Spontaneous externalization of peritoneal catheter through the abdominal wall in a patient with hydrocephalus: a case report

Since 1905, the abdominal cavity has been used for absorption of cerebrospinal fluid in patients with hydrocephalus. We report a case of a 33-year-old female, in which a spontaneous extrusion of the peritoneal catheter of a ventriculo-peritoneal shunt through the intact abdominal wall occurred. We suggest that the rather hard peritoneal catheter eroded the abdominal wall, caused local inflammation, and then extruded through the skin. Additionally, the intestinal peristaltic movements, the omental activity and the intraabdominal pressure could play an adjuvant part, pressing direct the foreign body from the peritoneal cavity toward the skin

Silicone models as basic training and research aid in endovascular neurointervention—a single-center experience and review of the literature

The rapid development and wider use of neurointerventional procedures have increased the demand for a comprehensive training program for the trainees, in order to safely and efficiently perform these procedures. Artificial vascular models are one of the dynamic ways to train the new generation of neurointerventionists to acquire the basic skills of material handling, tool manipulation through the vasculature, and development of hand-eye coordination. Herein, the authors present their experience regarding a long-established training program and review the available literature on the advantages and disadvantages of vascular silicone model training. Additionally, they present the current research applications of silicone replicas in the neurointerventional arena

Bacterial production and direct functional screening of expanded molecular libraries for discovering inhibitors of protein aggregation.

Protein misfolding and aggregation are associated with a many human disorders, including Alzheimer's and Parkinson's diseases. Toward increasing the effectiveness of early-stage drug discovery for these conditions, we report a bacterial platform that enables the biosynthesis of molecular libraries with expanded diversities and their direct functional screening for discovering protein aggregation inhibitors. We illustrate this approach by performing, what is to our knowledge, the largest functional screen of small-size molecular entities described to date. We generated a combinatorial library of ~200 million drug-like, cyclic peptides and rapidly screened it for aggregation inhibitors against the amyloid-β peptide (Aβ42), linked to Alzheimer's disease. Through this procedure, we identified more than 400 macrocyclic compounds that efficiently reduce Aβ42 aggregation and toxicity in vitro and in vivo. Finally, we applied a combination of deep sequencing and mutagenesis analyses to demonstrate how this system can rapidly determine structure-activity relationships and define consensus motifs required for bioactivity

Overview of the interactive task in BioCreative V

Fully automated text mining (TM) systems promote efficient literature searching, retrieval, and review but are not sufficient to produce ready-to-consume curated documents. These systems are not meant to replace biocurators, but instead to assist them in one or more literature curation steps. To do so, the user interface is an important aspect that needs to be considered for tool adoption. The BioCreative Interactive task (IAT) is a track designed for exploring user-system interactions, promoting development of useful TM tools, and providing a communication channel between the biocuration and the TM communities. In BioCreative V, the IAT track followed a format similar to previous interactive tracks, where the utility and usability of TM tools, as well as the generation of use cases, have been the focal points. The proposed curation tasks are user-centric and formally evaluated by biocurators. In BioCreative V IAT, seven TM systems and 43 biocurators participated. Two levels of user participation were offered to broaden curator involvement and obtain more feedback on usability aspects. The full level participation involved training on the system, curation of a set of documents with and without TM assistance, tracking of time-on-task, and completion of a user survey. The partial level participation was designed to focus on usability aspects of the interface and not the performance per se. In this case, biocurators navigated the system by performing pre-designed tasks and then were asked whether they were able to achieve the task and the level of difficulty in completing the task. In this manuscript, we describe the development of the interactive task, from planning to execution and discuss major findings for the systems tested

Silicone models as basic training and research aid in endovascular neurointervention-a single-center experience and review of the literature

The rapid development and wider use of neurointerventional procedures have increased the demand for a comprehensive training program for the trainees, in order to safely and efficiently perform these procedures. Artificial vascular models are one of the dynamic ways to train the new generation of neurointerventionists to acquire the basic skills of material handling, tool manipulation through the vasculature, and development of hand-eye coordination. Herein, the authors present their experience regarding a long-established training program and review the available literature on the advantages and disadvantages of vascular silicone model training. Additionally, they present the current research applications of silicone replicas in the neurointerventional arena

A Retrospective Analysis of Intrathecal Catheter Tip Position in Plain Radiography: How Much Do We Agree?

