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Introducing an Innovative Method to Treat Spastic Cerebral Palsy with Faster Recovery Time: Post-Achilles Tendon Lengthening with Bandaging

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Journal of Biosciences and Medicines 2021年第12期9卷 30-39页

作者： Hamed Yazdanshenas Firoozeh Madadi Kevin Perez eleby rudolph washington iii Arya Nick Shamie Firooz Madadi Department of Orthopedic Surgery College of Medicine Charles R. Drew University of Medicine and Science (CDU) Los Angeles USA Department of Orthopedic Surgery David Geffen School of Medicine University of California Los Angeles (UCLA) Los Angeles USA Department of General Surgery College of Medicine Charles R. Drew University of Medicine and Science Los Angeles (CDU) Los Angeles USA Department of Family Medicine David Geffen School of Medicine University of California Los Angeles (UCLA) Los Angeles USA Department of Family Medicine College of Medicine Charles R. Drew University of Medicine and Science Los Angeles (CDU) Los Angeles USA Department of Anesthesiology Anesthesiology Research Center Shabid Beheshti University of Medical Sciences (SBMU) Tehran Iran College of Medicine Charles R. Drew University of Medicine and Science (CDU) Los Angeles USA David Geffen School of Medicine University of California Los Angeles (UCLA) Los Angeles USA Department of Orthopedic Surgery Akhtar Hospital Shabid Beheshti University of Medical Sciences (SBMU) Tehran Iran

Equinus deformity is one of the most common musculoskeletal deformities of Cerebral Palsy (CP) which is defined as an abnormality in ankle dorsiflexion that can cause severe walking disability. The standard surgical intervention for Equinus deformity is Achilles Tendon Lengthening (ATL) with post-operative leg casting, however in some cases, it requires months of recovery post-operation to regain movement. The objective of this study was to find an alternative to leg casting that would provide a safe and faster time course to recovery. Therefore, we conducted a semi-experimental clinical trial study of a population that included 62 CP patients between the ages of 6 - 15 years of age with diplegia, hemiplegia, or quadriplegia that randomly underwent ATL followed by subsequent leg casting (control, 32 patients) or bandage and ankle-foot orthosis (AFO;experimental, 30 patients). Patients were periodically evaluated for mobility and walking ability pre-operation and at 2 weeks post- operation, 6 weeks post-operation, and then every month for 6 months. We found that all 32 patients in the experimental group regained their walking ability within two weeks (100%), while majority of patients in the control group (84%) regained their walking ability after 4 - 6 weeks, regardless of CP type. We also found that on 6-month follow-up, progression of walking abilities was similar in both groups. Rupture of the repaired tendon was not observed in any of the participants in either group. This study suggests applying a bandage with a foot or ankle orthosis as an alternative to long leg cast in children of 15 years of age or younger with CP treated with ATL for Equinus deformity to facilitate faster post-operative recovery. It also recommends follow-up studies on confounding factors, categorization of pre- and post-operative range of movement, and post-op complications with longer follow up while treating CP patient with ATL followed by AFO.

关键词： Cerebral Palsy Equinus Deformity Recovery

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Knowledge‐based deep learning system for classifying Alzheimer's disease for multi‐task learning

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CAAI Transactions on Intelligence Technology 2024年第4期9卷 805-820页

作者： Amol Dattatray Dhaygude Gaurav Kumar Ameta Ihtiram Raza Khan Pavitar Parkash Singh Renato R.Maaliw iii Natrayan Lakshmaiya Mohammad Shabaz Muhammad Attique Khan Hany S.Hussein Hammam Alshazly Department of Data Science University of WashingtonSeattleWashingtonUSA Department of Computer Science&Engineering Parul Institute of TechnologyParul UniversityVadodaraGujaratIndia Department of Computer Science Jamia HamdardDelhiIndia Department of Management Lovely Professional UniversityPhagwaraIndia 5 College of Engineering Southern Luzon State UniversityLucbanQuezonPhilippines Department of Mechanical Engineering Saveetha School of EngineeringSIMATSChennaiTamil NaduIndia Model Institute of Engineering and Technology JammuJ&KIndia Department of Computer Science HITEC UniversityTaxilaPakistan Department of Computer Science and Mathematics Lebanese American UniversityBeirutLebanon Electrical Engineering Department College of EngineeringKing Khalid UniversityAbhaSaudi Arabia Electrical Engineering Department Aswan UniversityAswanEgypt Faculty of Computers and Information South Valley UniversityQenaEgypt

