Effect of excessive Arm Swing on Speed and Cadence of walking

Introduction: One of the changes in the movement patterns that can be seen in upper limb swing is the excessive increase in upper limb movement and swing during walking. As temporal parameters such as cadence and speed in stationary and mobile environments can be equally used to determine early fall potentials, Therefore, this study aims to investigate the effect of excessive arm swing on speed and cadence of walking. Material and Methods: 30 healthy subjects were exposed to Vicon 10 motion capture system analysis and were asked to first walk normally at normal speeds and then move their hands excessively while walking at the same speed. The temporal data were extracted and analyzed by Matlab software. Descriptive (mean, SD) and Shapiro-Wilk test for normality of data distribution, and paired sample t-test were used to compare the patterns. Results: there was a significant difference in cadence and speed variables, between the means of natural arm swing and excessive arm swing modes (p ≤ 0.05). Conclusion: Given these results, it should be considered that the effects of upper limb pattern changes on the lower limbs and gait can compensate for the lack of attention to movement and pattern of upper extremity positioning during walking

Pan-cancer classifications of tumor histological images using deep learning

Histopathological images are essential for the diagnosis of cancer type and selection of optimal treatment. However, the current clinical process of manual inspection of images is time consuming and prone to intra- and inter-observer variability. Here we show that key aspects of cancer image analysis can be performed by deep convolutional neural networks (CNNs) across a wide spectrum of cancer types. In particular, we implement CNN architectures based on Google Inception v3 transfer learning to analyze 27815 H&E slides from 23 cohorts in The Cancer Genome Atlas in studies of tumor/normal status, cancer subtype, and mutation status. For 19 solid cancer types we are able to classify tumor/normal status of whole slide images with extremely high AUCs (0.995±0.008). We are also able to classify cancer subtypes within 10 tissue types with AUC values well above random expectations (micro-average 0.87±0.1). We then perform a cross-classification analysis of tumor/normal status across tumor types. We find that classifiers trained on one type are often effective in distinguishing tumor from normal in other cancer types, with the relationships among classifiers matching known cancer tissue relationships. For the more challenging problem of mutational status, we are able to classify TP53 mutations in three cancer types with AUCs from 0.65-0.80 using a fully-trained CNN, and with similar cross-classification accuracy across tissues. These studies demonstrate the power of CNNs for not only classifying histopathological images in diverse cancer types, but also for revealing shared biology between tumors. We have made software available at: https://github.com/javadnoorb/HistCNNFirst author draf

A comparison of effectiveness of regulation of working memory function and methylphenidate on remediation of attention deficit hyperactivity disorder (ADHD).

Abstract: Attention Deficit/Hyperactivity Disorder (ADHD) is a prevalent and serious disorder affecting such key cognitive components as working memory. Working memory serves to facilitate and check attention in any individual and to focus on those affairs that need to be retained in mind. This study examines whether a combination of the two therapeutic methods of working memory training and Methylphenidate might be more effective in treating ADHD in children aged 6 to 12 years of age than when methylphenidate is applied alone. Method: Subjects of the study are 48 children suffering from ADHD. They were selected by random sampling. The experimental group included 23 children with ADHD who received a combination of working memory training and Methylphenidate, and the control group which included 25 children with ADHD received Methylphenidate only. To check the effects of the intervention, Conners' Parent Rating Scale (CPRS-48) was applied before and after the intervention. After intervention, data were collect d from the remaining samples in the two groups. Data were examined both through descriptive statistical methods and analytic statistical methods, including T-student test and Quantile-Quantile Plots diagram . Results: The study demonstrated that a combination of the cognitive intervention of working memory training and methylphenidate is more effective in alleviating ADHD symptoms rather than when methylphenidate is applied in isolation. In the CPRS pre-test and post-test, the mean difference of the experimental and the control group was 8.39 and 1.88 respectively, indicating that the working memory group has improved more than the control group. Conclusions: The study reveals that the ADHD symptoms were more contained in the test group than the control group due to working memory training . The cognitive intervention through working memory training may be effective in alleviating the severity of disorder measured in the pre-test

Clinical Study Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics

A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0 ∘ to 90 ∘ . No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension ( < 0.05). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0 ∘ ( = 0.002) and 15 ∘ ( = 0.012). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise

A 24-year-old Female Traumatic Patient Following a Car Accident

A healthy 24-year-old female presented at the emergency department (ED) after a car accident with ambulance while injured severely after the bus got run over her lower limb. As the trauma team was activated, her primary survey was started: Ac (Airway and cervical collar): She was awake and could talk. Cervical collar was fixed, oxygenation with face mask was started. B (Breathing): Her chest rising was symmetrical without any laceration or abrasion. Chest auscultation was clear and there was no tenderness or crepitation on palpation. No tracheal shift was found. She had normal respiratory rate and O2 saturation of 94% at ambient air. C (Circulation): Two large bore IV lines were inserted and blood samples were obtained. Her vital signs were BP = 60/40 mmHg, PR = 130/min, RR = 12. E-FAST was performed which was negative for free fluid in abdomen, pelvis and thorax, tamponade, and hemopneumothorax. Her pelvis was unstable on examination and pelvic wrapping was performed with sheath. IV fluid therapy with normal saline was started followed by 3 units of packed RBC transfusion. More pack cells and FFP were also requested. D (Disability): She had Glasgow coma scale of 15/15 with normal size and reactive pupil. No neurologic deficit was found except disability of lower extremities due to crush injury. E (Exposure): She had no midline spinal tenderness with normal sphincter anal tone, but there was a laceration in the perineum which extended to the vagina. Portable chest and pelvic x-ray as an adjutant to primary survey were performed which showed type C pelvic fracture. On her secondary survey, she had abrasion on her scalp, 1.5 cm laceration on her right tibia, deformity of her right thigh, and laceration in her genitalia with some vaginal bleeding. Direct pressure was applied and all lacerations were packed. According to negative e-FAST and pelvic fracture and shock, since the angiography was not available, it was decided to fix the pelvis with external fixator in the operation room. After the fixation, and because shock persisted, operative pelvic packing was undertaken. Unfortunately, she suffered cardiorespiratory arrest in the operating room and died

The study of upper gastrointestinal endoscopy in patients with inflammatory bowel disease and ulcerative colitis

زمینه و هدف: در بررسی های تشخیصی بیماری های التهابی روده، یکی از موارد تشخیصی انجام آندوسکوپی فوقانی است که علاوه بر تأیید تشخیص، در افتراق کولیت های نامشخص نیز کمک کننده است. هدف از این مطالعه بررسی لزوم انجام آندوسکوپی فوقانی در بیماران مبتلا به التهاب روده بوده است. روش بررسی: در این مطالعه توصیفی- تحلیلی تعداد 30 کودک در بیمارستان مرکز طبی به صورت سرشماری از مهر 1388 تا اسفند 1389 که به عنوان بیماری کرون و کولیت اولسراتیو به تشخیص قطعی رسیدند؛ تحت انجام آندوسکوپی فوقانی قرار گرفتند و داده ها با استفاده از نرم افزارSPSS و آزمون آماری t-test تجزیه و تحلیل شدند. یافته ها: از30 کودک با تشخیص بیماری التهابی روده، تعداد 15 بیمار دچار کرون و مابقی کولیت اولسراتیو داشتند. نتایج مطالعه حاضر حاکی از درگیری ماکروسکوپی مری در 93 بیماران، درگیری معده در 87 و درگیری دئودنوم در 26 بیماران با تشخیص کرون بود. در بیماران کولیت اولسراتیو درگیری مری 80، معده 66 و دئودنوم 20 بود. از نظر میکروسکوپی در بیماران کرون درگیری مری 94، درگیری معده 80 و در نهایت درگیری دئودنوم 47 مشاهده شد. در بیماران کولیت اولسراتیو از نظر میکروسکوپی 94 درگیری مری، 87 درگیری معده و 67 درگیری دئودنوم داشتند. نتیجه گیری: با توجه به درصد قابل توجه درگیری دستگاه گوارش فوقانی در بیماران با بیماری التهابی روده، انجام آندوسکوپی در تمام بیماران جدا از نوع و محل درگیری و بررسی هیستوپاتولوژیک کاری منطقی و لازم بنظر می رسد

Deep learning-based cross-classifications reveal conserved spatial behaviors within tumor histological images.

Histopathological images are a rich but incompletely explored data type for studying cancer. Manual inspection is time consuming, making it challenging to use for image data mining. Here we show that convolutional neural networks (CNNs) can be systematically applied across cancer types, enabling comparisons to reveal shared spatial behaviors. We develop CNN architectures to analyze 27,815 hematoxylin and eosin scanned images from The Cancer Genome Atlas for tumor/normal, cancer subtype, and mutation classification. Our CNNs are able to classify TCGA pathologist-annotated tumor/normal status of whole slide images (WSIs) in 19 cancer types with consistently high AUCs (0.995 ± 0.008), as well as subtypes with lower but significant accuracy (AUC 0.87 ± 0.1). Remarkably, tumor/normal CNNs trained on one tissue are effective in others (AUC 0.88 ± 0.11), with classifier relationships also recapitulating known adenocarcinoma, carcinoma, and developmental biology. Moreover, classifier comparisons reveal intra-slide spatial similarities, with an average tile-level correlation of 0.45 ± 0.16 between classifier pairs. Breast cancers, bladder cancers, and uterine cancers have spatial patterns that are particularly easy to detect, suggesting these cancers can be canonical types for image analysis. Patterns for TP53 mutations can also be detected, with WSI self- and cross-tissue AUCs ranging from 0.65-0.80. Finally, we comparatively evaluate CNNs on 170 breast and colon cancer images with pathologist-annotated nuclei, finding that both cellular and intercellular regions contribute to CNN accuracy. These results demonstrate the power of CNNs not only for histopathological classification, but also for cross-comparisons to reveal conserved spatial behaviors across tumors