AIM: To assess interrater and intrarater reliability of postoperative plain radiographs, which are routinely performed to confirm the correct placement of the catheter tip after intrathecal drug delivery systems (IDDS) implantation. MATERIAL and METHODS: This was a retrospective analysis of plain radiographs obtained from patients implanted with intrathecal catheters and morphine pumps. Each plain radiograph was assessed independently by three raters with varying expertise, at three different time points, to confirm the position of the intrathecal catheter tip. Krippendorff's alpha coefficient was used to calculate both the interrater and intrarater reliability. RESULTS: There was a high level of agreement among the three raters and the three reviews of each rater separately when assessing the location of intrathecal catheter tips in plain radiographs from 126 patients. This was evidenced by the Krippendorff's alpha value being >0.99 in all cases, which was greater than the cutoff threshold value of 0.8. CONCLUSION: The interrater and intrarater reliability of plain radiographs for determination of catheter tip position after IDDS implantation was high. The experience and expertise of the raters did not significantly affect the assessments

Correlation of Glasgow coma scale (GCS), CT, and apache - II system findings in patients with traumatic brain injury

The aim of this thesis is to investigate the existing relationship among the scores of the GCS and the APACHE-II system and the CT findings in patients with traumatic brain injury who were admitted to the mixed medical and surgical ICU of University Hospital of Alexandroupolis, Greece during the decade 1994-2003. In addition, the validation of APACHE-II system in this sample is attempted. Furthermore, effort is made to produce regression models to accurately predict a) the verbal response of the GCS based upon the eye and motor components of the GCS and b) the APACHE-II score using a more limited set of variables. The male:female ratio and the traffic accidents:falls ratio is 7,2:1 and 3,3:1 respectively. The mean age is 45,19±2,555 years (34,07±3,628 for survivors and 55,48±3,672 for non-survivors). The mean ICU stay is 11,5±2,051 days and the ICU mortality is 48,6%. The mean GCS score is 6,39±0,554 (6,81±0,983 for survivors and 5,55±0,706 for non-survivors). The most frequently found GCS scores are: 3 (60,8%, extremely high percentage), 15 (12,2%), 14 (6,8%) and 11 (5,4%). The mean APACHE-II score is 15,91±0,890 (12,85±1,243 for survivors and 19,30±1,304 for non-survivors). Scores ≥25 and ≤4 are never found in survivors and non-survivors respectively. The most frequently found APACHE-II scores are: 15 and 17 (8,1% each), 9, 13, 18 and 22 (6,8% each) and 7, 11, 14 and 25 (4,1% each). The incidence on CT scans of fractures, cerebral oedema, SAH and SDH is 64,9%, 48,6%, 43,2% and 37,8% respectively. The presence of blood in paranasal sinuses, injuries of extracranial soft tissues and contusions are revealed in 28,4%, 28,4% and 24,3% of cases respectively. ICH