses important factors, i.e., thermal gradient, amounts of salt and metals, and radiation effect, that influence morphological changes of materials in MS, critical for fundamental understanding of material–MS interactions as well as for practical applications. [ABSTRACT FROM AUTHOR]

This work aimed to evaluate the usage of a web-based intervention (WISE: Work ability Improvement through Symptom and Ergonomic strategies) developed to improve work ability for women recently diagnosed with breast cancer. Twenty-two women undergoing adjuvant treatment for breast cancer were provided access to WISE. This website includes content pages (e.g., information on ergonomics, symptom management, and other work-related resources) and worksheets (e.g., journals to track symptoms or goals). It could be personalized based on individual work activities and symptoms. Measures assessed at 3 months included usage of the website and perceived usefulness. Thirteen of the 22 participants (60%) accessed WISE; 11 personalized their information. Content and worksheet pages had 97 and 79 visits, respectively. Most frequently visited pages were "setting goals" (i.e., prioritize and track symptoms; 45 visits) and "steps to creating your WISE plan" (i.e., incorporate symptom and ergonomic strategies; 16 visits). Median duration time was 11.05 (range 0.35–79.55) minutes. Usefulness of the content and worksheet pages assessed via a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree) was 5.08 (SD = 1.59) and 4.26 (SD = 2.03), respectively. Participants were likely to recommend WISE to other women undergoing cancer treatment (mean = 6.11; SD = 1.05). The majority of participants personalized WISE work and symptom strategies. Overall, participants agreed that WISE content pages were useful and would recommend WISE for other breast cancer survivors. Results support that majority of breast cancer survivors, undergoing treatment with curative intent, accessed a web-based intervention that provided personalized information on workplace and symptom strategies. [ABSTRACT FROM AUTHOR]

Porous materials with high specific surface area, high porosity, and high electrical conductivity are promising materials for functional applications, including catalysis, sensing, and energy storage. Molten salt dealloying was recently demonstrated in microwires as an alternative method to fabricate porous structures. The method takes advantage of the selective dissolution process introduced by impurities often observed in molten salt corrosion. This work further investigates molten salt dealloying in bulk Ni–20Cr alloy in both KCl–MgCl2 and KCl–NaCl salts at 700 ℃, using scanning electron microscopy, energy dispersive spectroscopy, and X-ray diffraction (XRD), as well as synchrotron X-ray nano-tomography. Micro-sized pores with irregular shapes and sizes ranging from sub-micron to several microns and ligaments formed during the process, while the molten salt dealloying was found to progress several microns into the bulk materials within 1–16 h, a relatively short reaction time, enhancing the practicality of using the method for synthesis. The ligament size increased from ~ 0.7 μm to ~ 1.3 μm in KCl–MgCl2 from 1 to 16 h due to coarsening, while remaining ~ 0.4 μm in KCl–NaCl during 16 h of exposure. The XRD analysis shows that the corrosion occurred primarily near the surface of the bulk sample, and Cr2O3 was identified as a corrosion product when the reaction was conducted in an air environment (controlled amount sealed in capillaries); thus surface oxides are likely to slow the morphological coarsening rate by hindering the surface diffusion in the dealloyed structure. 3D-connected pores and grain boundary corrosion were visualized by synchrotron X-ray nano-tomography. This study provides insights into the morphological and chemical evolution of molten salt dealloying in bulk materials, with a connection to molten salt corrosion concerns in the design of next-generation nuclear and solar energy power plants. [ABSTRACT FROM AUTHOR]

