Endoscopic retrieval of a proximally migrated biliary stent: digital cholangioscope to the rescue

Endoscopic techniques for the retrieval of proximally migrated biliary stents include the following: fluoroscopy-guided grasping of the stent with a rat-tooth forceps, balloon placement parallel to the stent with traction retrieval, cannulation of the stent lumen with a wire (standard technique, or use of the curved plastic tip of a modified Soehendra stent retriever [Cook Medical, Bloomington, Ind]) followed by use of standard or modified Soehendra stent retriever, wire-guided retrieval basket, and snare. The technique used depends on the extent of proximal stent migration, the presence of ductal dilatation or biliary stricture, and the endoscopist’s experience. This report describes the retrieval of a proximally migrated biliary stent within an aberrant right hepatic duct (RHD) using a digital cholangioscope (SpyGlass DS system; Boston Scientific, Natick, Mass

Crowd-Sourcing Fuzzy and Faceted Classification for Concept Search

Searching for concepts in science and technology is often a difficult task. To facilitate concept search, different types of human-generated metadata have been created to define the content of scientific and technical disclosures. Classification schemes such as the International Patent Classification (IPC) and MEDLINE's MeSH are structured and controlled, but require trained experts and central management to restrict ambiguity (Mork, 2013). While unstructured tags of folksonomies can be processed to produce a degree of structure (Kalendar, 2010; Karampinas, 2012; Sarasua, 2012; Bragg, 2013) the freedom enjoyed by the crowd typically results in less precision (Stock 2007). Existing classification schemes suffer from inflexibility and ambiguity. Since humans understand language, inference, implication, abstraction and hence concepts better than computers, we propose to harness the collective wisdom of the crowd. To do so, we propose a novel classification scheme that is sufficiently intuitive for the crowd to use, yet powerful enough to facilitate search by analogy, and flexible enough to deal with ambiguity. The system will enhance existing classification information. Linking up with the semantic web and computer intelligence, a Citizen Science effort (Good, 2013) would support innovation by improving the quality of granted patents, reducing duplicitous research, and stimulating problem-oriented solution design. A prototype of our design is in preparation. A crowd-sourced fuzzy and faceted classification scheme will allow for better concept search and improved access to prior art in science and technology

Pathogen burden, inflammation, proliferation and apoptosis in human in-stent restenosis - Tissue characteristics compared to primary atherosclerosis

Pathogenic events leading to in-stent restenosis (ISR) are still incompletely understood. Among others, inflammation, immune reactions, deregulated cell death and growth have been suggested. Therefore, atherectomy probes from 21 patients with symptomatic ISR were analyzed by immunohistochemistry for pathogen burden and compared to primary target lesions from 20 stable angina patients. While cytomegalovirus, herpes simplex virus, Epstein-Barr virus and Helicobacter pylori were not found in ISR, acute and/or persistent chlamydial infection were present in 6/21 of these lesions (29%). Expression of human heat shock protein 60 was found in 8/21 of probes (38%). Indicated by distinct signals of CD68, CD40 and CRP, inflammation was present in 5/21 (24%), 3/21 (14%) and 2/21 (10%) of ISR cases. Cell density of ISR was significantly higher than that of primary lesions ( 977 +/- 315 vs. 431 +/- 148 cells/mm(2); p < 0.001). There was no replicating cell as shown by Ki67 or PCNA. TUNEL+ cells indicating apoptosis were seen in 6/21 of ISR specimens (29%). Quantitative analysis revealed lower expression levels for each intimal determinant in ISR compared to primary atheroma (all p < 0.05). In summary, human ISR at the time of clinical presentation is characterized by low frequency of pathogen burden and inflammation, but pronounced hypercellularity, low apoptosis and absence of proliferation. Copyright (C) 2004 S. Karger AG, Basel

Dislocation of a cerebral protection device component during carotid stenting: A case report of favorable outcome from conservative management after failure of retrieval

tINTRODUCTION: Cerebral-protection devices (CPDs) are a well-established system for reduction ofembolic risk in carotid artery angioplasty and stenting (CAS). Although rare, adverse events with CPDsare unpredictable and can be associated with serious outcomes and iatrogenic sequelae.PRESENTATION OF CASE: We describe the unique case of dislocation of a FilterWire EXTMfilter loop duringright CAS. On trying to recapture the CPD filter at the end of the procedure, the filter loop suddenlydetached from the guidewire and dislocated to the proximal middle cerebral artery. Attempted retrievalof the loop failed and the patient developed a transient neurological deficit caused by an acute ischemicinfarction in the lenticular nucleus. No further retrieval attempt was pursued. No further dislocation ofthe loop or clinical event have been reported during the 16-year follow up.DISCUSSION: This case reported a favorable outcome of conservative management for entrapped materialfrom a CPD after iatrogenic damage from failed retrieval. No similar reports are available in the litera-ture, and conservative management is generally not a recommended approach because of the potentialcomplications. However, rescue retrieval attempts are as well a potential source of serious events, andno clear guidelines exist on the management of mechanical complications from CPD.CONCLUSION: Entrapment of CPD components constitutes an adverse event with no unique solution forrisk-free management. The potential risks associated with the use of protection devices are still to befully explored, and improving the standard of care and patient safety needs to be a top priority

