Online headspace monitoring of volatile organic compounds using proton transfer reaction-mass spectrometry: Application to the multiphase atmospheric fate of 2,4-hexadienedial.

Chemical processes in clouds have been suggested to contribute significantly to the mass of organic aerosol particles in the atmosphere. Experimental and theoretical evidence suggest that organic mass production in clouds can be substantial and depends on the concentration of organic precursor compounds available in the gas phase. The present study aims at studying the aqueous phase reactivity of one of these overlooked precursors, i.e. 2,4-hexadienedial, an important and toxic intermediate in the atmospheric oxidation of aromatic species. Cautious synthesis and purification of 2,4-hexadienedial was performed. Its effective Henry's law constant was measured using a new simple and fast method based on online flow-injection analysis. The reactivity of 2,4-hexadienedial in the aqueous phase relevant to atmospheric conditions was studied, including hydrate formation, photolysis, ∙OH- and SO4∙--oxidation as well as reaction with NH3. The results revealed a low hydration constant compared to other dicarbonyls (Khyd1 = 7 × 10-2) and no dihydrate formation, indicating in an intermediate solubility (KH = 1.0 × 104 M atm-1) and high absorption cross sections (σ278nm > 10-16 cm2 molecule-1). Compared to its gas phase photolysis, its aqueous phase photolysis showed low quantum yields (Φ290-380nm = 0.9 %), and a significant red shift of the absorbance maximum, leading to a fast aqueous photolysis kinetics (Jaq,atm = 8.7 × 10-5 s-1) under atmospheric solar radiation, but no triplet state formation was detected. Radical oxidation experiments revealed extremely rapid oxidation kinetics (k∙OH = 1.10 × 1010 M-1 s-1 and kSO4∙- = 1.4 × 109 M-1 s-1) driven by fast addition of the radicals to the unsaturated bonds. In contrast, the reaction with aqueous NH3 (kNH3 = 2.6 × 10-3 M-1 s-1) was found slower than glyoxal and 2-butenedial, likely due to the hyperconjugation of 2,4-hexadienedial. Using these new data complemented with assumed aqueous phase kinetics (for NO3, 3C* and 1O2 reactions) and previous gas-phase kinetic ones, the multiphase atmospheric fate of 2,4-hexadienedial was established under atmospheric conditions reported from previous field measurements and models. The results revealed a short day lifetime (∼1 h) and a long night lifetime (>12 h). It was shown that daytime atmospheric chemistry of 2,4-hexadienedial can be influenced by aqueous-phase reactivity during cloud events, up to ∼50 % under thick cloud conditions (Liquid Water Content >2000 g/m3), indicating that even a compound of intermediate solubility can be strongly affected by condensed-phase reactivity. Besides its fast aqueous phase reactivity towards ∙OH and photolysis, its daytime condensed-phase reactivity may be driven by reactions with dissolved triplet states (3C*), up to 35 %, highlighting the need to study further the kinetics, the nature and concentrations of dissolved 3C* under various atmospheric conditions. In addition, the molecular properties and atmospheric behavior of 2,4-hexadienedial were found different from those of glyoxal and 2-butenedial, highlighting the need for detailed atmospheric reactivity studies of polyfunctional compounds, in particular unsaturated compounds.

On-the-fly Raman microscopy guaranteeing the accuracy of discrimination.