Deep learning has recently become a viable approach for classifying Alzheimer's disease(AD)in medical ***,existing models struggle to efficiently extract features from medical images and may squander additional information resources for illness *** address these issues,a deep three‐dimensional convolutional neural network incorporating multi‐task learning and attention mechanisms is *** upgraded primary C3D network is utilised to create rougher low‐level feature *** introduces a new convolution block that focuses on the structural aspects of the magnetORCID:ic resonance imaging image and another block that extracts attention weights unique to certain pixel positions in the feature map and multiplies them with the feature map ***,several fully connected layers are used to achieve multi‐task learning,generating three outputs,including the primary classification *** other two outputs employ backpropagation during training to improve the primary classification *** findings show that the authors’proposed method outperforms current approaches for classifying AD,achieving enhanced classification accuracy and other in-dicators on the Alzheimer's disease Neuroimaging Initiative *** authors demonstrate promise for future disease classification studies.

关键词： classification deep learning

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Storylines of family medicine Ⅺ:professional identity formation—nurturing one’s own story

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Family Medicine and Community Health 2024年第S3期12卷 99-108页

作者： William B Ventres Leslie A Stone Hamish J Wilson Sumi M Sexton David J Doukas Jessica P Cerdena David M Kelley Michael D Fetters Jeffrey J Haney John J Frey iii Family and Preventive Medicine University of Arkansas for Medical Sciences College of MedicineLittle RockArkansasUSA General Practice and Rural Health University of Otago Dunedin School of MedicineDunedinNew Zealand Family Medicine Georgetown University School of MedicineWashingtonDistrict of ColumbiaUSA Family and Community Medicine Tulane University School of MedicineNew OrleansLouisianaUSA Family Medicine Residency Program Middlesex HealthMiddletownConnecticutUSA Family Medicine University of Michigan Medical SchoolAnn ArborMichiganUSA Medical Education and Clinical Sciences Washington State UniversitySpokaneWashingtonUSA Family Medicine and Community Health University of Wisconsin-Madison School of Medicine and Public HealthMadisonWisconsinUSA

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the ***‘Ⅺ:professional identity formation—nurturing one’s own story’,authors address the following themes:‘The social construction of professional identity’,‘On becoming a family physician’,‘What’s on the test?—professionalism for family physicians’,‘The ugly doc-ling’,‘Teachers—the essence of who we are’,‘Family medicine research—it starts in the clinic’,‘Socially accountability in medical education’,‘Personal philosophy and how to find it’and‘Teaching and learning with Storylines of Family Medicine’.May these essays encourage readers to find their own creative spark in medicine.

关键词： own becoming professional

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Quantifying the early snowmelt event of 2015 in the Cascade Mountains,USA by developing and validating MODIS-based snowmelt timing maps

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Frontiers of Earth Science 2018年第4期12卷 693-710页

作者： Donal O'LEARY iii Dorothy HALL Michael MEDLER Aquila FLOWER University of Maryland Department of Geographical SciencesCollege ParkMD 20740USA Westem washington University Department of Environmental StudiesBellinghamWA 98225USA National Aeronautics and Space Administration Goddard Space Flight CenterGreenbeltMD 20771USA Earth System Science Interdisciplinary Center University of MarylandCollege ParkMD 20740USA

Spring snowmelt serves as the major hydrological contribution to many watersheds of the US West. Since the 1970s the conterminous western USA has seen an earlier arrival of spring snowmelt. The extremely low snowpack and early melt of 2015 in the Cascade Mountains may be a harbinger of winters to come, underscoring the interest in advancements in spring snowmelt monitoring. Target-of-opportunity and point measurements of snowmelt using meteorological stations or stream gauges are common sources of these data, however, there have been few attempts to identify snowmelt timing using remote sensing. In this study, we describe the creation of snowmelt timing maps (STMs) which identify the day of year that each pixel of a remotely sensed image transitions from “snow-covered” to “no snow” during the spring melt season, controlling for cloud coverage and ephemeral spring snow storms. Derived from the 500 m MODerate-resolution Imaging Spectroradiometer (MODIS) standard snow map, MOD10A2, this new dataset provides annual maps of snowmelt timing, with corresponding maps of cloud interference and interannual variability in snow coverage from 2001–2015. We first show that the STMs agree strongly with in-situ snow telemetry (SNOTEL) meteorological station measurements in terms of snowmelt timing. We then use the STMs to investigate the early snowmelt event of 2015 in the Cascade Mountains, USA, highlighting the protected areas of Mt. Rainier, Crater Lake, and Lassen Volcanic National Parks. In 2015 the Cascade Mountains experienced snowmelt 41 days earlier than the 2001–2015 average, with 25% of its land area melting>65 days earlier than average. The upper elevations of the Cascade Mountains experienced the greatest snowmelt anomaly. Our results are relevant to land managers and biologists as they plan adaptation strategies for mitigating the effects of climate change throughout temperate mountains.

