ChatGPT versus NASS clinical guidelines for degenerative spondylolisthesis: a comparative analysis.

BACKGROUND CONTEXT: Clinical guidelines, developed in concordance with the literature, are often used to guide surgeons' clinical decision making. Recent advancements of large language models and artificial intelligence (AI) in the medical field come with exciting potential. OpenAI's generative AI model, known as ChatGPT, can quickly synthesize information and generate responses grounded in medical literature, which may prove to be a useful tool in clinical decision-making for spine care. The current literature has yet to investigate the ability of ChatGPT to assist clinical decision making with regard to degenerative spondylolisthesis. PURPOSE: The study aimed to compare ChatGPT's concordance with the recommendations set forth by The North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Degenerative Spondylolisthesis and assess ChatGPT's accuracy within the context of the most recent literature. METHODS: ChatGPT-3.5 and 4.0 was prompted with questions from the NASS Clinical Guideline for the Diagnosis and Treatment of Degenerative Spondylolisthesis and graded its recommendations as "concordant" or "nonconcordant" relative to those put forth by NASS. A response was considered "concordant" when ChatGPT generated a recommendation that accurately reproduced all major points made in the NASS recommendation. Any responses with a grading of "nonconcordant" were further stratified into two subcategories: "Insufficient" or "Over-conclusive," to provide further insight into grading rationale. Responses between GPT-3.5 and 4.0 were compared using Chi-squared tests. RESULTS: ChatGPT-3.5 answered 13 of NASS's 28 total clinical questions in concordance with NASS's guidelines (46.4%). Categorical breakdown is as follows: Definitions and Natural History (1/1, 100%), Diagnosis and Imaging (1/4, 25%), Outcome Measures for Medical Intervention and Surgical Treatment (0/1, 0%), Medical and Interventional Treatment (4/6, 66.7%), Surgical Treatment (7/14, 50%), and Value of Spine Care (0/2, 0%). When NASS indicated there was sufficient evidence to offer a clear recommendation, ChatGPT-3.5 generated a concordant response 66.7% of the time (6/9). However, ChatGPT-3.5's concordance dropped to 36.8% when asked clinical questions that NASS did not provide a clear recommendation on (7/19). A further breakdown of ChatGPT-3.5's nonconcordance with the guidelines revealed that a vast majority of its inaccurate recommendations were due to them being "over-conclusive" (12/15, 80%), rather than "insufficient" (3/15, 20%). ChatGPT-4.0 answered 19 (67.9%) of the 28 total questions in concordance with NASS guidelines (P = 0.177). When NASS indicated there was sufficient evidence to offer a clear recommendation, ChatGPT-4.0 generated a concordant response 66.7% of the time (6/9). ChatGPT-4.0's concordance held up at 68.4% when asked clinical questions that NASS did not provide a clear recommendation on (13/19, P = 0.104). CONCLUSIONS: This study sheds light on the duality of LLM applications within clinical settings: one of accuracy and utility in some contexts versus inaccuracy and risk in others. ChatGPT was concordant for most clinical questions NASS offered recommendations for. However, for questions NASS did not offer best practices, ChatGPT generated answers that were either too general or inconsistent with the literature, and even fabricated data/citations. Thus, clinicians should exercise extreme caution when attempting to consult ChatGPT for clinical recommendations, taking care to ensure its reliability within the context of recent literature.

RNA Post-transcriptional Modifications of an Early-Stage Large-Subunit Ribosomal Intermediate.

Protein production by ribosomes is fundamental to life, and proper assembly of the ribosome is required for protein production. The RNA, which is post-transcriptionally modified, provides the platform for ribosome assembly. Thus, a complete understanding of ribosome assembly requires the determination of the RNA post-transcriptional modifications in all of the ribosome assembly intermediates and on each pathway. There are 26 RNA post-transcriptional modifications in 23S RNA of the mature Escherichia coli (E. coli) large ribosomal subunit. The levels of these modifications have been investigated extensively only for a small number of large subunit intermediates and under a limited number of cellular and environmental conditions. In this study, we determined the level of incorporations of 2-methyl adenosine, 3-methyl pseudouridine, 5-hydroxycytosine, and seven pseudouridines in an early-stage E. coli large-subunit assembly intermediate with a sedimentation coefficient of 27S. The 27S intermediate is one of three large subunit intermediates accumulated in E. coli cells lacking the DEAD-box RNA helicase DbpA and expressing the helicase inactive R331A DbpA construct. The majority of the investigated modifications are incorporated into the 27S large subunit intermediate to similar levels to those in the mature 50S large subunit, indicating that these early modifications or the enzymes that incorporate them play important roles in the initial events of large subunit ribosome assembly.

Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis.

PURPOSE: To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). METHODS: The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. RESULTS: Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. CONCLUSION: While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.

Robust prediction of nonhome discharge following elective anterior cervical discectomy and fusion using explainable machine learning.

PURPOSE: Predict nonhome discharge (NHD) following elective anterior cervical discectomy and fusion (ACDF) using an explainable machine learning model. METHODS: 2227 patients undergoing elective ACDF from 2008 to 2019 were identified from a single institutional database. A machine learning model was trained on preoperative variables, including demographics, comorbidity indices, and levels fused. The validation technique was repeated stratified K-Fold cross validation with the area under the receiver operating curve (AUROC) statistic as the performance metric. Shapley Additive Explanation (SHAP) values were calculated to provide further explainability regarding the model's decision making. RESULTS: The preoperative model performed with an AUROC of 0.83 ± 0.05. SHAP scores revealed the most pertinent risk factors to be age, medicare insurance, and American Society of Anesthesiology (ASA) score. Interaction analysis demonstrated that female patients over 65 with greater fusion levels were more likely to undergo NHD. Likewise, ASA demonstrated positive interaction effects with female sex, levels fused and BMI. CONCLUSION: We validated an explainable machine learning model for the prediction of NHD using common preoperative variables. Adding transparency is a key step towards clinical application because it demonstrates that our model's "thinking" aligns with clinical reasoning. Interactive analysis demonstrated that those of age over 65, female sex, higher ASA score, and greater fusion levels were more predisposed to NHD. Age and ASA score were similar in their predictive ability. Machine learning may be used to predict NHD, and can assist surgeons with patient counseling or early discharge planning.

RNA Post-Transcriptional Modifications in Two Large Subunit Intermediates Populated in E. coli Cells Expressing Helicase Inactive R331A DbpA.

23S ribosomal RNA (rRNA) of Escherichia coli 50S large ribosome subunit contains 26 post-transcriptionally modified nucleosides. Here, we determine the extent of modifications in the 35S and 45S large subunit intermediates, accumulating in cells expressing the helicase inactive DbpA protein, R331A, and the native 50S large subunit. The modifications we characterized are 3-methylpseudouridine, 2-methyladenine, 5-hydroxycytidine, and nine pseudouridines. These modifications were detected using 1-cyclohexyl-3-(2-morpholinoethyl)carbodiimide metho-p-toluenesulfonate (CMCT) treatment followed by alkaline treatment. In addition, KMnO4 treatment of 23S rRNA was employed to detect 5-hydroxycytidine modification. CMCT and KMnO4 treatments produce chemical changes in modified nucleotides that cause reverse transcriptase misincorporations and deletions, which were detected employing next-generation sequencing. Our results show that the 2-methyladenine modification and seven uridines to pseudouridine isomerizations are present in both the 35S and 45S to similar extents as in the 50S. Hence, the enzymes that perform these modifications, namely, RluA, RluB, RluC, RluE, RluF, and RlmN, have already acted in the intermediates. Two uridines to pseudouridine isomerizations, the 3-methylpseudouridine and 5-hydroxycytidine modifications, are significantly less present in the 35S and 45S, as compared to the 50S. Therefore, the enzymes that incorporate these modifications, RluD, RlmH, and RlhA, are in the process of modifying the 35S and 45S or will incorporate these modifications during the later stages of ribosome assembly. Our study employs a novel high throughput and single nucleotide resolution technique for the detection of 2-methyladenine and two novel high throughput and single nucleotide resolution techniques for the detection of 5-hydroxycytidine.

