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Article ; Online: Cost burden of breakthrough hemolysis in patients with paroxysmal nocturnal hemoglobinuria receiving ravulizumab versus eculizumab.

Tomazos, Ioannis / Sierra, J Rafael / Johnston, Karissa M / Cheung, Antoinette / Brodsky, Robert A / Weitz, Ilene C

2020 Volume 25, Issue 1, Page(s) 327–334

Abstract: Objectives: ...

Abstract	Objectives:
MeSH term(s)	Antibodies, Monoclonal, Humanized/economics ; Antibodies, Monoclonal, Humanized/therapeutic use ; Complement Inactivating Agents/economics ; Complement Inactivating Agents/therapeutic use ; Cost of Illness ; Hemoglobinuria, Paroxysmal/drug therapy ; Hemoglobinuria, Paroxysmal/economics ; Hemoglobinuria, Paroxysmal/pathology ; Hemolysis/drug effects ; Humans ; Patient Acceptance of Health Care
Chemical Substances	Antibodies, Monoclonal, Humanized ; Complement Inactivating Agents ; eculizumab (A3ULP0F556) ; ravulizumab (C3VX249T6L)
Language	English
Publishing date	2020-08-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1341428-8
ISSN	1607-8454 ; 1024-5332 ; 1024-5340
ISSN (online)	1607-8454
ISSN	1024-5332 ; 1024-5340
DOI	10.1080/16078454.2020.1807226
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Article ; Online: Ocean acidification alters morphology of all otolith types in Clark’s anemonefish (Amphiprion clarkii)

Robert J. Holmberg / Eric Wilcox-Freeburg / Andrew L. Rhyne / Michael F. Tlusty / Alan Stebbins / Steven W. Nye Jr. / Aaron Honig / Amy E. Johnston / Christine M. San Antonio / Bradford Bourque / Robyn E. Hannigan

PeerJ, Vol 7, p e

2019 Volume 6152

Abstract: Ocean acidification, the ongoing decline of surface ocean pH and [CO ${}_{3}^{2-}$ 3 2 − ] due to absorption of surplus atmospheric CO2, has far-reaching consequences for marine biota, especially calcifiers. Among these are teleost fishes, which ... ...

Abstract	Ocean acidification, the ongoing decline of surface ocean pH and [CO ${}_{3}^{2-}$ 3 2 − ] due to absorption of surplus atmospheric CO2, has far-reaching consequences for marine biota, especially calcifiers. Among these are teleost fishes, which internally calcify otoliths, critical elements of the inner ear and vestibular system. There is evidence in the literature that ocean acidification increases otolith size and alters shape, perhaps impacting otic mechanics and thus sensory perception. Here, larval Clark’s anemonefish, Amphiprion clarkii (Bennett, 1830), were reared in various seawater pCO2/pH treatments analogous to future ocean scenarios. At the onset of metamorphosis, all otoliths were removed from each individual fish and analyzed for treatment effects on morphometrics including area, perimeter, and circularity; scanning electron microscopy was used to screen for evidence of treatment effects on lateral development, surface roughness, and vaterite replacement. The results corroborate those of other experiments with other taxa that observed otolith growth with elevated pCO2, and provide evidence that lateral development and surface roughness increased as well. Both sagittae exhibited increasing area, perimeter, lateral development, and roughness; left lapilli exhibited increasing area and perimeter while right lapilli exhibited increasing lateral development and roughness; and left asterisci exhibited increasing perimeter, roughness, and ellipticity with increasing pCO2. Right lapilli and left asterisci were only impacted by the most extreme pCO2 treatment, suggesting they are resilient to any conditions short of aragonite undersaturation, while all other impacted otoliths responded to lower concentrations. Finally, fish settlement competency at 10 dph was dramatically reduced, and fish standard length marginally reduced with increasing pCO2. Increasing abnormality and asymmetry of otoliths may impact inner ear function by altering otolith-maculae interactions.
Keywords	Ocean acidification ; Fish otoliths ; CaCO3 mineralogy ; Scanning Electron Microscopy ; Medicine ; R ; Biology (General) ; QH301-705.5
Subject code	551
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	PeerJ Inc.
Document type	Article ; Online
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Article ; Online: Frequency and Geographic Distribution of Borrelia miyamotoi, Borrelia burgdorferi, and Babesia microti Infections in New England Residents.