Purpose: By 2020, the US population living with metastatic breast cancer (MBC) has exceeded 165,000. A knowledge gap exists regarding the factors affecting work ability for these individuals. We sought to characterize the work status, importance of work, and work-related information needs for women living with MBC. Methods: We conducted an online survey using an MBC listserv and clinic flyers in 2014–2015. Respondents working at the time of MBC diagnosis were divided into "stably-working" and "no-longer-working" based on employment status at the time of survey. Comparisons were made with chi-square or two-tailed t test. Results: Respondents (n = 133) were predominantly non-Hispanic White (93.2%); 72 were stably-working, while 61 reported no-longer-working. Those no-longer-working were older (54.0 vs 49.5 years old, p < 0.01, Cohen's d = 0.55), further from initial diagnosis of MBC (4.6 vs 3.3 years, p < 0.01, Cohen's d = 0.36), and reported high rates of life interference due to MBC (n = 51, 83.6% vs n = 39, 54.2%, p < 0.01, Cramer's V = 0.32). Stably-working respondents considered work to be important (n = 58, 80.5% vs n = 18, 29.5%, p < 0.01, Cramer's V = 0.57); the top reasons cited were financial and/or insurance (80.4%), importance of staying busy (67.9%), and desire to support themselves and family (64.3%). The stably-working respondents more often valued information on how to talk with employers or co-workers about diagnosis (n = 38, 57.6% vs n = 16, 27.1%; p < 0.01), legal rights in workplace (n = 43, 65.2% vs n = 22, 36.7%; p < 0.01), when to think about stopping work (n = 45, 68.2% vs n = 18, 30%; p < 0.01), and applying for disability (n = 42, 63.6% vs n = 26, 42.6%; p < 0.05), when compared to no-longer-working. Conclusion: The decision to stop working may represent a subsequent event driven by cancer progression. This research highlights the ongoing need of information targeting MBC to facilitate the management of employment and financial issues early in the MBC trajectory. [ABSTRACT FROM AUTHOR]

Three-dimensional bicontinuous porous materials formed by dealloying contribute significantly to various applications including catalysis, sensor development and energy storage. This work studies a method of molten salt dealloying via real-time in situ synchrotron three-dimensional X-ray nano-tomography. Quantification of morphological parameters determined that long-range diffusion is the rate-determining step for the dealloying process. The subsequent coarsening rate was primarily surface diffusion controlled, with Rayleigh instability leading to ligament pinch-off and creating isolated bubbles in ligaments, while bulk diffusion leads to a slight densification. Chemical environments characterized by X-ray absorption near edge structure spectroscopic imaging show that molten salt dealloying prevents surface oxidation of the metal. In this work, gaining a fundamental mechanistic understanding of the molten salt dealloying process in forming porous structures provides a nontoxic, tunable dealloying technique and has important implications for molten salt corrosion processes, which is one of the major challenges in molten salt reactors and concentrated solar power plants. Understanding how pores evolve in metals submerged in molten salts is important for nanofabrication technology and molten salt corrosion in nuclear and solar power plants. Here, the authors present an in situ X-ray 3D imaging to directly visualize and quantify the process. [ABSTRACT FROM AUTHOR]

Purpose: Strokes associated with cervical artery dissection have been managed primarily with antithrombotics with poor outcomes. The additive role of endovascular thrombectomy remains unclear. The objective was to perform systematic review and meta-analysis to compare endovascular thrombectomy and medical therapy for acute ischemic stroke associated with cervical artery dissection. Methods: Studies from six electronic databases included outcomes of patient cohorts with acute ischemic stroke secondary to cervical artery dissection who underwent treatment with endovascular thrombectomy. A meta-analysis of proportions was conducted with a random effects model. Modified Rankin score at 90 days (mRS 0–2) was the primary outcome. Other outcomes included proportion of patients with thrombolysis in cerebral infarction (TICI) 2b-3 flow, 90-day mortality rate, and 90-day symptomatic intracerebral hemorrhage (sICH) rate. Results: Six studies were included, comprising 193 cases that underwent thrombectomy compared with 59 cases that were managed medically. Successful recanalization with a pooled proportion of thrombolysis in cerebral infarction (TICI) 2b-3 flow in the thrombectomy group was 74%. Favorable outcome (mRS 0–2) was superior in the pooled thrombectomy group (62.9%, 95% CI 55.8–69.5%) compared with medical management (41.5%, 95% CI 29.0–55.1%, P = 0.006). The pooled rate of 90-day mortality was similar for endovascular vs medical (8.6% vs 6.3%). The pooled rate of symptomatic intracranial haemorrhage (sICH) did not significantly differ (5.9% vs 4.2%, P = 0.60). Conclusions: Current data suggest that endovascular thrombectomy may be an option in patients with acute ischemic stroke due to cervical artery dissection. This requires further confirmation in higher quality prospective studies. [ABSTRACT FROM AUTHOR]

Objective: To determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI.Materials and Methods: Three hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined.Results: Significantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1).Conclusions: MTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle. [ABSTRACT FROM AUTHOR]

