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Despite progress in the prevention and diagnosis of cancer, current technologies for tumor detection present several limitations including invasiveness, toxicity, inaccuracy, lengthy testing duration and high cost. Therefore, innovative diagnostic techniques that integrate knowledge from biology, oncology, medicinal and analytical chemistry are now quickly emerging in the attempt to address these issues. Following this approach, here we developed a paper-based electrochemical device for detecting cancer-derived Small Extracellular Vesicles (S-EVs) in fluids. S-EVs were obtained from cancer cell lines known to express, at a different level, the αvβ6 integrin receptor, a well-established hallmark of numerous epithelial cancer types. The resulting biosensor turned out to recognize αvβ6-containing S-EVs down to a limit of 0.7*10 3 S-EVs/mL with a linear range up to 10 5 S-EVs /mL, and a relative standard deviation of 11%, thus it may represent a novel opportunity for αvβ6 expressing cancers detection., (© 2024. The Author(s).)

Background: The bleach-boosting capability of xylanases is well-known. The use of xylanase pre-treatment before the application of chemical bleach has multiple advantages including (i) lesser use of polluting chemicals of the traditional bleaching process; (ii) less damage to the cellulosic fibers, therefore better recyclability; and (iii) better brightness of chemical bleach. The major impediment in the application is the availability of commercial enzymes that are active at the elevated temperature and pH that exist during the industrial pulping process. In the present paper, xylanase having suitability for application in deinking is reported., Results: The xylanase used showed high deinking potential. Optimal deinking was obtained at the xylanase dosing of 20U/g of the dried pulp at 60℃ for a treatment time of 1h. It could bring about a 50% reduction in the usage of chemical bleach that was applied after xylanase pre-treatment. The comparison of FTIR spectra showed changes in intensity without significant changes in the functional group signatures implying that there is negligible damage to the fiber strength in the xylanase pre-treatment process as compared to the chemical bleach process., Conclusion: The xylanase used in this study was effective in deinking paper pulp and can be used for bio-bleaching of recycled paper., (© 2023. Academy of Scientific Research and Technology.)

Purpose: The orthopaedic surgeons, especially the young budding surgeons should have a well-balanced knowledge of the past evidence as well the current evidence in the literature for the appropriate as well as optimum management of tibial plateau fractures. Bibliometric analysis of the top-cited papers on tibial plateau fracture management can help know their concurrent interests, deficiencies and conflicting issues regarding their management. This study aimed to identify the 50 most cited research articles in tibial plateau research and analyse their characteristics., Methods: We searched the Thompson Reuters Web of Science database for articles relevant to tibial plateau fracture and prepared a list of top 50 cited articles that included original articles and review articles concerning tibial plateau fractures. The included articles were analysed for contributing journals, corresponding author's country, publication year, cumulative citations, annual citations, citation trends over time, level of evidence and a qualitative review., Results: The search strategy resulted in 2263 articles. The top 50 cited articles were published from 1974 to 2014 and belonged to 12 journal sources. There were 47 original articles and 3 review articles. The average citations per article were 126.2, and the annual citations per article were 6.478 per year. The top-cited articles were relevant to the strategies in the management, classification, fracture reduction, articular restoration, types and number of fixation devices, surgical approaches, associated menisco-ligamentous injuries and applicability of bone grafts/substitutes in tibial plateau fractures., Conclusion: The current bibliometric analysis summarises the top-cited evidence concerning tibial plateau fractures and can be a potential resource for reviewing and locating the same. The analysis shows that most top-cited evidence belongs to the year 2000 onwards. Also, recent articles have a higher annual citation rate. A limited number of journals and mostly, western countries have contributed to the top-cited evidence. Whilst the top-cited evidence has touched several aspects of tibial plateau fractures, it is in the form of level IV case series. It needs better prospective evidence to establish sound recommendations., Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00932-4., Competing Interests: Conflict of interestNone of the authors have any conflicts to declare., (© Indian Orthopaedics Association 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Lignocellulosic biomasses produced from agriculture and forest-based industries are the cheapest or negative-cost biomass with a great potential for biotransformation to value-added bioproducts. Paper mill sludge, an important lignocellulosic biomass creates an environmental threat, which requires financial input for disposal. Thus, this study was aimed to isolate a novel bacterial strain capable of degrading cellulosic biomass including paper mill sludge to produce reducing sugar and other value-added bioproducts., Results: A novel bacterial strain Arthrobacter woluwensis TDS9 isolated from the soil was screened for its cellulolytic activity using carboxymethyl cellulose (CMC) as the sole carbon source. The incubation period, temperature, pH, carbon, and nitrogen sources are the most important factors ruling the CMCase and sugar productions of the strain A. woluwensis TDS9, and an alkaline pH (pH 8.0) led to enhanced sugar production up to 1100.09 μg/mL after 72 h of incubation at 25°C in a medium containing 1.5% CMC and 1.25% beef extract. The optimal conditions for maximum CMCase activity were defined, and the potassium ion boosted the CMCase activity up to 1.06 U/mL when the enzymatic reaction was performed for 30 min at 50°C and pH 8 using CMC as a substrate. Moreover, the strain A. woluwensis TDS9 produced 433.33 μg/mL reducing sugar from 1% pretreated paper mill sludge. Significant alterations in the structural arrangement of cellulosic fiber of paper mill sludge observed under microscope after each step of chemical treatment process helped for loosening the cellulose fibers and increased the saccharification for enzymatic hydrolysis. Endoglucanase IV (33 KDa) and beta-glucosidase II (53 KDa) were identified in crude enzyme based on the zymogram analysis and substrate specificity., Conclusions: The research has for the first time proved that this A. woluwensis TDS9 strain can efficiently convert cellulose. Therefore, the strain TDS9 could be a potential candidate for cellulase production in an industrial biotransformation process of paper mill sludge to produce reducing sugar. This sugar stream can be further used as a substrate to produce biofuels and other organic acids using another microorganism, which represents a greener alternative to add value to the paper production helping paper mill industries., (© 2022. The Author(s).)

