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Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study
Iris Busscher, Frits Wapstra, Albert G Veldhuizen
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-93
Abstract: The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity.Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic scoliosis.This study will determine the value of many maturity indicators and will be useful as well for other clinicians treating children with disorders of growth. Since not all clinicians have access to the presented new 3D X-ray system or have the time to make EMG's, for example, all indicators will be correlated to the timing of the peak growth velocity of total body height and curve progression in idiopathic scoliosis. Therefore each clinician can chose which indicators can be used best in their practice.NTR2048Scoliosis is present in 3-5% of the child
The value of shoe size for prediction of the timing of the pubertal growth spurt
Iris Busscher, Idsart Kingma, Frits Wapstra, Sjoerd K Bulstra, Gijsbertus J Verkerke, Albert G Veldhuizen
Scoliosis , 2011, DOI: 10.1186/1748-7161-6-1
Abstract: The aim of this study was to describe the increase in shoe size during adolescence and to determine whether the timing of the peak increase could be an early indicator for the timing of the peak growth velocity of sitting height.Data concerning shoe sizes of girls and boys were acquired from two large shoe shops from 1991 to 2008. The longitudinal series of 242 girls and 104 boys were analysed for the age of the "peak increase" in shoe size, as well as the age of cessation of foot growth based on shoe size.The average peak increase in shoe size occurred at 10.4 years (SD 1.1) in girls and 11.5 years (SD 1.5) in boys. This was on average 1.3 years earlier than the average peak growth velocity of sitting height in girls, and 2.5 years earlier in boys. The increase in shoe size diminishes when the average peak growth velocity of sitting height takes place at respectively 12.0 (SD 0.8) years in girls, and 13.7 (SD 1.0) years in boys.Present data suggest that the course of the shoe size of children visiting the outpatient clinic can be a useful first tool for predicting the timing of the pubertal growth spurt of sitting height, as a representative for spinal length.This claim needs verification by direct comparison of individual shoe size and sitting height data and than a step forward can be made in clinical decision making regarding adolescent idiopathic scoliosis.In adolescent idiopathic scoliosis in particular it is highly important to know when the peak growth velocity of spinal length takes place. Since a close relationship exists between the spinal growth of the patient and the angle progression of the idiopathic scoliosis, it is essential to know the timing of the pubertal growth spurt in order to determine the optimum treatment strategy for the individual child [1-4]. However, exact spinal length is hard to obtain and therefore sitting height can be a representative alternative.It is still highly difficult to predict when the individual child will have his or he
Estimating the number of children exposed to parental psychiatric disorders through a national health survey
Bassani Diego G,Padoin Cintia V,Philipp Diane,Veldhuizen Scott
Child and Adolescent Psychiatry and Mental Health , 2009, DOI: 10.1186/1753-2000-3-6
Abstract: Objective Children whose parents have psychiatric disorders experience an increased risk of developing psychiatric disorders, and have higher rates of developmental problems and mortality. Assessing the size of this population is important for planning of preventive strategies which target these children. Methods National survey data (CCHS 1.2) was used to estimate the number of children exposed to parental psychiatric disorders. Disorders were diagnosed using the World Psychiatric Health Composite International Diagnostic Interview (WMH-CIDI) (12 month prevalence). Data on the number of children below 12 years of age in the home, and the relationship of the respondents with the children, was used to estimate exposure. Parent-child relations were identified, as was single parenthood. Using a design-based analysis, the number of children exposed to parental psychiatric disorders was calculated. Results Almost 570,000 children under 12 live in households where the survey respondent met criteria for one or more mood, anxiety or substance use disorders in the previous 12 months, corresponding to 12.1% of Canadian children under the age of 12. Almost 3/4 of these children have parents that report receiving no mental health care in the 12 months preceding the survey. For 17% of all Canadian children under age 12, the individual experiencing a psychiatric disorder is the only parent in the household. Conclusion The high number of children exposed causes major concern and has important implications. Although these children will not necessarily experience adversities, they possess an elevated risk of accidents, mortality, and of developing psychiatric disorders. We expect these estimates will promote further research and stimulate discussion at both health policy and planning tables.