Accelerating the measurement for discrimination of samples, such as classification of cell phenotype, is crucial when faced with significant time and cost constraints. Spontaneous Raman microscopy offers label-free, rich chemical information but suffers from long acquisition time due to extremely small scattering cross-sections. One possible approach to accelerate the measurement is by measuring necessary parts with a suitable number of illumination points. However, how to design these points during measurement remains a challenge. To address this, we developed an imaging technique based on a reinforcement learning in machine learning (ML). This ML approach adaptively feeds back "optimal" illumination pattern during the measurement to detect the existence of specific characteristics of interest, allowing faster measurements while guaranteeing discrimination accuracy. Using a set of Raman images of human follicular thyroid and follicular thyroid carcinoma cells, we showed that our technique requires 3,333 to 31,683 times smaller number of illuminations for discriminating the phenotypes than raster scanning. To quantitatively evaluate the number of illuminations depending on the requisite discrimination accuracy, we prepared a set of polymer bead mixture samples to model anomalous and normal tissues. We then applied a home-built programmable-illumination microscope equipped with our algorithm, and confirmed that the system can discriminate the sample conditions with 104 to 4,350 times smaller number of illuminations compared to standard point illumination Raman microscopy. The proposed algorithm can be applied to other types of microscopy that can control measurement condition on the fly, offering an approach for the acceleration of accurate measurements in various applications including medical diagnosis.

Flame Retardancy of Short Flax Fibers Modified by Radiation-Induced Grafting of Phosphonated Monomers: Comparison between Pre- and Simultaneous Irradiation Grafting.

Short flax fibers have been modified by radiation-induced grafting using methacrylate monomers containing phosphorus to give them a flame-retardant character. Two methodologies, namely pre-irradiation and simultaneous irradiation grafting, were examined. Certain parameters, notably the dose and the irradiation source (e-Beam and γ rays), were evaluated. The grafting efficiency, in terms of phosphorus content (mass percentage), was measured by X-ray fluorescence spectrometry (XRF). Using simultaneous irradiation, 2.39 wt% phosphorus could be obtained from 10 kGy, compared to 100 kGy in pre-irradiation. Furthermore, for similar phosphorus levels, the location of the grafted polymer chains was different for the two methodologies. The effect of phosphorus content on thermal properties and fire behavior was evaluated on a microscopic scale using a pyrolytic flow combustion calorimeter (PCFC) and on a laboratory scale using a cone calorimeter. It was then pointed out that flammability was linked to the phosphorus content and likely its location, which is associated with the radiation-induced grafting methodology, showing that the grafting conditions influence the final fire properties. Simultaneous irradiation, thus, proved to be more interesting in terms of efficiency and final properties.

Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review.

The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.

Repetitive Behaviors in Alzheimer's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Repetitive behaviors (RBs) are a well-known symptom of Alzheimer's disease (AD); however, they have been little studied and have not been the subject of any specific literature review. OBJECTIVE: To conduct a systematic review of all studies to document RBs in AD. METHODS: An extensive literature search combining five databases and a meta-analysis were conducted to investigate the frequency, nature, and cognitive correlates of RBs in AD. RESULTS: Ten studies were included in the review. Seven studies out of ten investigated the frequency of RBs in patients with AD, which ranged from 52.3% to 87%. A meta-analysis showed an overall frequency of 66.3% (95% CI: 55.5; 77.1) of patients exhibiting RBs in AD, but important heterogeneity was observed between studies. Three studies investigated the predominant nature of RBs in AD. Verbal RBs, complex behavioral stereotypies, and simple motor stereotypies have been identified to different degrees depending on the level of dementia. Most verbal RBs are underpinned by episodic memory impairment, while simple motor stereotypies and complex behavioral stereotypies are mostly underpinned by executive dysfunction. CONCLUSIONS: The current review seems to suggest that there are two types of mechanisms underpinning RBs involved in AD. The first is observed especially in the mild stages of the disease and is mediated by episodic memory impairment. The second occurs later and is mediated by executive impairment. Additional studies should be conducted to improve the knowledge about RBs in AD and thus improve their management.Systematic review registration number: PROSPERO 2022: CRD42022310027.

Conception and Evaluation of a Library of Cleavable Mass Tags for Digital Polymers Sequencing.