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the need for versatile diagnostic assays that can discriminate among emerging variants of the virus. Here we report the development and performance benchmarking of an inexpensive (approximately US$0.30 per test) assay for the rapid (sample-to-answer time within 30 min) colorimetric detection of SARS-CoV-2 variants. The assay, which we integrated into foldable paper strips, leverages nucleic acid strand-displacement reactions, the thermodynamic energy penalty associated with single-base-pair mismatches and the metal-ion-controlled enzymatic cleavage of urea to amplify the recognition of viral RNAs for the colorimetric readout of changes in pH via a smartphone. For 50 throat swab samples, the assay simultaneously detected the presence of SARS-CoV-2 and mutations specific to the SARS-CoV-2 variants Alpha, Beta and Gamma, with 100% concordance with real-time quantitative polymerase chain reaction and RNA sequencing. Customizable and inexpensive paper-based assays for the detection of viruses and their variants may facilitate viral surveillance., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

As a primary anticounterfeiting technology, most paper anticounterfeiting devices take advantage of photoresponsive behaviors of certain security materials or structures, thus featuring low-security threshold, which has been a critical global issue. To incorporate optoelectronic devices into existing anticounterfeiting technology suggests a feasible avenue to address this challenge. Here we report a high-performance organic light-emitting paper-based flexible anticounterfeiting (FAC) device with multiple stimuli-responsiveness, including light, electricity, and their combination. Without sacrificing the preexisted security information on the paper, we fabricate FAC device in a facile, low-cost yet high-fidelity fashion by integrating patterned electro-responsive and photo-responsive organic emitters onto paper substrates. By introducing optical microcavities, the FAC device shows considerable color shift upon different viewing angle and applied voltage, which is easily discernible by naked eyes. Notably, the FAC device is bendable, unclonable, and durable (a half-lifetime over 4000 hours at 100 cd m -2 )., (© 2022. The Author(s).)