Objective: To evaluate ultrashort time to echo (UTE) magnetic resonance (MR) morphology of the cartilaginous endplates (CEP) in cadaveric lumbar spines with bony vertebral endplate (VEP) lesions, to determine inter-reader agreement as well as associations between the CEP morphology and VEP lesions as well as other abnormalities.Materials and Methods: MR imaging of cadaveric lumbar spines from 10 donors was performed at 3T using a UTE MR sequence. Two musculoskeletal radiologists identified the location of vertebral endplate lesions in consensus. The morphology of the CEP overlying the lesions and in the adjacent normal regions was assessed individually. A total of 55 vertebral lesions and 55 normal regions were assessed. The presence of osteophytosis, morphological changes of the anterior and posterior longitudinal ligament, and intervertebral disc signal and morphology was also assessed. Agreement between observers was determined using Cohen's kappa analysis, and association between CEP and vertebral endplate lesions was determined using the chi square test.Results: Fifty-five vertebral endplate lesions were identified and the morphology of CEP evaluated by two readers was in substantial agreement with Cohen's kappa of 0.78. The presence of vertebral endplate abnormality was associated with the presence of osteophytes (39 out of 55 levels), altered morphology and signal of the anterior longitudinal ligament (23 out of 55 levels) and intervertebral discs (30 out of 55 levels).Conclusion: UTE MRI enables evaluation of the CEP with substantial inter-reader agreement. Abnormal changes of the CEP may facilitate formation of lesions of vertebral endplate over time and are associated with degenerative changes of the lumbar spine. [ABSTRACT FROM AUTHOR]

Malaysia, Singapore, China, and South Korea employed branch campuses as a means to develop and promote economic growth and global competitiveness. The aim of this study was to explore national policies and regulatory frameworks for international branch campuses in the four key nations identified above. The development of internal quality assurance mechanisms and external review approaches in international branch campuses were investigated, via in-depth interview and document analysis. The study presented three major findings. First, an inclusive model of internal quality has been developed in international branch campuses found in the four nations. Second, the international branch campuses' external quality assurance approaches, in the four countries, were diverse and included exemption, reliance on home country accreditation, duplication, and international accreditation. Third, South Korea and Singapore were more closely aligned to liberal regulation with minimal quality assurance, whereas Malaysia and China were in the category of liberal regulation and restrict regulation, respectively, but with comprehensive quality assurance process. [ABSTRACT FROM AUTHOR]

In 2012, Taiwan implemented a dual-track quality assurance system comprising accreditation and self-accreditation in higher education institutions. Self-accrediting institutions can accredit their programs without requiring approval from external quality assurance agencies. In contrast to other countries, the Ministry of Education of Taiwan authorized self-accrediting institutions to develop their own evaluation standards. This study investigated the institution-based accreditation standards and their implications on institutional internal quality assurance. Content analysis revealed that 37 % of the indicators of self-accreditation were new and not used as review indicators in the original accreditation track. Two frequently added indicators were featured indicators and levels of internationalization. The results also indicated that institutions tend to structure their internal quality assurance systems uniquely. Three types of approaches for developing institution-based standards were identified: bottom-up, hybrid, and innovative approaches. Self-accreditation has benefited institutions committed to educational quality and pursuing excellence by enabling them to employ a fitness-for-purpose approach. The diversity of higher education and educational policy changes constitute new challenges to higher education. Balancing between accountability and autonomy is critical for all stakeholders of higher education. [ABSTRACT FROM AUTHOR]

Trigger finger (or trigger thumb), also known as sclerosing tenosynovitis, is a common clinical diagnosis that rarely presents for imaging. Because of this selection bias, many radiologists may not be familiar with the process. Furthermore, patients who do present for imaging frequently have misleading examination indications. To our knowledge, magnetic resonance (MR) imaging findings of trigger thumb have not been previously reported in the literature. In this article, we review the entity of trigger thumb, the anatomy involved, and associated imaging findings, which include flexor pollicis longus tendinosis with a distinct nodule, A1 pulley thickening, and tenosynovitis. In addition, in some cases, an abnormal Av pulley is apparent. In the rare cases of trigger finger that present for MR imaging, accurate diagnosis by the radiologist can allow initiation of treatment and avoid further unnecessary workup. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this retrospective study is to describe the MRI findings of the 'shiny corner' of the knee (bone marrow lesions at the meniscal-covered portions of the tibial plateau) and to determine its association with compromise of the medial meniscal-osteochondral unit. Materials and methods: A retrospective review of 200 knee MRI exams was performed and images were evaluated in consensus by two musculoskeletal radiologists. Presence and location of a shiny-corner lesion was recorded, which was defined as a focal, peripheral hyperintense lesion on fluid-sensitive images at the superior portion of the medial tibial plateau. Meniscal and root ligament abnormalities were recorded, including tearing, degeneration, and extrusion. Results: Sixty exams demonstrated a shiny-corner lesion. Shiny corners involved the medial rim of the medial tibial plateau in 50 cases, only involved the posterior rim in seven cases, and only involved the anterior rim in two cases. Patients with shiny corners were older than patients without shiny corners (mean, 53 years vs. 44 years, p = 0.01). The shiny-corner sign was associated with tears of the medial meniscus, root ligament, and meniscal extrusion ( p < 0.001). The presence of a shiny-corner lesion could detect a tear of the medial meniscus or root ligaments with a sensitivity, specificity, positive predictive value, and negative predictive value of 62, 97, 95, and 75 %, respectively. Conclusions: Shiny-corner lesions of the knee are associated with tears of the menisci and root ligaments. This observation supports the concept that the menisci protect the underlying covered portions of the tibial plateau. [ABSTRACT FROM AUTHOR]

