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Purpose This study assessed the environmental quality of an adapted, play-based LEGO® robotics program for children and youth with disabilities to determine the degree to which the activity setting supports the therapeutic goals of the program.Materials and methods We measured the environmental qualities of a robotics program held at a paediatric rehabilitation hospital. We observed and coded video-recordings of the robotics program, specifically one session from each of five different rooms where the program took place. Using the 32-item Measure of Environmental Qualities of Activity Settings (MEQAS), we described the place- and opportunity-related qualities of these settings.Results Our observations revealed that, across all five settings, the environments support the therapeutic goals of the program, including providing opportunities for social interaction with peers and adults to a great extent. We also identified several environmental features of the robotics program that support optimal outcomes for children and youth with disabilities.Conclusions Our findings lend support for the value of examining environmental opportunities and affordances of play-based therapy within rehabilitation.IMPLICATIONS FOR REHABILITATIONAssessing the environmental opportunities and affordances of play-based activities using the Measure of Environmental Qualities of Activity Settings (MEQAS) is valuable for supporting positive outcomes in rehabilitation.The settings of an adapted LEGO® robotics program offer children with disabilities opportunities to engage in social interactions with peers and adults, to learn a new skill, and to develop a sense of self-identity.Optimal therapeutic outcomes of an adapted LEGO® robotics program can be supported by environmental features, including large tables with sufficient space for two youth and one or two adult volunteers to interact at eye-level, arranged separately with enough space to invite movement between tables, in such a way that children may also interact across tables.RATIONALE The mTOR pathway is one of the key signal cascades in the pathogenesis of idiopathic pulmonary fibrosis. Previous studies have mainly focused on this pathway in the fibroblasts and/or myofibroblasts, but not in the epithelial cells. OBJECTIVES To investigate the role of the mTOR pathway in lung epithelial cells in lung fibrosis. METHODS Using Sftpc-mTORSL1 + IT Tg mice, in which active mTOR is conditionally expressed in lung epithelial cells, we assessed the effects of chronically activated mTOR in lung epithelial cells on lung phenotypes as well as bleomycin-induced lung fibrosis. Furthermore, we isolated AEC2 from mice and performed RNA sequencing. RESULTS Sftpc-mTORSL1 + IT Tg mice had no obvious abnormal findings, but after bleomycin administration showed severer fibrotic changes and lower lung compliance than control mice. RNA sequencing revealed angiopoietin-like 4 (ANGPTL4) as a candidate downstream gene of the mTOR pathway. In vitro studies revealed that ANGPTL4 as well as mTOR promoted tight junction vulnerability and epithelial-mesenchymal transition. CONCLUSIONS mTOR activation in lung epithelial cells promoted lung fibrosis and the expression of ANGPTL4, a novel downstream target of the mTOR pathway, which could be related to the etiology of fibrosis.Aim Fusidic acid (FA) is a narrow-spectrum bacteriostatic antibiotic. We inadvertently discovered that a FA derivative modified by an amino-terminal group at the 3-OH position, namely 2, inhibited the growth of Cryptococcus neoformans. Methods & results Multiscale molecular modeling approaches were used to analyze the binding modes of 2 with eEF2. FA derivatives modified at the 3-OH position were designed based on the in silico models; seven derivatives possessing different amino-terminal groups were synthesized and tested in vitro for antifungal activity against C. neoformans. Conclusion Compound 7 had the strongest minimum inhibitory concentration. Two protonated nitrogen atoms of 7 interacted with a negative electrostatic pocket of eEF2 likely explain the superiority of 7-2.OBJECTIVE Adnexal torsion is a rare gynecologic emergency caused by twisting of an adnexal mass. Twisted vascular pedicle is the most specific imaging finding for adnexal torsion, however, identification of twisted vascular pedicle can be challenging. The purpose of this study is to evaluate the feasibility of susceptibility-weighted MR sequence (SWS) for the diagnosis of adnexal torsion. METHODS MR imaging including SWS (SWAN susceptibility-weighted angiography) of surgically proven four benign ovarian masses with torsion (one acute and three subacute to chronic torsions) were retrospectively evaluated. Three cystic masses and one solid mass were included in this study. RESULTS High signal intensity venous thrombus within the twisted vascular pedicle on T1-weighted imaging (T1WI) was detected in three lesions with subacute to chronic torsion (75%) but not in one lesion with acute torsion, whereas susceptibility-induced signal voids within the twisted vascular pedicle on SWAN were detected in all four lesions (100%). CONCLUSION The demonstration of venous thrombus in the twisted vascular pedicle by SWS may be diagnostic for adnexal torsion. ADVANCES IN KNOWLEDGE SWS can detect blood products sensitively and can reveal venous thrombus in the twisted vascular pedicle, which may be helpful for the diagnosis of adnexal torsion.OBJECTIVES To compare the performance of arterial spin labelling (ASL) in evaluating arteriovenous malformations (AVMs) against the current gold standard of catheter angiography. METHODS We systematically reviewed the published literature using EMBASE and Medline. We included studies that compared ASL to catheter angiography