In low-resource settings, resilience to infectious disease outbreaks can be hindered by limited access to diagnostic tests. Here we report the results of double-blinded studies of the performance of paper-based diagnostic tests for the Zika and chikungunya viruses in a field setting in Latin America. The tests involved a cell-free expression system relying on isothermal amplification and toehold-switch reactions, a purpose-built portable reader and onboard software for computer vision-enabled image analysis. In patients suspected of infection, the accuracies and sensitivities of the tests for the Zika and chikungunya viruses were, respectively, 98.5% (95% confidence interval, 96.2-99.6%, 268 serum samples) and 98.5% (95% confidence interval, 91.7-100%, 65 serum samples) and approximately 2 aM and 5 fM (both concentrations are within clinically relevant ranges). The analytical specificities and sensitivities of the tests for cultured samples of the viruses were equivalent to those of the real-time quantitative PCR. Cell-free synthetic biology tools and companion hardware can provide de-centralized, high-capacity and low-cost diagnostics for use in low-resource settings., (© 2022. The Author(s).)

Purpose: The knowledge regarding meniscus has vastly evolved over the past few decades. The meniscus's intact, injured, and repaired status can affect other joint structures, i.e., ligaments, articular surfaces, and overall biomechanics of the knee joint. Due to available evidence's extensiveness, it is challenging to determine the most influential topics and the emerging trends in concurrent meniscus research. This study aims to identify the top fifty cited papers in meniscus research and concurrent knee issues and analyse their characteristics., Methods: A comprehensive search was conducted on the Thompson Reuters Web of Science database to prepare a list of top fifty cited articles that included original articles and review articles concerning meniscus. The included articles were analysed for the source journal, investigating institution, country of the corresponding author, year of publication, total citations, annual citation rate, and a qualitative review., Results: The search strategy resulted in 6768 original articles and 453 review articles. The top fifty cited articles were published from 1969 to 2014 and belonged to 14 journal sources. There were 43 original articles and seven review articles. The average citations per article were 417.4 and the average citations per paper per year were 22.6. Besides the meniscus, a general interest in the clinical assessment scores, anterior cruciate ligament, long-term osteoarthritis, and cartilage was observed., Conclusion: Most of the research concerning meniscus relates to the importance of meniscus preservation, the link between meniscus injuries and concomitant anterior cruciate ligament and chondral injuries, and its role in long-term gonarthrosis. The western countries have contributed the maximum to the top-cited evidence concerning meniscus. The meniscus repair and transplantation techniques have recently gained importance and need further research to qualify for the top-cited evidence., Competing Interests: Conflict of InterestNone of the authors has any conflicts or competing to declare., (© Indian Orthopaedics Association 2021.)

Education is a critical indication of progress and a major factor in well-being. The UNs Sustainable Development Goals establish specific requirements for increasing educational quality and protecting the well-being of children. UN's agenda for Sustainable Development Goal 4 which aims to "ensure inclusive and equitable quality education and promote lifelong learning opportunities for all" was adopted in India in 2015. Students' academic success is a vital part of the education system. Predicting student performance has grown more challenging due to the enormous amount of data in educational databases. Low-performing students will experience a variety of difficulties, including delayed graduation and even dropping out. Therefore, educational institutions should closely monitor the academic progress of their students and provide quick assistance to those who have low performance. Using Students' academic achievement predictions to accomplish that is one method. This method will help educational institutions in identifying and supporting low-performing students at an initial stage. This study presents a systematic review of research on sentiment analysis towards SDG4 quality education through social media platform such as Twitter, Facebook and a review of 21 studies indexed in SCOPUS. Using social media data rather than a conventional survey of the data, evaluation of outspoken opinion and feelings of students towards their institution to obtain Quality Education. In this study, the dataset is taken from kaggle with names as student-performance-data-set which uses two files named as student-math, and student-por which shows the student performance in a Math language course and Portuguese language course, respectively, with 33 attributes and 396 records in each. Of 396 records, 110 records were selected as sample. During the visualization, we analyzed SVM model is stable because even minor data changes have no impact on the hyperplane and it handles the nonlinear data using Kernel techniques., Competing Interests: Conflict of InterestBoth authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: The analysis of the quality of food is important to protect humans from food-borne or food-based illnesses caused by pathogens, such as bacteria, fungi, viruses, and protozoa. Rapid identification of these pathogens is critical to ensure food safety. Various detection and identification strategies exist; however, they are laborious and time consuming and hence the detection takes longer time. The aim of this study was to develop the specific and fast method for the detection of contaminants in milk., Results: In this study, we have developed a simple paper-based PCR method with minimum sample preparation process. The 16S rDNA universal primers were used for the detection of bacterial contaminants. LacZ primers were used for coliform detection which causes serious illness and hence their detection is crucial. ITS region primers were used for fungal detection. The most unique thing about this study is use of Whatman paper no. 1 as sample carrier material. We developed and validated the paper-based PCR method and used it for the detection of microbes and coliforms using milk as a representative sample., Conclusion: We evaluated this method for its suitability in the detection of contaminant microbes using different milk samples. The paper-based method could successfully detect contaminants in the milk samples and the results were comparable to the traditional microbial detection method. The traditional microbiological method takes at least 18-20 h for detecting the presence of microbes in any sample but the developed paper-based PCR method can confirm the microbial presence in 2-3 h. This is very promising especially in the testing where sample sterility is crucial.

