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St. Louis, MO, United States

Allan B.F.,Washington University in St. Louis | Goessling L.S.,Washington University in St. Louis | Storch G.A.,St. Louis Childrens Hospital | Thach R.E.,Washington University in St. Louis
Emerging Infectious Diseases | Year: 2010

Efforts to identify wildlife reservoirs for tick-borne pathogens are frequently limited by poor understanding of tick - host interactions and potentially transient infectivity of hosts under natural conditions. To identify reservoir hosts for lone star tick (Amblyomma americanum)-associated pathogens, we used a novel technology. In field-collected ticks, we used PCR to amplify a portion of the 18S rRNA gene in remnant blood meal DNA. Reverse line blot hybridization with host-specific probes was then used to subsequently detect and identify amplified DNA. Although several other taxa of wildlife hosts contribute to tick infection rates, our results confirm that the white-tailed deer (Odocoileus virginianus) is a reservoir host for several A. americanum - associated pathogens. Identification of host blood meal frequency and reservoir competence can help in determining human infection rates caused by these pathogens. Source

Brossier N.M.,St. Louis Childrens Hospital | Gutmann D.H.,University of Washington
Expert Review of Anticancer Therapy | Year: 2015

Children and adults with neurofibromatosis type 1 (NF1) are predisposed to developing CNS tumors, including optic pathway gliomas (OPGs), brainstem gliomas (BSGs) and high-grade gliomas. Although current first-line treatments for low-grade gliomas (OPGs and BSGs) may prevent further tumor growth, they rarely result in restoration of the associated visual or neurological deficits. The availability of accurate small-animal models of NF1-associated brain tumors has established tractable experimental platforms for the discovery and evaluation of promising therapeutic agents. On the basis of these preclinical studies, biologically targeted agents are now being evaluated in children with NF1-associated low-grade brain tumors. Collectively, these models have also begun to reveal potential neuroprotective and risk assessment strategies for this brain tumor-prone population. © 2015 Informa UK Ltd. Source

Fay A.J.,St. Louis Childrens Hospital | Mowry E.M.,University of California at San Francisco | Strober J.,University of California at San Francisco | Waubant E.,University of California at San Francisco
Multiple Sclerosis Journal | Year: 2012

Background: Factors determining severity and recovery of early demyelinating events in pediatric multiple sclerosis (MS) patients are unknown. Objective: The objective of this study was to characterize the severity and recovery of early demyelinating events in pediatric MS. Methods: Multivariate logistic regression was performed to determine predictors of severe (versus mild/moderate) relapses and poor or fair (versus complete) recovery in patients aged 18 years or less with MS or clinically isolated syndrome (CIS). Results: Optic nerve involvement (OR 4.30, 95% CI 1.50-12.3, p = 0.007) was associated with a severe initial demyelinating event (IDE), while non-White race (OR 2.55, 95% CI 0.87-7.49, p = 0.088), localization to the cerebral hemispheres (OR 7.94, 95% CI 0.86-73.8, p = 0.068), or encephalopathy (OR 8.70, 95% CI 0.86-88.0, p = 0.067) showed a trend towards increased IDE severity. A similar association with race was found for severe second events. A severe IDE (OR 6.90, 95% CI 2.47-19.3, p < 0.001) was associated with incomplete IDE recovery, with similar trends for second and third events. Incomplete recovery from the first event predicted incomplete second event recovery (OR 3.36, 95% CI 0.98-11.6, p = 0.055). Conclusions: These results may help identify children at risk for a more aggressive disease course. © The Author(s) 2012. Source

Smith J.R.,St. Louis Childrens Hospital | Smith J.R.,University of Missouri - Kansas City
Advances in Neonatal Care | Year: 2012

Infants born prematurely lose the protection of the uterus at a time of fetal development when the brain is growing and organizing exponentially. Environmental factors such as stress in the neonatal intensive care unit (NICU) may play a role in altered brain maturation and neurobehavioral outcomes. Strategies aimed at reducing stress and promoting infant well-being are essential to improve neurologic and behavioral outcomes. Infant massage is a developmentally supported strategy aimed at promoting relaxation. However, despite the well-documented benefits of infant massage, infants born very preterm (≤30 weeks' gestation) are often excluded from these studies, leaving neonatal clinicians and families without guidance in how to provide a stress-reducing supplemental touch. Much of the touch in the NICU is a procedural touch, and infants born very preterm often miss out on comforting touch stimulation. A systematic review of the literature is presented with an aim to explore the research that examines the various comforting touch therapies used on hospitalized NICU infants born very preterm within the first few days of postnatal life.The purpose of this review was to identify appropriate stress-reducing comforting touch techniques for physiologically fragile very preterm infants in order to inform and provide guidance to neonatal clinicians and families. Copyright © 2012 by The National Association of Neonatal Nurses. Source

Yang J.S.,University of Washington | Dobbs M.B.,St. Louis Childrens Hospital
The Journal of bone and joint surgery. American volume | Year: 2015

BACKGROUND: The most common historical treatment method for congenital vertical talus is extensive soft-tissue release surgery. A minimally invasive treatment approach that relies primarily on serial cast correction was introduced almost ten years ago, with promising early results. The purpose of this study was to assess the long-term outcome of patients with congenital vertical talus managed with the minimally invasive technique and compare them with a cohort treated with extensive soft-tissue release surgery.METHODS: The records of twenty-seven consecutive patients with vertical talus (forty-two feet) were retrospectively reviewed at a mean of seven years (range, five to 11.3 years) after initial correction was achieved. The minimally invasive method was used to treat sixteen patients (twenty-four feet), and extensive soft-tissue release surgery was used to treat eleven patients (eighteen feet). Patient demographics, ankle range of motion, the PODCI (Pediatric Outcomes Data Collection Instrument) questionnaire, and radiographic measurements were analyzed.RESULTS: At the latest follow-up, the mean range of motion of patients treated with the minimally invasive method was 42.4° compared with 12.7° for patients treated with extensive surgery (p < 0.0001). The PODCI normative pain and global function scores were superior in the minimally invasive treatment group compared with the extensive soft-tissue release group. Greater correction of hindfoot valgus (anteroposterior talar axis-first metatarsal base angle) was achieved in the minimally invasive treatment group compared with the extensive surgery group (40.1° versus 27.9°, p = 0.03), although all other radiographic values were similar between the two groups (p > 0.1 for all). Subgroup analysis of patients with isolated vertical talus also showed superior range of motion and PODCI normative global function scores in the minimally invasive group.CONCLUSIONS: The minimally invasive treatment method for vertical talus resulted in better long-term ankle range of motion and pain scores compared with extensive soft-tissue release surgery. Longer-term studies are necessary to determine whether the improved outcomes are maintained into adulthood and whether the superior outcome is related to reduced scarring. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated. Source

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