Composition and formation of the sleeve enveloping a central venous catheter

AbstractPurpose:After catheterization, 42% to 100% of central venous catheters are surrounded by a “fibrin sleeve.” This sleeve has been considered the cause of catheter-related infections, withdrawal occlusion, and pulmonary embolism. The reactions between the vein wall and the catheter were studied. Methods: A silicone catheter was placed in the anterior caval vein of 123 rats. After in situ fixation at scheduled intervals, the pathologic changes were studied on semi-serial histologic sections by means of light microscopy, transmission electron microscopy, and scanning electron microscopy (SEM). In 36 rats, the catheter was withdrawn immediately; in 72 rats, it was left in situ up to 6 months; and in 15 rats, the study was performed up to 10 months after withdrawal of a catheter that had remained in situ for 6 months. Results: In the group in which the catheter was withdrawn immediately, mural thrombi disappeared by day 7. In the group in which the catheter remained in situ, thrombi remained around the proximal portion of the catheter. This pericatheter thrombosis (PCT) was invaded by migrating and proliferating smooth muscle cells (SMCs), originating from an injured vein wall, and transformed from day 7 into a tissue composed predominantly of SMCs and collagen and covered by endothelial cells. Later, the number of cells decreased, and the relative amount of collagen increased. Up to 10 months after withdrawal of the catheter, the collapsed sleeve was still present within the vein. Conclusion: The sleeve around a central venous catheter is not a fibrin sleeve, but a stable cellular-collagen tissue covered by endothelium. It is mainly formed by smooth muscle cells migrating from the injured vein wall into the early pericatheter thrombus. (J Vasc Surg 1998;28:260-271.

Geoheritage, a National Inventory in France

International audienceGood protection measures for geological heritage should begin with an inventory of geosites. In France, for example, a law enacted in 2002 grants formal recognition to the notion of geological heritage. An inventory and evaluation were then established on a region-by-region basis. By April 2007, the French Ministry of Environment launched the inventory programme for the nation’s geological heritage and the data are now being collected at a regional scale. The data are being gathered and homogenised, and then transferred to the French National Museum of Natural History for examination.The ratified site data are stored and available for public use on a website (http://inpn.mnhn.fr) in a similar structure to natural data that are also processed and stored (flora, fauna, ecosystems, habitats). Today, protecting global heritage is understood as a dynamic process. Instead of placing objects beneath a display case, the conservation approach is now a more modern, active effort, which facilitates access for knowledge and researc

The Dynamics of the Pulmonary Microbiome During Mechanical Ventilation in the Intensive Care Unit and the Association with Occurrence of Pneumonia

RATIONALE: Ventilator-associated pneumonia (VAP) is the most common nosocomial infections in patients admitted to the ICU. The adapted island model predicts several changes in the respiratory microbiome during intubation and mechanical ventilation. OBJECTIVES: We hypothesised that mechanical ventilation and antibiotic administration decrease the diversity of the respiratory microbiome and that these changes are more profound in patients who develop VAP. METHODS: Intubated and mechanically ventilated ICU-patients were included. Tracheal aspirates were obtained three times a week. 16S rRNA gene sequencing with the Roche 454 platform was used to measure the composition of the respiratory microbiome. Associations were tested with linear mixed model analysis and principal coordinate analysis. MEASUREMENTS AND MAIN RESULTS: 111 tracheal aspirates were obtained from 35 patients; 11 had VAP, 18 did not have VAP. Six additional patients developed pneumonia within the first 48 hours after intubation. Duration of mechanical ventilation was associated with a decrease in α diversity (Shannon index; fixed-effect regression coefficient (β): -0.03 (95% CI -0.05 to -0.005)), but the administration of antibiotic therapy was not (fixed-effect β: 0.06; 95% CI -0.17 to 0.30). There was a significant difference in change of β diversity between patients who developed VAP and control patients for Bray-Curtis distances (p=0.03) and for Manhattan distances (p=0.04). Burkholderia, Bacillales and, to a lesser extent, Pseudomonadales positively correlated with the change in β diversity. CONCLUSION: Mechanical ventilation, but not antibiotic administration, was associated with changes in the respiratory microbiome. Dysbiosis of microbial communities in the respiratory tract was most profound in patients who developed VAP.info:eu-repo/semantics/publishedVersio

Ecteinascidin-743: Evidence of Activity in Advanced, Pretreated Soft Tissue and Bone Sarcoma Patients

Purpose. To evaluate the activity and safety of ecteinascidin (ET-743) in pretreated patients with advanced or metastatic soft tissue and bone sarcoma. Patients or subjects. Eighty-nine patients received ET-743 as a 24-hour continuous infusion at a dose of 900–1500 μg/m(2) every 3 weeks. Results. We observed one complete remission, 5 partial remissions, one minimal response, and 16 patients with a disease stabilization of 6 months or more. The objective response rate was 6.7% and the clinical benefit rate at 3 and 6 months was 37.7% and 23.4%, respectively. Responses were noted in patients with lipo-, leiomyo-, osteo-, and myogenic sarcoma, with a median duration of 9.85 months. Toxicity mainly involved an asymptomatic elevation of transaminases and neutropenia. Estimated 1- and 2-year survival rates were 39.4% and 15.8%. Median overall survival was 8.25 months. Discussion. This retrospective analysis confirms that ET-743 induces objective responses and progression arrest in a clinically relevant proportion of patients

