This study aimed to examine the impact of handwriting versus iPad writing on cervical alignment and pinch muscle strength among female university students at the Faculty of Physical Therapy, Cairo University. Thirty female students were divided into two equal groups: Group A engaged in handwriting, and Group B used iPad writing. The mean body mass index of the participants was 25.12 kg/m². Each participant was instructed to write for 15 min. Cervical range of motion (ROM) devices were used to assess cervical flexion, lateral bending, and rotation, whereas key pinch strength was measured to evaluate the strength of the dominant pinch muscles. Analysis of variance (ANOVA) indicated no significant differences in the pinch strength outcome variables between the handwriting and iPad writing groups, F (1, 28) = 12.54, P = 0.25; η² = 0.05. The handwriting group exhibited lower mean values within their group compared to the iPad group. Furthermore, a repeated-measures ANOVA comparing the groups revealed no significant difference in the mean cervical range of motion (ROM) in flexion between the two groups (P = 0.67). However, the mean values for the handwriting group increased post-writing compared to those for the iPad group. The repeated-measures ANOVA between groups also demonstrated no significant difference in the mean cervical range of motion values for rotation to the right after writing for either group (P = 0.34) or for the cervical range of motion for rotation to the left (P = 0.49); however, an increase in the mean values of cervical rotation to the right was observed for the handwriting group. Using an iPad increases the degree of lateral bending and rotation to the left and right. In addition, the degree of right rotation increased in the iPad group. However, key-pinch muscle strength was lower in the handwriting group than in the iPad writing group.
Background: Patch testing is the gold standard for diagnosing contact allergies, but its diagnostic accuracy can be influenced by subjective visual assessment and variability in measurement using 2D imaging systems.Objective: This study evaluated the accuracy of the Iko Derma Monitor 3D imaging system in comparison to a standard clinic iPad for patch test reaction evaluation.Methods: Forty-two patients undergoing patch testing were included, yielding 293 evaluated reactions. Reactions were imaged on day 2 and day 4 using the Iko Derma Monitor, an iPad, and a handheld dermatoscope. Measurements of lesion area were compared across imaging modalities, and statistical tests were conducted to assess changes over time and accuracy differences between the Iko Derma Monitor and iPad.Results: The 3D imaging device demonstrated significantly higher accuracy than the iPad when compared to the dermatoscope as the reference standard (P < 0.001). Both devices detected significant changes in lesion area over time, but the 3D device provided more consistent and sensitive measurements.Conclusion: The Iko Derma Monitor 3D camera offers superior accuracy and sensitivity compared to iPad-based imaging for patch test reactions. Its ability to standardize documentation may improve diagnostic precision and expand access to remote or underserved populations.
iPad-based eye tracking could support Parkinson's disease (PD) screening and longitudinal monitoring by enabling objective, low-cost, portable assessment of oculomotor function. We previously validated an iPad-based eye-tracking system against the EyeLink 1000 Plus for temporal and spatial saccade metrics. Here, in a convenience sample of 19 healthy controls (HC) and 12 patients with PD, we recorded eye movements simultaneously with both devices during pro-saccade, anti-saccade (AS), memory-guided saccade (MGS), and self-generated saccade tasks. Across all pre-specified metrics, statistically significant PD-HC differences and null results were concordant between devices. In addition, saccade-level mixed-effects models showed small group × device interaction effects that remained below literature-based benchmarks for clinically meaningful PD-HC differences, indicating that iPad-based measurements preserved benchmark clinical-grade group-level effects. A compact three-metric iPad-based classifier comprising AS directional error rate, AS gain, and MGS gain supported strong subject-level PD-HC discrimination, with an area under the receiver operating characteristic curve of 0.98, sensitivity of 0.91, specificity of 1.00, and accuracy of 0.96. These findings support scalable tablet-based oculomotor assessment for PD-related screening and longitudinal monitoring.