A library of phosphoramidite monomers containing a main-chain cleavable alkoxyamine and a side-chain substituent of variable molar mass (i.e. mass tag) was prepared in this work. These monomers can be used in automated solid-phase phosphoramidite chemistry and therefore incorporated periodically as spacers inside digitally-encoded poly(phosphodiester) chains. Consequently, the formed polymers contain tagged cleavable sites that guide their fragmentation in mass spectrometry sequencing and enhance their digital readability. The spacers were all prepared via a seven steps synthetic procedure. They were afterwards tested for the synthesis and sequencing of model digital polymers. Uniform digitally-encoded polymers were obtained as major species in all cases, even though some minor defects were sometimes detected. Furthermore, the polymers were decoded in pseudo-MS3 conditions, thus confirming the reliability and versatility of the spacers library.

The relationship between semantic and episodic memory: evidence from a case of severe anterograde amnesia.

It is increasingly being recognized that new declarative, consciously accessible information can be learned in anterograde amnesia, but it is not clear whether this learning is supported by episodic or semantic memory. We report a case of a 55-year-old man who experienced severe amnesia after limited damage to the medial temporal lobe following neurosurgical complications. His general cognitive performance and knowledge of new French words and public events that occurred before and after the onset of amnesia were assessed. Performance remained satisfactory on post-morbid vocabulary and public events, with a drop in performance observed for very recent public events only, while knowledge of very recent vocabulary was comparable to that of the control subjects. The implications of these findings for our understanding of the underlying learning mechanisms are discussed. This is the first report of acquisition of consciously accessible postmorbid knowledge of public events in a patient with severe amnesia.

Polycyclic aromatic hydrocarbon dynamics in soils along proglacial chronosequences in the Alps.

Polycyclic aromatic hydrocarbons (PAHs) were studied in the soils of three proglacial areas in France (Noir and Chardon Glaciers) and Italy (Miage Glacier). PAH contents, PAH stocks and PAH contents normalized to the total organic carbon contents (PAHs/TOC ratio) were investigated along proglacial soil chronosequences to infer their evolutions with soil age (from 3 to 4200 years), where the PAH contamination was only related to long-range atmospheric transport. Evolutions of PAH and TOC contents, PAHs/TOC ratio and PAH stock were fitted with exponential and logarithmic relations. For the three proglacial areas, PAH contents increased rapidly during the first 150 years of soil development, ranged from 4 to 152 ng·g-1, and showed a strong relationship with total organic carbon (TOC) contents (r = 0.83, p < 0.05). The joint increase of PAH and TOC contents suggested that PAH accumulation in soils were not only driven by PAH inputs but also by the capacity of soils to store these contaminants. PAH contents in the oldest soils (from 1200 BCE and 2200 BCE) were similar than for soils from 1850 CE. The period 1850-2019 CE corresponded to a decrease in the PAHs/TOC ratio suggesting both a faster accumulation of TOC than PAHs and a dilution effect of PAHs already present in soils. For the oldest soils, the PAHs/TOC ratio appeared similar to those for soils from 1850 CE, with values ranging from 0.48 to 2.06 ng·mg-1, suggesting an equilibrium between both parameters for soils older than 170 years. Finally, PAH stocks ranged from 0.41 mg·m-2 to 6.80 mg·m-2 in the youngest and oldest soils, respectively. These results do not allow us to identify the same period of greatest emission as other studies (estimated ~1960), but they revealed changes in the capacity of soils to store these pollutants.

Differentiability of cell types enhanced by detrending a non-homogeneous pattern in a line-illumination Raman microscope.