in the assessment of AVMs in three outcome domains detection, angioarchitectural and haemodynamic features. RESULTS From 314 unique citations, 19 studies representing 289 patients with intracranial AVMs met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. Seven studies showed high diagnostic performance of ASL in identifying arterial feeders, with sensitivity ranging from 84.6 to 100% and specificity ranging from 93.3 to 100%. Six studies showed strong ability in detecting arteriovenous shunting, with sensitivity ranging from 91.7 to 100% and specificity ranging from 90 to 100%. Seven studies demonstrated that ASL could identify nidal location and size as well as catheter angiography, while five studies showed relatively poorer performance in delineating venous drainage. Two studies showed 100% sensitivity of ASL in the identification of residual or obliterated AVMs following stereotactic radiosurgery. CONCLUSIONS Despite limitations in the current evidence base and technical challenges, this review suggests that ASL has a promising role in the work-up and post-treatment follow-up of AVMs. Larger scale prospective studies assessing the diagnostic performance of ASL are warranted. ADVANCES IN KNOWLEDGE ASL demonstrates overall validity in the evaluation of intracranial AVMs.OBJECTIVE The purpose of this study was to evaluate the image quality in virtual monochromatic imaging (VMI) at 40 kilo-electron volts (keV) with three-dimensional iterative image reconstruction (3D-IIR). METHODS A phantom study and clinical study (31 patients) were performed with dual-energy CT (DECT). VMI at 40 keV was obtained and the images were reconstructed using filtered back projection (FBP), 50% adaptive statistical iterative reconstruction (ASiR), and 3D-IIR. We conducted subjective and objective evaluations of the image quality with each reconstruction technique. RESULTS The image contrast-to-noise ratio and image noise in both the clinical and phantom studies were significantly better with 3D-IIR than with 50% ASiR, and with 50% ASiR than with FBP (all, p less then 0.05). The standard deviation and noise power spectra of the reconstructed images decreased in the order of 3D-IIR to 50% ASiR to FBP, while the modulation transfer function was maintained across the three reconstruction techniques. In most subjective evaluations in the clinical study, the image quality was significantly better with 3D-IIR than with 50% ASiR, and with 50% ASiR than with FBP (all, p less then 0.001). Regarding the diagnostic acceptability, all images using 3D-IIR were evaluated as being fully or probably acceptable. CONCLUSIONS The quality of VMI at 40 keV is improved by 3D-IIR, which allows the image noise to be reduced and structural details to be maintained. ADVANCES IN KNOWLEDGE The improvement of the image quality of VMI at 40 keV by 3D-IIR may increase the subjective acceptance in the clinical setting.Tobacco menace is responsible for significant mortality and morbidity worldwide. Smokeless tobacco (SLT) is consumed in more than 140 countries, thus is emerging as a global problem. Several adverse health outcomes like oropharyngeal, oesophageal, and pancreatic cancers; oral potentially malignant lesions; diabetes mellitus; cardiovascular diseases; mental illness; osteopenia; low birth weight; preterm births; small for gestation age babies; and stillbirths are attributed to SLT usage. Smokeless tobacco products vary greatly in types, constituents, packaging, forms, addiction, and harm potential, and thus are challenging to study and control. Involvement of both formal and informal sector in SLT production and sales further add to the complexities. The problem of SLT is usually understated and less researched upon. This paper summarizes the existing knowledge and provides evidence to strengthen the case against the SLT, stressing on the need to enhance the SLT control across the globe.OBJECTIVES Computed tomography scans of the kidney, ureters, and bladder (CT-KUB) are crucial in investigating urinary calculi but impart a substantial radiation doses. Radiation can be limited by minimising the scanning field to the necessary area (i.e. from the kidneys to urethra). Before auditing, the superior limit of CT-KUB scans had not been formally clarified at our trust. Consistently ensuring the upper limit of scans is at or below T10 has been shown to be a viable method of performing CT-KUB scans. This study aimed to assess the overscan length of CT-KUB investigations and modify practice accordingly to minimise it. There were two standards that were set for CT-KUB scanning. https://www.selleckchem.com/products/gdc-0068.html First, the mean percentage overscan length (i.e. percentage of the scan above the kidneys) should be 15% was present in 94.4% of scans. The mean percentage overscan length was 28.2%. The superior vertebral limit of 59% of scans was at T10 or below and a lower superior vertebral limit correlated with decreasing overscan. 99% of scans fully included both kidneys. In the second phase (3 months later), the mean overscan percentage reduced to 10.6% (standard deviation = 4.4%). Excessive overscan affected 35.2% of scans. The superior vertebral limit of 8% of scans was at T10 or below. 100% of scans fully included both kidneys. CONCLUSION Excessive overscanning was due to inconsistent technique in capturing CT-KUB scans. Before this audit, the superior limit of CT-KUB scans had not been formally clarified at our trust. By successfully standardising the process with a reproducible method, the overscan target was comfortably met. Therefore, patient dose was minimised without compromising scan quality. ADVANCES IN KNOWLEDGE This audit has successfully shown a feasible standardised protocol for CT-KUB investigations which can be used to minimise overscanning of patients.
