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INTRODUCTION: The consensus among orthopedic surgeons on the management of equinus deformity in cerebral palsy (CP) children has not been reported previously despite being a prevalent deformity. The goals of this study were to examine the orthopedic surgeons' current practice regarding the management of equinus deformity in children with ambulatory CP, and analyze variations in current practice between general orthopedic and pediatric orthopedic surgeons. METHODS: We implemented a brief cross-sectional self-reported questionnaire that addressed the areas of clinical examination and decision-making skills of management of equinus deformity in CP children. We targeted a convenience sample of 400 participants. Surgeons that provided complete responses to the questionnaire were 223 with a response rate of 56%, of which 123 (55%) were general orthopedic surgeons, whereas 100 (45%) were pediatric orthopedic surgeons. The target population consisted of orthopedic surgeons who were further sub-classified in accordance with practice age, general versus pediatric, and exposure to children's orthopedics during the last three years of their practice. For analytical statistics, the Chi-Square test and Fisher's exact test were used to examine the relationship between two qualitative variables. RESULTS: The overall clinical practice preferences of all survey participants were unimpressive with discordant survey responses. Pediatric orthopedic surgeons generally demonstrated a statistically significant difference regarding clinical assessment skill items of the survey, in contrast to general orthopedic surgeons. However, we found no differences between pediatric orthopedic and general orthopedic surgeons regarding most of the decision-making/knowledge items. DISCUSSION: Generally, there are insufficient clinical practice trends of both general and pediatric orthopedic surgeons regarding equinus treatment in CP children. This may indicate a knowledge-practice gap with potential risks to CP children undergoing surgery for equinus. There is a need for a more competent exposure to CP in orthopedic surgeons' educational curricula and an updated health referral system.
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Recently, there have been several advancements in material sciences and nanosciences. At the moment these new techniques are slowly entering into clinical settings in drug delivery and imaging. In this review, we will look more closely at the applications that are at the forefront of this translation and examine critical aspects that are involved in the process. Nanoparticles have been increasingly used in clinical settings for drug delivery over the past two decades. Lipid-based nanoparticles are front-runners, but other innovative strategies, such as small inorganic nanoparticles, are entering into the field, particularly for imaging applications. Lipid-based nanoparticles can be metabolized and consumed by the body and are regarded as safe for clinical use. They are usually large with hydrodynamic diameters of approximately 100-200 nm; however, phospholipid-containing particles such as microbubbles with diameters as low as 10 microm in size and micelles with diameters of 10-40 nm can also be used. Hollow liposomes with a large aqueous inner cavity can carry high payloads of drugs and imaging moieties, but are easily trapped by liver kupffer cells and can result in lower tissue penetration rates. New classes of particles with hydrodynamic diameters of < 10 nm, which are cleared by the kidneys, have recently been developed. These particles have been used primarily for imaging applications since they offer only small loading capacities for drugs. However, new strategies such as surface-coupled prodrugs have been developed to facilitate drug delivery in small nanoparticles. We describe different strategies for targeted delivery, imaging and controlled release, and discuss the ability of small inorganic particles as well as larger nanoparticles to be used broadly in human diagnostics and drug delivery.