关键词： Cascade Mountains snowmelt spring phenology MODIS remote sensing

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Interactive Effects of Elevated CO_2 and Growth Temperature on the Tolerance of Photosynthesis to Acute Heat Stress in C_3 and C_4 Species

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Journal of Integrative Plant Biology 2008年第11期50卷 1375-1387页

作者： E. William Hamilton iii Scott A. Heckathorn Puneet Joshi Dan Wang Deepak Barua Department of Biology Washington and Lee University Lexington Virginia USA Department of Environmental Sciences University of Toledo Toledo Ohio USA

Determining effects of elevated CO2 on the tolerance of photosynthesis to acute heat-stress （heat wave） is necessary for predicting plant responses to global warming, as photosynthesis is thermolabile and acute heat-stress and atmospheric CO2 will increase in the future. Few studies have examined this, and past results are variable, which may be due to methodological variation. To address this, we grew two C3 and two C4 species at current or elevated CO2 and three different growth temperatures （GT）. We assessed photosynthetic thermotolerance in both unacclimated （basal tolerance） and preheat-stressed （preHS = acclimated） plants. In C3 species, basal thermotolerance of net photosynthesis （Pn） was increased in high CO2, but in C4 species, Pn thermotlerance was decreased by high CO2 （except Zea mays at low GT）; CO2 effects in preHS plants were mostly small or absent, though high CO2 was detrimental in one C3 and one C4 species at warmer GT. Though high CO2 generally decreased stomatal conductance, decreases in P, during heat stress were mostly due to non-stomatal effects. Photosystem Ⅱ （PSⅡ） efficiency was often decreased by high CO2 during heat stress, especially at high GT; CO2 effects on post-PSⅡ electron transport were variable. Thus, high CO2 often affected photosynthetic theromotolerance, and the effects varied with photosynthetic pathway, growth temperature, and acclimation state. Most importantly, in heat-stressed plants at normal or warmer growth temperatures, high CO2 may often decrease, or not benefit as expected, tolerance of photosynthesis to acute heat stress. Therefore, interactive effects of elevated CO2 and warmer growth temperatures on acute heat tolerance may contribute to future changes in plant productivity, distribution, and diversity.

关键词： carbon dioxide global climate change photosynthesis thermotolerance.

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Interactive Effects of Elevated CO_2 and Ozone on Leaf Thermotolerance in Field-grown Glycine max

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Journal of Integrative Plant Biology 2008年第11期50卷 1396-1405页

作者： Sasmita Mishra Scott A. Heckathorn Deepak Barua Dan Wang Puneet Joshi E. William Hamilton iii Jonathan Frantz Department of Environmental Sciences University of Toledo Toledo Ohio USA Department of Biology Washington and Lee University Lexington Virginia USA United States Department of Agricuffure-Agricultural Research Service University of Toledo Toledo Ohio 43606 USA

Humans are increasing atmospheric CO2, ground-level ozone （O3）, and mean and acute high temperatures. Laboratory studies show that elevated CO2 can increase thermotolerance of photosynthesis in C3 plants. O3-related oxidative stress may offset benefits of elevated CO2 during heat-waves. We determined effects of elevated CO2 and O3 on leaf thermotolerance of field-grown Glycine max （soybean, C3）. Photosynthetic electron transport （Фet） was measured in attached leaves heated in situ and detached leaves heated under ambient CO2 and O3. Heating decreased Фet, which O3 exacerbated. Elevated CO2 prevented O3-related decreases during heating, but only increased Фet under ambient O3 in the field. Heating decreased chlorophyll and carotenoids, especially under elevated CO2. Neither CO2 nor O3 affected heat-shock proteins. Heating increased catalase （except in high O3） and Cu/Zn-superoxide dismutase （SOD）, but not Mn- SOD; CO2 and O3 decreased catalase but neither SOD. Soluble carbohydrates were unaffected by heating, but increased in elevated CO2. Thus, protection of photosynthesis during heat stress by elevated CO2 occurs in field-grown soybean under ambient O3, as in the lab, and high CO2 limits heat damage under elevated O3, but this protection is likely from decreased photorespiration and stomatal conductance rather than production of heat-stress adaptations.

