Biomedical subjects

D L Johnson

Publications and source records attributed to D L Johnson.

At least 19 recordsLinked to original sources

PubMed2006

N-glucuronidation of the platelet-derived growth factor receptor tyrosine kinase inhibitor 6,7-(dimethoxy-2,4-dihydroindeno[1,2-C]pyrazol-3-yl)-(3-fluoro-phenyl)-amine by human UDP-glucuronosyltransferases.

The potential cancer therapeutic agent, 6,7-(dimethoxy-2, 4-dihydroindeno[1,2-c]pyrazol-3-yl)-(3-fluoro-phenyl)-amine (JNJ-10198409), formed three N-glucuronides that were positively identified by liquid chromatography-tandem mass spectrometry and NMR as N-amine-glucuronide (Glu-A), 1-N-pyrazole-glucuronide (Glu-B), and 2-N-pyrazole-glucuronide (Glu-C). All three N-glucuronides were detected in rat liver microsomes, whereas only Glu-A and -B were found in monkey and human liver microsomes. In contrast to common glucuronides, Glu-B was completely resistant to beta-glucuronidase. Kinetic analyses revealed that glucuronidation of JNJ-10198409 in human liver microsomes exhibited atypical kinetics that may be described by a two-site binding model. For the high affinity binding, K(m) values were 1.2 and 5.0 microM, and V(max) values were 2002 and 2,403 nmol min(-1) mg(-1) for Glu-A and Glu-B, respectively. Kinetic constants of low affinity binding were not determined due to low solubility of the drug. Among the human UDP-glucuronosyltransferases (UGTs) tested, UGT1A9, 1A8, 1A7, and 1A4 were the most active isozymes to produce Glu-A; for the formation of Glu-B, UGT1A9 was the most active enzyme, followed by UGT1A3, 1A7, and 1A4. Glucuronidation of JNJ-10198409 by those UGT1A enzymes followed classic Michaelis-Menten kinetics. In contrast, no glucuronides were formed by all UGT2B isozymes tested, including UGT2B4, 2B7, 2B15, and 2B17. Collectively, these results suggested that glucuronidation of JNJ-10198409 in human liver microsomes is catalyzed by multiple UGT1A enzymes. Since UGT1A enzymes are widely expressed in various tissues, it is anticipated that both hepatic and extrahepatic glucuronidation will likely contribute to the elimination of the drug in humans. Additionally, conjugation at the nitrogens of the pyrazole ring represents a new structural moiety for UGT1A-mediated reactions.

Animals↗

PubMed2006

Direct electrochemistry of human, bovine and porcine cytochrome P450c17.

The direct electrochemistry of human, bovine and porcine cytochrome P450c17 (CYP17) has been examined on an edge-oriented pyrolytic graphite electrode. The recombinant protein was immobilized on an electrode modified with a surfactant to simulate the environment of a biological membrane, and hence physiological electron-transfer conditions. The P450 enzymes all retained 'electron-transfer' activity while immobilized at the electrode surface as assessed by the presence of catalytic signals under aerobic conditions. The redox potentials for porcine P450c17 were more positive (anodic) than both the human and bovine forms, perhaps reflecting the differences in substrate specificity for these species. In addition, these enzymes were all influenced by pH, consistent with a single proton associated with the single electron-transfer event. Ionic strength of the buffer medium also shifted the redox potentials towards positive, suggesting that electrostatic forces contribute to the protein environment required for the electron-transfer process. The effect of substrate on the redox potential for each P450c17 was measured in the presence of pregnenolone, progesterone, 17alpha-hydroxypregnenolone and 17alpha-hydroxyprogesterone. However, no influence on the redox parameters was observed.

Animals↗

PubMed2005

Electrochemical characterisation of the human cytochrome P450 CYP2C9.

The electrochemistry of human cytochrome P4502C9 (CYP2C9) was characterised using purified His-tagged enzyme. The His-tagged enzyme was shown to have similar functional characteristics to native CYP2C9 heterologously expressed in Escherichia coli and to the CYP2C9 activity of human liver microsomes. Evidence was observed for a reversible one-electron transfer between the P450 heme and the electrode. Both pH and ionic strength influenced the electrochemical behaviour of CYP2C9. A range of substrates was investigated to determine the effect of the heme-substrate interaction on CYP2C9 redox potential. In the absence of oxygen, tolbutamide, diclofenac, warfarin and sulfaphenazole did not alter the redox potential of the iron heme. In contrast, torsemide, carbon monoxide and oxygen led to an anodic shift in redox potential. These results suggest alternative mechanisms by which CYP2C9 (and by inference other P450 enzymes) may alter redox potential to facilitate electron delivery from physiological donors.