A line illumination Raman microscope extracts the underlying spatial and spectral information of a sample, typically a few hundred times faster than raster scanning. This makes it possible to measure a wide range of biological samples such as cells and tissues - that only allow modest intensity illumination to prevent potential damage - within feasible time frame. However, a non-uniform intensity distribution of laser line illumination may induce some artifacts in the data and lower the accuracy of machine learning models trained to predict sample class membership. Here, using cancerous and normal human thyroid follicular epithelial cell lines, FTC-133 and Nthy-ori 3-1 lines, whose Raman spectral difference is not so large, we show that the standard pre-processing of spectral analyses widely used for raster scanning microscopes introduced some artifacts. To address this issue, we proposed a detrending scheme based on random forest regression, a nonparametric model-free machine learning algorithm, combined with a position-dependent wavenumber calibration scheme along the illumination line. It was shown that the detrending scheme minimizes the artifactual biases arising from non-uniform laser sources and significantly enhances the differentiability of the sample states, i.e., cancerous or normal epithelial cells, compared to the standard pre-processing scheme.

Enhanced recovery following posterior spinal fusion for adolescent idiopathic scoliosis: A medical and economic study in a French private nonprofit pediatric hospital.

INTRODUCTION: Little data exist on the efficacy of enhanced recovery after surgery (ERAS) protocols in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). HYPOTHESIS: ERAS reduces hospital costs (HC) and length of stay (LOS) without increasing pain or complications. MATERIALS AND METHODS: This was a retrospective comparative medical and economic study of 2 cohorts of patients who underwent PSF for AIS: a prospective group who underwent surgery with an ERAS protocol without a specially assigned care coordinator from 2020 to 2021 (n=30) and a retrospective group (control) who received standard care from 2017 to 2018 (n=30). The key amendments to the ERAS protocol were reduced preoperative investigations, opioid-sparing analgesia, ambulation starting on postoperative day (POD) 1, early resumption of oral diet, and early transition to oral analgesics. Moreover, an intensive care unit (ICU) stay, surgical drainage, and the postoperative CT scan were no longer routine. The discharge criteria were the same for both groups: normal bowel function, independent walking, pain Visual Analog Scale (VAS)<3 without strong opioids, and no signs of complications. The endpoints were: decreased HC (calculated by subtracting the costs of hospital days and complementary exams that were not carried out) and LOS, complications, and postoperative pain according to the VAS on POD 1, POD 3, and discharge. All means were reported with the standard deviation. RESULTS: The mean age of patients undergoing surgery (14.5±1.7 years), sex ratio, curve type according to the Lenke classification, mean Cobb angle (54±12°), and the number of instrumented vertebrae (9±2) were similar in both groups (p>0.5). The HC decreased on average by 3029€ per patient. The mean LOS was 5±0.9 days in the ERAS group versus 6.5±0.6 days in the control group (p<0.001). The VAS scores on POD 1 and POD 3 were lower in the ERAS group. One postoperative complication was noted in each group. CONCLUSION: Implementing an ERAS protocol without a specifically assigned care coordinator for patients with AIS undergoing PSF significantly decreased HC, LOS, and early postoperative pain. LEVEL OF EVIDENCE: III; retrospective comparative study.

A fast and efficient method for the analysis of α-dicarbonyl compounds in aqueous solutions: Development and application.

Among the highly oxygenated species formed in situ in the atmosphere, α-dicarbonyl compounds are the most reactive species, thus contributing to the formation of secondary organic aerosols that affect both air quality and climate. They are ubiquitous in the atmosphere and are easily transferred to the atmospheric aqueous phase due to their high solubility. In addition, α-dicarbonyl compounds are toxic compounds found in food in biochemistry studies as they can be produced endogenously through various pathways and exogenously through the Maillard reaction. In this work, we take advantage of the high reactivity of α-dicarbonyl compounds in alkaline solutions (intramolecular Cannizzaro reaction) to develop an analytical method based on high performance ion chromatography. This fast and efficient method is suitable for glyoxal, methylglyoxal and phenylglyoxal which are detected as glycolate, lactate and mandelate anions respectively, with 100% conversion at pH > 12 and room temperature for exposure times to hydroxide ranging from 5 min to 4 h. Diacetyl is detected as 2,4-dihydroxy-2,4-dimethyl-5-oxohexanoate due to a base-catalysed aldol reaction that occurs before the Cannizzaro reaction. The analytical method is successfully applied to monitor glyoxal consumption during aqueous phase HO∙-oxidation, an atmospherically relevant reaction using concentrations that can be observed in fog and cloud water. The method also reveals potential analytical artifacts that can occur in the use of ion chromatography for α-hydroxy carboxylates measurements in complex matrices due to α-dicarbonyl conversion during the analysis time. An estimation of the artifact is given for each of the studied α-hydroxy carboxylates. Other polyfunctional and pH-sensitive compounds that are potentially present in environmental samples (such as nitrooxycarbonyls) can also be converted into α-hydroxy carboxylates and/or nitrite ions within the HPIC run. This shows the need for complementary analytical measurements when complex matrices are studied.

