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Background:Idiopathic toe walking (ITW) is a diagnosis of exclusion and represents a spectrum of severity. Treatment for ITW includes observation and a variety of conservative treatment methods, with surgical intervention often reserved for severe cases. Previous studies reviewing treatment outcomes are often difficult to interpret secondary to a mixture of case severity. The goal of this study was to review surgical outcomes in patients with severe ITW who had failed prior conservative treatment, as well as determine differences in outcomes based on the type of surgery performed.Methods:After IRB approval, all patients with surgical management of severe ITW at a single institution were identified. Zone II or zone III plantar flexor lengthenings were performed in all subjects. Clinical, radiographic, and motion analysis data were collected preoperatively and at 1 year following surgery.Results:Twenty-six patients (46 extremities) with a diagnosis of severe ITW from 2002 to 2017 were included. Zone II lengthenings were performed in 25 extremities (mean age=9.9 y) and zone III lengthenings were performed in 21 extremities (mean age=8.6 y). At the most recent follow-up, 100% of zone III lengthening extremities and 88% of zone II lengthening demonstrated decreased severity of ITW. Six extremities required additional treatment, all of which were initially managed with zone II lengthenings.Conclusions:Severe ITW or ITW that has not responded to conservative treatment may benefit from surgical intervention. More successful outcomes, including continued resolution of toe walking, were observed in subjects treated with zone III lengthenings.Level of Evidence:Level III - case series.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19573号 / 医博第4080号 / 新制||医||1013(附属図書館) / 32609 / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 小池 薫, 教授 瀬原 淳子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24808号 / 社医博第132号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 西浦 博, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

There has been much discussion about the relationship between hormonal contraceptives and the development of pseudotumor cerebri (PTC). Some have claimed that progestin-containing contraceptives, such as levonorgestrel intrauterine devices, are linked to PTC. However, the relationship and mechanism of PTC following the use of progestin-containing contraceptives remain controversial. We present a case of PTC following implantation of Nexplanon® (etonogestrel) (Merck Sharp & Dohme BV, Haarlem, The Netherlands), a progestin contraceptive. Clinicians should be vigilant for visual disturbances, headache, nausea, and other signs of increased intracranial pressure in patients receiving progestin-containing contraceptives.

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Bakgrund: JIA (juvenil idiopatisk artrit) är den vanligast förekommande reumatiska sjukdomen bland barn. Fysisk träning en viktig del av behandlingen där fysioterapeuten har huvudansvar. Tidigare forskning tyder på att barn med JIA inte är lika fysiskt aktiva som sina friska jämnåriga och att det i dagsläget saknas fördjupad kunskap om faktorer som påverkar fysisk aktivitet hos dessa barn.  Syfte: Syftet med arbetet var för vårdnadshavare för barn med JIA, utforska upplevelser och erfarenheter kring faktorer som påverkar barnets fysiska aktivitet.  Metod: Kvalitativ metod genom fem semistrukturerade intervjuer som genomfördes med vårdnadshavare till barn med JIA. Bekvämlighetsurval användes för att hitta deltagare. Materialet bearbetades genom en kvalitativ innehållsanalys.  Resultat: I analysen framkom fem kategorier med faktorer som påverkar fysisk aktivitet: hitta rätt – medicineringens roll i främjandet av fysisk aktivitet, upplevt ansvar att hitta och förmedla information, anpassningar i skolmiljö, uppmuntran och integration – vikten av normalitet i livet med JIA och önskemål kring utökade vårdinsatser.  Konklusion: Vårdnadshavare till barn med JIA erfarande att en adekvat medicinering var en faktor som främjade fysisk aktivitet. Vidare upplevde informanterna att de har ett stort ansvar att söka information om sjukdomen, samt att förmedla denna till berörda parter såsom skola och idrottsorganisationer för att främja sitt barns fysiska aktivitet. Otillräcklig kunskap om sjukdomen i samhället anses vara en hindrande faktor till att barnen kan vara fysiskt aktiva, medan lyhördhet och anpassningar i skola och idrottssammanhang var underlättande faktorer. Informanterna framförde önskemål om förbättrad kontinuitet i vården för att effektivisera behandlingen. / Background: JIA (juvenile idiopathic arthritis) is the most common rheumatic disease among children. Exercise is an important part of the treatment, and physiotherapists have primary responsibility for the treatment plan. Previous research suggests that children with JIA are not as physically active as their healthy peers, and currently, there is a lack of in-depth knowledge about factors that affect physical activity in children with JIA.  Objectives: The aim of this study was to explore the experiences of factors influencing a child's physical activity for guardians of children with JIA.  Method: A qualitative design was conducted through five semi-structured interviews with guardians of children with JIA. Convenience sampling was used to identify participants. The data was processed through qualitative content analysis.  Result: The analysis revealed five categories of factors that influence physical activity: the role of medication in promoting physical activity, guardians’ responsibility to find and convey information, adaptations in school environment, the importance of normalcy in life with JIA and preferences for expanded healthcare interventions.  Conclusion: Guardians of children with JIA experienced that adequate medication was a factor that facilitated physical activity. Moreover, the guardians of children with JIA felt that they had a responsibility to seek information about the disease and convey it to relevant parties such as schools and sports organizations to promote their child's physical activity. Insufficient knowledge about the disease in society was considered a hindering factor for children to be physically active, while awareness and adaptations in school and sports settings were facilitating factors. The informants expressed a desire for improved continuity in healthcare to streamline treatment.