Aryl Hydrocarbon Hydroxylases↗

PubMed2005

Direct evidence of oxidized gold on supported gold catalysts.

Supported gold catalysts have drawn worldwide interest due to the novel properties and potential applications in industries. However, the origin of the catalytic activity in gold nanoparticles is still not well understood. In this study, time-of-flight secondary ion mass spectroscopy (TOF-SIMS) has been applied to investigate the nature of gold in Au (1.3 wt %)/gamma-Al2O3 and Au (2.8 wt %)/TiO2 catalysts prepared by the deposition-precipitation method. The SIMS spectrum of the supported gold catalysts presented AuO-, AuO2-, and AuOH- ion clusters. These measurements show direct evidence for oxidized gold on supported gold catalysts and may be helpful to gaining better understanding of the origin of the catalytic activity.

Letter↗

PubMed2005

Initial results for urban metal distributions in house dusts of Syracuse, New York, USA.

A program of house dust sample collection and analysis has begun in Syracuse, New York, USA, in order to determine the feasibility of a geography-based exposure assessment for urban metals. The sampling program, and the protocols it employs, is described for two different types of wipe media, Ghost Wipes and Whatman Filters. Preliminary results show that strong spatial patterns of floor dust loading (mg dust per square foot) can be observed for data aggregated at a spatial scale of about 1600 m (approximately 2.5 km2). Floor dust metal concentrations were similar to those found in other urban environments, with some regional variation. The median floor dust Pb concentration was approximately 108 mg x kg(-1) for this initial data set of approximately 264 sampled residential locations, and varied from 50 to 1100 mg Pb x kg(-1).

Air Pollution, Indoor↗

PubMed2005

The influence of host suitability on the range of grasshopper species utilized by Blaesoxipha atlanis (Diptera: Sarcophagidae) in the field.

Blaesoxipha atlanis (Aldrich) is a common parasitic fly of agriculturally important grasshoppers in Canada. The suitability of Camnula pellucida (Scudder), Melanoplus bivittatus (Say), Melanoplus packardii Scudder, and Melanoplus sanguinipes (Fabricius) as hosts was studied in the laboratory. Grasshoppers were singly-parasitized or left unparasitized and reared for 9 days. Melanoplus bivittatus and M. packardii did not support parasite development, i.e. were non-permissive hosts. In both species, parasite larvae were melanized and encapsulated, but development proceeded further in M. packardii. Melanoplus sanguinipes and C. pellucida were permissive host species with, respectively, 70% and 35% of the implanted larvae emerging from their hosts of which 86% and 50% developed into adults. Parasite development time was longer in C. pellucida. Adult B. atlanis dry mass varied with host species and host mass at parasitism, but not with host sex. Parasites developing in M. sanguinipes were larger in terms of dry mass than counterparts developing in C. pellucida. In permissive species, unparasitized grasshoppers gained in body mass while parasitized insects lost mass during the 9-day observation period. In non-permissive species, all insects gained in body mass, but parasitized females gained less mass than unparasitized conspecifics. All unparasitized grasshoppers survived while 75-95% of permissive and 30-40% of non-permissive hosts died. Variation in the intensity of field parasitism among grasshopper species may be explained, at least in part, by qualitative differences in suitability between potential host species. Novel pest management strategies emphasize preservation of a small proportion of the pest population for natural enemies. Consideration of the outcome of specific host-parasite interactions should improve the understanding of grasshopper population dynamics and increase the predictive value of models that assess potential crop losses.

Animals↗

PubMed2004

Test of hyperelasticity in highly nonlinear solids: sedimentary rocks.

