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Landmark Study May Pave the Way for Personalized Treatment of Lupus and Other Complex Autoimmune Diseases

Dallas researcher, Virginia Pascual, MD, publishes new findings in prestigious Cell journal

DALLAS (March 31, 2016) – New research that may dramatically improve drug development for systemic lupus erythematosus patients will be published April 21 in Cell, the most prestigious scientific journal among biologists. The paper, “Personalized Immunomonitoring Uncovers Molecular Networks That Stratify Lupus Patients,” is authored by Dr. Virginia Pascual, principal investigator of the study and researcher at Baylor Institute for Immunology Research, part of Baylor Scott & White Research Institute.

“This achievement reflects Dr. Pascual’s commitment to excellence and to continuous improvement of quality care for patients with lupus,” said Donald Wesson, senior vice president of medical education and research for Baylor Scott & White Research Institute. “For many investigators, simply getting a publication in Cell is the highlight of their career, but for Dr. Pascual it’s another great honor in a career that has brought prestige to her work and to Baylor Scott & White Health.”

Lupus is a chronic disease that causes the body’s immune system to attack its own tissues, causing inflammation, pain and organ damage. It’s a complicated condition that’s difficult to diagnose – no single test can definitively detect it – and complex to treat since no two cases are alike. Clinical trials for effective drug treatments have had limited success. In this study, Dr. Pascual and her team aimed to understand the molecular diversity of the disease in an effort to make future drug development easier and more effective.

“The results included in this paper provide an explanation for why clinical trials fail in lupus, and opens the door for true personalized approaches to drug discovery and treatment in this disease,” Dr. Pascual said.

Researchers studied the transcription of genes in 924 blood samples from 158 pediatric lupus patients from Texas Scottish Rite Hospital for Children clinics and other children’s hospitals for up to four years. This personalized immunomonitoring approach, which measures gene expression activity of different cell types, allowed researchers to classify patients into seven groups with similar molecular disease structure at the time of both disease flares and remissions.

Dr. Marilynn Punaro, medical director of rheumatology at Scottish Rite Hospital, and members of her team are co-authors of the study, which may improve clinical trial design and implementation of tailored therapies in lupus and other genetically and clinically complex autoimmune diseases.

“This is a landmark study that has the potential to dramatically improve treatment and quality of life for the hundreds of thousands of people suffering with lupus,” Dr. Pascual said.

For more information on studies conducted at Baylor Scott & White Research Institute, visit www.BaylorHealth.com/AdvancingMedicine.

About Baylor Scott & White Health
Formed from the 2013 merger between Baylor Health Care System and Scott & White Healthcare, the system referred to as Baylor Scott & White Health is the largest not-for-profit health care system in the state of Texas. With total assets of $9 billion* and serving a population larger than the state of Georgia, Baylor Scott & White Health has the vision and resources to provide its patients continued quality care while creating a model system for a dramatically changing health care environment. The system now includes 48 hospitals, more than 900 access points, 6,000 active physicians, and 40,000 employees, plus the Scott & White Health Plan, Baylor Scott & White Research Institute and Baylor Scott & White Quality Alliance — a network of clinical providers and facilities focused on improving quality, managing the health of patient populations, and reducing the overall cost of care. For more information visit: BaylorScottandWhite.com

* based on unaudited 2015 fiscal year statements


For more information, view an article on Baylor’s website.

Treating Perthes Disease

Also known as Legg-Calvé-Perthes disease, Perthes disease is a childhood disorder of the hip. The disease affects the ball portion of the hip joint, known as the femoral head. Perthes is uncommon— approximately 5 to 10 children per 100,000 will be diagnosed — and it more commonly affects boys -1 in 760 boys. Here are some interesting facts about this pediatric hip disorder.

What Happens to the Hips in Perthes Disease

In a normal hip joint, the round head of your femur fits into the round socket in the pelvis. Perthes disease interrupts the blood flow to the femoral head, causing all or part of it to die due to lack of blood. The bone death is medically referred to as osteonecrosis.

Once the bone dies, the femoral head is more prone to breakage and heals poorly. As a result, the pressure and weight on the bone from normal rigorous activities can cause the round portion to become flat over few months to a year after the diagnosis. For one to two years after bone death occurs, new bone gradually begins to fill in the areas where the body has removed away the dead bone.

The Cause of Perthes Is Still Unknown

Screen Shot 2016-02-05 at 1.12.53 PMWhile we know what happens to the hip to alter the shape of the femoral head, we still don’t know what causes the precipitating interruption of blood flow. We also know that Perthes is not heritable, since less than five percent of its patients have a family history of the disease. However, some other heritable hip conditions or blood disorder can mimic Perthes, such as multiple epiphyseal dysplasia and sickle cell disease. History of taking corticosteroid for treatment of asthma, inflammatory conditions, or cancer can also produce bone necrosis that mimics Perthes.