Johnston, Demerise / Kelly, Jill R / Ledizet, Michel / Lavoie, Nathalie / Smith, Robert P / Parsonnet, Jeffrey / Schwab, Jonathan / Stratidis, John / Espich, Scott / Lee, Giyoung / Maciejewski, Kaitlin R / Deng, Yanhong / Majam, Victoria / Zheng, Hong / Bonkoungou, Sougr-Nooma / Stevens, June / Kumar, Sanjai / Krause, Peter J

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022

Abstract: Background: Borrelia miyamotoi is a relapsing fever spirochete that relatively recently has been reported to infect humans. It causes an acute undifferentiated febrile illness that can include meningoencephalitis and relapsing fever. Like Borrelia ... ...

Abstract	Background: Borrelia miyamotoi is a relapsing fever spirochete that relatively recently has been reported to infect humans. It causes an acute undifferentiated febrile illness that can include meningoencephalitis and relapsing fever. Like Borrelia burgdorferi, it is transmitted by Ixodes scapularis ticks in the northeastern United States and by Ixodes pacificus ticks in the western United States. Despite reports of clinical cases from North America, Europe, and Asia, the prevalence, geographic range, and pattern of expansion of human B. miyamotoi infection are uncertain. To better understand these characteristics of B. miyamotoi in relation to other tickborne infections, we carried out a cross-sectional seroprevalence study across New England that surveyed B. miyamotoi, B. burgdorferi, and Babesia microti infections. Methods: We measured specific antibodies against B. miyamotoi, B. burgdorferi, and B. microti among individuals living in 5 New England states in 2018. Results: Analysis of 1153 serum samples collected at 11 catchment sites showed that the average seroprevalence for B. miyamotoi was 2.8% (range, 0.6%-5.2%), which was less than that of B. burgdorferi (11.0%; range, 6.8%-15.6%) and B. microti (10.0%; range, 6.5%-13.6%). Antibody screening within county residence in New England showed varying levels of seroprevalence for these pathogens but did not reveal a vectoral geographical pattern of distribution. Conclusions: Human infections caused by B. miyamotoi, B. burgdorferi, and B. microti are widespread with varying prevalence throughout New England.
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac107
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Article ; Online: Unraveling the Complexity of the Senescence-Associated Secretory Phenotype in Adamantinomatous Craniopharyngioma Using Multi-Modal Machine Learning Analysis.

Prince, Eric W / Apps, John R / Jeang, John / Chee, Keanu / Medlin, Stephen / Jackson, Eric M / Dudley, Roy / Limbrick, David / Naftel, Robert / Johnston, James / Feldstein, Neil / Prolo, Laura M / Ginn, Kevin / Niazi, Toba / Smith, Amy / Kilburn, Lindsay / Chern, Joshua / Leonard, Jeffrey / Lam, Sandi /

Hersh, David S / Gonzalez-Meljem, Jose Mario / Amani, Vladimir / Donson, Andrew M / Mitra, Siddhartha S / Bandohpadhayay, Pratiti / Martinez-Barbera, Juan Pedro / Hankinson, Todd C

Neuro-oncology

2024

Abstract: Background: Cellular senescence can have positive and negative effects on the body, including aiding in damage repair and facilitating tumor growth. Adamantinomatous Craniopharyngioma (ACP), the most common pediatric sellar/suprasellar brain tumor, ... ...

Abstract	Background: Cellular senescence can have positive and negative effects on the body, including aiding in damage repair and facilitating tumor growth. Adamantinomatous Craniopharyngioma (ACP), the most common pediatric sellar/suprasellar brain tumor, poses significant treatment challenges. Recent studies suggest that senescent cells in ACP tumors may contribute to tumor growth and invasion by releasing a Senesecence-Associated Secretory Phenotype (SASP). However, a detailed analysis of these characteristics has yet to be completed. Methods: We analyzed primary tissue samples from ACP patients using single-cell, single-nuclei, and spatial RNA Sequencing. We performed various analyses, including gene expression clustering, inferred senescence cells from gene expression, and conducted cytokine signaling inference. We utilized LASSO to select essential gene expression pathways associated with senescence. Finally, we validated our findings through immunostaining. Results: We observed significant diversity in gene expression and tissue structure. Key factors such as NFKB, RELA, and SP1 are essential in regulating gene expression, while senescence markers are present throughout the tissue. SPP1 is the most significant cytokine signaling network among ACP cells, while the Wnt signaling pathway predominantly occurs between epithelial and glial cells. Our research has identified links between senescence-associated features and pathways, such as PI3K/Akt/mTOR, MYC, FZD, and Hedgehog, with increased P53 expression associated with senescence in these cells. Conclusions: A complex interplay between cellular senescence, cytokine signaling, and gene expression pathways underlies ACP development. Further research is crucial to understand how these elements interact to create novel therapeutic approaches for patients with ACP.
Language	English
Publishing date	2024-02-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2028601-6
ISSN	1523-5866 ; 1522-8517
ISSN (online)	1523-5866
ISSN	1522-8517
DOI	10.1093/neuonc/noae015
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Article ; Online: Definition of Tweener: Consensus Among Experts in Treating Early-onset Scoliosis.