We report measurements of three-wave mixing amplitudes on systems whose third order elastic constants have also been measured by means of the elastoacoustic effect. Because attenuation and diffraction are an important aspect of our measurement technique we analyze our results using a modified Khoklhov-Zabolotskaya-Kuznetsov equation in the frequency domain. We find that the value of beta so deduced for polymethyl methacrylate agrees quite well with that predicted from the stress dependent sound speed measurements, establishing that polymethyl methacrylate may be considered as a hyperelastic solid. The beta values of sedimentary rocks, though they are typically 2 orders of magnitude larger than, e.g., polymethyl methacrylates, are still a factor 3-10 less than those predicted from the elastoacoustic effect.

Journal Article↗

PubMed2004

Method-induced misclassification for a respirable dust sampled using ISO/ACGIH/CEN criteria.

The single cut measurement of exposure to respirable dust is the accepted method of exposure classification in occupational hygiene. We previously showed that actual pulmonary tissue dose may be substantially different from the dose expected, or the indicated dose, based on measurements using current single cut methodologies. We now examine exposure misclassification of workers based on any single cut respirable dust measurement using the internationally accepted ISO/ACGIH/CEN single cut respirable dust measurement criteria. Hypothetical aerosols with 12 generalized size distributions typical of the method of aerosol generation (condensation, aged condensation, mechanical low energy, mechanical high energy and mixtures thereof) were assumed. Using previously reported models for sampler penetration and pulmonary deposition, Monte Carlo simulations of actual mass dose to pulmonary tissues in comparison to the dose estimate from an ideal respirable aerosol sampler were carried out. Measurement-based indicated doses were used to classify exposures into five exposure categories and these classifications were compared with the 'true' classifications from the dose-based exposure estimates. Misclassification rates were generally severe and were greatest for aerosols with mass median aerodynamic diameter (MMAD) <1 microm (approximately 100%) and MMAD 5-15 microm (65-95%). Misclassification rates were moderate (<20%) only for extremely coarse aerosols of MMAD>15 microm. Misclassification rates for oral and nasal breathing at 750 and 1500 ml tidal volume and 15 breaths/min were similar for each aerosol examined.

Aerosols↗

PubMed2004

Influence of prepartum pirlimycin hydrochloride or penicillin-novobiocin therapy on mastitis in heifers during early lactation.

A study was conducted in 2 dairy research herds to determine whether prepartum therapy of heifer mammary glands with penicillin-novobiocin or pirlimycin hydrochloride was effective for reducing the percentage of heifers and mammary quarters infected with mastitis pathogens during early lactation. Almost 96% of Jersey heifers (67 of 70) and 71.3% of quarters (199 of 279) were infected 14 d before expected calving. Of the quarters infected at 14 d before expected parturition, 75% (54 of 72) were uninfected following treatment with penicillin-novobiocin; 87% (61 of 70) were uninfected following treatment with pirlimycin, and 56% (32 of 57) were uninfected in the untreated negative control group. The majority of intramammary infections in Jersey heifers were due to coagulase-negative staphylococci (61%), Streptococcus species, primarily Streptococcus uberis (19%), and Staphylococcus aureus (8%). Almost 73% of Holstein heifers (40 of 55) and 34.3% of mammary quarters (73 of 213) were infected 14 d before expected calving. Of the quarters infected at 14 d before expected parturition, 76% (19 of 25) were uninfected following treatment with penicillin-novobiocin; 59% (17 of 29) were uninfected following treatment with pirlimycin, and 26% (5 of 19) were uninfected in the untreated negative control group. The majority of intramammary infections in Holstein heifers were due to coagulase-negative staphylococci (44%) and Staph. aureus (30%). In both herds, the bacteriological cure rate was significantly higher in heifer mammary glands treated with penicillin-novobiocin or pirlimycin hydrochloride than in untreated controls. Prepartum therapy of heifer mammary glands with penicillin-novobiocin or pirlimycin hydrochloride significantly reduced the percentage of heifers and quarters infected with mastitis pathogens during early lactation.

Animals↗

PubMed2004

Efficacy of extended ceftiofur intramammary therapy for treatment of subclinical mastitis in lactating dairy cows.