Probing background ionization: Positive streamers with varying pulse repetition rate and with a radioactive admixture
S. Nijdam,G. Wormeester,E. M. van Veldhuizen,U. Ebert
Physics , 2011, DOI: 10.1088/0022-3727/44/45/455201
Abstract: Positive streamers need a source of free electrons ahead of them to propagate. A streamer can supply these electrons by itself through photo-ionization, or the electrons can be present due to external background ionization. Here we investigate the effects of background ionization on streamer propagation and morphology by changing the gas composition and the repetition rate of the voltage pulses, and by adding a small amount of radioactive Krypton 85. We find that the general morphology of a positive streamer discharge in high purity nitrogen depends on background ionization: at lower background ionization levels the streamers branch more and have a more feather-like appearance. This is observed both when varying the repetition rate and when adding Krypton 85, though side branches are longer with the radioactive admixture. But velocities and minimal diameters of streamers are virtually independent of the background ionization level. In air, the inception cloud breaks up into streamers at a smaller radius when the repetition rate and therefore the background ionization level is higher. When measuring the effects of the pulse repetition rate and of the radioactive admixture on the discharge morphology, we found that our estimates of background ionization levels are consistent with these observations; this gives confidence in the estimates. Streamer channels generally do not follow the paths of previous discharge channels for repetition rates of up to 10 Hz. We estimate the effect of recombination and diffusion of ions and free electrons from the previous discharge and conclude that the old trail has largely disappeared at the moment of the next voltage pulse; therefore the next streamers indeed cannot follow the old trail.
The Memory Metal Minimal Access Cage: A New Concept in Lumbar Interbody Fusion—A Prospective, Noncomparative Study to Evaluate the Safety and Performance
D. Kok,R. D. Donk,F. H. Wapstra,A. G. Veldhuizen
Advances in Orthopedics , 2012, DOI: 10.1155/2012/898606
Abstract: Study Design/Objective. A single-centre, prospective, non-comparative study of 25 patients to evaluate the performance and safety of the Memory Metal Minimal Access Cage (MAC) in Lumbar Interbody Fusion. Summary of Background Data. Interbody fusion cages in general are designed to withstand high axial loads and in the meantime to allow ingrowth of new bone for bony fusion. In many cages the contact area with the endplate is rather large leaving a relatively small contact area for the bone graft with the adjacent host bone. MAC is constructed from the memory metal Nitinol and builds on the concept of sufficient axial support in combination with a large contact area of the graft facilitating bony ingrowth and ease in minimal access implantation due to its high deformability. Methods. Twenty five subjects with a primary diagnosis of disabling back and radicular leg pain from a single level degenerative lumbar disc underwent an interbody fusion using MAC and pedicle screws. Clinical performance was evaluated prospectively over 2 years using the Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores. The interbody fusion status was assessed using conventional radiographs and CT scan. Safety of the device was studied by registration of intra- and post-operative adverse effects. Results. Clinical performance improved significantly (<.0018), CT scan confirmed solid fusion in all 25 patients at two year follow-up. In two patients migration of the cage occurred, which was resolved uneventfully by placing a larger size at the subsequent revision. Conclusions. We conclude that the Memory Metal Minimal Access Cage (MAC) resulted in 100% solid fusions in 2 years and proved to be safe, although two patients required revision surgery in order to achieve solid fusion.