A newly modified paper-based enzyme-linked immunosorbent assay (P-ELISA) was established by immobilizing more proteins on the paper surface through an atom transfer radical polymerization (ATRP) reaction. In addition, introducing graphene oxide (GO) sheets, Au nanoparticles (AuNps) and two primary antibodies (Ab1s) led to signal amplification and cost reduction., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Study Design: Bibliometric analysis., Objectives: To identify the 100 most cited orthopedic papers in adolescent idiopathic scoliosis (AIS) over the past 25 years and characterize them by study type, topic, and country and assess study quality (design, level of evidence, and impact factor) to provide an updated account of the most impactful AIS evidence. AIS represents a three-dimensional deformity that drives a significant number of investigations. Although available evidence continues to grow, recent impactful studies pertaining to AIS have not been identified; their quality has not been thoroughly assessed., Methods: Web of Science was reviewed to identify the top 1000 cited AIS studies published from 1992 to 2017. Articles were organized by number of citations. Titles and abstracts were screened for inclusion/relevance, and the top 100 articles by citation count were identified, and study and publication characteristics were extracted., Results: Among the top 100 articles, 42 were cited ≥ 100 times. Mean number of authors and citations of these studies was 5.6 and 118.3, respectively. Study types were predominantly retrospective (n = 53), followed by prospective (n = 18), cross-sectional (n = 13), and systematic review/meta-analysis (n = 7). Topics covered in these studies included clinical/patient outcomes (n = 47), methodology/validation (n = 22), basic science (n = 15), radiographic analyses (n = 12), and gait/biomechanics (n = 4). Most studies originated in the United States of America (n = 65) and were published in Spine (n = 76), with 8266 total citations. Most studies were of Level III (n = 55) or Level II (n = 23) evidence. Mean impact factor was 3.47., Conclusions: Despite recent studies' shorter time frames for impact, citations of AIS research have progressively increased during the past 25 years. The top 100 cited orthopedic studies were predominantly Level III, retrospective, nonrandomized studies, and therefore, were subject to biases. The low proportion of prospective studies (18%) reflects an area of future improvement, underscoring the need for higher-quality studies to support our practice., Level of Evidence: N/A.

Background: Measuring concentrations of metabolites of estradiol and progesterone in urine, instead of measuring serum concentrations, is common in research and also is used in patient care. The primary aim of this study was to demonstrate that analysis of urine samples dried on filter paper by gas chromatography with tandem mass spectrometry (GC-MS/MS) provides results similar to serum analyzed by radioimmunoassay (RIA). Secondary aims were to show that collection of four samples during the day (4-spot method) can be substituted for a 24-h collection, and that analysis of urine from dried samples is equivalent to liquid urine samples., Methods: This prospective observational study compared results of urine and serum analyses. Urine samples from women throughout the menstrual cycle and single samples from postmenopausal women were evaluated. Urine was collected onto filter paper and dried. Dried urine was extracted, hydrolyzed, and derivatized prior to analysis by GC-MS/MS. Hormone concentrations were normalized to creatinine. Single samples were used to compare results of 24-h urine collection to the 4-spot method from a separate population of women and men. A subset of these samples were used to compare results from dried urine to liquid urine., Results: The primary study showed good reliability in the comparisons between the dried urine and serum assays. During the menstrual cycles of a subset of four women, urine metabolite concentrations followed the same pattern as serum concentrations. Comparison of 4-spot to 24-h urine collections and of dried to liquid urine measurements had intraclass correlation coefficients (ICC) greater than 0.95, indicating excellent agreement., Conclusions: For estradiol and progesterone, the dried urine assay is a good surrogate for serum testing. The 4-spot method can be used instead of 24-h urine collections and dried urine results are comparable to liquid urine. The dried urine assay is useful for some clinical assessments of hormone disorders and may be useful in large epidemiologic studies due to ease of sample handling., Competing Interests: Precision Analytical, Inc. is a commercial laboratory offering hormone testing to medical practitioners and individuals. All statistics were calculated and interpreted by an independent agent.