Effects of antipsychotic and anticholinergic medications on cognition in chronic patients with schizophrenia.

BACKGROUND: Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. STUDY DESIGN: A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. STUDY RESULTS: A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p = .028), higher chlorpromazine equivalent dose (SB = -.30; p = .001), and taking mood stabilizer medications (SB = -.24; p = .004) were significantly associated with lower cognition. CONCLUSION: This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia.

Geometrical analysis identified morphological features of hydrogel-induced cancer stem cells in synovial sarcoma model cells.

Cancer stem cells (CSCs) has been a key target to cure cancer patients completely. Although many CSC markers have been identified, they are frequently cancer type-specific and those expressions are occasionally variable, which becomes an obstacle to elucidate the characteristics of the CSCs. Here we scrutinized the relationship between stemness elevation and geometrical features of single cells. The PAMPS hydrogel was utilized to create the CSCs from mouse myoblast C2C12 and its synovial sarcoma model cells. qRT-PCR analysis confirmed the significant increase in expression levels of Sox2, Nanog, and Oct3/4 on the PAMPS gel, which was higher in the synovial sarcoma model cells. Of note, the morphological heterogeneity was appeared on the PAMPS gel, mainly including flat spreading, elongated spindle, and small round cells, and the Sox2 expression was highest in the small round cells. To examine the role of morphological differences in the elevation of stemness, over 6,400 cells were segmented along with the Sox2 intensity, and 12 geometrical features were extracted at single cell level. A nonlinear mapping of the geometrical features by using uniform manifold approximation and projection (UMAP) clearly revealed the existence of relationship between morphological differences and the stemness elevation, especially for C2C12 and its synovial sarcoma model on the PAMPS gel in which the small round cells possess relatively high Sox2 expression on the PAMPS gel, which supports the strong relationship between morphological changes and the stemness elevation. Taken together, these geometrical features can be useful for morphological profiling of CSCs to classify and distinguish them for understanding of their role in disease progression and drug discovery.

Optimisation and validation of a co-manipulated robot for brachytherapy procedure.

BACKGROUND: Low-dose rate brachytherapy is the referent treatment for early-stage prostate cancer and consists in manually inserting radioactive seeds within the organ to destroy tumorous cells. This treatment is inaccurate leading to side effects. Researchers developed robots to improve this technique. Despite ameliorating accuracy, they cannot be clinically used because of size and acceptability. Therefore, a 6-DOF parallel and co-manipulated robot is proposed to meet these requirements. METHODS: To fulfil the application requirements, a compact design was modelled. The robot's optimal dimensions were defined by establishing kinematics and implementing genetic algorithm. The robot's relevance was evaluated by measuring workspace and needle placement errors. RESULTS: The robot fits into a cube of 300 × 300 × 300 mm3 and provides a free-singularity workspace of 55 × 55 × 150 mm3 with a possible end-effector rotation of 15° and a needle placement error <3 mm. CONCLUSION: The results are promising and prove that our robot fulfils the application requirements and presents a beneficial alternative to the manual procedure.

ERK MAP Kinase Signaling Regulates RAR Signaling to Confer Retinoid Resistance on Breast Cancer Cells.