Deep learning-based cross-classifications reveal conserved spatial behaviors within tumor histological images

Histopathological images are a rich but incompletely explored data type for studying cancer. Manual inspection is time consuming, making it challenging to use for image data mining. Here we show that convolutional neural networks (CNNs) can be systematically applied across cancer types, enabling comparisons to reveal shared spatial behaviors. We develop CNN architectures to analyze 27,815 hematoxylin and eosin scanned images from The Cancer Genome Atlas for tumor/normal, cancer subtype, and mutation classification. Our CNNs are able to classify TCGA pathologist-annotated tumor/normal status of whole slide images (WSIs) in 19 cancer types with consistently high AUCs (0.995 ± 0.008), as well as subtypes with lower but significant accuracy (AUC 0.87 ± 0.1). Remarkably, tumor/normal CNNs trained on one tissue are effective in others (AUC 0.88 ± 0.11), with classifier relationships also recapitulating known adenocarcinoma, carcinoma, and developmental biology. Moreover, classifier comparisons reveal intra-slide spatial similarities, with an average tile-level correlation of 0.45 ± 0.16 between classifier pairs. Breast cancers, bladder cancers, and uterine cancers have spatial patterns that are particularly easy to detect, suggesting these cancers can be canonical types for image analysis. Patterns for TP53 mutations can also be detected, with WSI self- and cross-tissue AUCs ranging from 0.65-0.80. Finally, we comparatively evaluate CNNs on 170 breast and colon cancer images with pathologist-annotated nuclei, finding that both cellular and intercellular regions contribute to CNN accuracy. These results demonstrate the power of CNNs not only for histopathological classification, but also for cross-comparisons to reveal conserved spatial behaviors across tumors.R01 CA230031 - NCI NIH HHSPublished versio

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017 : a systematic analysis for the Global Burden of Disease study 2017

Background: Stomach cancer is a major health problem in many countries. Understanding the current burden of stomach cancer and the differential trends across various locations is essential for formulating effective preventive strategies. We report on the incidence, mortality, and disability-adjusted life-years (DALYs) due to stomach cancer in 195 countries and territories from 21 regions between 1990 and 2017. Methods: Estimates from GBD 2017 were used to analyse the incidence, mortality, and DALYs due to stomach cancer at the global, regional, and national levels. The rates were standardised to the GBD world population and reported per 100 000 population as age-standardised incidence rates, age-standardised death rates, and age-standardised DALY rates. All estimates were generated with 95% uncertainty intervals (UIs). Findings: In 2017, more than 1·22 million (95% UI 1·19–1·25) incident cases of stomach cancer occurred worldwide, and nearly 865 000 people (848 000–885 000) died of stomach cancer, contributing to 19·1 million (18·7–19·6) DALYs. The highest age-standardised incidence rates in 2017 were seen in the high-income Asia Pacific (29·5, 28·2–31·0 per 100 000 population) and east Asia (28·6, 27·3–30·0 per 100 000 population) regions, with nearly half of the global incident cases occurring in China. Compared with 1990, in 2017 more than 356 000 more incident cases of stomach cancer were estimated, leading to nearly 96 000 more deaths. Despite the increase in absolute numbers, the worldwide age-standardised rates of stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with improved Socio-demographic Index. Globally, 38·2% (21·1–57·8) of the age-standardised DALYs were attributable to high-sodium diet in both sexes combined, and 24·5% (20·0–28·9) of the age-standardised DALYs were attributable to smoking in males. Interpretation: Our findings provide insight into the changing burden of stomach cancer, which is useful in planning local strategies and monitoring their progress. To this end, specific local strategies should be tailored to each country's risk factor profile. Beyond the current decline in age-standardised incidence and death rates, a decrease in the absolute number of cases and deaths will be possible if the burden in east Asia, where currently almost half of the incident cases and deaths occur, is further reduced. Funding: Bill & Melinda Gates Foundation