Cuff meshoma post-laparoscopic sacrocolpopexy: vaginal-endoscopic mesh excision.

INTRODUCTION AND HYPOTHESIS: The objective was to present endoscopic images of a meshoma and describe the complete excision of a complicated mesh after sacrocolpopexy (SCP) using a combined vaginal-endoscopic technique. METHODS: We present a video documentation of an innovative technique. A 58-year-old woman was referred with painless, foul-smelling vaginal discharge and recurrent vaginal mesh erosions. She had undergone a laparoscopic SCP 12 years ago and her symptoms had begun 5 years ago. A pre-operative MRI scan revealed a cuff meshoma and an inflammatory sinus around the mesh extending from the cuff to the sacral promontory. Under general anesthesia, a 30° hysteroscope was inserted transvaginally into the sinus, where the retained mesh was seen in the form of a shrunken meshoma, and then the mesh arms were recognized extending cephalad into a sinus tract. Under direct endoscopic visualization, the mesh was carefully mobilized at its highest point with the use of laparoscopic grasping forceps. Then, the mesh was dissected with hysteroscopic scissors in close proximity to the bone. No peri-operative complications were recognized. RESULTS: A combined vaginal-endoscopic approach was successfully used to remove an eroded mesh and cuff meshoma after SCP. CONCLUSION: This procedure offers a minimally invasive, low-morbidity, and rapid-recovery approach.

Logometro®: The psychometric properties of a norm-referenced digital battery for language assessment of Greek-speaking 4-7 years old children.

In educational and clinical settings, few norm-referenced tests have been utilized until now usually focusing on a single or a few language subcomponents, along with very few language rating scales for parents and educators. The need for a comprehensive language assessment tool for preschool and early school years children which could form the basis for valid and reliable screening and diagnostic decisions, led to the development of a new norm-referenced digital tool called Logometro®. The aim of the present study is to describe Logometro® as well as its psychometric characteristics. Logometro® evaluates an array of oral language skills across the different language domains such as phonological awareness, listening comprehension, vocabulary knowledge (receptive and expressive), narrative speech, morphological awareness, pragmatics, as well emergent literacy skills (letter sound knowledge and invented writing) in Greek-speaking 4-7 years old children. More specifically, Logometro® has been designed in order to: (a) map individual language development paths as well as difficulties, (b) provide a descriptive profile of children's oral language and emergent literacy skills, and (c) assist in the identification of children who are at risk for Developmental Language Disorder (DLD) or Specific Learning Disabilities (SLD). The sample consisted of 926 children aged from 4 to 7 years, which were recruited from diverse geographical provinces and represented a variety of socioeconomic backgrounds in Greece. Eight hundred participants were typically developing children (N boys = 384 and N girls = 416), 126 children (N SLI = 44 and N SLD = 82) represented children with Special Educational Needs, and 126 children were typically developing peers matched for gender and age with the clinical groups. The administration lasted 90 min, depending on the participant's age and competence. Validity (construct, criterion, convergent, discriminant, and predictive) as well as internal consistency and test-retest reliability were assessed. Results indicated that Logometro® is characterized by good psychometric properties and can constitute a norm-referenced battery of oral language and emergent literacy skills. It could be used to inform the professionals as well as the researchers about a child's language strengths and weaknesses and form the basis on which they can design an appropriate individualized intervention if needed.

Oral Language and Story Retelling During Preschool and Primary School Years: Developmental Patterns and Interrelationships.

Oral language and narrative skills constitute very critical factors for children's academic performance and social competence. The aim of the present study was to investigate the developmental patterns of story retelling, as well as the relationship between oral language and story retelling in preschool and primary school children. Two hundred and thirty-seven Greek-speaking children (4-5, 5-6 and 6-7 years old) participated in the study. Vocabulary knowledge, phonological awareness, morphological awareness skills and pragmatics were examined through a standardized psychometric test. Story retelling was measured by inviting the children to listen to a story and then retell it. Children's narratives were evaluated according to microstructure (use of conjunctions and lexical cohesion) and macrostructure (story grammar and temporal sequencing) criteria. The results showed that children performed better as they got older across all the oral language and story retelling tasks. Structural equation modeling revealed that vocabulary skills stand out as a stable predictor across all the three age groups. A new finding was also demonstrated, highlighting that morphological awareness, phonological awareness skills and pragmatics work together with vocabulary skills in diverse patterns at different points of a child's development, in order to support his/her ability to retell a story.

Isolated aberrant right cysticohepatic duct injury during laparoscopic cholecystectomy: Evaluation and treatment challenges of a severe postoperative complication associated with an extremely rare anatomical variant.