Quan, Theodore / Matsumoto, Hiroko / Bonsignore-Opp, Lisa / Ramo, Brandon / Murphy, Robert F / Brooks, Jaysson T / Welborn, Michelle C / Emans, John B / Anari, Jason B / Johnston, Charles E / Akbarnia, Behrooz A / McCarthy, Richard / Flynn, John / Sawyer, Jeffrey R / Vitale, Michael G / Roye, Benjamin D

Journal of pediatric orthopedics

2022 Volume 43, Issue 3, Page(s) e215–e222

Abstract: Background: The term "Tweener" is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a ... ...

Abstract	Background: The term "Tweener" is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population. Methods: A 3-round survey of surgeons in an international EOS study group was conducted. Surgeons were provided with various patient characteristics and asked if each was part of their definition for Tweener patients. Responses were analyzed for consensus (≥70%), near-consensus (60% to 69%), and no consensus (<60%). Results: Consensus was reached (89% of respondents) for including chronological age in the Tweener definition; 8 to 10 years for females and 9 to 11 years for males. Surgeons agreed for inclusion of Sanders score, particularly Sanders 2 (86.0%). Patients who have reached Sanders 4, postmenarche, or have closed triradiate cartilage should not be considered Tweeners. Bone age range of 8 years and 10 months to 10 years and 10 months for females (12 y for males) could be part of the Tweener definition. Conclusions: This study suggests that the Tweener definition could be the following: patients with open triradiate cartilage who are not postmenarche and have not reached Sanders 4, and if they have one of the following: Sanders 2 or chronological age 8 to 10 years for females (9 to 11 y for males) or bone age 8 years and 10 months to 10 years and 10 months for females (12 y for males). This definition will allow for more focused and comparative research on this population. Level of evidence: Level V-expert opinion.
MeSH term(s)	Male ; Female ; Humans ; Infant ; Child ; Scoliosis/diagnosis ; Scoliosis/surgery ; Consensus ; Surgeons ; Surveys and Questionnaires ; Expert Testimony
Language	English
Publishing date	2022-12-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000002321
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Article: Reconstruction of the pelvis after resection of tumors about the acetabulum.

Satcher Jr, Robert L / O'Donnell, Richard J / Johnston, James O

Clinical orthopaedics and related research

2003 , Issue 409, Page(s) 209–217

Abstract: Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis ... ...

Abstract	Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis and shortened limb. The current authors describe a reconstruction technique using Steinmann pins augmented with methylmethacrylate reconstruction, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis. For this study, the results of 15 patients at two institutions who had surgery by the same surgeons were retrospectively reviewed. The patients had primary malignant tumors of the pelvis, and had limb-sparing resections between 1985 and 2000. Three measures of outcome were evaluated: survival, function, and pain. The surgical method uses Steinmann pins with bone cement to fill in areas of bone loss that cannot be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Twelve patients had chondrosarcoma and one patient had osteosarcoma. The remaining two patients had alveolar sarcoma of soft parts. Six patients died of disease. Seven patients were alive with no evidence of disease, and two were alive with disease at the most recent followup. Early return to ambulation without assistive devices occurred in nine of 15 patients. The functional outcome of this technique compares favorably with others reported. Sixty percent of patients ambulated independently without assistive devices, compared with 0% to 10% in other studies reviewed. The time required for independent gait is similar to recovery from a total hip arthroplasty. Moreover, this method minimized leg length discrepancy, while also producing a favorable cosmetic result.
MeSH term(s)	Acetabulum/physiopathology ; Acetabulum/surgery ; Adolescent ; Adult ; Aged ; Bone Cements/therapeutic use ; Bone Nails ; Cementation/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Methylmethacrylate/therapeutic use ; Middle Aged ; Outcome Assessment (Health Care) ; Pelvic Neoplasms/mortality ; Pelvic Neoplasms/physiopathology ; Pelvic Neoplasms/surgery ; Reconstructive Surgical Procedures/methods ; Recovery of Function/physiology ; Retrospective Studies ; Sarcoma/mortality ; Sarcoma/physiopathology ; Sarcoma/surgery ; Survival Rate ; Weight-Bearing/physiology
Chemical Substances	Bone Cements ; Methylmethacrylate (196OC77688)
Language	English
Publishing date	2003-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/01.blo.0000057791.10364.7c
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Article: Dissection and immunohistochemistry of larval, pupal and adult Drosophila retinas

