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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 (

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.

Development of Cognitive and Academic Abilities in Greek Elementary School Students The development of language and reading skills is closely linked to the maturation ofcognitive abilities. This study focuses on Attention and Executive skills (EFs) and theirconnection with the development of language and reading skills among elementary schoolstudents, with emphasis on reading comprehension. In the context of two studies weexamined: the effect of Attention and EFs on Reading Comprehension controlling for printrelatedskills, the direct and indirect effects of attention, the factors that may moderate theseeffects of cognitive abilities on Reading Comprehension, and the cognitive and academicperformance of children demonstrating teacher-rated ADHD-related symptoms. A battery of tests assessing Sustained Attention, Short-term Memory (STM), EFs, andacademic skills was administered to a representative sample of, largely untreated, Greekelementary school students (N= 597 and N=923, respectively). Attention and EFs contributedsignificant additional variance to the prediction of Reading Comprehension after controllingfor efficiency, accuracy, morphosyntactic and vocabulary knowledge. Attention-relatedabilities contributed to Reading Comprehension indirectly through EFs. The only factor thatmoderated the effects of EFs on Reading Comprehension was Reading Efficiency. Significantdeficits in EFs and STM were restricted to the groups of students displaying inattentionsymptoms. Results demonstrated a close link between EFs, other than inhibition and set-shifting,everyday symptoms of inattention, and achievement in math and word-level reading skills.Reduced performance on EF measures was identified as the most important factor thatdistinguished between students with pervasive academic difficulties and their typicallyachieving peers, regardless of the presence of inattention symptoms. Considering the crosssectionalnature of the present study, our results provide some support to the hypothesis that EF deficits are causally related to developmental academic difficulties, and may set a firmbasis for implementing a cognitive approach to the management of students with ReadingComprehension difficulties and severe inattention symptoms.

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.

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 β-lactamases are often reported as resistant to available β-lactamase inhibitors (clavulanic acid, tazobactam and sulbactam). Therefore, the identification of novel non β-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-β-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 β-lactam antibiotic meropenem by four-fold. publishedVersion

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 β-lactamases are often reported as resistant to available β-lactamase inhibitors (clavulanic acid, tazobactam and sulbactam). Therefore, the identification of novel non β-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-β-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 β-lactam antibiotic meropenem by four fold.

Background and aim: A multicentre nationwide surveillance study was conducted in Greek hospitals to evaluate epidemiology of carbapenemase-producing Klebsiella pneumoniae clinical isolates, and their susceptibilities to last-line antibiotics. Methods: Minimum inhibitory concentrations (MICs) were evaluated by Etest, colistin MICs were also evaluated by broth microdilution SensiTest (now known as ComASP) Colistin. Carbapenemase genes were detected by PCR. Clonal relatedness was assessed by PFGE. Isolates were prospectively collected between November 2014 and April 2016, from 15 hospitals. Results: Among 394 isolates, K. pneumoniae carbepenemase (KPC) remained the most prevalent carbapenemase (66.5%). NDM was the second most prevalent (13.7%), identified in 12 hospitals, followed by VIM (8.6%). OXA-48- and double carbapenemase-producers remained rare (3.6%, 6.3%, respectively). Carbapenemase-producing K. pneumoniae isolates showed high resistance to last-line antibiotics. Gentamicin and colistin were the most active in vitro with 61.9% and 59.6% of the isolates to be inhibited at

