Dylewski M.L.,Shriners Hospitals for Children
The Journal of trauma | Year: 2010
BACKGROUND: Dietary selenium (Se) requirements during critical illness are not well known. The objective of this study was to assess the longitudinal Se status of pediatric patients with burns. METHODS: Twenty patients admitted to our hospital with burns exceeding 10% of their total body surface area were studied longitudinally during the first 8 weeks of admission or until 95% wound closure was achieved. Dietary Se intake was calculated daily, and plasma and urine samples were collected weekly for analyses of plasma Se, urinary Se, and glutathione peroxidase activity. RESULTS: Patients included in this study were individuals with an average age of 6.5 years ± 5.3 years and with burn injury of a mean total body surface area of 42% ± 21%. Dietary Se intake throughout the study (mean = 60 μg/d ± 39 μg/d) was consistent with established standards for healthy children and did not change throughout the study. Plasma Se (mean = 1.08 μmol/L ± 0.34 μmol/L) and plasma glutathione peroxidase (mean = 3.2 U/g protein ± 1.42 U/g protein) were below reported normal values for healthy American children. Mean urinary Se excretion (65.9 μg/L ± 50 μg/L) exceed dietary Se intake. Plasma Se was inversely related to incidence of total infection (p = 0.04). CONCLUSIONS: Results from this study indicate that Se status is depressed among pediatric patients with burns and that recommended Se intake for healthy children is likely insufficient for this population. Further studies are necessary to elucidate the amount of dietary Se required to maximize Se stores among pediatric patients with burn injuries. Source
Samdani A.F.,Shriners Hospitals for Children
Spine | Year: 2012
Prospective, longitudinal cohort (nonrandomized). To compare thoracoplasty (Th), direct vertebral body derotation (DVBD), and Th and DVBD with respect to correction of the rib prominence and Scoliosis Research Society (SRS) self-image scores in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Rib prominence correction is one of the main goals of AIS surgery. Th and DVBD are powerful tools for correction of the rib prominence; however, a paucity of literature exists comparing Th, DVBD, and Th and DVBD. A prospective longitudinal database was queried to identify patients with AIS who underwent a posterior spinal fusion with pedicle screws and 2 years of follow-up. A total of 326 patients were identified and divided into 3 groups: (1) Th alone (N = 47), (2) DVBD alone (N = 196), and (3) both Th and DVBD (N = 83). Patients were subdivided into categories on the basis of their preoperative inclinometer reading: (1) ≤9° (mild), (2) 10 to 15° (moderate), and (3) ≥ 16° (severe). Pre- and postoperative inclinometer readings and SRS self-image scores were compared using analysis of variance. Overall, the groups were similar preoperatively except for the DVBD group having higher percentage of thoracic flexibility. The preoperative rib prominence values were Th = 13.2, DVBD = 14.0, and Th and DVBD = 12.9 (P = 0.27). Taken collectively, the postoperative 2-year inclinometer readings were similar for all 3 groups (Th = 5.2, DVBD = 7.0, Th and DVBD = 5.6; P = 0.66). However, the SRS-22 self-image scores were significantly better for patients having both Th and DVBD (Th = 3.37, DVBD = 3.44, Th and DVBD = 3.76; P < 0.01). When patients were stratified by severity of preoperative rib prominence, all patients with mild prominences achieved similar corrections, although SRS self-image scores were highest in the Th and DVBD group. In patients with larger rib prominences, the addition of Th was necessary for optimal rib prominence correction, but there was no difference in SRS-22 self-image scores. Our results suggest that Th alone, DVBD alone, or both Th and DVBD provide equivalent inclinometer results in patients with mild preoperative rib prominences (≤ 9°), but higher SRS-22 self-image scores are achieved using both Th and DVBD. For larger rib prominences, better inclinometer readings are achieved with Th, although SRS-22 self-image scores are comparable. Source
Raney E.M.,Shriners Hospitals for Children
Journal of Pediatric Orthopaedics | Year: 2011
Fixation of the scoliotic spine can be achieved through the use of hooks and wires. These "tried and true" forms of fixation are discussed less commonly in the current era of focus on pedicle screw fixation. Sublaminar wires are still commonly used for neuromuscular scoliosis, in unusual curves, and at the apices of moderate curves. With careful attention to the technique, sublaminar wires can be safe and versatile. Hook fixation is generally expedient and safe. Both types of fixation are considerably less expensive than pedicle screws. Technical pearls and pitfalls are reviewed. © 2010 by Lippincott Williams & Wilkins. Source
Shriners Hospitals For Children and University of South Florida | Date: 2013-08-20
A material derived from sea cucumber collagen fibrils is suitable for use in corneal replacements or as an implantable contact lens. To produce material, the collagen fibrils are centrifuged into orthogonal stacks of lamellae comprised of aligned fibrils. The resulting structure is a transparent film of arbitrary thickness very similar in structure to mammalian corneal tissue.
University of Cincinnati and Shriners Hospitals For Children | Date: 2014-06-09
A device, and method of making the device, capable of therapeutic treatment and/or for in vitro testing of human skin. The device may be used on skin wounds for burned, injured, or diseased skin, and provides structures and functions as in normal uninjured skin, such as barrier function, which is a definitive property of normal skin. The device contains cultured dermal and epidermal cells on a biocompatible, biodegradable reticulated matrix. All or part of the cells may be autologous, from the recipient of the cultured skin device, which advantageously eliminates concerns of tissue compatibility. The cells may also be modified genetically to provide one or more factors to facilitate healing of the engrafted skin replacement, such as an angiogenic factor to stimulate growth of blood vessels. The inventive device is easy to handle and manipulate for surgical transplant, can be made into large sheets to minimize the number of grafts required to cover a large surface area to be treated, and can be produced within the time frame to treat a burned individual requiring a skin graft.