Hsiao, Hui-Yi / Johnston Jr., Robert J / Jukam, David / Vasiliauskas, Daniel / Desplan, Claude / Rister, Jens

Journal of visualized experiments. 2012 Nov. 14, , no. 69

2012

Abstract: The compound eye of Drosophila melanogaster consists of about 750 ommatidia (unit eyes). Each ommatidium is composed of about 20 cells, including lens-secreting cone cells, pigment cells, a bristle cell and eight photoreceptors (PRs) R1-R8 2. The PRs ... ...

Abstract	The compound eye of Drosophila melanogaster consists of about 750 ommatidia (unit eyes). Each ommatidium is composed of about 20 cells, including lens-secreting cone cells, pigment cells, a bristle cell and eight photoreceptors (PRs) R1-R8 2. The PRs have specialized microvillar structures, the rhabdomeres, which contain light-sensitive pigments, the Rhodopsins (Rhs). The rhabdomeres of six PRs (R1-R6) form a trapezoid and contain Rh1 3 4. The rhabdomeres of R7 and R8 are positioned in tandem in the center of the trapezoid and share the same path of light. R7 and R8 PRs stochastically express different combinations of Rhs in two main subtypes5: In the 'p' subtype, Rh3 in pR7s is coupled with Rh5 in pR8s, whereas in the 'y' subtype, Rh4 in yR7s is associated with Rh6 in yR8s 6 7 8. Early specification of PRs and development of ommatidia begins in the larval eye-antennal imaginal disc, a monolayer of epithelial cells. A wave of differentiation sweeps across the disc9 and initiates the assembly of undifferentiated cells into ommatidia10-11. The 'founder cell' R8 is specified first and recruits R1-6 and then R7 12-14. Subsequently, during pupal development, PR differentiation leads to extensive morphological changes 15, including rhabdomere formation, synaptogenesis and eventually rh expression. In this protocol, we describe methods for retinal dissections and immunohistochemistry at three defined periods of retina development, which can be applied to address a variety of questions concerning retinal formation and developmental pathways. Here, we use these methods to visualize the stepwise PR differentiation at the single-cell level in whole mount larval, midpupal and adult retinas (Figure 1).
Keywords	Drosophila melanogaster ; adults ; epithelial cells ; immunohistochemistry ; larvae ; ommatidia ; photoreceptors ; pupae ; pupal development ; retina ; rhodopsin ; synaptogenesis
Language	English
Dates of publication	2012-1114
Size	p. e4347.
Publishing place	Journal of Visualized Experiments
Document type	Article
ZDB-ID	2259946-0
ISSN	1940-087X
ISSN	1940-087X
DOI	10.3791/4347
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis.

Campbell, Jonathon R / Johnston, James C / Ronald, Lisa A / Sadatsafavi, Mohsen / Balshaw, Robert F / Cook, Victoria J / Levin, Adeera / Marra, Fawziah

American journal of kidney diseases : the official journal of the National Kidney Foundation

2018 Volume 73, Issue 1, Page(s) 39–50

Abstract: Rationale & objective: In countries with a low tuberculosis (TB) incidence, TB disproportionately affects populations born abroad. TB persists in these populations through reactivation of latent TB infection (LTBI) acquired before immigration. Those ... ...