Purpose To evaluate the in vitro efficacy of several anti-staphylococcal agents against a nationwide collection of contemporary Staphylococcus aureus clinical isolates from several healthcare centres in Greece. Methods Thirty hospitals throughout Greece (18 in Attica) provided all clinical isolates of S.aureus from April 2012 to May 2013 to a central lab to be re-submitted to susceptibility testing. The MICs were evaluated by Vitek (R) 2 with the exception of ceftaroline (OXOID M.I.C. Evaluator). Vancomycin and daptomycin MICs were also evaluated by Etest (R). Heterogeneously vancomycin-intermediate strains (hVISA) were detected by the Etest (R) GRD. VISA phenotype was confirmed by PAP-AUC. Results A total of 1005 isolates (39% MRSA) were studied. Susceptibility rates were: erythromycin 66.5%, clindamycin 79.2%, SXT 98.9%, rifampicin 97.3%, fusidic acid 67%, moxifloxacin 78.8%, vancomycin 99.9%, ceftaroline 92.9% and linezolid, tigecycline and daptomycin 100%. For mupirocin, high level resistance could be excluded for 98.9% of isolates. Vancomycin Etest (R) MIC50/90 were 1.5/1.5mg/L, 58.5% of isolates exhibited a MIC>1 and 8.7% a MIC of 2mg/L, while Vitek (R) MIC50/90 were 1/1 and 3.1% showed MIC>1mg/L. One VISA strain was detected. Among the selected 175 isolates that were screened for hVISA phenotype, six (3.4%) were positive. In 315 bloodstream isolates, 64.1% had a vancomycin Etest (R) MIC>1mg/L. Conclusions This multi-centre surveillance study revealed that a significant percentage of contemporary S.aureus isolates from Greek patients have a vancomycin MIC (>1mg/L) that may compromise the clinical efficacy of the drug for the treatment of serious infections. The in vitro activity of SXT, rifampicin, mupirocin, linezolid, tigecycline, daptomycin and ceftaroline remains excellent.

ancreatic metastases are rare, with a reported incidence varying from 1.6% to 11% in autopsy studies of patients with advanced malignancy. In clinical series, the frequency of pancreatic metas-tases ranged from 2% to 5% of all pancreatic malignant tumors (1–5). The most common primary tumors to give rise to pancreatic metastases are renal cell carcinoma, lung cancer, breast cancer and colorectal carci-noma followed by malignant melanoma and leiomyosarcoma (1, 6). The disparity in prognosis and management of patients with primary and secondary pancreatic tumors, as well as the fact that in very selected cases a radical surgical resection can be considered as treatment of pancreatic metastases and achieve prolonged survival, underlines the importance of detection and characterization of these lesions on computed tomogra-phy (CT) and magnetic resonance imaging (MRI) (1, 6, 7). CT can also be considered as an important tool in providing guidance in order to obtain a definitive tissue diagnosis in controversial cases (1, 2, 7). Material and methodsIn a period of 5 years, between January 2002 and January 2007, 11 patients with pancreatic metastases, 4 women and 7 men, were exam-ined. Patients’ ages ranged from 27 to 78 years with a mean age of 62.45 years. All patients underwent CT examination and 3 patients were fur-ther evaluated by MRI. CT-guided biopsy was performed in 5 cases. Pa-tients with neoplastic involvement of the pancreas by direct extension from adjacent viscera, as well as patients with metastatic involvement of peripancreatic lymph nodes but not of the pancreas itself, were excluded from the study. CT scans were obtained with a Picker PQ 5000 CT scanner device with slice thickness, 5 mm; pitch, 2; reconstruction interval, 5 mm; FOV, rang-ing from 320–400 mm depending on the patient’s size. Images were ob-tained after contrast agent administration during portal phase (60–70 s after injection). A bolus injection of 120–150 mL (3–4 mL/s) of non-ionic contrast medium was given.MRI scans were obtained with a Siemens 1 T scanner (Siemens Ex-pert Plus, Erlangen, Germany). Before contrast administration, axial and coronal HASTE T2-weighted images (TR, 6 ms; TE, 60 ms) were obtained with a slice thickness of 8 mm; FOV, 340–400 mm depending on pa-tient’s size; and matrix, 256 x 192. After administration of 10 mL of contrast agent axial FLASH T1-weighted images (TR, 11 ms; TE, 4.2 ms) were obtained with a slice thickness of 8 mm; FOV, 340–400 mm, ma-trix, 256 x 192.CT guided pancreatic biopsies were performed using 18 G cutting nee-dles with the coaxial technique (Temno Evolution, Cardinal Health, Or-lando, Florida, USA). All patients were informed and gave their written consent before biopsy.