Diagnosing Perthes Disease

Because so many other diseases can mimic the symptoms of Perthes, it is known as a disease of exclusion. Doctors will rule out other conditions by taking a careful look at medical history and performing a physical exam. The physician will typically ask about the following diseases to rule them out:

  • Family history of hip disorders or early joint replacement
  • Steroid use, such as for asthma
  • Prior hip surgeries
  • History of sickle cell disease
  • History of hip infection
  • History of endocrine or clotting disorders

To confirm a potential Perthes diagnosis, doctors will perform an X-ray of the hips. If the X-ray is taken too soon after symptoms have begun, it may appear normal. In that case, physicians can order a very sensitive diagnostic test called perfusion MRI if they still suspect Perthes.

Treatments and Complications

The body will naturally remove and replace the dead bone of the femoral head with new bone, so, to some extent, Perthes heals itself. However, the healing process may be slow and even after healing has taken place, the femoral head may not return to its original round shape. When that fails to happen, patients may experience long-term complications, such as pain, stiffness and a greater risk of arthritis later in life.

Screen Shot 2016-02-05 at 1.24.29 PMUntil the healing phase is complete, non-surgical treatments might include crutches, wheelchairs, casting and/or bracing, and reduced physical activity. Surgical treatments might include pelvic or femoral osteotomy, a process that reshapes the pelvis or femur.

While Perthes is in some ways self-healing, femoral heads sometimes don’t heal properly. With the interventions we have today and new treatment knowledge about the condition, those with Perthes can usually return to daily activities and sports activities without problems.

For more information about Perthes Disease and becoming a patient at TSRHC, visit the hip disorders section on our website.

Our Pediatric Orthopaedic Education Series is this Saturday

Physicians and other health-care professionals attending the Pediatric Orthopaedic Education Series (POES) on Saturday will experience fully interactive sessions with 11 specialists from Texas Scottish Rite Hospital for Children, according to Dr. Anthony Riccio, the course director.

Instead of a lecture, each of the nine continuing medical education sessions will be built around multiple-choice questions about the cases being presented. Participants can answer on their smartphones using the app, Poll Everywhere.

The responses will guide the direction of the sessions, which cover such conditions as trauma, musculoskeletal infection, back and hip pain, scoliosis, hip dislocation, rheumatologic disease and athletic injuries.

Riccio“Traditional continuing medical education usually consists of didactic lectures and a brief Q&A,” Riccio says. “This will be a discussion tailored to meet the needs of the audience completely. We think it’s a more effective form of adult education.”

Titled Keeping Out of Trouble in Pediatric Orthopaedics and Sports Medicine: A Case Based Approach to Avoiding Jeopardy, POES also will feature two Jeopardy-like contests during which preselected participants can gauge what they’ve learned for fun and prizes.

This is the 18th year that the education series has been held at Scottish Rite Hospital. It takes place from 7 a.m. to 3:30 p.m. in the hospital’s T. Boone Pickens Training and Conference Center at 2222 Welborn St. Participation in POES is worth up to 6.25 credits from the Accreditation Council for Continuing Medical Education.

Course director Riccio is a pediatric orthopedic surgeon at Scottish Rite Hospital. He graduated from the Georgetown University School of Medicine and served five years in the U.S. Navy, during which he was director of pediatric orthopedics at the Naval Medical Center in San Diego.

For more information about POES or to register, visit http://community.tsrhc.org/POESDallas.

Learn about our Center for Pediatric Bone Biology and Translational Research

A core mission of Texas Scottish Rite Hospital for Children is to conduct research that improves the care of children. Since 1921, the hospital has developed a deep reservoir of medical history, renowned expertise in treating pediatric orthopedic disorders, and a robust research program that fosters a strong collaboration between clinic and laboratory. Through patient-centered research, our scientists strive to define the fundamental cause of pediatric orthopedic disorders.

Watch this video to learn more about our Center for Pediatric Bone Biology and Translational Research.

Bracing Compliance Improves When Scoliosis Patients Know They’re Monitored

Study found adolescents wore braces longer and enjoyed better outcomes when tracking data shared

Adolescent scoliosis patients being treated with bracing were more likely to comply when they knew that the number of hours they wore their braces was being monitored and they were counseled on the results, according to a study published last week in The Journal of Bone and Joint Surgery.