Little research has focused on treatment of cows with subclinical mastitis during lactation. Ceftiofur is a new broad-spectrum, third-generation cephalosporin antibiotic for veterinary use that inhibits bacterial cell wall synthesis by interfering with enzymes essential for peptidoglycan synthesis. Ceftiofur should be effective against a wide range of contagious and environmental mastitis pathogens. Objectives of the present study were to evaluate the efficacy of ceftiofur for treatment of subclinical mastitis in lactating dairy cows, and to determine if extended therapy regimens enhanced efficacy of ceftiofur. Holstein and Jersey dairy cows (n = 88) from 3 dairy research herds were used. Cows were enrolled in the study based on milk somatic cell counts >400,000/mL and isolation of the same mastitis pathogen in 2 samples obtained 1 wk apart. Cows with one or more intramammary infections (IMI) were blocked by parity and DIM and allocated randomly to 1 of 3 different ceftiofur treatment regimens: 2-d (n = 49 IMI), 5-d (n = 41 IMI), and 8-d (n = 38 IMI) treatment regimens. For all groups, 125 mg of ceftiofur hydrochloride was administered via intramammary infusion. Eighteen cows with 38 IMI were included as an untreated negative control group. A bacteriological cure was defined as a treated infected mammary quarter that was bacteriologically negative for the presence of previously identified bacteria at 14 and 28 d after the last treatment. Efficacy of ceftiofur therapy against all subclinical IMI was 38.8, 53.7, and 65.8% for the 2-, 5-, and 8-d ceftiofur treatment regimens, respectively. Four of 38 (10.5%) IMI in control cows were cured spontaneously without treatment. All 3 ceftiofur treatment regimens were significantly better than the negative control, and the 8-d extended ceftiofur treatment regimen treatment group was significantly better than the standard 2-d treatment group. Pathogen groups had significantly different cure rates from one another. The cure rate for the 8-d extended ceftiofur treatment regimen was 70% for Corynebacterium bovis, 86% for coagulase-negative Staphylococcus species, 36% for Staph. aureus, 80% for Streptococcus dysgalactiae ssp. dysgalactiae, and 67% for Strep. uberis.

Animals↗

PubMed2004

Extended ceftiofur therapy for treatment of experimentally-induced Streptococcus uberis mastitis in lactating dairy cattle.

Streptococcus uberis is an important cause of mastitis in dairy cows throughout the world, particularly during the dry period, the period around calving, and during early lactation. Strategies for controlling Strep. uberis mastitis are poorly defined and are currently inadequate. Objectives of the present study were to evaluate efficacy of ceftiofur, a new broad-spectrum cephalosporin antibiotic, for treatment of experimentally induced Strep. uberis intramammary infections (IMI) in lactating dairy cows during early lactation and to determine whether extended therapy regimens enhanced efficacy of ceftiofur. Efficacy of extended ceftiofur intramammary therapy regimens was investigated in 37 mammary quarters of 23 dairy cows that developed clinical mastitis following experimental infection with Strep. uberis during early lactation. Cows that developed clinical mastitis during the challenge period were allocated randomly to 3 groups representing 3 different ceftiofur treatment regimens: 2-d (n = 7 mammary quarters), 5-d (n = 16 mammary quarters), and 8-d (n = 14 mammary quarters) treatment regimens. For all groups, 125 mg of ceftiofur hydrochloride was administered via intramammary infusion. A bacteriological cure was defined as an experimentally infected quarter that was treated and was bacteriologically negative for the presence of Strep. uberis at 7, 14, 21, and 28 d posttreatment. Percentage of Strep. uberis IMI eliminated was 43, 88, and 100% for the 2-, 5-, and 8-d ceftiofur treatment regimens, respectively. Both the 5- and 8-d ceftiofur extended therapy treatment regimens had significantly higher bacterial cure rates than the standard 2-d ceftiofur treatment regimen. The bacterial cure rate of the 8-d ceftiofur extended therapy group was marginally better (P = 0.052) than the 5-d ceftiofur extended therapy group. Results of this study indicate that ceftiofur therapy was effective for eliminating Strep. uberis experimental IMI, and 5- and 8-d extended ceftiofur therapy regimens were more effective than the standard 2-d treatment.

Animals↗

PubMed2002

The influence of promoter and of electrode material on the cyclic voltammetry of Pisum sativum plastocyanin.