Geometric analysis of pedicle subtraction osteotomy (PSO) for Kyphosis correction: anterior lengthening may occur at the osteotomized body as well as at the discs above and below.

OBJECTIVE: To validate the authors kyphosis correction formula for pedicle subtraction osteotomy (PSO) cases. Additionally, to use the formula to evaluate the safety of PSO by determining if there is anterior lengthening. METHODS: Twenty-two patients with primarily kyphosis corrected by PSO and with clear landmarks on preoperative and postoperative x-rays were selected. Several anatomical lines and angle measurements were utilized as depicted previously in the Vertebral Column Resection formula (see below). Two approximations were calculated: the geometric approximation (G) = (tanG°*2 + 1)*15° and the rough approximation (R) which is about the same amount of actual shortening (x), if parallel length (y) ≥ 40; twice of x, if y < 40. For each patient, the change of segmental kyphosis angle (K°) was measured and compared with G° and R°, and the correlation between each value was analyzed. RESULTS: The absolute Mean ± SE for K - G and K - R was 2.33° ± 0.34 and 6.09° ± 0.58, respectively. K - G is < 3° (p = 0.03). K - R is < 8° (p = 0.001). In other words, K was close to G and R and thus can be predicted by these approximations. Average posterior shortening, anterior shortening, and kyphosis correction at each level were 20.8 ± 2.0 mm, - 3.64 ± 1.5 mm (which equates to anterior lengthening), and 31.05° ± 2.0, respectively. Anterior lengthening occurred in 13 cases (in 4 cases, both at the body as well as at the disc above and below.) The correlation between posterior and anterior shortening was 0.03 (p = 0.88). There were 3 cage insertion cases: 1 had anterior lengthening, while 2 had anterior shortening even with the cage. CONCLUSION: This study validated the geometric and rough approximations originally used in PVCR patients, for PSO patients. Additionally, this study found that anterior lengthening may occur in PSOs usually at the discs, but occasionally at the osteotomized body.

Thoracolumbar corpectomy/spondylectomy for spinal metastasis: a pooled analysis comparing the outcome of seven different surgical approaches.

OBJECTIVE: To compare surgical outcomes between seven different approaches for thoracolumbar corpectomy/spondylectomy in the setting of spinal metastasis. METHODS: A systematic review of literature was performed including articles on corpectomy for thoracolumbar spinal metastasis. Data were extracted and sorted by surgical approach: en bloc spondylectomy (group 1), transpedicular (group 2), costotransversectomy (group 3), mini-open retropleural/retroperitoneal (group 4a), lateral extracavitary approach (group 4b), open transthoracic/transretroperitoneal (group 5), and thoracoscopic (group 6). Comparison of demographics, blood loss, directly procedure related complications, operating time, and postoperative improvement of pain. RESULTS: A total of 63 articles were included comprising data of 774 patients with various primary tumor entities. Mean age was 51.8 years, 54% of patients were female, on average 1.46 levels were treated per patient, and mean follow-up was 1.59 years. The following statistically significant findings were observed: Blood loss was lowest for the mini-open retropleural/retroperitoneal (917 ml), thoracoscopic (1107 ml) and transthoracic approach (1172 ml) versus the posterior approach groups (1633-2261 ml); directly procedure related complications were lowest for mini-open retropleural/retroperitoneal and thoracoscopic approach (0% each) versus 7-15% in the other groups; operating time was lowest in mini-open retropleural/retroperitoneal approach (184 min) versus 300-588 min in the other groups. CONCLUSION: Less invasive approaches (mini-open retropleural/retroperitoneal and thoracoscopic) not only had superior outcome in terms of blood loss and operating time, but also were shown to be safe techniques in cancer patients with low rates of procedure-related complications. These slides can be retrieved under Electronic Supplementary Material.

Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique.

