No abstract

PurposeBracing is a common treatment for patients with adolescent idiopathic scoliosis (AIS) and is recommended for most skeletally immature patients with a curve of 25–45° in order to prevent or delay curve progression. The aim of this study was to determine at which body habitus orthotic management for AIS becomes less effective. We hypothesize that overweight children are more likely to fail brace treatment.MethodsThis was a retrospective cohort study involving consecutive patients with AIS treated with a thoracolumbosacral orthosis at a large pediatric tertiary care center. Patients were divided into three groups based on BMI: (1) high-BMI group (BMI >85th percentile); (2) low-BMI group (BMI <20th percentile); (3) mid-BMI group (BMI 20th–85th percentile). Successful orthotic treatment was defined as an increase in the primary curve of <5°, prevention of progression past 45°, and avoidance of surgery.ResultsThe study cohort comprised 182 patients with a mean age of 12.5 years at brace prescription and a mean follow-up of 2 years. Compared to the mid-BMI group, high- and low-BMI patients were significantly more likely to fail orthotic management. The association between high-BMI and orthotic failure disappeared when compliance and in-brace correction were taken into account, but the association between low-BMI and each poor outcome remained significant.ConclusionsBased on our results, children on either end of the BMI spectrum are more likely to fail brace treatment for scoliosis than their mid-BMI counterparts. In high-BMI patients, this appears to be in large part attributable to an inadequacy of in-brace curve correction as well as to poorer brace compliance, while a low BMI appears to be an independent risk factor for brace failure.Level of evidence III.

Background There are conflicting reports on the role of fibrates in CVD-risk. Several studies indicate beneficial effects of fibrates on CVD risk in type-2 diabetic patients. We tested how fenofibrate changes lipoprotein subfractions and glucose homeostasis in type-2 diabetic patients. Study design Selected markers of lipid and glucose homeostasis and inflammation were measured in 204 diabetic patients who participated in the Diabetes Atherosclerosis Intervention Study (DAIS) and were randomly assigned to 200 mg fenofibrate or placebo for a minimum of 3 years. Results Triglyceride and remnant-like particle cholesterol (RLP-C) levels decreased significantly, as well as LpPLA2 activity on fenofibrate compared to placebo. HDL-C and apoA-I levels increased on fenofibrate. In contrast to other lipid-modifying drugs that increase HDL-C and the large (α-1) HDL particles; on fenofibrate, the medium and small (α-3 and α-4) HDL particles increased. Although, preβ-1 HDL particle levels decreased significantly from baseline on fenofibrate, they remained elevated compared to normal level (28.6 mg/dl vs. <15 mg/dl). The concentrations of total LDL-C and small dense LDL-C did not change on fenofibrate compared to placebo. On fenofibrate, glycoalbumin levels increased moderately, while insulin and adiponectin levels did not change. Conclusion On fenofibrate, lipid homeostasis improved and Lp-PLA2 activity decreased while there was no improvement in glucose homeostasis. Despite of increasing HDL-C and apoA-I levels fenofibrate failed to change the HDL subpopulation profile beneficially.