Retinoic acid (RA) and its synthetic derivatives, retinoids, have been established as promising anticancer agents based on their ability to regulate cell proliferation and survival. Clinical trials, however, have revealed that cancer cells often acquire resistance to retinoid therapy. Therefore, elucidation of underlying mechanisms of retinoid resistance has been considered key to developing more effective use of retinoids in cancer treatment. In this study, we show that constitutive activation of ERK MAP kinase signaling, which is often caused by oncogenic mutations in RAS or RAF genes, suppresses RA receptor (RAR) signaling in breast cancer cells. We show that activation of the ERK pathway suppresses, whereas its inhibition promotes, RA-induced transcriptional activation of RAR and the resultant upregulation of RAR-target genes in breast cancer cells. Importantly, ERK inhibition potentiates the tumor-suppressive activity of RA in breast cancer cells. Moreover, we also reveal that suppression of RAR signaling and activation of ERK signaling are associated with poor prognoses in breast cancer patients and represent hallmarks of specific subtypes of breast cancers, such as basal-like, HER2-enriched and luminal B. These results indicate that ERK-dependent suppression of RAR activity underlies retinoid resistance and is associated with cancer subtypes and patient prognosis in breast cancers.

Poor Sleep Quality and Other Risk Factors for Unemployment Among Patients on Opioid Agonist Treatment.

Purpose: Patients with opioid use disorder (OUD) face high rates of unemployment, putting them at higher risk of treatment nonadherence and poor outcomes, including overdose death. The objective of this study was to investigate sleep quality and its association with other biopsychosocial risk factors for unemployment in patients receiving opioid agonist treatment (OAT) for OUD. Methods: Using a cross-sectional survey design, participants from 3 OAT programs for OUD completed questionnaires to measure sleep quality (Pittsburgh Sleep Quality Index [PSQI]); pain disability; catastrophic thinking; injustice experience; quality of life; and self-assessed disability. Spearman's rank correlation was used to test for associations between sleep quality and other study variables. Results: Thirty-eight participants completed the study, with mean age 45.6 ± 10.9 years, 27 (71.1%) males, and 16 (42.1%) reporting a high school diploma/equivalent certification as the highest level of academic attainment. Poor sleep quality (defined as PSQI > 5) was identified in 29 participants (76.3%) and was positively correlated with pain disability (r = 0.657, P < .01), self-assessed disability (r = 0.640, P < .001), symptom catastrophizing (r = 0.499, P < .001), and injustice experience (r = 0.642, P < .001), and negatively correlated with quality of life (r = -0.623, P < .001). Conclusions: There was a high prevalence of poor sleep quality in patients with OUD on OAT and this was associated with multiple known risk factors for unemployment. These findings warrant the consideration of regular screening for sleep problems and the inclusion of sleep-related interventions to improve sleep quality, decrease the unemployment rate, and enhance the recovery process for individuals with OUD undergoing OAT.

Adolescent and Juvenile Idiopathic Scoliosis: Which Patients Obtain Good Results with 12 Hours of Cheneau-Toulouse-Munster Nighttime Bracing?

BACKGROUND: The results of 12 h nighttime Cheneau-Toulouse-Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. OBJECTIVE: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. METHODS: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success. RESULTS: Overall success was 70%: 60% for main thoracic (MT) and 84% for main lumbar scoliosis (ML) (p = 0.003). Efficacy was 62% at Risser stage 0 and 78% at Risser stage 1-2 (p = 0.054). For MT, failure was associated with high in-brace sagittal C7 tilt (Odds Ratio = 0.72, p = 0.014) and low initial overcurve CA (Odds Ratio = 0.42, p = 0.044). For ML, a high standing height was associated with success (OR = 1.42, p = 0.035), and frontal unbalanced C7 tilt was associated with failure (OR = 0.43, p = 0.02). CONCLUSION: Twelve-hour nighttime CTM brace wear provided good results for main lumbar curves with balanced frontal C7 tilt. For MT, this treatment is indicated if the in-brace sagittal C7 tilt is well balanced from Risser stage 2.