S-COL: A Copernican turn for the development of flexibly reusable collaboration scripts

Collaboration scripts are usually implemented as parts of a particular collaborative-learning platform. Therefore, scripts of demonstrated effectiveness are hardly used with learning platforms at other sites, and replication studies are rare. The approach of a platform-independent description language for scripts that allows for easy implementation of the same script on different platforms has not succeeded yet in making the transfer of scripts feasible. We present an alternative solution that treats the problem as a special case of providing support on top of diverse Web pages: In this case, the challenge is to trigger support based on the recognition of a Web page as belonging to a specific type of functionally equivalent pages such as the search query form or the results page of a search engine. The solution suggested has been implemented by means of a tool called S-COL (Scripting for Collaborative Online Learning) and allows for the sustainable development of scripts and scaffolds that can be used with a broad variety of content and platforms. The tool’s functions are described. In order to demonstrate the feasibility and ease of script reuse with S-COL, we describe the flexible re-implementation of a collaboration script for argumentation in S-COL and its adaptation to different learning platforms. To demonstrate that a collaboration script implemented in S-COL can actually foster learning, an empirical study about the effects of a specific script for collaborative online search on learning activities is presented. The further potentials and the limitations of the S-COL approach are discussed

Analyzing collaborative learning processes automatically

In this article we describe the emerging area of text classification research focused on the problem of collaborative learning process analysis both from a broad perspective and more specifically in terms of a publicly available tool set called TagHelper tools. Analyzing the variety of pedagogically valuable facets of learners’ interactions is a time consuming and effortful process. Improving automated analyses of such highly valued processes of collaborative learning by adapting and applying recent text classification technologies would make it a less arduous task to obtain insights from corpus data. This endeavor also holds the potential for enabling substantially improved on-line instruction both by providing teachers and facilitators with reports about the groups they are moderating and by triggering context sensitive collaborative learning support on an as-needed basis. In this article, we report on an interdisciplinary research project, which has been investigating the effectiveness of applying text classification technology to a large CSCL corpus that has been analyzed by human coders using a theory-based multidimensional coding scheme. We report promising results and include an in-depth discussion of important issues such as reliability, validity, and efficiency that should be considered when deciding on the appropriateness of adopting a new technology such as TagHelper tools. One major technical contribution of this work is a demonstration that an important piece of the work towards making text classification technology effective for this purpose is designing and building linguistic pattern detectors, otherwise known as features, that can be extracted reliably from texts and that have high predictive power for the categories of discourse actions that the CSCL community is interested in

Feasibility of Mechanical Extrusion to Coat Nanoparticles with Extracellular Vesicle Membranes

Biomimetic functionalization to confer stealth and targeting properties to nanoparticles is a field of intense study. Extracellular vesicles (EV), sub-micron delivery vehicles for intercellular communication, have unique characteristics for drug delivery. We investigated the top-down functionalization of gold nanoparticles with extracellular vesicle membranes, including both lipids and associated membrane proteins, through mechanical extrusion. EV surface-exposed membrane proteins were confirmed to help avoid unwanted elimination by macrophages, while improving autologous uptake. EV membrane morphology, protein composition and orientation were found to be unaffected by mechanical extrusion. We implemented complementary EV characterization methods, including transmission- and immune-electron microscopy, and nanoparticle tracking analysis, to verify membrane coating, size and zeta potential of the EV membrane-cloaked nanoparticles. While successful EV membrane coating of the gold nanoparticles resulted in lower macrophage uptake, low yield was found to be a significant downside of the extrusion approach. Our data incentivize more research to leverage EV membrane biomimicking as a unique drug delivery approach in the near future

Using CIPP model to evaluate “NTUE 2012 Nepal Snowland school” service-learning project

In 2012, the department of Education, National Taipei University of Education (NTUE), conducted an oversea service-learning project to Nepal. The project was tied with two courses, i.e., Service-Learning Theory and Practice as well as International Education research. There were 9 university students (volunteer teachers) and 4 professors in the NTUE delegation. They served the 150 students of Snowland Ranag Light of Education School at Kathmandu, Nepal. This study aimed to use the CIPP model to evaluate the context, input, process and product of the project. Classroom observations, interviews questionnaires and document analysis were used to collect data following the triangulation principle. The research findings were as follows. 1. The context of the NTUE Nepal service-learning project includes the impact of low birth rate to NTUE, the high demand of international education in Taiwan, and the enhancement of pre- and in-service teacher’s affective domain. 2. The inputs include internal and external human resources in Taiwan and Nepal, funds from government and university, donated supplies collected by students. 3. The process includes the five phases of service-learning, with preparation from October, 2011 to August, 2012; service in the first two weeks of September, 2012; series of celebration activities in mid September at Snowland and autumn at NTUE; while reflection and evaluation phases throughout the entire process. 4. The product was evaluated according to the three instructional objectives, i.e., (1) to learn about Nepali culture and education, (2) to be able to teach Nepali 4th to 9th grade students mandarin Chinese and Taiwanese culture in English, and (3) to demonstrate affection to Snowland or Nepal. Based on the findings, recommendations were made to future practice and research