The Impact of Intermittent Umbilical Cord Occlusions on the Inflammatory Response in Pre-Term Fetal Sheep
Andrew P. Prout, Martin G. Frasch, Ruud Veldhuizen, Rob Hammond, Brad Matushewski, Bryan S. Richardson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039043
Abstract: Fetal hypoxic episodes may occur antepartum with the potential to induce systemic and cerebral inflammatory responses thereby contributing to brain injury. We hypothesized that intermittent umbilical cord occlusions (UCOs) of sufficient severity but without cumulative acidosis will lead to a fetal inflammatory response. Thirty-one chronically instrumented fetal sheep at ~0.85 of gestation underwent four consecutive days of hourly UCOs from one to three minutes duration for six hours each day. Maternal and fetal blood samples were taken for blood gases/pH and plasma interleukin (IL)-1β and IL-6 levels. Animals were euthanized at the end of experimental study with brain tissue processed for subsequent counting of microglia and mast cells. Intermittent UCOs resulted in transitory fetal hypoxemia with associated acidemia which progressively worsened the longer umbilical blood flow was occluded, but with no cumulative blood gas or pH changes over the four days of study. Fetal arterial IL-1β and IL-6 values showed no significant change regardless of the severity of the UCOs, nor was there any evident impact on the microglia and mast cell counts for any of the brain regions studied. Accordingly, intermittent UCOs of up to three minutes duration with severe, but limited fetal hypoxemia and no cumulative acidemia, do not result in either a systemic or brain inflammatory response in the pre-term ovine fetus. However, fetal IL-1B and IL-6 values were found to be well correlated with corresponding maternal values supporting the placenta as a primary source for these cytokines with related secretion into both circulations. Female fetuses were also found to have higher IL-1β levels than males, indicating that gender may impact on the fetal inflammatory response to various stimuli.
The Memory Metal Minimal Access Cage: A New Concept in Lumbar Interbody Fusion—A Prospective, Noncomparative Study to Evaluate the Safety and Performance
D. Kok,R. D. Donk,F. H. Wapstra,A. G. Veldhuizen
Advances in Orthopedics , 2012, DOI: 10.1155/2012/898606
Abstract: Study Design/Objective. A single-centre, prospective, non-comparative study of 25 patients to evaluate the performance and safety of the Memory Metal Minimal Access Cage (MAC) in Lumbar Interbody Fusion. Summary of Background Data. Interbody fusion cages in general are designed to withstand high axial loads and in the meantime to allow ingrowth of new bone for bony fusion. In many cages the contact area with the endplate is rather large leaving a relatively small contact area for the bone graft with the adjacent host bone. MAC is constructed from the memory metal Nitinol and builds on the concept of sufficient axial support in combination with a large contact area of the graft facilitating bony ingrowth and ease in minimal access implantation due to its high deformability. Methods. Twenty five subjects with a primary diagnosis of disabling back and radicular leg pain from a single level degenerative lumbar disc underwent an interbody fusion using MAC and pedicle screws. Clinical performance was evaluated prospectively over 2 years using the Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores. The interbody fusion status was assessed using conventional radiographs and CT scan. Safety of the device was studied by registration of intra- and post-operative adverse effects. Results. Clinical performance improved significantly ( ), CT scan confirmed solid fusion in all 25 patients at two year follow-up. In two patients migration of the cage occurred, which was resolved uneventfully by placing a larger size at the subsequent revision. Conclusions. We conclude that the Memory Metal Minimal Access Cage (MAC) resulted in 100% solid fusions in 2 years and proved to be safe, although two patients required revision surgery in order to achieve solid fusion. 1. Introduction Chronic low back pain is an insidious problem. Individuals suffer from prolonged discomfort, anxiety, and disability. Low back pain has been shown as the leading cause of man-hours lost to disease or injury. Degeneration of the intervertebral disc is the most common cause of low back pain [1]. Conservative treatment for low back pain may include rest, heat, physical therapy, medication, bracing, and education. Most individuals will find relief given conservative treatments. However, for those with significant continuing specific symptoms, surgical intervention may be appropriate. One of the interventions is posterior lumbar interbody fusion (PLIF). The goal of spinal fusion is to obtain a solid arthrodesis. There is a wide range of fusion
The Insular Taste Cortex Contributes to Odor Quality Coding
Maria G. Veldhuizen,Danielle Nachtigal,Lynsey Teulings,Darren R. Gitelman,Dana M. Small
Frontiers in Human Neuroscience , 2010, DOI: 10.3389/fnhum.2010.00058
Abstract: Despite distinct peripheral and central pathways, stimulation of both the olfactory and the gustatory systems may give rise to the sensation of sweetness. Whether there is a common central mechanism producing sweet quality sensations or two discrete mechanisms associated independently with gustatory and olfactory stimuli is currently unknown. Here we used fMRI to determine whether odor sweetness is represented in the piriform olfactory cortex, which is thought to code odor quality, or in the insular taste cortex, which is thought to code taste quality. Fifteen participants sampled two concentrations of a pure sweet taste (sucrose), two sweet food odors (chocolate and strawberry), and two sweet floral odors (lilac and rose). Replicating prior work we found that olfactory stimulation activated the piriform, orbitofrontal and insular cortices. Of these regions, only the insula also responded to sweet taste. More importantly, the magnitude of the response to the food odors, but not to the non-food odors, in this region of insula was positively correlated with odor sweetness rating. These findings demonstrate that insular taste cortex contributes to odor quality coding by representing the taste-like aspects of food odors. Since the effect was specific to the food odors, and only food odors are experienced with taste, we suggest this common central mechanism develops as a function of experiencing flavors.