Patient activation, defined as the knowledge, skills, and confidence to manage one’s health, is associated with better outcomes in chronic disease. However, evidence on interventions that improve activation in people with kidney failure on hemodialysis remains limited. This single-centre, prospective, randomised controlled trial conducted with adults undergoing long-term hemodialysis in an acute dialysis unit tests the hypothesis that adding tailored activation interventions to usual care improves patient activation and reduces complications in hemodialysis patients compared to usual care alone. A target sample size of 140 patients was recruited and randomised to IPAD interventions or usual care in a 1:1 ratio with an expected intervention period of at least 6 months. The primary outcome of IPAD was change in patient activation from baseline to 18 months. Recruitment has been completed, with 140 participants enrolled out of 147 individuals screened. The study cohort had a mean age of 58.4 ± 14.8 years and was predominantly male (72.1%, n = 101). The leading cause of kidney failure was diabetes (41.4%, n = 58), followed by IgA nephropathy (15%, n = 21) and hypertension (7.9%, n = 11). Comorbidity burden was substantial, with 55.7% (n = 78) of participants classified as severe. The mean Patient Activation Measure (PAM) score was 61.9 (± 15.0), reflecting moderate levels of engagement in self-management at the start of the study. Of 147 individuals screened, 140 were enrolled in the study. Recruitment and enrolment targets were successfully achieved, with the cohort broadly representative of the dialysis population, including strong participation from culturally and linguistically diverse and socioeconomically disadvantaged groups. The careful planning and successful execution of the study in resource-constrained environments highlight its feasibility and flexibility, establishing it as a scalable and cost-efficient model for broad implementation in dialysis care globally. The online version contains supplementary material available at 10.1186/s12882-026-05005-w.
Shigellosis is a major cause of morbidity and mortality worldwide, especially among children under five in low- and middle-income countries. Despite its public health burden, there is no licensed vaccine. Recombinant and nanoparticle-based vaccine approaches offer promising alternatives to conventional methods. This study aimed to develop a chimeric nanovaccine based on the fusion of Shigella flexneri IpaD and StxB, encapsulated in PLGA nanoparticles, and to evaluate its immunogenic potential in a murine model. The recombinant IpaD-StxB (IdSb) protein was expressed in E. coli, purified under denaturing conditions, and encapsulated into PLGA nanoparticles using a double emulsion solvent evaporation technique. Particle size, morphology, encapsulation efficiency, and in vitro release were characterized. BALB/c mice were immunized with either Nano-IdSb or free IdSb, and serum IgG levels were assessed via ELISA to evaluate the humoral immune response. The 24 kDa recombinant IdSb protein was successfully expressed in a prokaryotic system, yielding 10 mg/mL. PLGA nanoparticles encapsulating IdSb had an average diameter of 166 nm, high encapsulation efficiency (97%), and a loading capacity of 3.5%. They enabled sustained protein release over 40 days. Mice immunized with Nano-IdSb exhibited significantly stronger IgG responses than those receiving the free protein, indicating enhanced immunogenicity and antigen stability. PLGA-encapsulated IdSb nanovaccine elicited a robust humoral immune response and demonstrated favorable physicochemical properties, supporting its potential as a cost-effective and broadly protective vaccine candidate against Shigella spp.
