Endurance Of Total Knee Replacements In Younger Patients With Juvenile Arthritis
When you think of knee replacement surgery, you generally envision an older adult with painful arthritis. But the procedure is also used for younger patients with juvenile idiopathic arthritis (JIA) whose joints have been severely damaged by the disease. Because the surgery in younger patients is relatively rare, little data exist on the longevity of knee replacements in JIA patients.
An international, multi-center study led by researchers at Hospital for Special Surgery (HSS) has found that total knee replacements in younger patients with juvenile arthritis last at least 10 years in 92 percent of cases. More than 75 percent of the implants lasted 20 years or more.
"The surgery in this patient population, although performed by only a small number of highly specialized orthopedic surgeons nationwide, is life-changing for JIA patients," said Dr. Mark P. Figgie, senior author of the study and chief of the Surgical Arthritis Service at HSS. "Joint replacement can free patients - many of them adolescents - from a life of unrelenting pain. It can enable those in a wheel chair to walk again, giving many a new lease on life."
Scars from Childhood Cancer Can Affect Adult Quality Of Life
Scars left behind by childhood cancer treatments are more than skin-deep. The increased risk of disfigurement caused by childhood cancer and treatment is associated with emotional distress and reduced quality of life in adulthood, according to a new study led by a Northwestern Medicine advanced practice nurse, Karen Kinahan, and based on data from the Childhood Cancer Survivor Study (CCSS).
The largest study of its kind, published in the Journal of Clinical Oncology, compared adult survivors, who were scarred or disfigured by childhood cancer, to their siblings, who were not childhood cancer survivors. The study found that survivors with a head, neck, arm, or leg disfigurement had increased risk of depression.
"The results of this study help illustrate the complex chain of events childhood cancer can have on quality of life as an adult," said senior author Kevin Krull, Ph.D., an associate member in the St. Jude Children’s Research Hospital departments of epidemiology and cancer control and psychology. "We have long been aware that radiation therapy is associated with increased risk for emotional distress and social problems, though we did not fully understand the process this involves. The current study begins to map this process."
Photo: Steven Depalo
Differences Seen In The Brains Of Depressed Preschoolers
A key brain structure that regulates emotions works differently in preschoolers with depression compared with their healthy peers, according to new research at Washington University School of Medicine in St. Louis.
The differences, measured using functional magnetic resonance imaging (fMRI), provide the earliest evidence yet of changes in brain function in young children with depression. The researchers say the findings could lead to ways to identify and treat depressed children earlier in the course of the illness, potentially preventing problems later in life.
"The findings really hammer home that these kids are suffering from a very real disorder that requires treatment," said lead author Michael S. Gaffrey, PhD. "We believe this study demonstrates that there are differences in the brains of these very young children and that they may mark the beginnings of a lifelong problem."
Photo: Cheung Sha Wan
To Avoid Future Knee Injuries And Complications, Pediatric ACL Injuries Require Special Treatment
Until a child’s bones have fully matured (in girls, typically by age 14; in boys, age 16), an injury to the anterior cruciate ligament (ACL) - the primary, stabilizing ligament of the knee joint - requires special consideration, treatment and care to ensure appropriate healing and to prevent long-term complications.
To avoid potential future complications, such as early onset osteoarthritis, the literature review outlines the optimal strategies for treating pediatric ACL injuries based on the specifics of the injury and the child’s skeletal (bone), age and developmental maturity.
Among the recommendations:
- Children should be treated by an orthopaedic surgeon who has expertise in the operative treatment of pediatric ACL injuries.
- For pediatric and adolescent patients with partial ACL tears compromising less than 50 percent of the diameter of the ligament, non-surgical management, including activity modification, bracing and/or physical therapy, can be considered.
- Treatment for complete ACL ruptures typically involves transphyseal ACL reconstruction surgery that partially or completely spares the femoral physis (the growth plate, contributing to 70 percent of thigh-bone growth), and adult-type surgical or arthroscopic reconstruction in adolescents at or nearing skeletal maturity.