Kayden Triplett age 4 of Amarillo_06The research was conducted at Texas Scottish Rite Hospital for Children by orthopedic staff surgeon Dr. Lori Karol, orthotists Donald Virostek and Kevin Felton, and researcher Lesley Wheeler.

The study found that patients who were counseled with the use of compliance data wore their braces an average of 13.8 hours per day. Patients who were unaware that their bracing was being monitored and were not counseled wore their braces an average of 10.8 hours a day. The patients who were counseled also had less curve progression than the patients who were not.

The study began with 222 patients who were divided into two groups. “In the counseled group, patients were aware of the compliance monitor in the brace and were counseled at each visit regarding downloaded brace-usage data,” according to the study’s methodology. “The patients in the non-counseled group were not told the purpose of the monitor in their brace, and the compliance data were not made available to the physician, orthotist or patient.”

The study builds on earlier research that found better outcomes for patients who followed the prescribed treatment regimen for brace wear. It was conducted to determine if monitoring and counseling would improve compliance.

“Providing patients undergoing bracing for adolescent idiopathic scoliosis with feedback about their compliance with brace wear improves that compliance,” researchers concluded. “[And] patients who wore their braces more hours per day had less curve progression … Compliance monitoring and counseling based on that monitoring should become part of the clinical orthotic management of patients with adolescent idiopathic scoliosis.”

For the full study, please visit http://jbjs.org/content/98/1/9.

Genetic Mutation That Causes Childhood Bone Disorder Discovered

Texas Scottish Rite Hospital and two other medical institutions publish groundbreaking study

Researchers at Texas Scottish Rite Hospital for Children (TSRHC) and two other medical institutions have discovered the genetic mutations that cause osteofibrous dysplasia, a disorder that is marked by lesions, usually in the bones of the lower leg such as the tibia and fibula. The condition adversely affects the growth and strength of those bones in children.

The discovery was made possible after researchers learned of multiple generations of four families that had suffered from the disease. The study was published Thursday in The American Journal of Human Genetics.

The research by TSRHC, New Zealand’s Dunedin School of Medicine and The Hospital for Sick Kids in Toronto built on earlier work by TSRHC’s Dr. Lori Karol, who published a paper in 2005 in The Journal of Bone and Joint Surgery establishing a genetic link to osteofibrous dysplasia. However, the causal genetic mutation was not identified at the time.

Dr. Karol based her research on a Texarkana patient. It turned out there was family history, which was unusual because osteofibrous dysplasia was not thought to be genetic. In fact, physicians at TSRHC had treated two previous generations of the family in the 1950s and ’70s.

The researchers in New Zealand and Canada contacted Dr. Karol about similar patient families in their practices, and the three groups subsequently teamed up to study the gene further.

Dr. Carol Wise, director of basic research, led the efforts at TSRHC that discovered the causal gene in the Texarkana family. Dr. Wise was joined in the study by TSRHC’s Dr. Karl Rathjen and hospital scientists Drs. Swarkar Sharma, Jonathan Rios, Nandina Paria and Dongping Zhang.

Research - Genetics 2015_13They discovered a mutation in the MET gene, which has been studied extensively and is implicated in non-inherited cancerous tumors later in life. However, its role in controlling the growth and development of long bones such as the tibia and fibula was not appreciated until now.

“This discovery brings fundamental new insight into our understanding of how certain bones grow and develop in children. It may also provide new avenues for targeted therapies to improve bone growth or repair,” Dr. Wise said.

The work performed at Texas Scottish Rite Hospital for Children was funded by the G.O.O.D. for Kids program, the Pediatric Orthopedic Society of North America and the National Institutes of Health. Drs. Wise, Rios, Karol and Rathjen are faculty members at the University of Texas Southwestern Medical Center in the departments of Orthopaedic Surgery (Wise, Rios, Karol, Rathjen) and Pediatrics (Wise, Rios) and in the McDermott Center for Human Growth and Development (Wise, Rios).

Fall Spine Symposium is Friday, October 30

The 12th Annual Fall Spine Symposium will be held on Friday, Oct. 30, in the T. Boone Pickens Training and Conference Center at Texas Scottish Rite Hospital for Children (TSRHC) from 7 a.m. to 5 p.m. The symposium is open to all orthopedic surgeons, primary care physicians and other allied health professionals, but the course material will emphasize pediatric orthopedic surgery with a focus on early onset scoliosis. The event welcomes visiting professor Dr. Muharrem Yazici, professor of orthopedics at Hacettepe University in Ankara, Turkey, who will present the day’s lectures. In addition to Yazici, hospital staff will also be making presentations throughout the day, making this symposium a worthwhile event for any practitioner to attend.