STUDY DESIGN: Meta-analysis. OBJECTIVE: To conduct a meta-analysis investigating the relationship between spinopelvic alignment parameters and development of adjacent level disease (ALD) following lumbar fusion for degenerative disease. ALD is a degenerative pathology that develops at mobile segments above or below fused spinal segments. Patient outcomes are worse, and the likelihood of requiring revision surgery is higher in ALD compared to patients without ALD. Spinopelvic sagittal alignment has been found to have a significant effect on outcomes post-fusion; however, studies investigating the relationship between spinopelvic sagittal alignment parameters and ALD in degenerative lumbar disease are limited. METHODS: Six e-databases were searched. Predefined endpoints were extracted and meta-analyzed from the identified studies. RESULTS: There was a significantly larger pre-operative PT in the ALD cohort versus control (WMD 3.99, CI 1.97-6.00, p = 0.0001), a smaller pre-operative SS (WMD - 2.74; CI - 5.14 to 0.34, p = 0.03), and a smaller pre-operative LL (WMD - 4.76; CI - 7.66 to 1.86, p = 0.001). There was a significantly larger pre-operative PI-LL in the ALD cohort (WMD 8.74; CI 3.12-14.37, p = 0.002). There was a significantly larger postoperative PI in the ALD cohort (WMD 2.08; CI 0.26-3.90, p = 0.03) and a larger postoperative PT (WMD 5.23; CI 3.18-7.27, p < 0.00001). CONCLUSION: The sagittal parameters: PT, SS, PI-LL, and LL may predict development of ALD in patients' post-lumbar fusion for degenerative disease. Decision-making aimed at correcting these parameters may decrease risk of developing ALD in this cohort. These slides can be retrieved under Electronic Supplementary Material.

Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis.

PURPOSE: Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice. METHODS: A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements. RESULTS: Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%. CONCLUSION: Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare.

Posterior vertebral column resection in spinal deformity: a systematic review.

PURPOSE: This study aimed to assess the amount of correction and risk of complications of posterior vertebral column resection (PVCR) in the treatment of spinal deformity. METHODS: A comprehensive research was conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews for published articles about PVCR in spinal deformity. Data from these included studies were pooled with the help of the Review Manager software from the Cochrane Collaboration and the R software. The amount of correction of PVCR was indicated with change of coronal and sagittal Cobb angle after operation. Risk of complications was demonstrated with prevalence. RESULTS: 7 studies, a total of 390 patients, were included for analysis. The average operative time for PVCR was 430 min and the estimated blood loss was 2,639 ml. The mean amount of correction by PVCR was 64.1° in scoliosis and 58.9° in kyphosis, accounting a correction rate of 61.2 and 63.1 %, respectively. As to coronal and sagittal imbalance, data were limited. The overall prevalence of complications of PVCR was 32 % (95 % CI 12-54 %). The most common was neurologic complications, estimated to be 8 % (95 % CI 2-16 %). And risk of spinal cord injury was 2 % (95 % CI 0-3 %). The revision rate was 6 % (95 % CI 1-13 %). Incidence of infection was pooled to be 2 % (95 % CI 1-4 %). Complication rate related with implant was 2 % (95 % CI 0-6 %). CONCLUSION: PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team.

Proximal Junctional Kyphosis Following Spinal Deformity Surgery in the Pediatric Patient.

Proper understanding and restoration of sagittal balance is critical in spinal deformity surgery, including conditions such as adolescent idiopathic scoliosis and Scheuermann kyphosis. One potential complication following spinal reconstruction is proximal junctional kyphosis. The prevalence of proximal junctional kyphosis varies in the literature, and several patient- and surgery-related risk factors have been identified. To date, the development of proximal junctional kyphosis has not been shown to lead to a negative clinical outcome following spinal fusion for adolescent idiopathic scoliosis or Scheuermann kyphosis. Treatment options range from simple observation in asymptomatic cases to revision surgery with extension of the fusion proximally. Several techniques and technologies are emerging that seek to address and prevent proximal junctional kyphosis.

MD Simulations of tRNA and Aminoacyl-tRNA Synthetases: Dynamics, Folding, Binding, and Allostery.