Patients who underwent thoracic spinal fusion at a young age returned at minimum 18-year follow-up for pulmonary function and functional activity testing. There was a statistically significant decline in their pulmonary function test results when compared to previous values from 11-year follow-up, and their functional activity was limited.

MCGR controls scoliosis progression and allows growth. Functional activity also improves generally. Primary infection rates are low. The overall unplanned return to theatre rates are still high but the psychosocial benefits are obvious.

Even though traditional growing rod (TGR) patients score lower in exercise tolerance and spirometry compared to age-matched controls, their pulmonary functions are similar to those of instrumented adolescent idiopathic scoliosis (AIS) patients.

Recent studies in the adult scoliosis population have shown effects of spinopelvic parameters on HRQoL outcomes. In this retrospective cohort study of 75 EOS patients treated with growth-friendly surgery, spinopelvic parameters affected HRQoL (EOSQ-24). Pre-operative PI>60° increased the risk for poor pain outcomes, pre- and post-operative LL>60° increased the risk for poor satisfaction, post-operative PI-LL mismatch of O >20° and post-operative PJK increased the risk of Fatigue.

Polysomnograms (PSGs) are not used in most spine centers for children with EOS. There are no standards for PSG referrals, and the yield from PSGs is unknown. We describe referrals for PSGs in 96 children > 5 years old with EOS, their lung functions, types of EOS, and frequency of abnormal PSGs.

At minimum 5 yr f/u, distraction-based surgeries (Spine-based (SB)&Rib-based (RB)) are an effective way to increase spine length for non-idiopathic EOS. Spine length is greater for spine based implants pre-operatively and this length is maintained to the 15th lengthening; however, if normalized to pre-op spine length, rib-based implants achieved greater percentage of increase in spine length beyond the 10th lengthening surgeries.

This was a reliability assessment of patients who underwent magnetically controlled growing rod (MCGR) treatment with EOS imaging. Most parameters have near perfect reliability except for the sagittal parameters which may limit the ability of investigators to detect complications like proximal junctional kyphosis (PJK).

Traditional growing rods (TGR), magnetically controlled growing rods (MCGR) and growth guidance systems (GGS) have demonstrated comparable radiographic outcomes in the treatment of early- onset scoliosis (EOS). The purpose of this study was to compare direct medical costs of GGS compared to TGR and MCGR using an economic model. Over a 6-year episode of care GGS had lower cumulative costs than MCGR and TGR, saving an estimated $25,226 vs TGR (16% decrease) and $29,916 vs MCGR (18% decrease).

Treatment of complex congenital scoliosis with growth friendly instrumentation led to only modest correction of major curves, residual imbalance, minimal gain in spine and thoracic height and a high incidence of complications. It is unknown whether this treatment improves upon the natural history or early fusion.

The aim of this study is to report the prevalence of spinal canal encroachment of pedicle screw in proximal anchor of GR construct and determine risk factors using a single-center cohort.

This is a prospective study of early onset scoliosis (EOS) patients treated with the magnetically controlled growing rod (MCGR) at up to 6 years follow-up with particular attention to the MCGR graduates at final surgery. Deformity control is consistent as is spine length gain. Further correction at final surgery for graduates are limited.

Early onset scoliosis can lead to significant chest wall deformity resulting in severe restrictive pulmonary disease and premature demise. Treatment of the spinal deformity should control the curvature but allow for continued growth of the spine and thorax. Serial derotational casting can potentially preserve and redirect spinal growth to achieve curve correction.