We report the occurrence of a short radiolunate ligament rupture in a rock climber. To our knowledge, an isolated traumatic rupture of this ligament has not been described in the literature, and awareness of this entity allows initiation of therapy. The magnetic resonance imaging and ultrasound appearances are reviewed and the mechanism of injury is discussed. [ABSTRACT FROM AUTHOR]

The 3D morphological evolution of titanium foams as they undergo a two-step fabrication process is quantitatively characterized through x-ray micro- and nano-tomography. In the first process step, a Cu–Ti–Cr–Zr prealloy is immersed in liquid Mg, where Cu is alloyed with Mg while a skeleton of crystalline Ti–Cr–Zr is created. In the second step, the Mg–Cu phase is etched in acid, leaving a Ti–Cr–Zr foam with submicron struts. 3D images of these solidified Ti–Cr–Zr/Mg–Cu composites and leached Ti–Cr–Zr foams are acquired after 5, 10, and 30 min exposure to liquid Mg. As the Mg exposure time increases, the Ti–Cr–Zr ligaments grow in size. The tortuosity loosely follows the Bruggeman relation. The interfacial surface distribution of these Ti-foams is qualitatively similar to other nano-porous metal prepared by one-step dealloying. The characteristic length of the Mg–Cu phase and pores are also reported. [ABSTRACT FROM AUTHOR]

Presents a study that shows that mice which overexpress the human mutant amyloid precursor protein exhibit a separate age-related deficit in learning a series of spatial locations. Correlation of this impairment with beta-amyloid plaque burden; Indication that overexpression and/or plaques are associated with disturbed cognitive function; Suggestion that some but not all forms of learning and memory are suitable behavioral assays of the progressive deficits associated with Alzheimer's-disease-type pathologies.

The quantitative evaluation of the three-dimensional (3D) morphology of porous composite materials is important for understanding mass transport phenomena, which further impact their functionalities and durability. Reactive porous paint materials are composites in nature and widely used in arts and technological applications. In artistic oil paintings, ambient moisture and water and organic solvents used in conservation treatments are known to trigger multiple physical and chemical degradation processes; however, there is no complete physical model that can quantitatively describe their transport in the paint films. In the present study, model oil paints with lead white (2PbCO3·Pb(OH)2) and zinc white (ZnO) pigments, which are frequently found in artistic oil paintings and are associated with the widespread heavy metal soap deterioration, were studied using synchrotron X-ray nano-tomography and unilateral nuclear magnetic resonance. This study aims to establish a relationship among the paints' compositions, the 3D morphological properties and degradation. This connection is crucial for establishing reliable models that can predict transport properties of solvents used in conservation treatments and of species involved in deterioration reactions, such as soap formation. [ABSTRACT FROM AUTHOR]