The relationship between the metabolic score for insulin resistance (METS-IR) and cardiometabolic risk factors in premature coronary artery disease (PCAD) is unclear. This study aimed to investigate the association between METS-IR and hypertension, as well as systolic blood pressure (SBP) and diastolic blood pressure (DBP), in patients with PCAD. This cross-sectional analysis of the Iran Premature Coronary Artery Disease (IPAD) study included women aged ≤ 70 and men aged ≤ 60 with PCAD. Associations between METS-IR and hypertension were examined using logistic regression, and those with SBP and DBP were examined using generalized linear models. METS-IR was modeled per 1-unit increase and quartiles. Ethnicity-stratified analyses were performed in quartiles. Results are reported as odds ratios (ORs), β coefficients, and 95% confidence intervals (CIs). Overall, 1,688 patients were analyzed, with a mean age of 55.0 ± 7.1 years. SBP and DBP increased across the METS-IR levels (P for trend < 0.001). Continuous METS-IR was associated with a higher odds of hypertension (OR: 1.03; 95% CI: 1.02-1.05). Compared with Q1, the highest quartile had a higher odds of hypertension (OR: 2.70; 95% CI: 1.96-3.72; P for trend < 0.001). In ethnicity-stratified analyses, the associations were significant in the Fars (P < 0.001), Azari (P = 0.005), and Bakhtiari (P = 0.040) populations. Other ethnic groups showed imprecise estimates, owing to the small sample sizes. METS-IR was positively associated with hypertension and higher SBP and DBP in patients with PCAD. Associations varied across ethnic groups, underscoring the need for prospective studies to define population-specific thresholds and prognostic implications.
ImportanceEfficient and accurate tools for early detection of hearing loss are essential for reducing delays in diagnosis and treatment.ObjectiveTo determine the accuracy and reliability of Automated iPad Hearing Screening (AIHS) as a screening tool compared to a formal pure tone audiometry (PTA).DesignA parallel cross-sectional study.SettingTertiary referral center in Hong Kong.ParticipantsSeventy-nine adult patients (158 ears) aged from 28 to 87 who were diagnosed with hearing loss were included.Exposure or InterventionParticipants underwent the AIHS screening at 1, 2, 4, and 0.5 kHz in the right and left ears, respectively, prior to a formal PTA, focusing solely on air conduction thresholds.Main Outcome MeasuresSensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) for detecting hearing loss at 3 thresholds: >25, >40, and >60 dBHL. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between AIHS and PTA.ResultsExcellent sensitivity and specificity of the AHIS were identified across 3 age groups and different hearing levels. The AUCs of AHIS were .917 (95% CI: .842-.993), .911 (.863-.960), and .968 (.942-.994) for thresholds over 25, 40, and 60 dBHL, respectively. ICC = .901 (.864-.927) and Bland-Altman analysis indicated good agreement between these 2 methods.ConclusionThe AIHS is a simple, intuitive, and portable screening test for hearing loss that can be repeated with high accuracy and reliability at relatively low cost.
Digital cognitive assessments are increasingly used in large-scale studies to assess brain health, offering scalable, standardized, and self-directed testing solutions. Cognitive function remains a concern for people with HIV despite antiretroviral therapy. The BRACE (BrainBaseline Assessment of Cognition and Everyday Functioning) is a validated tablet-based screener for cognition in people with HIV. Preliminary pilot norms were established in a small sample (n=144), but full regression-based normative data have not yet been developed. Consequently, HIV serostatus differences based on standardized BRACE scores and cognitive correlates have not been systematically examined. This study aims to develop regression-based normative data for BRACE performance in people without HIV who were demographically and behaviorally comparable to people with HIV within biological sex; to examine differences in cognitive performance by HIV status and biological sex; and to evaluate sociodemographic, behavioral, and clinical correlates of BRACE performance. A total of 2937 participants (1063 people without HIV [499 women] and 1874 people with HIV [1053 women]) in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study completed BRACE once between November 2020 and March 2025. BRACE includes the Trail Making Test (A and B), Stroop-Color, and visual spatial learning. Regression-based norms were derived from people without HIV using multiple demographic models (eg, age-only, age + education, and age + education + sex). The age + education model was selected for primary analyses because it provided the best balance of interpretability, parsimony, and generalizability while avoiding race-based corrections. HIV serostatus and sex differences were examined using ANOVA and χ2 tests, with effect sizes calculated using Cohen's d. Cognitive performance was largely comparable between people with HIV and people without HIV across all BRACE outcome measures. Statistically significant differences were very small in magnitude (all effect sizes<0.11) and primarily observed among men on Stroop-Color. Across groups, older age and fewer years of education were associated with poorer raw BRACE performance, although these associations attenuated after demographic adjustment using T-scores. Most clinical and behavioral factors (eg, hypertension, smoking, and noncannabis substance use) were related to poorer raw scores but not standardized performance. However, diabetes and cannabis use remained independently associated with T-scores across multiple measures-diabetes with poorer scores and cannabis use with higher scores, an association that should be interpreted cautiously. HIV-specific clinical factors, such as nadir CD4 count and antiretroviral therapy duration, were linked primarily to raw scores. This study establishes the first regression-based normative data for BRACE, derived from a large, demographically diverse people without HIV, and demonstrates its applicability for evaluating cognitive function in people with HIV. Findings indicate minimal cognitive differences between people with HIV and people without HIV and highlight the influence of common sociodemographic and metabolic factors. These results support BRACE as a scalable, reliable, and self-administered digital tool for assessing cognitive health in diverse populations and underscore its potential for longitudinal monitoring and precision phenotyping in both research and clinical contexts.
