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New Philadelphia, PA, United States

Fayssoux R.S.,Drexel University | Cho R.H.,Drexel University | Herman M.J.,St Christophers Hospital for Children
Clinical Orthopaedics and Related Research

The care of the patient with scoliosis has a history extending back over two millennia with cast and brace treatment being a relatively recent endeavor, the modern era comprising just over half a century. Much of the previous literature provides a modest overview with emphasis on the history of the operative management. To better understand the current concepts of brace treatment of scoliosis, an appreciation of the history of bracing would be helpful. As such, we review the history of the treatment of scoliosis with an emphasis on modern brace treatment, primarily from a North American perspective. Our review utilizes consideration of historical texts as well as current treatises on the history of scoliosis and includes discussion of brace development with their proponents' rationale for why they work along with an appraisal of their clinical outcomes. We provide an overview of the current standards of care and the braces typically employed toward that standard including: The Milwaukee brace, the Wilmington brace, the Boston brace, the Charleston brace, the Providence brace and the SpineCor brace. Finally, we discuss future trends including improvements in methods of determining the critical period of peak growth velocity in children with scoliosis, the exciting promise of gene markers for progressive scoliosis and "internal bracing" options. © 2009 The Association of Bone and Joint Surgeons®. Source

Kumar N.S.,Drexel University | Chin M.,Drexel University | O'Neill C.,Drexel University | Jakoi A.M.,Drexel University | And 2 more authors.
American Journal of Sports Medicine

Background: There are few data examining the short-term effects of concussions on player performance upon return to play. This study examined changes in on-field performance and the influence of epidemiologic factors on performance and return to play.Hypothesis: On-field performance is different in players who return within 7 days after concussion compared with players who miss at least 1 game.Study Design: Case-control study; Level of evidence, 3.Methods: Players in the National Football League who were active during the 2008 to 2012 seasons were considered for inclusion. Weekly injury reports identified concussed players. All players played in at least 4 games before and after the game of injury (sentinel game) within the year of injury (sentinel year). Players who had missed games secondary to another injury or had sustained a second concussion within the sentinel year were excluded. The players' league profiles were used to determine age, position, body mass index, career experience, and games missed. ProFootballFocus performance scores determined player ratings. Statistical analysis used 2-sided t tests and both univariate and multivariate logistic regression models.Results: There were a total of 131 concussions in the 124 players who qualified for this study; 55% of these players missed no games. Defensive secondary, wide receiver, and offensive line were the most commonly affected positions. Players who missed at least 1 game were younger and less experienced. Preinjury ProFootballFocus performance scores were similar to postinjury performance in players without games missed (0.16 vs 0.33; P = .129) and players who missed at least 1 game (-0.06 vs 0.10; P = .219). Age, body mass index, experience, and previous concussion did not correlate with changes in postinjury scores (P . .05). Older, more experienced players and players with late-season concussions were more likely to return to play without missing games (P\ .05). The odds of returning within 7 days increased by 18%for each career year and by 40% for each game before the sentinel game within the sentinel year; these same odds decreased by 85% after introduction of newer treatment guidelines in 2009.Conclusion: No difference in player performance after concussion was found whether the player did or did not miss games before return. Return without missing games may be associated with experience and timing of injury within a season and less likely after newer guidelines. © 2014 The Author(s). Source

Brain natriuretic peptide (BNP) is a cardiac hormone with diuretic, natriuretic, and vasodilator properties. Measurement of plasma B-type natriuretic peptide concentrations is increasingly used to aid diagnosis, assess prognosis, and tailor treatment in adults with congestive heart failure. Recent studies suggest that the peptide is also useful in pediatric patients. The diagnostic role of plasma BNP in neonates admitted to the NICU has shown promise as an aid in diagnosis in neonates with signs of congenital heart disease; as a biomarker of bronchopulmonary dysplasia, patent ductus arteriosus, and persistent pulmonary hypertension of the newborn; a predictive biomarker of the response to indomethacin in preterm infants; and, more significantly, in acute heart failure. © 2015 Springer Publishing Company. Source