Using the validated EOSQ24 collected on 31 MCGR and traditional growing rod (TGR) patients, there was no difference in multiple domain scores between the two groups at preop and postop.

Congenital thoracic lordosis or lordoscoliosis are rare deformities which causes severe cardiopulmonary problems in early ages. PVCR is effective in restoring thoracal kyphosis in treatment of these rare deformities and avoids morbidity of combined surgeries.

EOS treated with VCR were predominantly congenital or myelomeningocele with 84% performed at index surgery and 70% definitive fusion. Correction of major curve was 69% and increases in spinal and thoracic height. Complication rate was 33% with 57% being IONM/neuro related.

179 patients with congenital rib fusions treated with rib-based or spine-based constructs and minimum 2-year follow-up were reviewed. 19 patients were treated with proximal spine-based and 160 with proximal rib-based devices. Patients treated with growing rods achieved equivalent SAL to those treated with rib-based devices, while also achieving greater improvement to their spine deformity, as measured by postoperative kyphosis, and Cobb angle.

This is a prospective study of magnetically controlled growing rod (MCGR) patients with particular focus on the timing of rod slippage as it pertains to rod lengthening in early onset scoliosis. Findings suggest that early rod lengthening is related to older patients and reduced distance between magnets. Diminishing length gains were observed after a period of rod usage and returns to baseline after rod exchange.

The RSS was developed to quantify the risk of SSI when considering operative intervention in patients with early onset scoliosis undergoing spinal surgery. The tool includes neuromuscular etiology, myelomeningocele, spinal muscular atrophy, endocrine comorbidity, gastrointestinal comorbidity, pulmonary comorbidity, developmental delay, urinary incontinence, and ventriculoperitoneal shunt as predictive variables. The RSS can improve shared decision making with patients and families during preoperative counseling and aid policy makers and administrators in determining reliable and valid risk-adjusted outcome measures.

Etiology of early onset scoliosis as described by C-EOS does not predict pulmonary function. Further study is required to provide granularity with regard to specific C-EOS classifications.

Severe EOS can be treated as effectively with distraction instrumentation in comparison to less severe EOS.

Patients undergoing primary insertion of magnetically controlled growing rod (MCGR) compared to Vertical Expandable Prosthetic Titanium Rib (VEPTR) have higher overall complication and implant-related complications per procedure despite similar complication risk per patient. While there was a reduction in total repetitive surgeries in patients with MCGR implants, there was no significant difference in mean unplanned OR visits per patient between the groups.

The 6 minute walk (6MW) correlates with age and inversely with the Cobb angle for patients with congenital scoliosis prior to spine surgical intervention. All had low 6MW values compared to age-matched norms. 6MW is useful as a serial measure of functional status for each patient over time.

The use of magnetically controlled growing rods (MCGR) has the potential to decrease the morbidity associated with repeated surgeries, yet, strength of the lengthening mechanism as it lengthens may have an impact on the length gained with each lengthening.We evaluated the maximal force generated by MCGR at 3 different lengthened positions and found an average decrease of 0.089 pounds per mm of additional length. This decrease may result in diminished spine length gained with each subsequent MCGR lengthening.

Large rigid curves can be treated with MCGR and preop traction with equivalent correction to smaller flexible curves and maintain correction over time.

HIF-1α is critical to somitogenesis. Lack of HIF-1α disrupts the Notch signaling pathway which leads to vertebral malformations seen in congenital scoliosis.

In a series of 748 traditional growing rod patients the overall rate of post-op neurological deficit was 0.45%, and the rate of permanent deficit was 0.05%. Neurological events occurred in all types of procedures including routine lengthenings. It is recommended IOM be utilised as a default for all distraction-based surgeries including lengthenings.

Despite having lower HRQoL domain scores pre-operatively, EOS patients treated with magnetically-controlled growing (MCGR) had similar EOSQ-24 domain scores after two years of treatment compared to patients treated with traditional growing rods (TGR).

We provide a risk -benefit analysis of each traditional growing rod instrumentation (TGR) procedure that can aid in shared decision-making of initiating, continuing, and completing treatment with TGR.