A typical bile duct branching patterns represent one of the major causes of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). The most common classified variations of bile duct branching, involve the right posterior sectoral duct (RPSD) and its joining with the right anterior or left hepatic duct. Variant bile duct anatomy can rarely be extremely complex and unclassified. This report describes an extremely rare case of an isolated injury to an aberrant right hepatic duct formed by the joining of ducts from segments V, VII, and VIII draining into the cystic duct (cysticohepatic duct) during LC, associated with an inferior RPSD opening to left hepatic duct. Detailed evaluation of both endoscopic and magnetic cholangiograms established the diagnosis. Bile duct injury was subsequently managed surgically by a demanding Roux-en-Y hepaticojejunostomy. This extremely rare case aims to serve as a useful reminder of the consistent inconsistency of biliary anatomy, alerting surgeons to beware of variant bile duct branching patterns during open or LC that constitute a dreadful pitfall for severe and life-threatening bile duct injuries.

In silico identification and experimental validation of hits active against KPC-2 ß-lactamase.

Bacterial resistance has become a worldwide concern, particularly after the emergence of resistant strains overproducing carbapenemases. Among these, the KPC-2 carbapenemase represents a significant clinical challenge, being characterized by a broad substrate spectrum that includes aminothiazoleoxime and cephalosporins such as cefotaxime. Moreover, strains harboring KPC-type ß-lactamases are often reported as resistant to available ß-lactamase inhibitors (clavulanic acid, tazobactam and sulbactam). Therefore, the identification of novel non ß-lactam KPC-2 inhibitors is strongly necessary to maintain treatment options. This study explored novel, non-covalent inhibitors active against KPC-2, as putative hit candidates. We performed a structure-based in silico screening of commercially available compounds for non-ß-lactam KPC-2 inhibitors. Thirty-two commercially available high-scoring, fragment-like hits were selected for in vitro validation and their activity and mechanism of action vs the target was experimentally evaluated using recombinant KPC-2. N-(3-(1H-tetrazol-5-yl)phenyl)-3-fluorobenzamide (11a), in light of its ligand efficiency (LE = 0.28 kcal/mol/non-hydrogen atom) and chemistry, was selected as hit to be directed to chemical optimization to improve potency vs the enzyme and explore structural requirement for inhibition in KPC-2 binding site. Further, the compounds were evaluated against clinical strains overexpressing KPC-2 and the most promising compound reduced the MIC of the ß-lactam antibiotic meropenem by four-fold.

Preschool Phonological and Morphological Awareness As Longitudinal Predictors of Early Reading and Spelling Development in Greek.

Different language skills are considered fundamental for successful reading and spelling acquisition. Extensive evidence has highlighted the central role of phonological awareness in early literacy experiences. However, many orthographic systems also require the contribution of morphological awareness. The goal of this study was to examine the morphological and phonological awareness skills of preschool children as longitudinal predictors of reading and spelling ability by the end of first grade, controlling for the effects of receptive and expressive vocabulary skills. At Time 1 preschool children from kindergartens in the Greek regions of Attika, Crete, Macedonia, and Thessaly were assessed on tasks tapping receptive and expressive vocabulary, phonological awareness (syllable and phoneme), and morphological awareness (inflectional and derivational). Tasks were administered through an Android application for mobile devices (tablets) featuring automatic application of ceiling rules. At Time 2 one year later the same children attending first grade were assessed on measures of word and pseudoword reading, text reading fluency, text reading comprehension, and spelling. Complete data from 104 children are available. Hierarchical linear regression and commonality analyses were conducted for each outcome variable. Reading accuracy for both words and pseudowords was predicted not only by phonological awareness, as expected, but also by morphological awareness, suggesting that understanding the functional role of word parts supports the developing phonology-orthography mappings. However, only phonological awareness predicted text reading fluency at this age. Longitudinal prediction of reading comprehension by both receptive vocabulary and morphological awareness was already evident at this age, as expected. Finally, spelling was predicted by preschool phonological awareness, as expected, as well as by morphological awareness, the contribution of which is expected to increase due to the spelling demands of Greek inflectional and derivational suffixes introduced at later grades.

Pancreatic metastases: CT and MRI findings.

PURPOSE: The pancreas is an unusual but occasionally favored site for metastases in patients with advanced malignancy. The pivotal role of computed tomography (CT) and magnetic resonance imaging (MRI) examination in detecting the pancreatic mass and providing guidance to obtain a definitive tissue diagnosis is emphasized in this study. MATERIALS AND METHODS: Eleven patients with pancreatic metastases, 4 women and 7 men with a mean age of 62.45 years, were examined in a period of 5 years. All patients underwent CT examination and 3 patients were further evaluated by MRI. RESULTS: The primary malignancy was lung carcinoma in 7 patients, breast carcinoma in 3 patients and renal cell carcinoma in 1 patient. The pancreatic metastases were detected during initial staging in 4 cases and during follow-up in 7 cases. The type of metastases was solitary in 7 patients, multiple in 3 patients and diffuse in 1 patient, with rim or homogeneous enhancement. Seven patients had metastases to other organs. CT-guided biopsy was performed in 5 patients. CONCLUSION: Disparity in prognosis and management of patients with secondary pancreatic tumors makes detection and characterization of metastases to the pancreas an important goal of CT and MRI evaluation.