Intra-peritoneal adhesive disease (IPAD) can lead to debilitating symptoms including bowel obstruction, chronic abdominopelvic pain, and infertility. Standard tools to evaluate patient experiences for this disease process have not been described. This scoping review aims to (1) identify existing Patient Reported Outcome Measures (PROMs) related to IPAD and (2) evaluate the utility and quality of available IPAD-related PROMs, measured by predefined adhesive disease domains. Systematic searches were completed in PubMed using terms specific to IPAD-related symptoms and Quality of Life (QoL) domains including chronic abdominopelvic pain, bowel obstruction and function, and psychological impact on QoL. PROMs that reported exclusively on QoL were excluded. PROM development setting, psychometrics, and inclusion of adhesive disease domains were compared. Of 3290 articles originally identified, 38 articles yielded 10 PROMs related to IPAD. Patient input was considered in 80% of PROM development and 60% of field testing. Reliability testing and construct validity was performed for 70% of IPAD-related PROMs. All 10 IPAD-related PROMs assessed symptoms and QoL domains (i.e. chronic abdominopelvic pain, bowel obstruction/dysfunction, and impact on QoL). No PROM specific to IPAD was identified. The Memorial Sloan Kettering Bowel Function Instrument (MSK-BFI) included the fewest (3/10) and the Small Bowel Obstruction Questionnaire (SBO-Q) covered the most IPAD-related domains (9/10). There is currently no IPAD-specific PROM, though the SBO-Q was identified as the most robust, as it addressed multiple symptom/QoL domains and underwent reliability/construct validity testing. Future directions include external validation of the SBO-Q in IPAD-relevant patient populations and further refinement of an IPAD-specific PROM with patient and expert input.
To develop and evaluate iPad Quattro Checker® (iPad QC®), a tablet-based screening tool for detecting glaucomatous visual field (VF) abnormalities. We evaluated three screening methods-the iPad QC®, paper-based Quattro Checker® (paper QC®), and CLOCK CHART®-in glaucoma patients across disease stages (n = 64) and in normal participants (n = 38). VF abnormalities were defined in relation to corresponding quadrants of the Humphrey Field Analyzer (HFA). Sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) were calculated. Among all patients, the AUCs of the iPad QC®, paper QC®, and CLOCK CHART® were 0.97, 0.94, and 0.96, respectively. The iPad QC® retained 80.2% sensitivity in early glaucoma, with an AUC of 0.90 (95% CI: 0.81-0.98). More than half of previously unaware patients recognized their VF deficits using the iPad QC®. Testing required only a few minutes, could be self-administered on a widely available tablet, and was performed under ordinary room lighting. The iPad QC® demonstrated high sensitivity for detecting visual field abnormalities even in the early stages of glaucoma. Its capability for self-testing using widely available tablet devices, along with its ability to raise patients' awareness of VF defects, further enhances its usefulness as a practical screening tool. What is known Conventional visual field (VF) testing using the Humphrey Field Analyzer remains the gold standard for glaucoma detection and monitoring, but it requires specialized equipment and trained personnel, limiting its accessibility for large-scale screening. What is new The tablet-based iPad Quattro Checker® (iPad QC®) demonstrated high sensitivity for detecting glaucomatous VF defects, even in early-stage disease. The iPad QC® allows self-administered testing and enhances patients’ awareness of their own visual field loss. These findings suggest that portable, tablet-based VF testing could complement conventional perimetry and serve as a practical tool for community-based glaucoma screening and patient education.