Premature thoughts on writing disorders

Three papers appeared in the 19th century describing the dissociation between speech and writing: Marce (1856), Ogle (1867) and Pitres (1884). An account of the convincing evidence of dissociations put forward in these papers is presented. Three explanations are proposed as to the reason why the observations reported by these authors were overlooked or rejected by their contemporaries, namely: (a) in the first half of the century it seems that very little knowledge of the processes underlying writing (as opposed to speech) was available, (b) the debates focussed on the independence of speech versus motor control and language versus the intellect, (c) parallelisms between phylogeny, ontogeny and aphasia impeded the application of the principle of double dissociations, including the dissociations between speech and writing. It is argued that this phenomenon in the history of aphasia is best captured by the concept of prematurity in scientific discovery proposed by Stent (1972, 2003)

A Complex Case of Cholestasis in a Patient with ABCB4 and ABCB11 Mutations

The low-phospholipid-associated cholelithiasis (LPAC) syndrome is a form of symptomatic cholelithiasis occurring in young adults, characterized by recurrence of symptoms after cholecystectomy and presence of hepatolithiasis. The case refers to a healthy 39-year-old Caucasian male who presented with abdominal pain and jaundice. His blood tests showed conjugated hyperbilirubinemia and elevated liver enzymes (total bilirubin 6.65 mg/dL, γ-glutamyltransferase 699 IU/L) and abdominal computed tomography revealed dilation of common bile duct and left intrahepatic ducts. Magnetic resonance cholangiopancreatography identified choledocholithiasis, retrieved by endoscopic retrograde cholangiopancreatography, after which there was a worsening of jaundice (total bilirubin 23 mg/dL), which persisted for several weeks, possibly due to ciprofloxacin toxicity. After an extensive workup including liver biopsy, the identification of two foci of hepatolithiasis on reevaluation abdominal ultrasound raised the hypothesis of LPAC syndrome and the patient was started on ursodeoxycholic acid, with remarkable improvement. Genetic testing identified the mutation c.1954A>G (p.Arg652Gly) in ABCB4 gene (homozygous) and c.1331T>C (p.Val444Ala) in ABCB11 gene (heterozygous). In conclusion, we describe the unique case of an adult male with choledocholithiasis, hepatolithiasis, and persistent conjugated hyperbilirubinemia after retrieval of stones, fulfilling the criteria for LPAC syndrome and with possible superimposed drug-induced liver injury, in whom ABCB4 and ABCB11 mutations were found, both of which had not been previously described in association with LPAC.info:eu-repo/semantics/publishedVersio

The Impact of Inter-Hospital Transfer on Clinical Outcomes following Endovascular Treatment for Acute Ischemic Stroke

PURPOSE Hospitals designated as primary stroke centers offer noninvasive treatment for acute ischemic stroke, but only comprehensive stroke centers are equipped to provide endovascular treatment. When stroke patients needing endovascular treatment present to the emergency department at a primary stroke center, they then require inter-hospital transfer to a comprehensive center for definitive treatment. Recent studies have found significant treatment delays and poor clinical outcomes in patients requiring inter-hospital transfer1,2. The primary aim of this study is to determine if inter-hospital transfer impacts clinical outcomes after endovascular treatment for acute ischemic stroke. A secondary aim is to determine whether inter-hospital transfer coincides with any significant treatment delay. METHODS This study involves retrospective chart review for 107 patients undergoing endovascular treatment for acute ischemic stroke at one of three hospitals in Austin, Texas from October 2016 to September 2018. 26 patients required inter-hospital transfer, while 81 (the control group) presented directly to a hospital offering endovascular treatment. Two-tailed T- and U-tests were used for analysis of parametric and non-parametric variables pertaining to time intervals and baseline characteristics. Odds ratios were calculated to compare dichotomized outcomes between groups, with significance determined by chi-square. RESULTS Inter-hospital transfer significantly prolonged onset to groin (mean difference = 37.2 min, p=.02). The transfer group was more likely to experience intracranial hemorrhage (53.9% > 22.2%, p<.01). Clinical outcomes did not significantly differ between groups. CONCLUSIONS Although observed trends in these data suggest poor outcomes for transfer patients, small sample size limits the significance of these findings. However, the significant treatment delay seen in the transfer group warrants a discussion on city protocol changes regarding patient transport via emergency services. Protocol changes favoring direct delivery of patients to comprehensive stroke centers may reduce treatment delay and yield improved clinical outcomes.Dell Medical Schoo

Incorporation of two terminology projects into a system for information retrieval using NLP for term expansion

In this paper, we will discuss two medical terminology projects at the University College of Ghent, Faculty of translation studies, and the benefits of combining them to provide Dutch professionals and laymen with better access to information in biomedical databases. Our first project, the MeSH Termbase Project (MTB) is aimed at health care professionals, medical translators and also patients in need of language support. The main aim of our second project, the Multilingual Glossary of Technical and Popular Medical Terms, is the simplification of the terminology used in patient information leaflets

Simulation of a mechanical thrombectomy device based in the use of self-expandable stents for the blood clots extraction

Recently, we have presented some studies concerning the analysis, design and optimization of one experimental device developed in the UK - GPTAD - which has been designed to remove blood clots without the need to make contact with the clot itself, thereby potentially reducing the risk of problems such as downstream embolisation. Based on the idea of a modification of the previous device, in this work, we present a model based in the use of stents like the SolitaireTM FR, which is in contact with the clot itself. In the case of such devices, the stent is self-expandable and the extraction of the blood clot is faciliatated by the stent, which must be inside the clot. Such stents are generally inserted in position by using the guidewire inserted into the catheter. This type of modeling could potentially be useful in showing how the blood clot is moved by the various different forces involved. The modelling has been undertaken by analyzing the resistances, compliances and inertances effects. We model an artery and blood clot for range of forces for the guidewire. In each case we determine the interaction between blood clot, stent and artery