关键词： anti-oxidants global change heat-shock proteins photosynthesis.

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Decreasing recurrent bowel obstructions,improving quality of life with physiotherapy:Controlled study

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World Journal of Gastroenterology 2018年第19期24卷 2108-2119页

作者： Amanda D Rice Kimberley Patterson Evette D Reed Belinda F Wurn Kristen Robles Bernhard Klingenberg Leonard B Weinstock Janey SA Pratt C Richard King iii Lawrence J Wurn Department of Internal Medicine College of Medicine-PhoenixUniversity of ArizonaPhoenixAZ 85004United States Clear Passage Therapies GainesvilleFL 32606United States Department of Mathematics and Statistics Williams CollegeWilliamstownMA 01267United States Clinical Medicine and Surgery Washington University School of MedicineSpecialists in GastroenterologyLLCSt.LouisMO 63141United States Department of Surgery Stanford University School of MedicinePalo AltoCA 94035United States College of Medicine University of FloridaGainesvilleFL 32607United States

AIM To compare(1) quality of life and(2) rate of recurrent small bowel obstructions(SBO) for patients treated with novel manual physiotherapy vs no treatment. METHODS One hundred and three subjects(age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach(CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre-and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring *** Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls(total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire(SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life(QOL) and pain severity when compared to post CPA treatment were significantly improved(P < 0.0001). The medication domain was not changed in the CPA treated group(P = 0.176).CONCLUSION CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.

关键词： Clear passage approach Manual therapy Physical therapy Small bowel obstructions Adhesions Physiotherapy Alternative therapy

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The characteristics of CO_2 assimilation of photosynthesis and chlorophyll fluorescence in transgenic PEPC rice

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Chinese Science Bulletin 2001年第13期46卷 1080-1084页

作者： JIAO Demao, LI Xia, HUANG Xueqing, CHI Wei, KUANG Tingyun & Ku SB Maurice1. Institute of Agrobiological Genetics and Physiology, Jiangsu Academy of Agricultural Sciences, Nangjing 210014, China 2. Institute of Botany, the Chinese Academy of Sciences, Beijing 100093, China 3. Botany Department, washington State University, Pullman, WA 99164-4236, USA Institute of Agrobiological Genetics and Physiology Jiangsu Academy of Agricultural Sciences Nangjing China Institute of Botany The Chinese Academy of Sciences Beijing China Botany Department Washington State University Pullman USA

With PEPC, PPDK, NADP-ME and PEPC+ PPDK transgenic and untransformed rice (Orysa sativa L.), the activities of related C4 photosynthesis enzymes, the chlorophyll fluorescence parameters, CO2 exchange and other physiological indexes were compared, in which the physiological characteristics of PEPC transgenic rice were mainly studied. The results were as follows: (i) The activities of PEPC in PEPC transgenic rice were 20-fold higher than those in untransformed rice; the light-saturation photosynthetic rates and the carboxylation efficiency of PEPC transgenic rice were increased by 55% and 50% more than those of untransformed rice, respectively, while the CO2 compensation point decreased by 27%. (ii) The PS II photochemical efficiency (Fv/Fm) and photochemical quenching (qp) of transgenic PEPC rice decreased less in comparison with those of untransformed rice after the treatment with high light intensity (3 h) or methyl viologen (MV), a photooxidative reagent, which demonstrated that the tolerance of PEPC

关键词： transgenic rice photosynthetic characteristics photoin-hibition of photosynthesis chlorophyll fluorescence phosphoenopy-ruvate carboxylase (PEPC).