Adult hippocampal neurogenesis declines with aging and in neurological disorders, leading to cognitive impairment. We previously showed that inducing Plagl2 and antagonizing Dyrk1a (iPaD) rejuvenates aged neural stem cells (NSCs), enhancing neurogenesis and cognition in aged mice. Here, we found that NSC-specific iPaD treatment activates neurogenesis, reduces amyloid-β deposition, and improves cognition in Alzheimer's disease model mice. Transcriptomic analysis revealed widespread changes in gene expression in the hippocampus after iPaD treatment. The upregulated genes include those associated with astrocyte and microglial activation involved in amyloid-β clearance, while several genes upregulated in Alzheimer's disease are downregulated. Among the latter genes, knockdown of Prkag2 in the hippocampus most effectively enhances neurogenesis and reduces amyloid-β accumulation. Notably, both iPaD treatment and Prkag2 knockdown activate AMP-activated protein kinase signaling, upregulating genes involved in autophagy and cellular homeostasis. These results suggest that Prkag2 may represent a promising therapeutic target for neurodegenerative diseases, including Alzheimer's disease.
Older adults without digital access, who are attempting to manage their lives within a digital landscape often struggle to maintain their independence. Living on the periphery of their communities, older people without digital access often feel alone. Technology is transforming the world around them, but they are excluded from participating. The lack of digital connection to family and friends and limited availability of essential online products and services can adversely impact their well-being. The purpose of the research was to explore the implementation of the iPad Project, an evidence-based, inter/intragenerational digital equity program for older adults, by studying the interaction of elements, determinants, strategies, mechanisms, and outcomes through the synthesis of an Implementation Research Logic Model (IRLM). This qualitative case study included the completion of semi-structured interviews with 30 study participants and collaborators, a document review, and the creation of an IRLM. Interview questions were derived from relevant constructs in the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change strategies to explore the perspectives of project participants and collaborators. Study participant's responses were thematically analyzed. An in-depth analysis of existing literature, reflexive memos, and iPad Project notes, worksheets, and reports was completed to provide context and supporting information. Qualitative themes, implementation research theory, and document analysis informed the creation of an IRLM of the iPad Project, which displayed how the project was implemented. The IRLM presented the key core and adaptable elements of the iPad Project that contributed to the project's outcomes. Environmental determinants were found to impact these elements by challenging or facilitating project progress. Strategic approaches used to address these changing effects were identified and reflected how the project was managed. The interplay between hypothesized mechanisms and contextual determinants was examined and revealed the underlying influences that shaped the outcomes. The implementation outcomes were highlighted and illustrated the effect of this evidence-based intervention. By identifying the project elements, the environmental determinants, and the strategies that were used to facilitate mechanisms of change and overcome barriers with the IRLM, this study provides guidance for future digital equity research and program implementation.
