Boston vs. Providence brace in treatment of Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex condition characterized by a lateral curvature and axial rotational deformity of the spine. Though bracing is effective, a need remains to identify the effect brace type has on spine curvature. To examine differences in patient demographics between the Boston and Providence brace, determine the corrective change in Cobb angle and RVAD and investigate the effect of brace type on curvature over time. A retrospective chart review was conducted of 105 patients diagnosed with AIS from 2013-2016 at CHW. Five spinal parameters were measured: Cobb angle, Risser, RVAD, kyphosis and lordosis. Data was collected before bracing, in-brace and at 24 months. A final treatment outcome of either Cobb angle correction (reduction >5°), stabilization (change ±5°) or progression (deterioration >5°) was then evaluated. Providence brace provided significantly greater in-brace thoracolumbar Cobb angle and RVAD reduction in comparison to the Boston brace (Cobb angle -21.9° vs. -12.5°; RVAD: -1.8° vs. 1.62°). Similarly, Providence users had a significantly smaller increase in Cobb angle and RVAD over time (Cobb angle: thoracic 14.2° vs. 15.0°; thoracolumbar 23.6° vs. 26.0°; RVAD: 5.2° vs. 8.5°). Ultimately, no significant difference in final treatment outcome was established between brace groups. Although the Providence brace provides less of an increase in thoracic and thoracolumbar curvatures over time, both braces are an effective treatment and achieve comparable outcomes. Selection of braces may vary with primary curve angle, curve location, patient compliance and quality of life.

Correlation between anatomic foot and ankle movement measured with MRI and with a motion analysis system.

Several studies have attempted to measure how well external markers track internal bone movement using pins drilled into the foot, but this is too invasive for the pediatric population. This study investigated how well a six segment foot model (6SFM) using external markers was able to measure bone movement in the foot compared to MRI measurements. The foot was moved into different positions using a plastic foot jig and measurements were taken with both systems. The aims were to: (1) Look at the correlation between movement tracked with an Electronic Motion Tracking System (EMTS) and by measurements derived from MRI images, specifically the principal intercept angles (PIAs) which are the angles of intersection between principal axes of inertia of bone volumes. (2) To see how well external motion measured by the 6SFM could predict PIAs. Four bone pairs had their movement tracked: Tibia-Calcaneus, Calcaneus-Cuboid, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux. The results showed moderate correlation between measured PIAs and those predicted at the Tibia-Calcaneus, Navicular-1st Metatarsal, and 1st Metatarsal-Hallux joints. Moderate to high correlation was found between the PIA and movement in a single anatomic plane for all four joints at several positions. The 6SFM using the EMTS allows reliable tracking of 3D rotations in the pediatric foot, except at the Calcaneus-Cuboid joint.

Comparative analysis of BU and CY versus CY and TBI in full intensity unrelated marrow donor transplantation for AML, CML and myelodysplasia.

We retrospectively compared clinical outcomes in 1593 T-replete unrelated donor (URD) marrow transplant recipients with AML, MDS and CML who received myeloablative conditioning regimens of either BU and CY (BuCy), standard-dose Cy/TBI (1000-1260 cGy) or high-dose Cy/TBI (1320-1500 cGy). Subjects were drawn from patients transplanted between 1991 and 1999 facilitated by the National Marrow Donor Program. Patients who received high-dose Cy/TBI regimens were slightly younger, more likely to receive a mismatched transplant and to have intermediate or advanced disease compared with patients in the BuCy or standard-dose TBI group. Neutrophil recovery was significantly higher in the standard-dose CY/TBI group compared with the high-dose Cy/TBI or BuCy group. Patients who received the high-dose Cy/TBI regimen had an increased risk of developing grades III-IV aGVHD when compared with the control group who received BuCy (P = 0.011). OS, disease-free survival (DFS), TRM and relapse were not significantly different between any of the regimens. We conclude that BuCy, standard-dose and high-dose Cy/TBI regimens have equivalent efficacy profiles for OS, DFS, TRM and relapse risk in patients undergoing T-replete URD marrow transplantation for AML, CML and MDS.