Positive and negative streamers in ambient air: measuring diameter, velocity and dissipated energy
T. M. P. Briels,J. Kos,G. J. J. Winands,E. M. van Veldhuizen,Ute Ebert
Physics , 2008, DOI: 10.1088/0022-3727/41/23/234004
Abstract: Positive and negative streamers are studied in ambient air at 1 bar; they emerge from a needle electrode placed 40 mm above a planar electrode. The amplitudes of the applied voltage pulses range from 5 to 96 kV; most pulses have rise times of 30 ns or shorter. Diameters, velocities and energies of the streamers are measured. Two regimes are identified; a low voltage regime where only positive streamers appear and a high voltage regime where both positive and negative streamers exist. Below 5 kV, no streamers emerge. In the range from 5 to 40 kV, positive streamers form, while the negative discharges only form a glowing cloud at the electrode tip, but no streamers. For 5 to 20 kV, diameters and velocities of the positive streamers have the minimal values of d=0.2 mm and v \approx 10^5 m/s. For 20 to 40 kV, their diameters increase by a factor 6 while the voltage increases only by a factor 2. Above the transition value of 40 kV, streamers of both polarities form; they strongly resemble each other, though the positive ones propagate further; their diameters continue to increase with applied voltage. For 96 kV, positive streamers attain diameters of 3 mm and velocities of 4*10^6 m/s, negative streamers are about 20 % slower and thinner. An empirical fit formula for the relation between velocity v and diameter d is v=0.5 d^2/(mm ns) for both polarities. Streamers of both polarities dissipate energies of the order of several mJ per streamer while crossing the gap.
Reconnection and merging of positive streamers in air
S. Nijdam,C. G. C. Geurts,E. M. van Veldhuizen,U. Ebert
Physics , 2008, DOI: 10.1088/0022-3727/42/4/045201
Abstract: Pictures show that streamer or sprite discharge channels emerging from the same electrode sometimes seem to reconnect or merge though their heads carry electric charge of the same polarity; one might therefore suspect that reconnections are an artifact of the two-dimensional projection in the pictures. Here we use stereo-photography to investigate the full three-dimensional structure of such events. We analyze reconnection, possibly an electrostatic effect in which a late thin streamer reconnects to an earlier thick streamer channel, and merging, a suggested photoionization effect in which two simultaneously propagating streamer heads merge into one new streamer. We use four different anode geometries (one tip, two tips, two asymmetric protrusions in a plate, and a wire), placed 40 mm above a flat cathode plate in ambient air. A positive high voltage pulse is applied to the anode, creating a positive corona discharge. This discharge is studied with a fast ICCD camera, in many cases combined with optics to enable stereoscopic imaging. We find that reconnections as defined above occur frequently. Merging on the other hand was only observed at a pressure of 25 mbar and a tip separation of 2 mm, i.e., for a reduced tip distance of p*d=50 micrometer*bar. In this case the full width at half maximum of the streamer channel is more than 10 times as large as the tip separation. At higher pressures or with a wire anode, merging was not observed.
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