Abstract	Rationale & objective: In countries with a low tuberculosis (TB) incidence, TB disproportionately affects populations born abroad. TB persists in these populations through reactivation of latent TB infection (LTBI) acquired before immigration. Those with chronic kidney disease (CKD) are at increased risk for reactivation and may benefit from LTBI screening and treatment. Study design: Health administrative data from British Columbia, Canada, were used to inform a cost-effectiveness analysis evaluating LTBI screening in those diagnosed with stage 4 or 5 CKD not requiring dialysis (late-stage CKD) and those who began dialysis therapy. Setting & population: Permanent residents establishing residency in British Columbia, Canada, between 1985 and 2012 who had late-stage CKD diagnosed or began dialysis therapy. Interventions: Screening with the tuberculin skin test or interferon-gamma release assay (IGRA) compared to no LTBI screening at the time of late-stage CKD diagnosis and time of dialysis therapy initiation. Treatment for those who tested positive was isoniazid for 9 months. Outcomes: Costs (2016 Can $), TB cases, and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio for QALYs gained was calculated. Model, perspective, & timeframe: Discrete event simulation model using a health care system perspective, 1.5% discount rate, and 5-year time horizon. Results: Screening with IGRA was superior to the tuberculin skin test in all situations. Screening with IGRA was less expensive and resulted in better outcomes compared to no screening in those initiating dialysis therapy from countries with an elevated TB incidence. In individuals with late-stage CKD, screening with IGRA was only cost-effective in those 60 years or older (cost per QALY gained, <$48,000) from countries with an elevated TB incidence. Limitations: This study has limitations in generalizability to different epidemiologic settings and in modeling complicated clinical decisions. Conclusions: LTBI screening should be considered in non-Canadian-born residents initiating dialysis therapy and those with late stage CKD who are older.
MeSH term(s)	British Columbia ; Cost-Benefit Analysis ; Humans ; Latent Tuberculosis/complications ; Latent Tuberculosis/diagnosis ; Mass Screening/economics ; Middle Aged ; Renal Insufficiency, Chronic/complications ; Transients and Migrants
Language	English
Publishing date	2018-09-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2018.07.014
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Article ; Online: Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study.

Ronald, Lisa A / Campbell, Jonathon R / Balshaw, Robert F / Romanowski, Kamila / Roth, David Z / Marra, Fawziah / Cook, Victoria J / Johnston, James C

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2018 Volume 190, Issue 8, Page(s) E209–E216

Abstract: Background: Canadian tuberculosis (TB) guidelines recommend targeting postlanding screening for and treatment of latent tuberculosis infection (LTBI) in people migrating to Canada who are at increased risk for TB reactivation. Our objectives were to ... ...

Abstract	Background: Canadian tuberculosis (TB) guidelines recommend targeting postlanding screening for and treatment of latent tuberculosis infection (LTBI) in people migrating to Canada who are at increased risk for TB reactivation. Our objectives were to calculate robust longitudinal estimates of TB incidence in a cohort of people migrating to British Columbia, Canada, over a 29-year period, and to identify groups at highest risk of developing TB based on demographic characteristics at time of landing. Methods: We included all individuals ( Results: Active TB was diagnosed in 2814 individuals (incidence rate 24.2/100 000 person-years). Demographic factors (live-in caregiver, family, refugee immigration classes; higher TB incidence in country of birth; and older age) were strong predictors of TB incidence in BC, with elevated rates continuing many years after entry into the cohort. Recursive partitioning identified refugees 18-64 years of age from countries with a TB incidence greater than 224/100 000 population as a high-yield group, with 1% developing TB within the first 10 years. Interpretation: These findings support recommendations in Canadian guidelines to target postlanding screening for and treatment of LTBI in adult refugees from high-incidence countries. Because high-yield populations can be identified at entry via demographic data, screening at this point may be practical and high-impact, particularly if the LTBI care cascade can be optimized.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Aged ; British Columbia/epidemiology ; Child ; Child, Preschool ; Demography ; Emigrants and Immigrants/classification ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Mass Screening ; Middle Aged ; Registries ; Retrospective Studies ; Sex Distribution ; Tuberculosis/ethnology ; Young Adult
Language	English
Publishing date	2018-02-26
Publishing country	Canada
Document type	Journal Article
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.170817
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Article ; Online: Minimum 5-Year Follow-up on Graduates of Growing Spine Surgery for Early Onset Scoliosis.