Brower K.S.,St Christophers Hospital for Children | Del Vecchio M.T.,Temple University | Aronoff S.C.,Temple University
BMC pediatrics

BACKGROUND: While cystic fibrosis (CF) is the most common cause of bronchiectasis in childhood, non-CF bronchiectasis is associated with a wide variety of disorders. The objective of this study was to determine the relative prevalence and specific etiologies on non-CF bronchiectasis in childhood.METHODS: EMBASE, Medline, OVID Cochrane Reviews, Directory of Open Access Journals, Open Science Directory, EPSCO information services, and OAlster were searched electronically and the bibliographies of selected studies were searched manually. The search was conducted independently by 2 authors.STUDY SELECTION: (1) any clinical trial, observational study or cross-sectional case series of 10 or more patients with a description of the conditions associated with bronchiectasis; (2) subjects aged 21 years or younger; (3) cystic fibrosis was excluded and; (4) the diagnosis was confirmed by computed tomography of the chest.DATA EXTRACTION: Patient number, age range, inclusion criteria, diagnostic criteria, patient source, and categorical and specific etiology.RESULTS: From 491 studies identified, 12 studies encompassing 989 children with non-CF bronchiectasis were selected. Sixty-three percent of the subjects had an underlying disorder. Infectious (17%), primary immunodeficiency (16%), aspiration (10%), ciliary dyskinesia (9%), congenital malformation (3%), and secondary immunodeficiency (3%) were the most common disease categories; 999 etiologies were identified. Severe pneumonia of bacterial or viral etiology and B cell defects were the most common disorders identified.CONCLUSIONS: The majority of children with non-CF bronchiectasis have an underlying disorder. A focused history and laboratory investigated is recommended. Source

Cies J.J.,St Christophers Hospital for Children | Cies J.J.,Drexel University | Cies J.J.,DuPont Company | Jain J.,Center for Anti Infective Research and Development | Kuti J.L.,Center for Anti Infective Research and Development
Pediatric Blood and Cancer

Background: To describe the population pharmacokinetics of the piperacillin component of piperacillin/tazobactam. Procedure: This pharmacokinetic study included 21 pediatric (age 3-10 years) patients receiving piperacillin/tazobactam to treat fever with neutropenia. Each patient contributed 1-3 blood samples for piperacillin concentration determination. Population pharmacokinetic analyses were conducted using Pmetrics software. A 5,000 patient Monte Carlo simulation was performed to determine the probability of target attainment (PTA) for multiple dosing regimens, using 50% of free drug time above the minimum inhibitory concentration (MIC) as the primary pharmacodynamic threshold. Results: Mean±SD body weight was 28.5±9.7kg. Piperacillin concentration data best fit a two-compartment model with linear clearance, using total body weight as a covariate for clearance (CLθ) and volume of the central compartment (Vcθ). Population estimates for CLθ, Vcθ, and intercompartment transfer constants were 0.204±0.076L/h/kg, 0.199±0.107L/kg, 0.897±1.050h-1, and 1.427±1.609h-1, respectively. R2, bias, and precision for the Bayesian fit were 0.998, -0.032, and 2.2μg/ml, respectively. At the MIC breakpoint of 16μg/ml for Pseudomonas aeruginosa, PTAs for 50mg/kg q4h as a 0.5hr infusion was 93.9%; for 100mg/kg q8h as 0.5 and 4hr infusion: 64.6% and 100%; for 100mg/kg q6h as 0.5 and 3hr infusion: 86.5% and 100%; and for 400mg/kg continuous infusion: 100%, respectively. Conclusions: In children with fever and neutropenia, piperacillin/tazobactam dosing regimens that are administered every 4hr or that employ prolonged or continuous infusions should be considered to optimize pharmacodynamic exposure. © 2014 Wiley Periodicals, Inc. Source

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