Fall Spine Symposium

Goals and Objectives

By the end of the TSRHC Fall Spine Symposium, participants will be familiar with recent developments in pediatric orthopedics. They will be able to identify treatment options for early onset scoliosis and describe recent advances in pediatric orthopedics at TSRHC. The overreaching goal of this symposium is for participants to be better informed about state-of-the-art management approaches to spine deformities in pediatric patients.


This event is accredited, having been implemented in accordance with the Essential Areas of Policies of the Accreditation Council for Continuing Medical Education (ACCME). The University of Texas Southwestern Medical Center has designated this activity to carry a maximum of eight hours of AMA PRA Category 1 Credits. Off-label or unapproved uses may be discussed during presentations, but speakers will tell the audience when such a discussion occurs.

Fall Spine Symposium

Fall Spine Symposium

Lodging and Registration

Several hotels are located near the hospital for lodging convenience, but discounts are available at the Holiday Inn Dallas Market Center and the Warwick Melrose Hotel when you mention TSRHC when you make your reservation. Thanks to its convenient location downtown, participants of the symposium can enjoy the sites of downtown Dallas, including a variety of entertainment, shopping, and dining options.

Questions about the 2015 Fall Spine Symposium should be directed to Louise Hamilton at 214-559-7556 or Phyllis Cuesta at 214-559-7604. The T. Boone Pickens Training and Conference Center is located in TSRHC at 2222 Welborn St., Dallas, TX 75219.

The registration fee is $150. Current TSRHC staff and physicians in training are also encouraged to register and participate. For more information, visit community.tsrhc.org/FallSpine.

3 Advanced Scoliosis Treatment Methods

Pediatric scoliosis, which is diagnosed when a curvature of the spine is detected, affects approximately 2 to 3 percent of school-aged kids. Depending on the severity of the curvature, some patients may need advanced treatment from a trusted facility like the Texas Scottish Rite Hospital for Children (TSRHC). Learn more about this condition and what types of treatment are available to find out if you or your child should see a specialist for treatment.

What’s at Stake

In order to determine the best treatment, specialists consider the following factors regarding a patient’s scoliosis:

  • Degree: How severe is the curve? Does it cause problems in the child’s daily life?
  • Location: Is the curve located in the upper, middle, or lower spine?
  • Maturity: How much growth is left in the child’s spine?
  • Progression: What is the potential for progression? Has the child reached his or her adolescent growth spurt yet?

Keeping an Eye on Things

scoliometer reading

The first type of treatment for scoliosis is observation. This method is limited to milder cases of scoliosis. Typically, a curve of less than 20 degrees are regularly monitored by a doctor to determine if and how much progression is taking place. In these situations, advanced care from a specialized facility like TSRHC is not necessary. The observation can take place through routine clinical examinations and/or radiographic monitoring.

Bracing for the Future

scoliosis brace

For more severe curves of 25 to 45 degrees, braces (also known as orthoses) are often used to treat scoliosis. Scoliosis bracing can help to keep the curve from progressing, particularly during an adolescent growth spurt. Most braces are custom-made from special plastics to conform to the patient’s body. Depending on the patient’s condition, a brace may need to be worn for most of the day and night or only at night.

Scoliosis Surgical Treatment

For the most serious cases of scoliosis, specialists may recommend surgery to treat the condition. About 30 years ago, TSRHC researchers developed a surgical implant that eliminated the need for casts or braces after surgery. TSRHC released a revised version in 2005 that is smaller, easier to use, and more versatile, allowing for improved treatment of scoliosis. This method continues to be one of the most widely used surgical implants for spinal deformity. TSRHC has also recently started utilizing magnetic spinal rod systems that can be easily adjusted in minutes with no anesthesia, surgery, or recovery required.

What’s Next in Scoliosis Research

Scoliosis research

TSRHC continues to be at the top of the field when it comes to scoliosis research. In 2007, researchers at TSRHC identified the first gene linked to idiopathic scoliosis. Two other genes lending insight to this condition were also identified. With these discoveries, TSRHC may be able to ultimately find a genetic cause for scoliosis.

Being diagnosed with scoliosis doesn’t have to be scary for kids (or their parents). At TSRHC, patients can receive highly innovative scoliosis treatments from advanced specialists in the field.

5 Facts About the Movement Science Laboratory at TSRHC

Screen Shot 2015-09-03 at_ 11.08.50 AMThe Movement Science Laboratory at Texas Scottish Rite Hospital for Children uses revolutionary technology to evaluate and identify pediatric movement, so doctors can decide on the best course of treatment.

What is the Movement Science Laboratory, and how does it benefit children, researchers and the community?