The reversible cyclic voltammetry of pea plastocyanin (Pisum sativum) was studied with a wide range of electrodes: edge-oriented pyrolytic graphite (PGE), glassy carbon (GCE), gold (Au) and platinum (Pt) electrodes. Plastocyanin was coated onto the electrode surface by exploiting the electrostatic interaction between the negatively charged protein and a wide range of positively charged promoters. The effect of the redox response with an extended range of promoters, including poly-L-lysine, polymyxin B, neomycin, tobramycin, geneticin, spermine and spermidine, were included in this study. The resulting cyclic voltammograms reveal that the observed midpoint potential for plastocyanin can be shifted significantly depending on the choice of promoter. The stability of the negatively charged plastocyanin-promoter layer on an electrode was gauged by the rate of bulk diffusion of the protein from the immobilised film into the solution. Reversible cyclic voltammograms were obtained using edge-oriented pyrolytic graphite (PGE) and glassy carbon electrodes (GCE) with all promoters; however, platinum and gold electrodes were unable to sustain a defined redox response. The combination of pyrolytic graphite electrode/poly-L-lysine/plastocyanin was found to be the most stable combination, with a redox response which remained well defined in solution for more than 1 h at pH 7.0. The midpoint potentials obtained in this manner differed between the two graphite electrodes PGE and GCE using poly-L-lysine as the promoter. This effect was in addition to the expected pH dependence of the midpoint potential for plastocyanin and the results indicated that the pK(a) for plastocyanin on PGE was 4.94 compared to that on GCE of 4.66. It is concluded that both the electrode material and the nature of the promoter can influence the position of the redox potentials for proteins measured in vitro. This study extends the range of biogenic promoters used in combination with electrode materials. Thus, we can begin to develop a more comprehensive understanding of electrode-protein interactions and draw conclusions as to metalloprotein function, in vivo. To support these studies, we have sought information as to the nature of the electrode/promoter/protein interaction using scanning tunneling microscopy (STM) to study both the promoter and the plastocyanin protein on a gold surface.

Biogenic Amines↗

PubMed2002

A field comparison of the IOM inhalable aerosol sampler and a modified 37-mm cassette.

This research focused on comparing a modified 37-mm (Mod37) sampling cassette with an IOM inhalable dust sampler. Paired IOM and Mod37 breathing-zone air samples were collected for workers engaged in corrosion control maintenance operations on several types of aircraft at several U.S. Air Force bases in the United States. Sampled operations included hand and power sanding, blow-down and wipe-down to remove dust, and spray finishing. The cassettes' interior surfaces were swabbed and the swabs combined with the filters for chromium analysis by NIOSH Method 7300. This approach utilized total chromium as a sensitive surrogate indicator of total aspirated mass. The influences of work location, work type, sample duration, and sampler type on measured concentration were evaluated using analysis of variance techniques. Only work type (process) was found to be a statistically significant predictor of measured concentration. The relationship between IOM- and Mod37-measured values for paired samples was evaluated by work type using linear regression techniques. Linear regressions showed that the modified 37-mm cassette over-samples aerosol by 35 percent compared to the IOM when a wide range of aerosol concentrations and compositions for divergent work tasks in multiple field locations are sampled. Interpretation of these results in light of previous results involving filter-only Mod37 analyses suggests that while the Mod37 has a higher aspiration efficiency than the IOM, substantial Mod37 wall losses result in underestimation of exposure when only the 37-mm filter is analyzed rather than filters plus wall swabs.

Aerosols↗

PubMed2002

The variability of delivered dose of aerosols with the same respirable concentration but different size distributions.

The influences of aerosol size distribution and breath tidal volume on respirable dose estimates were examined for mouth breathing using the ACGIH/ISO/CEN criterion for respirable-equivalent aerosols. Actual tissue doses predicted from a set of pulmonary empirical deposition equations, the Heyder-Rudolf equations, were compared with deposition assumed to occur under the penetration-based respirable dust sampling criterion. Deposition estimate errors ranged from approximately 1/10- to 10-fold, with aerosol mass median aerodynamic equivalent diameter and geometric standard deviation as well as tidal volume each showing a substantial influence under appropriate conditions. These findings demonstrate that reliance on respirable aerosol sampling data obtained with devices performing on a penetration-based sampling criterion may lead to erroneous dose-response relationships in exposure standard development as well as exposure misclassification errors during epidemiological studies. A more reliable dose estimate would be obtained using devices with collection efficiency performance closely matching the alveolar deposition prediction curves of Heyder and Rudolf. We believe that if it is not currently required, the development of a deposition-based aerosol sampling methodology will soon be required for the determination and quantification of inhaled aerosol-induced adverse health effects.