While tRNA and aminoacyl-tRNA synthetases are classes of biomolecules that have been extensively studied for decades, the finer details of how they carry out their fundamental biological functions in protein synthesis remain a challenge. Recent molecular dynamics (MD) simulations are verifying experimental observations and providing new insight that cannot be addressed from experiments alone. Throughout the review, we briefly discuss important historical events to provide a context for how far the field has progressed over the past few decades. We then review the background of tRNA molecules, aminoacyl-tRNA synthetases, and current state of the art MD simulation techniques for those who may be unfamiliar with any of those fields. Recent MD simulations of tRNA dynamics and folding and of aminoacyl-tRNA synthetase dynamics and mechanistic characterizations are discussed. We highlight the recent successes and discuss how important questions can be addressed using current MD simulations techniques. We also outline several natural next steps for computational studies of AARS:tRNA complexes.

Folding path of P5abc RNA involves direct coupling of secondary and tertiary structures.

Folding mechanisms in which secondary structures are stabilized through the formation of tertiary interactions are well documented in protein folding but challenge the folding hierarchy normally assumed for RNA. However, it is increasingly clear that RNA could fold by a similar mechanism. P5abc, a small independently folding tertiary domain of the Tetrahymena thermophila group I ribozyme, is known to fold by a secondary structure rearrangement involving helix P5c. However, the extent of this rearrangement and the precise stage of folding that triggers it are unknown. We use experiments and simulations to show that the P5c helix switches to the native secondary structure late in the folding pathway and is directly coupled to the formation of tertiary interactions in the A-rich bulge. P5c mutations show that the switch in P5c is not rate-determining and suggest that non-native interactions in P5c aid folding rather than impede it. Our study illustrates that despite significant differences in the building blocks of proteins and RNA, there may be common ways in which they self-assemble.

Proximal junctional kyphosis following adult spinal deformity surgery.

PURPOSE: Proximal junctional kyphosis (PJK) is a common radiographic finding following long spinal fusions. Whether PJK leads to negative clinical outcome is currently debatable. A systematic review was performed to assess the prevalence, risk factors, and treatments of PJK. METHODS: Literature search was conducted on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials using the terms 'proximal junctional kyphosis' and 'proximal junctional failure'. Excluding reviews, commentaries, and case reports, we analyzed 33 studies that reported the prevalence rate, risk factors, and discussions on PJK following spinal deformity surgery. RESULTS: The prevalence rates varied widely from 6 to 61.7%. Numerous studies reported that clinical outcomes for patients with PJK were not significantly different from those without, except in one recent study in which adult patients with PJK experienced more pain. Risk factors for PJK included age at operation, low bone mineral density, shorter fusion constructs, upper instrumented vertebrae below L2, and inadequate restoration of global sagittal balance. CONCLUSIONS: Prevalence of PJK following long spinal fusion for adult spinal deformity was high but not clinically significant. Careful and detailed preoperative planning and surgical execution may reduce PJK in adult spinal deformity patients.

Innovative Developments in Lumbar Interbody Cage Materials and Design: A Comprehensive Narrative Review.

This review comprehensively examines the evolution and current state of interbody cage technology for lumbar interbody fusion (LIF). This review highlights the biomechanical and clinical implications of the transition from traditional static cage designs to advanced expandable variants for spinal surgery. The review begins by exploring the early developments in cage materials, highlighting the roles of titanium and polyetheretherketone in the advancement of LIF techniques. This review also discusses the strengths and limitations of these materials, leading to innovations in surface modifications and the introduction of novel materials, such as tantalum, as alternative materials. Advancements in three-dimensional printing and surface modification technologies form a significant part of this review, emphasizing the role of these technologies in enhancing the biomechanical compatibility and osseointegration of interbody cages. In addition, this review explores the increase in biodegradable and composite materials such as polylactic acid and polycaprolactone, addressing their potential to mitigate long-term implant-related complications. A critical evaluation of static and expandable cages is presented, including their respective clinical and radiological outcomes. While static cages have been a mainstay of LIF, expandable cages are noted for their adaptability to the patient's anatomy, reducing complications such as cage subsidence. However, this review highlights the ongoing debate and the lack of conclusive evidence regarding the superiority of either cage type in terms of clinical outcomes. Finally, this review proposes future directions for cage technology, focusing on the integration of bioactive substances and multifunctional coatings and the development of patient-specific implants. These advancements aim to further enhance the efficacy, safety, and personalized approach of spinal fusion surgeries. Moreover, this review offers a nuanced understanding of the evolving landscape of cage technology in LIF and provides insights into current practices and future possibilities in spinal surgery.

