OBJECTIVE: Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT.
METHODS: In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes.
RESULTS: Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ2(1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance.
CONCLUSIONS: While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF.

The electric solar wind sail (E-sail) is a new propellant-free propulsion concept. The under-actuated and highly nonlinear features of E-sail systems pose a great challenge to their attitude controller design. Conventional control schemes may not be capable of dealing with this tough problem. To this end, a reinforcement learning (RL)-based control scheme, which can explore and obtain optimal policies in the absence of training datasets, is proposed for the attitude control of a barbell E-sail system. The barbell E-sail comprises two end satellites linked to an insulated confluence point through long and conductive tethers. The voltages of the two tethers can be individually modulated for attitude control. The system attitude dynamics is described using a nonsingular formulation. The control scheme has a two-stage design. In the first stage, an RL controller based on the Proximal Policy Optimization (PPO) algorithm is used to obtain an RL control strategy, which is emulated and updated by neural networks. In the second stage, the attitude feedback control is accomplished with low computation and energy consumption and fast convergence speed by performing a real-time mapping from the system state to the control output using the updated control strategy. Finally, the simulation results demonstrate that the proposed RL-based control scheme can effectively adjust the E-sail to the design attitude by regulating the tether voltage difference. The comparisons with the NMPC scheme also indicate that the developed control scheme can significantly reduce the computation time with control accuracy maintained.

Proximal junctional failure following surgical correction for adult spinal deformity significantly impacts quality of life and increases the economic burden of treating underlying spinal deformity. The objective of this cadaver study was to determine optimal tension parameters in junctional tethers for proximal junctional kyphosis prevention.
Cadaveric specimens were used to establish the optimal tension range in polyethylene tethering devices, such as the VersaTie (NuVasive) used in this study. Three specimens were instrumented to test tether tensions of 0, 75, and 150 Newtons (N) at L1-L2, T9-T10, and T3-T4. An optical tracking system was used to measure when specimens reached proximal junctional kyphosis, experienced instrumentation or tissue failure, or reached a cap of 2500 cycles. Radiographs were obtained before and after testing.
At all levels, use of a tether at tension forces of 75 N and 150 N elicited a protective effect. The only level in which a higher tension on the tether resulted in more protection was at T3-T4. When averaged, the use of a tether at tension forces of 75 N and 150 N showed 1000 cycles of protection at L1-L2, 2000 cycles at T9-T10, and 1426 cycles at T3-T4. Radiographic analysis corroborated these findings.
The use of a tether in a cadaveric model prevents the development of proximal junctional kyphosis across all tested levels and an increased tension force of 150 N is protective at the proximal thoracic spine. These data can be used to develop further models for a tether system that reproducibly applies a fixed tension force above the thoracolumbar rod construct.

This article presents a new design of supporting tethers through the concept of force distribution. The transmitted force applied on tethers will be distributed on the new tether design area, resulting in low acoustic energy transferred to anchor boundaries and stored energy enhancement. This technique achieves an anchor quality factor of 175,000 compared to 58,000 obtained from the conventional tether design, representing a three-fold enhancement. Furthermore, the unloaded quality factor of the proposed design improved from 23,750 to 27,442, representing a 1.2-fold improvement.