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Treatment Recommendations among Radiation Oncologists in the Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion

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Journal of Cancer Therapy 2016年第11期7卷 824-835页

作者： Upendra Parvathaneni Madhu Shetti Daniel Berg Seesha Takagishi George E. Laramore Chrysalyne D. Schmults Anokhi Jambusaria-Pahlajani Stephen D. Hess Marvin Heyboer iii Jay J. Liao University of washington Medical Center Seattle Washington USA Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA University of Pennsylvania Philadelphia Pennsylvania USA State University of New York (SUNY) Syracuse New York USA

Purpose: Post-operative radiotherapy (PORT) for resected cutaneous squamous cell carcinoma (CSCC) with perineural invasion (PNI) is controversial. Therefore, we conducted a survey to review treatment recommendations among Radiation Oncologists (ROs) in the management of CSCC with PNI. Materials & Methods: In March 2011, we contacted all ROs and trainees in the US through email addresses listed in the 2009 ASTRO directory. Our web-based survey presented clinical vignettes involving Mohs micrographically resected CSCC with microscopic PNI (mPNI) or clinical PNI (cPNI). For each vignette, ROs were asked to indicate if PORT was appropriate and to further specify the dose and volume to treat. Results: Three hundred fifty two responses were completed and analyzed. The majority of ROs (72%) had over 10 years of post residency experience. 64% of the sampled ROs had a special interest in treating head and neck cancers, and 64% treated 4 or more cases per year. Approximately 95% recommended PORT for cPNI whereas 59% recommended PORT for mPNI. Post residency experience (10+ yrs vs. <10 yrs) was associated with a greater propensity to recommend PORT for mPNI (48% vs. 30%, p = 0.005) and for mPNI of deep subcutaneous non-named nerve involvement (80% vs. 60%, p = 0.001). ROs treating 8 or more cases per year (vs. <7) were more likely to recommend PORT for mPNI in immunocompromised patients (74% vs. 57%, p = 0.01). Conclusions: Our study demonstrates significant variability among ROs in the management of CSCC with mPNI. For cases of cPNI, an overwhelming majority recommended PORT. In cases of mPNI, there was no consensus for recommending PORT, although experienced practitioners had a lower threshold for offering treatment. These results indicate the need for prospective clinical studies to clarify the role of PORT in CSCC patients with mPNI.

关键词： Cutaneous Squamous Cell Carcinoma Perineural Invasion Head and Neck Post Operative Radiation Therapy

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Avian Community Density and Distribution Patterns among Nicaraguan Conventional and Organic Shade-Coffee Plantations

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Agricultural Sciences 2020年第1期11卷 27-53页

作者： Wayne J. Arendt R. Cary Tuckfield Juan Carlos Martínez-Sánchez Jennifer L. Reidy Frank R. Thompson iii Joseph M. Wunderle Jr. José Manuel Zolotoff USDA Forest Service International Institute of Tropical Forestry Sabana Field Research Station Luquillo PR USA ECOSTATys LLC Aiken SC USA Fundación Cocibolca Managua Nicaragua Department of Biology University of Washington Seattle WA USA Department of Fisheries and Wildlife Sciences 302 Anheuser-Busch Natural Resources Building University of Missouri Columbia MO USA North Central Research Station 202 Anheuser-Busch Natural Resources Building University of Missouri Columbia MO USA

We used a distance-sampling survey method and multivariate statistics to obtain a unique estimate of bird species density and seasonal variation in shade-coffee plantations. Our aim was to determine which cultivation practices among plantations contribute most to bird abundance. We conducted avian species counts at 200 points distributed across 10 shade-coffee plantations bordering the lower slopes of the Mombacho Volcano Natural Reserve, in western Nicaragua. We measured vegetation structure (coffee plants and overstory). We used principal components analysis (PCA) among 14 habitat variables to derive a single phyto-geoclimate summary measure (PGSM). We also used PCA to derive an avian abundance summary measure (AASM) from three bird survey variables, which proved to be a good predictor of bird density. We found higher bird species densities (AASM) in organic and traditional polyculture shade coffee plantations whose structurally complex and diverse overstory could be verified by PGSM. However, this finding was true only for birds that were habitat specialists. Our results provide further evidence for promoting organic coffee cultivation practices that maintain a structurally diverse overstory and help retain avian species richness and abundance in coffee plantations.

关键词： Bird Density Coffee Cultivation Practices Monoculture Organic Polyculture Spatial Distribution Species Richness

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