Identification of doping suspicions through artificial intelligence-powered analysis on athlete's performance passport in female weightlifting.

Introduction: Doping remains a persistent concern in sports, compromising fair competition. The Athlete Biological Passport (ABP) has been a standard anti-doping measure, but confounding factors challenge its effectiveness. Our study introduces an artificial intelligence-driven approach for identifying potential doping suspicious, utilizing the Athlete's Performance Passport (APP), which integrates both demographic profiles and performance data, among elite female weightlifters. Methods: Analyzing publicly available performance data in female weightlifting from 1998 to 2020, along with demographic information, encompassing 17,058 entities, we categorized weightlifters by age, body weight (BW) class, and performance levels. Documented anti-doping rule violations (ADRVs) cases were also retained. We employed AI-powered algorithms, including XGBoost, Multilayer Perceptron (MLP), and an Ensemble model, which integrates XGBoost and MLP, to identify doping suspicions based on the dataset we obtained. Results: Our findings suggest a potential doping inclination in female weightlifters in their mid-twenties, and the sanctioned prevalence was the highest in the top 1% performance level and then decreased thereafter. Performance profiles and sanction trends across age groups and BW classes reveal consistently superior performances in sanctioned cases. The Ensemble model showcased impressive predictive performance, achieving a 53.8% prediction rate among the weightlifters sanctioned in the 2008, 2012, and 2016 Olympics. This demonstrated the practical application of the Athlete's Performance Passport (APP) in identifying potential doping suspicions. Discussion: Our study pioneers an AI-driven APP approach in anti-doping, offering a proactive and efficient methodology. The APP, coupled with advanced AI algorithms, holds promise in revolutionizing the efficiency and objectivity of doping tests, providing a novel avenue for enhancing anti-doping measures in elite female weightlifting and potentially extending to diverse sports. We also address the limitation of a constrained set of APPs, advocating for the development of a more accessible and enriched APP system for robust anti-doping practices.

Perioperative pain protocols following surgery for adolescent idiopathic scoliosis: a snapshot of current treatments utilized by attending orthopedic surgeons.

PURPOSE: Perioperative management after adolescent idiopathic scoliosis (AIS) surgery varies extensively between surgeons and institutions. We devised a questionnaire to assess surgeon baseline characteristics, practice settings, and pain regimens to assess what factors contribute to perioperative pain protocols. METHODS: A multiple-choice questionnaire including 130 independent variables regarding baseline characteristics, practice environments, and pain regimen protocols was distributed to elicit information among surgeons performing AIS fusion surgery. Pairwise bivariate analysis between practice location, length of practice, and practice environment vs. type of post-operative analgesia was completed using two-tailed Fisher's exact test. RESULTS: 85 respondents participated, all identified as practicing orthopedic surgeons. The largest group of respondents reported 20-40% of their total practice was dedicated to AIS (36%). Respondents were predominantly hospital-employed academic physicians (67%). The most common pain medication administered preoperatively was gabapentin (54%). Postoperative regimens were highly varied. Discharge pain regimens most commonly included short-acting opiates (89%), acetaminophen (86%), antispasmodics (59%), and NSAIDs (51%). Bivariate analysis revealed that fentanyl PCA was significantly associated with practice location (p < 0.05). Utilization of NSAIDs was significantly associated with length in training, with older physicians utilizing anti-inflammatories more regularly than younger physicians (p < 0.05). CONCLUSION: This study identifies common perioperative regimens utilized in AIS surgery. Of interest, younger surgeons are less likely to prescribe NSAIDs post-operatively than surgeons who have been in practice for longer periods of time, which may represent a bias against anti-inflammatory medications in younger surgeons.