Technology Based on Video Games

The same technology that helps designers create video games contributes to the work in the Movement Science Laboratory. The laboratory’s staff employs multiple cameras that track markers on a child’s body. As the child moves through the exercises in the laboratory, the cameras record and process the information. A computer translates that data into a moving stick figure that doctors and scientists can then analyze.


Laboratory Used for Both Treatment and Research

Staff members at the Movement Science Laboratory use the technology to research disorders and conditions that impact pediatric movement. However, the laboratory also serves as a diagnostic aid, so it serves double duty, both conducting research and providing treatment. Doctors refer children to TSRHC for observation and evaluation.

Staff Can Measure Multiple Types of Movement

The camera- and computer-aided technology only constitutes part of the research conducted at the Movement Science Laboratory. Researchers at TSRHC use the facility to measure all types of movement. For example, a plate embedded in the laboratory’s floor allows researchers to measure the pressure a child exerts with each step.

Other devices help to measure a child’s limb strength, flexibility, range of motion, and dynamic joint motion. Researchers can also do electromyography (EMG) to analyze the electrical signals muscles send to the brain during movement.

Staff Is Comfortable Working With Children

Kids often develop anxiety when faced with a clinical setting. Fortunately, the TSRHC staff knows how to help children feel comfortable and safe. When kids visit for research or testing, staff members encourage parents to bring along favorite toys or stuffed animals, so their children feel more at home.

Additionally, after staff members record a child’s movements via the cameras and computers, they invite the child to show off a fun movement of his or her choice. Seeing a crazy dance on the screen, for instance, shows children the fun side of the experience.

You Can Participate

The Movement Science Laboratory at TSRHC invites participants who wish to give their time to research. You can call 214-559-7580 to talk about participation in a research study. If you meet the project’s qualifications, you have a chance to help TSRHC make an even greater impact on children’s lives.

You might also find yourself at the laboratory because of your pediatrician’s concerns about your child’s movements. In addition to movement disorders and conditions, the laboratory also works with children who wear prosthetic devices.

The Movement Science Lab creates a safe, high-tech space for studying and diagnosing movement issues in children. Whether you are visiting for research or diagnostics, you can benefit from the experience.

5 Common Questions About Limb Lengthening

If your limbs aren’t the same length, you can experience problems as you grow. In some cases, doctors can use a limb-lengthening device to even your limbs out, making it easier for you to life an active, healthy life. If you’re curious about what limb lengthening involves and how it will affect your day-to-day life, you’ll find the answers you’re looking for here.

Do I Have to Have Surgery?

If the difference between the lengths of your limbs is significant (more than 1 inch), you may need surgery to correct the condition. At Texas Scottish Rite Hospital for Children (TSRHC), physicians have developed an advanced device called the TRUE/LOK™ External Fixation System, a modification of the Ilizarov Frame, that helps your limb grow over a number of months. This device is attached to your body during surgery.

How Does the Limb-Lengthening Device Work?

During surgery, doctors separate the bone in your shorter limb. The TRUE/LOK™ External Fixation System has rods that are attached to this part of the bone. These rods are connected to an external frame attached to the outside of your limb. The frame will support your limb while the rods help the bone to grow. Over the course of many months, your limb could be lengthened by up to 6 inches!

Limb Lengthening

Will Limb Lengthening Hurt?

During surgery, you’ll be under anesthesia, so you won’t feel a thing. As you wear the frame, however, you may experience some discomfort. Some patients feel soreness when they have to turn the rods to help their bones lengthen. Your doctor may be able to give you medication to minimize the pain. In addition, TSRHC has psychologists who can teach you other ways to manage your pain.

How Long Will I Wear the Frame?

The amount of time you will need to wear the frame will be determined by how much your limb needs to grow. For most patients, the TRUE/LOK™ only needs to be worn for six to nine months. During that time, you’ll turn the rods several times per day to help the bone in your limb grow. Most of the bone lengthening actually takes place in the first few months. After that, the frame is worn for stability as your bones heal into place.

Can I Still Act Like a Normal Kid?

After you spend a little time healing from your surgery, you can go back to school. You can also participate in your favorite activities while you wear the frame, including most sports. You can even go swimming as long as you swim in a salinated or chlorinated pool. Your wardrobe may need to be adjusted to include pants, shorts, or skirts that fit over your TRUE/LOK™ frame. Because you’ll only have to visit the doctor every couple of weeks, you’ll essentially be able to keep up your regular routine.

Think of limb lengthening like wearing braces on your teeth. It causes a little discomfort at the time, but it’s worth it in the long run.. You’ll be in great hands when you have your limb lengthening done by the experts at TSRHC.