Adolescent idiopathic scoliosis (AIS) is an extremely common three-dimensional (3-D) deformity of the spine, affecting the population between 10 and 18 years of age. Early detection of AIS is critical, as the earlier that the spinal deformity can be identified, the more likely it is that curve progression can be minimized or arrested using conservative treatment options. However, today much of the responsibility for detecting AIS falls on untrained parents. Therefore, the purpose of this thesis project is to use images taken with a smartphone containing a depth sensor to create a simple and effective machine learning (ML) algorithm that can detect the absence or presence of scoliosis. Secondarily, this thesis project aims to 1) provide a proof of concept for a regression-based ML algorithm that can predict the main curvature of the scoliotic spine and 2) to determine if the depth information from the smartphone contains additional features or information that can improve the performance of the ML algorithm when compared to regular red-green-blue (RGB) images. Thirty-three participants (28 AIS; 5 Control) were recruited from the Children’s Hospital of Eastern Ontario (CHEO). Images of the unclothed backs of participants were taken with a smartphone (Samsung S20 Ultra 5G) containing a depth sensor, while participants assumed two positions: an upright standing posterior-anterior (PA; mirroring the position participants are in when getting an EOS scan) and a forward bending position. A convolutional-neural-network (CNN)-backed decision tree algorithm was developed and trained using three different data streams: a red-green-blue-depth (RGB-D), a Colourized depth map, and an RGB data stream. It was determined that the model trained with the Colourized forward bending images had the highest overall accuracy. The CNN backed decision tree was able to classify images of participants in a forward bend posture with an accuracy of 93%, specificity of 75%, and a sensitivity of 99%. Additionally, it was found that all algorithms trained with the varying data streams were able to predict the Cobb angle of the spine within 16° of the ground truth Cobb angles. The lowest root mean square error (RMSE) values were obtained from the RGB images when the participants were in the PA position. The PA RGB dataset had RMSE values of 7.17° between the ground truth and predicted Cobb angles. Inter-rater reliability errors typically range between 5-7° for manually measured Cobb angles. Therefore, given the calculated RMSE for the PA RGB dataset were close to this range, there is the potential to use this smartphone technology to screen for scoliosis and predict the curvature of the spine (Morrison et al., 2015). While these results are promising, the dataset is small compared to other studies; therefore, this thesis provides a proof of concept, and more work needs to be done to increase the robustness of the model and to further improve the ability of the model to predict the Cobb angle of the spine.