is seen in 18,9%, EDH in 17,6% and IVH in 4,1% of CT scans. Normal CT scans represent only 1,4%. Correlation is evident between a) the APACHE-II score and the presence or not of fractures, b) the GCS score and the presence or not of contusions, c) outcome and the presence or not of SDH, SAH and injuries of extracranial soft tissues, d) age and SDH, e) the APACHE-II score and outcome, f) age and outcome and g) predicted risk and outcome. The mean predicted risk is 0,2106±0,0217 (0,1345±0,0174 for survivors and 0,2729±0,0333 for non-survivors). On the contrary, there is no correlation between a) postoperative / non-operative patients and sex or positive CT scan and b) the GCS score and patients’ origin (postoperative / non-operative) and outcome. The calibration of APACHE-II is fair (χ2=5,37, p=0,683, df=8). The APACHE-II system overestimates the risk of death in the lower ranges of predicted risk (0-20% and 30-40%) and underestimates the deaths in the higher ranges (20-30% and >40%). The discriminative ability of APACHE-II and GCS, measured as the AUC of corresponding ROC curves, is 0,854±0,047 and 0,548±0,076 respectively. In this sample the best cut-off points are found to be 0,2226 (for predicted risk, Se=54,5%, Sp=88,9%, Youden=0,43), 19 (for APACHE-II, Se=48,5%, Sp=92,6%, Youden=0,41) and 10 (for GCS, Se=84,8%, Sp=33,3%, Youden=0,18). For the former cut-off points, the APACHE-II system presents CC=68,33%, PPV=88,88%, NPV=59,20%, LR+=6,6425, LR-=0,5564, while the corresponding percentages for the GCS are 61,67%, 60,86%, 64,29%, 1,2725 και 0,4548. For the shake of simplicity 4 regression models are proposed: a) GCS-Verbal = 0,963 + 0,029*EM,2 (where E stands for the eye and M for the motor component of the GCS), b) APS(12) = 148,843 – 1,074 * GCS – 16,878 * pH – 0,190 * HCT + 4,082 * CREAT, c) APACHE-II = 152,611 – 1,051 * GCS + 4,762 * CREAT + 0,097 * AGE – 17,625 * pH – 0,226 * HCT and d) APACHE-II = 1,789 + 1,025 * APS(12). Finally, generalization of the previous findings is limited by the relatively small sample size, the APACHE-II score calculation by residents (lack of experience) and the extremely frequent GCS score 3. Nonetheless, the APACHE-II system is still considered a useful tool in supporting clinical decisions.Αντικειμενικός σκοπός της διατριβής είναι η διερεύνηση των τιμών που λαμβάνουν οι κλίμακες GCS και APACHE-II, καθώς και των ευρημάτων που απεικονίζονται στη CT σε ασθενείς με αμιγείς ΚΕΚ που εισήχθησαν στη ΜΕΘ του Π. Γ. Ν. Αλεξανδρούπολης κατά τη δεκαετία 1994-2003. Παράλληλα, καταβάλλεται προσπάθεια να ελεγχθεί η εγκυρότητα του συστήματος APACHE-II σε αυτό το δείγμα. Επιχειρείται, ακόμη, η κατασκευή εξισώσεων παλινδρόμησης που να προβλέπουν α) την GCS-Ομιλία από τη GCS-Μάτια και τη GCS-Κινητικότητα και β) την APACHE-II, χρησιμοποιώντας λιγότερες μεταβλητές. Η αναλογία αντρών:γυναικών είναι 7,2:1 με μέση ηλικία τα 45,19±2,555 έτη (34,07±3,628 για τους επιζώντες και 55,48±3,672 για τους θανόντες) και η αναλογία τροχαίων: πτώσεων είναι 3,3:1. Η διάρκεια παραμονής και η θνητότητα στη