BACKGROUND: Surgery for adult spinal deformity (ASD) often involves long-segment posterior instrumentation that introduces stress at the proximal junction that can result in proximal junctional kyphosis (PJK) or proximal junctional failure (PJF). Recently, the use of tethers at the proximal junction has been proposed as a means of buffering the transitional stresses and reducing the risk of PJK/PJF. Our objectives are to summarize the clinical literature on proximal junctional tethers for PJK/PJF prophylaxis.
METHODS: Articles published between 1 January 2000 and 10 November 2022 were identified via a PubMed search using combinations of the search terms \"spine surgery,\" \"ASD,\" \"complication,\" \"surgery,\" \"PJK,\" \"PJF,\" \"tether,\" \"sublaminar band,\" and \"prophylaxis.\" No restrictions were placed on the number of patients, surgical indications, or surgical procedures. Relevant articles were reviewed and summarized.
RESULTS: Fifteen articles were identified, including 2 prospective cohorts (Level II), 10 retrospective cohorts (Level III), and 3 retrospective case series (Level IV). All studies were published between 2016 and 2022, and all focused on ASD patient populations. The mean age in each study ranged from 55 to 69 years, and most studies had a mean follow-up of at least 12 months (range, 5.5-45.4 months). Eleven studies used a polyethylene tether, 2 used soft sublaminar cables, and 2 used semitendinous allograft. The tether extended to the UIV+1 or UIV+2, passing either through or around the spinous processes, in 13 studies. In the remaining 2 studies, the tether was passed sublaminar at the UIV+1. Fourteen studies favored the use of tethers with regard to reduction of PJK/PJF rates, and one demonstrated similar rates of PJK between the tether and no-tether groups.
CONCLUSIONS: PJK/PJF remain major challenges in ASD surgery. Most early studies suggest that the use of tethers for ligamentous augmentation may help to mitigate the development of PJK/PJF. However, the multifactorial etiology of PJK/PJF makes it unlikely that any single technique will solve this complex problem. Further study is needed to address not only the effectiveness of junctional tethers but also to clarify whether there are optimal tether configurations, tether materials, and tether tension.
METHODS: 3.

When considering the vesicle-associated membrane protein-associated protein (VAP) family, major receptors at the surface of the endoplasmic reticulum (ER), it appears that VAP-A and VAP-B paralogs largely overlap in structure and function, and that specific features to distinguish these two proteins hardly exist or are poorly documented. Here, we question the degree of redundancy between VAP-A and VAP-B: is one simply a backup plan, in case of loss of function of one of the two genes, or are there molecular and functional divergences that would explain their maintenance during evolution?

In this news and views, we discuss our recent publication where we described how ER-PM membrane contact sites (MCS) are modulated during store operated calcium entry (SOCE). We also examine why enforcing ER-PM MCS by tethering proteins does not not enhance, but rather inhibits SOCE.

We examine the relationship between the top five cryptos and the U.S. S&P500 index from January 2018 to December 2021. We use the novel General-to-specific Vector Autoregression (GETS VAR) and traditional Vector Autoregression (VAR) model to analyze the short- and long-run, cumulative impulse-response, and Granger causality test between S&P500 returns and the returns of Bitcoin, Ethereum, Ripple, Binance and Tether. Additionally, we used the Diebold and Yilmaz (DY) spillover index of variance decomposition to validate our findings. Evidence from the analysis suggests positive short- and long-run effects of historical S&P500 returns on Bitcoin, Ethereum, Ripple, and Tether returns--and negative short- and long-run effects of the historical returns of Bitcoin, Ethereum, Ripple, Binance, and Tether on S&P500 returns. Alternatively, evidence suggests a negative short- and long-run effect of historical S&P500 returns on Binance returns. The cumulative test of impulse-response indicates a shock in historical S&P500 returns stimulates a positive response from cryptocurrency returns while a shock in historical crypto returns triggers a negative response from S&P500 returns. Empirical evidence of bi-directional causality between S&P500 returns and crypto returns suggest the mutual coupling of these market. Although, S&P500 returns have high-intensity spillover effects on crypto returns than crypto returns have on S&P500. This contradicts the fundamental attribute of cryptocurrencies for hedging and diversification of assets to reduce risk exposure. Our findings demonstrate the need to monitor and implement appropriate regulatory policies in the crypto market to mitigate the potential risks of financial contagion.

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Reliable quantification of a cell\'s biophysical properties is key for understanding the role of mechanics in cell biology. Plasma membrane tension, the energetic cost of increasing the surface area of the plasma membrane, has been shown to regulate a plethora of cellular processes, ranging from leading edge formation to phagocytosis and membrane trafficking. Here, we describe the measurement of this key mechanical property of the cell surface using atomic force microscopy (AFM)-based force spectroscopy. Depending on the nature of the force curve acquisition, AFM measurements can quantify various membrane tension components, such as apparent membrane tension and membrane-to-cortex attachment (MCA). We discuss the biophysical background (1), required materials (2), sample preparation (3.1), AFM-probe calibration and functionalization (3.2), force curve acquisition (3.3) and data analysis and representation (3.4).