Accurate maxillary positioning is critical in digital prosthodontics, particularly when transferring the spatial relationship of the maxilla to a virtual articulator. This study aimed to compare the accuracy of the two most common registration methods, three-dimensional (3D) match and UV (landmark-based point-pair registration) match, for virtual facebow transfer and to investigate whether the type of facial scanner used influences the accuracy of these registration techniques. A cone beam computed tomography (CBCT) scan of a manikin was used as the reference. The maxillary arch was scanned with three anatomical landmarks and aligned to the CBCT. A computer-aided design and computer-aided manufacturing (CAD-CAM)-printed facebow fork was affixed to the arch, followed by facial scans using the EinScan HX and iPad (10 scans each). For each scan, two registration methods (3D match and UV match) were performed, generating 40 virtual alignments. Superimpositions were completed in Exocad, and accuracy was evaluated by comparing each registration to the CBCT reference using a Python script to measure linear and angular deviations. Trueness and precision were analyzed using a linear mixed model. 3D match generally outperformed UV in both trueness and precision. The industrial scanner combined with 3D match yielded the highest accuracy, with linear trueness of 0.98 ± 0.67 mm and precision of 1.31 ± 0.79 mm (p < 0.001). With the iPad, 3D registration demonstrated significantly superior angular accuracy (p < 0.050). 3D registration provides higher accuracy than UV match, and 3D registration, in combination with an industrial-grade scanner, offers higher accuracy in virtual facebow transfer than using iPad.
With the rapid advancement of technology in recent years, signatures on contracts and documents have increasingly shifted from traditional handwritten forms on paper to digital handwritten signatures executed on devices (hereafter referred to as digital tablets). This transition introduces new challenges for forensic document examination due to the differences in writing instruments. According to the European Network of Forensic Science Institutes (ENFSI), a Digital Capture Signature (DCS) refers to data points captured during the writing process on digital devices such as tablets, smartphones, or signature pads. In addition to retaining the visual image of the signature, DCS provides more information previously unavailable, including pen pressure, stroke order, and writing speed. These features possess potential forensic value and warrant further study and evaluation. This study employs three devices-Samsung Galaxy Tab S10, Apple iPad Pro, and Apple iPad Mini-together with their respective styluses as experimental tools. Using custom-developed handwriting capture software for both Android and iOS platforms, we simulated signature-writing scenarios common in the financial and insurance industries. Thirty participants were asked to provide samples of horizontal Chinese, English, and number writings (FUJ-IRB NO: C113187), which were subsequently normalized and segmented into characters. For analysis, we adopted distance-based time-series alignment algorithms (FastDTW and SC-DTW) to match writing data across different instances (intra- and inter-writer). The accumulated distances between corresponding data points, such as coordinates and pressure, were used to assess handwriting stability and to study the differences between same-writer and different-writer samples. The findings indicate that preprocessing through character centroid alignment, followed by the analysis, substantially reduces the average accumulated distance of handwriting. This procedure quantifies the stability of an individual's handwriting and enables differentiation between same-writer and different-writer scenarios based on the distribution of DCS distances. Furthermore, the use of styluses provides more precise distinctions between same- and different-writer samples compared with direct finger-based writing. In the context of rapid advancements in artificial intelligence and emerging technologies, this preliminary study aims to contribute foundational insights into the forensic application of digital signature examination.
Over the past decade, increasing attention has been paid to neurofluid (NF) drainage in the brain, particularly to the glymphatic system and intramural periarterial drainage (IPAD) pathway, which are responsible for substance transport in the brain and are highly dependent on astrocyte function. The dysfunction of these drainage pathways can lead to the accumulation of toxic substances and fluids, and contribute to various brain diseases, such as stroke and Alzheimer's disease. Since astrocytes in the brain closely connect to the microvascular system with their endfeet, in this work, the roles of astrocytes in regulating the glymphatic system and IPAD pathway and their dysfunction in neurodegenerative diseases have been comprehensively reviewed. Additionally, the effects of aquaporin 4, a water channel protein located on astrocytic endfeet, on these two pathways are explored. Furthermore, the possible therapeutic strategies for brain diseases targeting the NF drainage systems have also been proposed and thoroughly discussed.