Comparison of four correction techniques for posterior spinal fusion in adolescent idiopathic scoliosis.

INTRODUCTION: When performing posterior spinal fusion for adolescent idiopathic scoliosis (AIS), it is of major importance to address both coronal and sagittal deformities. Although several techniques have been described, few data exist comparing them. Our objective was to compare four techniques (in situ bending (ISB), rod derotation (RD), cantilever (C) and posteromedial translation (PMT)) for the correction of spinal deformity in AIS including thoracic deformity. MATERIAL AND METHODS: We conducted a multicenter retrospective study including 562 AIS patients with thoracic deformity with at least 24-month follow-up. Radiographic analysis was performed preoperatively, postoperatively and at last follow-up. The main outcomes were main curve correction and thoracic kyphosis restoration (TK). RESULTS: Coronal correction rate was significantly different among the four treatment groups (ISB 64% vs C 57% vs RD 55% vs PMT 67%, p < 0.001). Multivariate regression revealed that correction technique did not influence correction rate, whereas implant density, convex side compression and use of derotation connectors did. TK increase was significantly higher in the PMT group (average + 13°) than in DR (+ 3°), while ISB (-3°) and cantilever (-13°) resulted in TK decrease (p < 0.001). Multivariate analysis revealed that TK increase was only influenced by the reduction technique (p < 0.001) and preoperative TK (p < 0.001). DISCUSSION: The four techniques had the same ability to correct spinal deformity in the coronal plane. Three factors were identified to improve correction rate: implant density, convex compression and use of derotation connectors. On the other hand, PMT was more effective in restoring TK, particularly in hypokyphotic patients.

Perceptions on barriers, facilitators, and recommendations related to mental health service delivery during the COVID-19 pandemic in Quebec, Canada: a qualitative descriptive study.

BACKGROUND: There was an increase in self-reported mental health needs during the COVID-19 pandemic in Canada, with research showing reduced access to mental health services in comparison to pre-pandemic levels. This paper explores 1) barriers and facilitating factors associated with mental health service delivery via primary care settings during the first two pandemic waves in Quebec, Canada, and 2) recommendations to addressing these barriers. METHODS: A qualitative descriptive study design was used. Semi-structured interviews with 20 participants (health managers, family physicians, mental health clinicians) were conducted and coded using a thematic analysis approach. RESULTS: Barriers and facilitating factors were organized according to Chaudoir et al. (2013)'s framework of structural, organizational, provider- and patient-related, as well as innovation (technological modalities for service delivery) categories. Barriers included relocation of mental health staff to non-mental health related COVID-19 tasks (structural); mental health service interruption (organizational); mental health staff on preventive/medical leave (provider); the pandemic's effect on consultations (i.e., perceptions of increased demand) (patients); and challenges with the use of technological modalities (innovation). Facilitating factors included reinforcements to mental health care teams (structural); perceptions of reductions in wait times for mental health evaluations during the second wave due to diminished FP referrals in the first wave, as well as supports (i.e., management, private sector, mental health trained staff) for mental health service delivery (organizational); staff's mental health consultation practices (provider); and advantages in increasing the use of technological modalities in practice (innovation). CONCLUSIONS: To our knowledge, this is the first study to explore barriers and facilitating factors to mental health service delivery during the pandemic in Quebec, Canada. Some barriers identified were caused by the pandemic, such as the relocation of staff to non-mental health services and mental health service interruption. Offering services virtually seemed to facilitate mental health service delivery only for certain population groups. Recommendations related to building and strengthening human and technological capacity during the pandemic can inform mental health practices and policies to improve mental health service delivery in primary care settings and access to mental health services via access points.