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Category Archives: Research

Excelling in Spine Research – #ScoliosisAwarenessMonth

Spinal conditions, such as scoliosis, can take many forms and vary in severity. Since the 1970s, our hospital has been an advocate for and leader in research and treatment of spinal disorders in pediatric patients. Discover why the Sarah M. and Charles E. Seay/Martha and Pat Beard Center for Excellence in Spine Research at TSRHC remains the nation’s premier center for spinal deformity research.

Center for a Team of Talent Collaborations

The purpose is to bring a number of different talented people in various disciplines to the table to try to answer the unanswerable questions we have in spine deformity today.

“There are a lot of treatment strategies — I call it tools in your toolbox — and we pick the right tool for each individual patient and case,” adds staff orthopedist Dr. Amy McIntosh. “But the beautiful thing about [TSRHC] and the Center for Excellence in Spine Research is all of the tools are available.”

Along with talent and tools, there’s another important T in the equation: the team approach that lies at the heart of the center’s mission and vision. Whether they’re being treated by physicians, nurses, or in-clinic orthotists, TSRHC patients receive only the best from the professionals working in these disciplines to provide treatment for scoliosis.

Putting Orthopedic Experts on the Research Front

The addition of Dr. Carol Wise as director of basic research has further advanced TSRHC’s research aims. Indeed, Wise was one of the first researchers to identify a gene for adolescent idiopathic scoliosis. “The end result we’re hoping for,” Dr. Wise says, “is to cure this disorder — to treat it non-invasively so that we’re not taking children into surgery to correct a deformity of their spine.”

Treatments as Personal as Patients Themselves

Because each patient who comes to TSRHC is a distinct individual, no two treatment options are the same. However, what does remain the same is the unparalleled level of care that the TSRHC team dedicates to each patient.

Overall, Dr. Sucato says, the TSRHC team aims to prevent scoliosis from intensifying, thus preventing intensive treatments. But when surgeries are required, the team dedicates itself to making them as safe as possible: “The most important thing we do is we ask, ‘What are the important clinical questions we have for our patients? What are the answers that we don’t have today that we can research today so we have a better answer for tomorrow?'”‘

Watch this video below to learn more about our Center for Excellence in Spine Research:

Scottish Rite Hospital is at the Center of Innovation

At Texas Scottish Rite Hospital for Children, our mission is to discover new and innovative ways to best care for children affected with orthopedic and certain related neurological conditions. We opened our doors in 1921, and since then, our doctors and researchers have been seeking ways to provide the best quality care for our patients.

Our Sarah M. and Charles E. Seay Center for Musculoskeletal Research consists of six Centers for Excellence. You may be wondering….What exactly is a Center for Excellence? The main objective of these centers is to support our holistic approach to treatment by bringing clinicians, researchers and other health care professionals together to collaborate on relevant research for challenging pediatric disorders.

Our Centers for Excellence:

Over the course of the rest of this year, we will unveil videos and information highlighting each of these six Centers for Excellence. Below you will find an overview video.

We hope your enjoy and stay tuned for more updates!

 

Sharing Research — Improving Care

While the internationally recognized research conducted at TSRHC benefits children around the world, many people may not realize how our research makes the leap from a local platform to a global stage. Whether publishing journal articles, educating fellows or hosting visiting physicians, our hospital is constantly engaged in sharing discoveries that improve treatment outcomes for children everywhere.Sucato Update_CELLR

To that end, our hospital also actively participates in medical conferences and symposiums nationally and internationally, many of which influence the direction of orthopedic care.

Recently, our Center for Excellence in Limb Lengthening and Reconstruction had a prominent presence at an international conference that brought together three notable limb-lengthening societies for the first time.

In addition to our team’s conference presentations, physicians from other institutions repeatedly featured TSRHC’s external fixations systems, the TRUE/LOK™ and the TL-HEX, in their lectures. This reflects our team’s positive influence in the international practice of limb lengthening and reconstruction.

This April, TSRHC’s medical team will have a highly visible role at the prestigious Pediatric Orthopaedic Society of North America’s annual meeting. Presentations submitted for this meeting are rigorously judged. This year, we have been invited to give 24 presentations. It will be one of the strongest representations of any pediatric orthopedic program in the country.

To have the work of our expert team of researchers and physicians recognized on a global scale is tremendously gratifying, but to know that the information and resources we share benefit children throughout the world is by far the greatest reward.

Scottish Rite Hospital Physicians Leaders at Orthopaedic Society Annual Meeting

Physicians and other medical staff from Texas Scottish Rite Hospital for Children are major participants in this week’s 32nd annual meeting of the Pediatric Orthopaedic Society of North America, including 19 podium presentations.

The meeting in Indianapolis, Ind., is being presided over by Dr. Lori Karol, assistant chief of staff at Scottish Rite Hospital and president of the Orthopaedic Society. Dr. Karol is the first female president of the organization.

Dr. John Birch, assistant chief of staff emeritus, delivered the opening keynote speech Wednesday, a historical review of lower extremity deformity correction. On Thursday, the hospital’s Dr. Lawson A. Copley delivered the results of research made possible by his 2014 Arthur Huene Memorial Research Award.

The meeting gathers orthopedic surgeons and other medical personnel for four days of advanced training. The scientific program includes 171 paper presentations, 20 posters and 110 e-posters.

On Friday, six subspecialty sessions will cover medical issues in the areas of spine, sports, hip, neuromuscular/lower extremity, trauma and hand/upper extremity.

Other Scottish Rite Hospital orthopedic surgeons giving talks at the meeting include Dr. Karol, who is also medical director of the hospital’s Movement Science Laboratory and Performance Improvement; Chief of Staff Dr. Daniel J. Sucato; Chief Medical Officer Dr. B. Stephens Richards; Assistant Chief of Staff Emeritus Dr. Charles E. Johnston; Assistant Chief of Staff Dr. Karl E. Rathjen; Assistant Chief of Staff Dr. Philip L. Wilson, a sports medicine specialist; Director of Research Dr. Harry Kim; Medical Director of Ambulatory Care Dr. Brandon Ramo; and staff orthopedic surgeons Dr. Anthony I. Riccio and Dr. Lane Wimberly.

The presentations cover topics such as angular deformity corrections in athletes; treatment of early onset scoliosis; compartment syndrome; and electronic medical record applications in pediatric orthopedics.

Several former Scottish Rite Hospital fellows also are making presentations at the meeting.

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

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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).