Reactive strength index (RSI) derived from single-leg vertical continuous jumps (SVCJ) is a low-cost method to assist in making return-to-sport (RTS) decisions after anterior cruciate ligament reconstruction (ACLR); however, its relationship with isokinetic knee strength at different postoperative time points remains unclear. The purpose of this study was to explore the relationship between the RSI during SVCJ and isokinetic knee muscle strength in patients five to eight months after ACLR. Retrospective cohort study. Patients who had undergone primary ACLR with hamstring tendon autografts were enrolled. At five, seven, and eight months postoperatively, the participants performed 15 SVCJ recorded on an iPad at 240 fps. RSI was calculated as jump height divided by ground contact time, with flight time and contact time derived from video analysis using a validated smartphone/tablet application. Isokinetic peak knee extension and flexion torques were measured bilaterally at 60°/s using the Biodex System 3. Limb symmetry index (LSI) was calculated for both isokinetic knee strength and RSI as (operated limb value / non-operated limb value) × 100 (%). Time effects were analyzed using repeated-measures analysis of variance, and Pearson correlations assessed associations between RSI and knee strength. Twelve competitive athletes (mean age, 34.3 ± 11.3 years), participating in cutting- and jumping-based sports were analyzed. Isokinetic knee flexion peak torque significantly improved from five to eight months (p < 0.05) postoperatively. The extension-strength LSI was 75% at eight months, whereas the flexion-strength LSI increased from 84.5% at five months to 93.5% at eight months. The RSI LSI reached 83.1% at eight months. Correlations between RSI and knee extension strength were strong and significant at five months (r = 0.81, p < 0.01) and seven months (r = 0.91, p < 0.01) but were weak and not significant at eight months (r = 0.36, p = 0.26). RSI may serve as a surrogate for isokinetic knee extension strength during midterm rehabilitation after ACLR, later reflecting higher-order explosive performance; smartphone/tablet-based assessment supports staged RTS decision making. 2b.
Shigellosis is a significant public health issue in developing countries, particularly affecting young children under the age of five. While it primarily causes gastrointestinal infections, there are rare complications, such as bacteremia, that mainly occur in young children. We present a case of dysentery caused by Shigella flexneri serotype 1c, followed by bacteremia. A 13-month-old Afghan child presented with fever, dysentery, distended abdomen, mild tenderness, and dehydration. He did not respond to empirical treatment with ceftriaxone. However, he was successfully treated with a combination of gentamicin and ciprofloxacin. This is the first report of a patient in Iran who was positive for S. flexneri serotype 1c and harbored the ipaB, ipaC, ipaD, ipaH, ipgD, virA, and sen virulence factors. This case alerts clinicians to consider the possibility of Shigella bacteremia in young children. Early and accurate diagnosis can improve management and prognosis to reduce the risk of fatality outcomes. Additionally, it emphasizes the need to characterize the role of Shigella spp. virulence genes in causing bacteremia.
American football quarterbacks (QBs) often sustain shoulder and elbow injuries from throwing. During the late cocking phase of pitching, decreased shoulder abduction and horizontal adduction angles at shoulder maximum external rotation (MER) contribute to these injuries. The relationship between incorrect shoulder positions at MER and the trunk and pelvic rotation angles at stride foot contact (SFC) during the early cocking phase has been analyzed. However, most studies focus on baseball pitchers rather than QBs. The relationship between shoulder kinematics at MER and trunk and pelvis kinematics at SFC in QBs during throwing remains underexplored. The purpose of this study was to explore the relationship between trunk and pelvic kinematics at SFC and shoulder kinematics at MER in QBs under nongame situations. Eleven male American football QBs participated, each throwing 5 balls over 27.4 m (30 yards) with maximum effort. Throwing motions were recorded at 240 Hz using an iPad positioned at the participant's side. Kinematic data were analyzed using PitchAI to calculate the trunk (flexion/extension and nonthrowing/throwing side rotation), pelvic (nonthrowing/throwing side rotation), and hip-shoulder separation angles at SFC, as well as the shoulder (horizontal adduction/abduction, abduction/adduction, and external/internal rotation) angles at MER. The hip-shoulder separation angle is the difference between the pelvic and trunk rotation angles, with a positive value indicating trunk rotation toward the throwing side relative to the pelvis. Although PitchAI does not completely match data obtained with a marker-based motion capture system, its validity for trunk and pelvic kinematics is considered sufficient. Relationships between trunk and pelvic angles at SFC and shoulder angles at MER were evaluated using Pearson's product-moment correlation coefficient (rp) or Spearman rank correlation coefficient (rs). Trunk (rp = .779, P = .005), pelvic (rs = 0.691, P = .019), and hip-shoulder separation (rp = .667, P = .025) angles at SFC were positively correlated with shoulder horizontal adduction at MER. Trunk (rp = -0.635, P = .036) and pelvic (rs = -0.682, P = .021) rotation angles at SFC were negatively correlated with shoulder abduction angle at MER. During the throwing motion in QBs, shoulder abduction and horizontal adduction angles at MER appear related to trunk and pelvic rotation movements at SFC.