Visually significant corneal injuries and subsequent scarring collectively represent a major global human health challenge, affecting millions of people worldwide. Unfortunately, less than 2% of patients who could benefit from a sight-restoring corneal transplant have access to cadaveric donor corneal tissue. Thus, there is a critical need for new ways to repair corneal defects that drive proper epithelialization and stromal remodeling of the wounded area without the need for cadeveric donor corneas. Emerging therapies to replace the need for donor corneas include pre-formed biosynthetic buttons and in situ-forming matrices that strive to achieve the transparency, biocompatibility, patient comfort, and biointegration that is possible with native tissue. Herein, we report on the development of an in situ-forming hydrogel of collagen type I crosslinked via multi-functional polyethylene glycol (PEG)-N-hydroxysuccinimide (NHS) and characterize its biophysical properties and regenerative capacity both in vitro and in vivo. The hydrogels form under ambient conditions within minutes upon mixing without the need for an external catalyst or trigger such as light or heat, and their transparency, degradability, and stiffness are modulated as a function of number of PEG arms and concentration of PEG. In addition, in situ-forming PEG-collagen hydrogels support the migration and proliferation of corneal epithelial and stromal cells on their surface. In vivo studies in which the hydrogels were formed in situ over stromal keratectomy wounds without sutures showed that they supported multi-layered surface epithelialization. Overall, the in situ forming PEG-collagen hydrogels exhibited physical and biological properties desirable for a corneal stromal defect wound repair matrix that could be applied without the need for sutures or an external trigger such as a catalyst or light energy. [ABSTRACT FROM AUTHOR]

Tungsten accumulates in bone but is neither labile nor inert once absorbed. Tungsten's relatively high cytosolic solubility and availability are problematic given its association with childhood lymphocytic leukemia. In light of tungsten's technological prevalence, and the increased concern of regulatory agencies, here we characterize the chemical form and localization in mice exposed to tungsten through drinking water. Using X-ray fluorescence spectroscopy, we report accumulation of tungsten in bone tissue with some sites having ~10-fold greater intensities than background levels. The long bone tissue studied includes cortical, cancellous and bone marrow. Persistence of tungsten in cortical bone tissue following removal of the source indicates that it is retained in an insoluble form. The X-ray absorption near-edge structure spectra for tungsten in these tissues indicate that it is no longer in the originally administered form, orthotungstate, but rather resembles the heteropolytungsate species, phosphotungstate. Tungstate accumulates in bone and can be resistant to chelation therapies typically used to remove heavy metals in vivo. Here, tungstate is shown to accumulate in mouse bone tissue in a persistent, insoluble form proposed to be condensed polytungstate. [ABSTRACT FROM AUTHOR]

Hypothesis: The frequency of disc degeneration (DD) in the distal mobile segments will increase over time following surgery for adolescent idiopathic scoliosis (AIS)., Design: Retrospective review of a prospective AIS registry., Introduction: Durability of surgical outcomes is essential for maintenance of quality of life as well as for family decision making and for assessment of the value of a healthcare intervention. We assessed DD, its risk factors, and association with health-related quality of life 10 years after AIS surgery., Methods: Five radiographic indicators of DD, previously validated, were evaluated preoperatively and 1 month, 2, 5, and 10 years postoperatively by a radiologist in operative AIS patients. A composite radiographic score (CRS; range 0-10) was calculated using the sum of each of the DD indicators. The severity of CRS in relation to the time point after surgery and various risk factors were assessed using linear regression or Pearson χ 2 test. CRS ≥3 was chosen to indicate significant DD. Association of CRS with SRS-22 outcome was evaluated by linear regression., Results: 193 consecutive patients (mean age at surgery 14.4 years; 86% female) were assessed. Surgical approach included 102 posterior and 91 anterior fusions. Contributors to maximum CRS at 10 years were Schmorl's nodes (7.3% of patients), osteophytes (40.4%), sclerosis (29%), and irregular endplate (8.3%). CRS ≥3 occurred in 1.6%, 0.54%, 3.7%, 6.8%, and 7.3% of patients at the various time points (r 2 =0.83, p=.0313), respectively. More than 50% of DD occurred at the second (35.5%) and third (20%) disc caudal to the LIV. LIV of L4 compared with more cephalad LIV had the highest risk of developing significant DD (27.3%; p=.0267). It was found that disc wedging subjacent to the LIV (≥5°) and LIV translation (≥2 cm) lead to a sixfold increase in significant DD (odds ratio=6.71 and 6.13, respectively). Severity of DD was not associated with the number of levels fused (p=.2131), the surgical approach (p=.8245), or the construct type (p=.2922). No significant association was established between 10-year CRS and SRS-22 scores., Conclusion: In the first study of its kind, we found that only 7.3% of patients had significant DD 10 years after surgical correction of AIS. Rates of DD increased over time. Our data provide evidence to support recommendations to save as many caudal motion segments as possible, to avoid fusing to L4, and maintain the LIV tilt angle below 5° and LIV translation less than 2 cm., (Copyright © 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)