ΜΕΘ είναι 11,5±2,051 ημέρες και 48,6% αντίστοιχα. Η μέση τιμή GCS είναι 6,39±0,554 (6,81±0,983 για τους επιζώντες και 5,55±0,706 για τους θανόντες), μικρότερη από άλλες μελέτες. Ως πιο συχνές τιμές GCS συναντώνται η 3 (60,8%, ιδιαίτερα υψηλό ποσοστό), η 15 (12,2%), η 14 (6,8%) και η 11 (5,4%). Η μέση τιμή APACHE-II είναι 15,91±0,890 (12,85±1,243 για τους επιζώντες και 19,30±1,304 για τους θανόντες), παρόμοια με άλλες έρευνες. Από τους επιζώντες κανείς δεν εμφανίζει τιμή ≥25 και από τους θανόντες ≤4. Ως πιο συχνές τιμές APACHE-II συναντώνται οι 15 και 17 (από 8,1%), οι 9, 13, 18 και 22 (από 6,8%) και οι 7, 11, 14 και 25 (από 4,1%). Τα πιο συχνά ευρήματα στη CT είναι: κατάγματα (64,9%), οίδημα (48,6%), SAH (43,2%), SDH (37,8%), κατάληψη με αίμα των παραρρινικών κόλπων (28,4%), κακώσεις εξωκράνιων μαλακών ιστών (28,4%), θλάσεις (24,3%), ICH (18,9%), EDH (17,6%), IVH (4,1%) και φυσιολογικά ευρήματα (1,4%). Υπάρχει συσχέτιση μεταξύ της τιμής της APACHE-II και της ύπαρξης ή μη καταγμάτων, μεταξύ της τιμής της GCS και της ύπαρξης ή μη θλάσεων, μεταξύ της έκβασης και της ύπαρξης ή μη SDH, SAH και κακώσεων των εξωκράνιων μαλακών ιστών, μεταξύ της ηλικίας και του SDH, μεταξύ των τιμών της APACHE-II και της έκβασης, μεταξύ της ηλικίας και της έκβασης, μεταξύ των Pr και της έκβασης. Η μέση Pr είναι 0,2106±0,0217 (0,1345±0,0174 για τους επιζώντες και 0,2729±0,0333 για τους θανόντες). Αντίθετα, δεν υπάρχει συσχέτιση α) μεταξύ της διενέργειας ή μη χειρουργείου και του φύλου αφενός και της ύπαρξης κάποιου απεικονιστικού ευρήματος αφετέρου και β) μεταξύ της τιμής της GCS και της προέλευσης (χειρουργείο / μη χειρουργείο) και της έκβασης. Η βαθμονόμηση του συστήματος APACHE-II είναι καλή (χ2=5,37, p=0,683, 8 Β.Ε.). Η APACHE-II υπερεκτιμά την πιθανότητα θανάτου για τις ομάδες κινδύνου 0-20% και 30-40% και την υποεκτιμά για τις ομάδες κινδύνου 20-30% και >40%. Η διαχωριστική ικανότητα της APACHE-II και της GCS, όπως μετράται με την AUC της αντίστοιχης ROC, είναι 0,854±0,047 και 0,548±0,076 αντίστοιχα. Για τους δεδομένους ασθενείς τα καλύτερα διαχωριστικά όρια είναι το 0,2226 (για τις Pr, Se=54,5%, Sp=88,9%, Youden=0,43), το 19 (για την APACHE-II, Se=48,5%, Sp=92,6%, Youden=0,41) και το 10 (για τη GCS, Se=84,8%, Sp=33,3%, Youden=0,18). Για τα όρια αυτά, η APACHE-II έχει CC=68,33%, PPV=88,88%, NPV=59,20%, LR+=6,6425, LR-=0,5564, ενώ οι αντίστοιχες τιμές για τη GCS είναι: 61,67%, 60,86%, 64,29%, 1,2725 και 0,4548. Προτείνονται, επίσης, ως πιο απλές, οι εξής 4 εξισώσεις παλινδρόμησης: α) GCS-Ομιλία = 0,963 + 0,029*ΜΚ,2 β) APS(12) = 148,843 – 1,074 * GCS – 16,878 * pH – 0,190 * HCT + 4,082 * CREAT, γ) APACHE-II = 152,611 – 1,051 * GCS + 4,762 * CREAT + 0,097 * AGE – 17,625 * pH – 0,226 * HCT και δ) APACHE-II = 1,789 + 1,025 * APS(12). Τέλος, περιοριστικοί παράγοντες στη γενίκευση των παραπάνω ευρημάτων είναι ο σχετικά μικρός αριθμός ασθενών, η βαθμολόγηση της APACHE-II από ειδικευόμενους ιατρούς (μικρή εμπειρία) και η υπερβολικά συχνή τιμή GCS 3. Ωστόσο, η APACHE-II θεωρείται χρήσιμο εργαλείο στην υποστήριξη των κλινικών αποφάσεων