Murphy, Robert F / Barfield, William R / Emans, John B / Akbarnia, Behrooz / Thompson, George / Sponseller, Paul / Skaggs, David / Marks, David / Smith, John T / Flynn, John / Presson, Angela / Sawyer, Jeffrey R / Johnston, Charles

Journal of pediatric orthopedics

2020 Volume 40, Issue 10, Page(s) e942–e946

Abstract: Introduction: After discontinuation of growth friendly (GF) surgery for early onset scoliosis, patients undergo spinal fusion or continued observation. This last planned treatment is colloquially called "definitive" treatment, conferring these patients ... ...

Abstract	Introduction: After discontinuation of growth friendly (GF) surgery for early onset scoliosis, patients undergo spinal fusion or continued observation. This last planned treatment is colloquially called "definitive" treatment, conferring these patients as "graduates" of a growing program. The 5-year radiographic and clinical outcomes of this cohort are unknown. Methods: An international pediatric spine database was queried for patients from a GF program (spine or rib-based) with minimum 5-year follow-up from last planned surgery (GF or spinal fusion). Radiographs and charts were reviewed for main coronal curve angle and maximum kyphosis as well as occurrence of secondary surgery. Results: Of 580 graduates, 170 (29%) had minimum 5-year follow-up (37% male). Scoliosis etiology was congenital in 41 (24%), idiopathic 36 (21%), neuromuscular 51 (30%), and syndromic 42 (25%). Index surgery consisted of spine-based growing rods in 122 (71%) and rib-based distraction in 48 (29%). Mean age at index surgery was 6.8 years, and patients underwent an average of 5.4 lengthenings over an average of 4.9 years (range, 6 mo to 11 y). Last planned treatment was at an average age of 11.8 years (range, 7 to 17 years). Last planned treatment consisted of spinal fusion in 114 patients, 47 had growing implants maintained, 9 had implants removed. Average follow-up was 7.3 years (range, 5 to 13 y).When compared from postdefinitive treatment to 2-year follow-up, there was noted progression of the coronal curve angle (46±19 to 51±21 degrees, P=0.046) and kyphosis (48±20 to 57±25 degrees, P=0.03). However, between 2 and 5 years, no further progression occurred in the coronal (51±21 to 53±21 degrees, P=0.26) or sagittal (57±25 to 54±28 degrees, P=0.93) planes. When stratified based on etiology, there was no significant coronal curve progression between 2- and 5-year follow-up. When comparing spinal fusion patients to those who had maintenance of their growing construct, there was also no significant curve progression.Thirty-seven (21%) underwent at least 1 (average, 1.7; range, 1 to 7) revision surgery following graduation, and 15 of 37 (41%) underwent 2 or more revision surgeries. Reason for revision was implant revision (either GF or spinal fusion) in 34 patients, and implant removal in 3. On an average, the first revision was 2.5 years after the definitive treatment plan (range, 0.02 to 7.4 y). In total, 15 of 37 (41%) revisions occurred over 2 years following the final decision for treatment plan, and 7 of 37 (19%) occurred 5 or more years after the definitive treatment.Patients who underwent spinal fusion as a definitive treatment strategy were more likely to undergo revision surgery (27%) than patients who had their GF implants maintained (11%) (P=0.04). Conclusions: Five years following "graduation" from growing surgery for early onset scoliosis, there is progression of curve magnitude in both the coronal and sagittal planes up to 2 years, with no further progression at 5 years. A total of 21% of patients undergo at least 1 revision surgery, and average time to revision surgery is over 2 years from last planned surgery. Risk of revision surgery was higher in patients who underwent a spinal fusion as their definitive treatment strategy. Level evidence: Level III-retrospective comparative. Type of evidence: Therapeutic.
MeSH term(s)	Adolescent ; Age of Onset ; Child ; Child, Preschool ; Cohort Studies ; Device Removal ; Female ; Follow-Up Studies ; Humans ; Infant ; Kyphosis/diagnostic imaging ; Male ; Orthopedic Procedures/statistics & numerical data ; Prostheses and Implants ; Radiography ; Reoperation ; Retrospective Studies ; Scoliosis/surgery ; Spinal Fusion ; Spine/diagnostic imaging ; Spine/surgery ; Treatment Outcome
Language	English
Publishing date	2020-05-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	604642-3
ISSN	1539-2570 ; 0271-6798
ISSN (online)	1539-2570
ISSN	0271-6798
DOI	10.1097/BPO.0000000000001646
Database	MEDical Literature Analysis and Retrieval System OnLINE

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