Aerosols↗

PubMed2002

Strategic targeting of essential host-pathogen interactions in chlamydial disease.

The chlamydiae are obligate intracellular gram-negative bacteria that are exquisitely adapted for exploitation of their hosts and contribute to a wide range of acute and chronic human diseases. Acute infections treated with non-cidal antibiotics can lead to the development of persistent, non-replicating bacteria with the corollary that these persistent (yet viable) chlamydiae can resist eradication by further antimicrobial treatment and cause chronic disease. These findings highlight an urgent need for therapeutics that are effective against persistent infections and call for creative approaches to identify potential drug targets. The C. pneumoniae and C. trachomatis genome projects have greatly expanded our knowledge of chlamydial pathogenesis and have provided an enormous potential for the identification and characterization of unknown genes and potential virulence factors in these bacteria. As intracellular pathogens, chlamydiae rely on host cells for all aspects of their survival, from the initial attachment with host cell membranes, to cellular invasion, acquisition of host cell metabolites and intracellular replication. As such, the molecules participating in interactions with the host could be attractive targets for therapeutic intervention. This review describes recent advances in chlamydial genomics, proteomics and cell biology that have cast light on host-pathogen relations that are essential for chlamydial survival. Using this knowledge, we discuss how strategically interfering with essential interactions between chlamydiae and the host cell could be exploited to develop an innovative, and potentially more relevant arsenal of therapeutic compounds.

Anti-Bacterial Agents↗

PubMed2001

Initial sequencing and analysis of the human genome.

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.

Animals↗

PubMed2001

Cancer cells surviving hypoxia obtain hypoxia resistance and maintain anti-apoptotic potential under reoxygenation.

In solid tumors hypoxia and reoxygenation may be important factors in secondary expansion after anti-cancer therapy. Our study examined the effect of hypoxia and reoxygenation on the apoptotic potential of cancer cells. Four experimental groups were studied using a human colorectal cancer cell line (HCT116) that is apoptosis-competent in conventional culture: (1) sham, cells grown under conventional conditions; (2) hypoxic, cells cultured in 95% N2 and 5% CO2 for 24 hr; (3) continued hypoxic, cells cultured for 48 hr; and (4) reoxygenation, cells grown in hypoxic conditions for 24 hr followed by another 24 hr under conventional conditions. Protein expression of p53, bcl-2 and PCNA were determined by immunohistochemistry and immunoblotting (p53), and viable cell growth rate was determined. Hypoxia for 24 hr induced significant up-regulation of p53 and bcl-2 expression, accompanied by significant decreases of cell growth rate and PCNA expression. Up-regulation of p53 and bcl-2 expression persisted with both continued hypoxia and reoxygenation, despite increased cell growth rate and PCNA expression. Cells escaping hypoxia acquired sustained resistance to apoptosis and proliferate despite an elevated p53 level, suggesting that p53 transfer to hypoxic solid tumor should be reevaluated as a cancer gene therapy approach.

Apoptosis↗

PubMed2001

Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures.

This retrospective study assessed 5 male and 5 female patients, age 35.1+/-16 years, height 171.8+/-12 cm, and weight 75.5+/-18 kg (mean+/-SD) who were more than 1 year post isolated tibial fracture (18+/-6 months) and had been treated with an intramedullary tibial nail. Subjects completed a 12-question visual analog scale, a physical symptom and activity of daily living survey, and were also tested for bilateral isokinetic (60 degrees/s) quadriceps femoris and hamstring strength. Knee pain during activity, stiffness, swelling, and buckling were the primary symptomatic complaints. Perceived functional task deficits were greatest for climbing or descending stairs, pivoting, squatting, and walking on uneven surfaces. Involved lower extremity knee extensor and flexor torque production deficits were 25% and 17%, respectively. Early rehabilitation focuses on maintaining adequate operative site bony fixation while providing controlled, progressive, and regular biomechanical loading to restore functionally competent tissue. Following adequate fracture healing, greater emphasis should be placed on lower extremity functional recovery including commonly performed activities of daily living and other functional tasks that are relevant to the patient's disability level. A cyclic rehabilitation program that progresses the weight-bearing environment to facilitate bone and soft tissue healing and neuromuscular re-education is proposed.

Adult↗