Posterolateral tibial plateau fractures (PLTFs) have been increasingly studied due to their association with soft tissue injuries around the knee. This prospective study aimed to determine whether the presence of PLTFs is associated with soft tissue injuries around the knee and correlates with an increased preoperative quantitative pivot shift (PS). It was hypothesized that the presence of PLTFs is associated with greater clinical and quantitative PS. A prospective registry study was conducted, and patients who underwent primary unilateral anterior cruciate ligament (ACL) reconstruction at a single institution were included. The PS test was preoperatively performed in general anaesthesia and quantified using the PIVOT iPad application. The anterior translation of the lateral tibia plateau (ATLT) was measured in both the injured and uninjured knee, and the side-to-side difference was calculated. The PS test was additionally graded according to International Knee Documentation Committee (IKDC) criteria. PLTFs were classified according to Bernholt's classification. Injuries to the Kaplan fibres (KFs), anterolateral complex (ALC) and the menisci were evaluated on preoperative magnetic resonance imaging (MRI) scans. Student's t-test was used to compare means, and chi-square was used to test for correlations. Statistical significance was set to p < 0.05. A total of 142 patients with a mean age of 30.9 ± 11.7 years were included. PLTFs were present in 94 (66%) of patients. The presence of PLTFs was associated with concomitant injuries to the KF (p < 0.001), ALC (p < 0.001), medial and lateral meniscus (both p < 0.01). The presence or the severity of a PLTF did not increase the ATLT during quantitative PS or IKDC PS grading (n.s.). PLTFs are associated with concomitant injuries to the ALC and both menisci, indicating that they occur within a broader pattern of structural knee damage. However, these injuries do not appear to contribute to a greater preoperative PS. The presence of PLTFs should alert surgeons to the high probability of associated injuries. Level III, diagnostic studies.
Diarrheagenic E. coli (DEC) and Shigella species are leading causes of under-5 mortality globally, prompting the development of a broad-spectrum vaccine. Here, we rationally designed a novel chimeric antigen ("SEISL") incorporating five virulence determinants: StxB and EspA (EHEC), LTB and a detoxified STa (ETEC), and the N-terminal domain of IpaD (Shigella). Bioinformatically optimized for maximal antigenicity, SEISL was expressed in E. coli BL21(DE3), purified from inclusion bodies under denaturing conditions, and confirmed by western blot. Immunization with SEISL + Freund's adjuvants in pathogen-specific models elicited robust protection in all models.In rabbits (ETEC challenge), serum IgG significantly increased and ileal loop assays with virulent ETEC H10408 showed a significant reduction in fluid accumulation (p<0.05). The Guinea pigs exhibited 71.4% protection against Shigella flexneri-induced keratoconjunctivitis in Sereny tests, and finally the mice (EHEC challenge) demonstrated elevated serum IgG and significant reduction in fecal shedding of EHEC O157:H7 post-challenge (p<0.05). These results demonstrate that the SEISL antigen elicits broad protection immune responses against three critical diarrheal pathogens in preclinical models, providing proof-of-concept support for its continued development as a multipathogen vaccine candidate.