- Postoperative management may include weight-bearing and activity modifications, bracing, and a progressive physical therapy program emphasizing range of motion (ROM), closed-chain strengthening (exercises on the knee while the foot remains stationary) and a gradual and measured return to sport-specific maneuvers and activities.
Timing of First Exposure To Solid Food Appears Associated With Development Of Type 1 Diabetes
Both an early and late first exposure to solid food for infants appears to be associated with the development of type 1 diabetes mellitus (T1DM), according to a study published by JAMA Pediatrics, a JAMA Network publication.
T1DM is increasing around the world with some of the most rapid increase among children younger than 5 years of age. The infant diet has been of particular interest in the origin of the disease, according to the study background.
Brittni Frederiksen, M.P.H., Colorado School of Public Health, University of Colorado, Aurora, and colleagues examined the associations between perinatal and infant exposures, especially early infant diet, and the development of T1DM. Newborn screening of umbilical cord blood for diabetes susceptibility in the human leukocyte antigen (HLA) region was performed at St. Joseph’s Hospital in Denver and first-degree relatives of individuals with T1DM were recruited from the Denver area.
Both early (less than 4 months of age) and late (greater than or equal to 6 months of age) first exposure to any solid food was associated with development of T1DM (hazard ratio [HR] 1.91, and HR, 3.02, respectively), according to the study results. Early exposure to fruit and late exposure to rice/oat was associated with an increased risk of T1DMB (HR, 2.23 and HR, 2.88, respectively), whereas breastfeeding when wheat /barley (HR, 0.47) were introduced appeared to be associated with a decreased risk, the results also indicate.
"Our data suggest multiple foods/antigens play a role and that there is a complex relationship between the timing and type of infant food exposures and T1DM risk. In summary, there appears to be a safe window in which to introduce solid foods between 4 and 5 months of age; solid foods should be introduced while continuing to breastfeed to minimize T1DM risk in genetically susceptible children. These findings should be replicated in a larger cohort for confirmation," the authors conclude.
Photo: Bradley Gordon
“Would you like to know the sex of your baby?”
Ottawa Public Health is pleased to present some of the ups and downs of breastfeeding as experienced by local mothers on our blog this week.
“Would you like to know the sex of your baby”? It was a question that my husband and I pondered for the first 19 weeks of my second pregnancy. So, we decided to have that question answered, and got the response at a routine ultrasound. So there we were, holding our breath, waiting for three little words. “It’s a….BOY”!!! We were overjoyed to learn that we were going to be blessed with a boy. It was an emotional high that I will never forget, and I can still live in that moment. But as quickly as it came, that moment began to pass. I could tell that the tech was not sharing something with us. The next series of questions, only confirmed my suspicions, and we had answers within the hour.
Customer: “I’d like a kid’s bean and cheese burrito.”
Me: “Alright, would you like a fountain drink, juice, or milk?”
Customer: *turns to her child* “Okay, do you want soda or juice?”
Customer’s daughter: “I just want water.”
Customer: “But soda’s better for you!”
Preventing Back-to-School Back Pain
School has returned, and unfortunately that means so has back pain. Backpacks are major contributors to back pain, both in children and adults. Here are some tips to help you protect your back throughout the coming school year.
- Wearing backpacks with only one strap on one shoulder is not only a fading fashion trend, but it puts more weight on one side of your body. This imbalance creates stress on the spine, ribs, and neck, which can cause multiple areas of discomfort. Pick comfort over fashion!
- A backpack’s weight is supposed to be distributed evenly across one’s back so there is not stress on one specific spot. Try purchasing a backpack that has wide and padded straps because if the straps are too thin, they can affect circulation. This bag for example, has great padding that will improve comfort.
- A bag with multiple compartments, such as this one, distributes the weight better.
- For those experiencing great discomfort, try a rolling bag. This takes off any stress and allows you to simply roll wherever you have to go.