Bronchiolitis – It Is Time for a Unique Definition

Bronchiolitis is the most common lower respiratory tract infections in infants. It is time to reach a unique clinical definition, encompassing the acute onset of respiratory distress with cough, tachypnoea, retraction and diffuse crackles on auscultation in infants aged less than 12 months

Application de la mécanique des fluides numérique à l'imagerie de la pathologie de l'aorte thoracique et des traitements endovasculaires modernes par pose d'endoprothèse

La prise en charge des malades porteurs de maladie de l'aorte thoracique a été révolutionnée pendant ces dernières années par l'introduction du traitement endovasculaire par implantation d'endoprothèse, présenté à la communauté scientifique sur le New England Journal of Medicine en 1994. Depuis ce temps, une multitude d'études ont alimenté la littérature scientifique spécialisée. Cependant, même si les résultats cliniques ont étés encourageants au point de proposer la nouvelle thérapie comme référence dans certaines indications, notamment en cas d'urgence, moins d'attention a été réservée aux conséquences fonctionnelles liées à la pose du dispositif à l'intérieur du vaisseau. A partir de l'état vasculaire natif, quelles sont les modifications induites par l'endoprothèse sur l'anatomie et l'hémodynamique de l'aorte ? Cette question est le fil conducteur de mon projet de recherche. J'aborde dans cette thèse l'ensemble des problèmes liés au rôle de l'imagerie vasculaire fonctionnelle dans la prise en charge du patient aux différentes étapes de la méthodologie développée. Les simulations hémodynamiques par application de la mécanique des fluides numérique (MFN) sont, à ce jour, la seule méthode proposée pour obtenir une imagerie fonctionnelle de l'aorte thoracique pour l'évaluation des endoprothèses. En comptant sur une solide expérience au sein du laboratoire OCFIA avec la fusion des techniques d'imagerie classiques et la MFN, l'objectif des travaux de cette thèse de science est le développement de la filière de recherche dédiée à l'application de la mécanique des fluides numérique pour l'exploration hémodynamique de l'aorte thoracique et des conséquences des nouveaux traitements endovasculaires par implantation d'endoprothèse. Le projet a été structuré en deux axes : le premier a été focalisé sur l'évaluation d'une méthode d'imagerie fonctionnelle visant la reconstruction de conditions réalistes et spécifiques à l'aide du couplage entre l'imagerie par résonance magnétique (IRM) et la MFN. La méthodologie, mise au point au sein du laboratoire OCFIA, permet d'obtenir des vraies cartographies hémodynamiques centrées sur des paramètres différents, notamment la vitesse, la vorticité du flux et la force de cisaillement pariétal. La participation des médecins de l'équipe a permis de vérifier la faisabilité de la méthode in vivo et de comparer les études fonctionnelles aux données anatomiques pour en évaluer la fiabilité. Le deuxième axe du projet a été conçu pour développer l'application de la MFN à la recherche clinique. Dans ce but, le code Xflow a été choisi pour le couplage avec le scanner afin de réaliser une analyse quantitative de deux paramètres (le WSS et la vorticité), sur une série de 30 patients pour mettre en évidence les éventuelles modifications de l'état fonctionnel aortique avant et après mise en place d'endoprothèse. Le développement de la méthode scanner-MFN a permis d'évaluer, dans un premier temps, l'impact anatomique de l'implantation sur 60 géométries aortiques, un travail original dans le cadre de la littérature spécialisée. Ensuite, la base des données a été exploitée pour obtenir les simulations numériques à l'aide de différents outils à l'intérieur du logiciel solveur. Une extraction ponctuelle a été réalisée sur les zones d'implantation, permettant de confirmer l'hypothèse concernant les conséquences fonctionnelles du traitement sur le vaisseau natif. La publication des travaux dans des revues internationales incite les futurs développements pour optimiser l'application de nouvelles méthodes à la recherche clinique afin d'individualiser le rôle des facteurs fonctionnels soit dans le contexte du suivi des patients, soit dans l'évaluation de l'efficacité des dispositifs.Since 1994, when thoracic endovascular aortic repair (TEVAR) was presented to the medical community on the New England Journal of Medicine, the management of the aortic pathologies has dramatically changed in favour of a less invasive treatment associated with lower mortality and morbidity rates. A multitude of clinical trials, institutional registers and case reports has enriched the scientific literature and consecrated the new therapy which has been recently proposed as the new gold standard for such a theatre as the acute traumatic aortic rupture (ATAR). Nevertheless, little is known about the consequences of the device implantation on the native aortic status, in term either of anatomy and function. All routinely available techniques certainly provide well-detailed analysis of the aortic morphology but, so far, none of them allows for a functional exploration of the post-implantation status of the patients treated by TEVAR. The purpose of this PhD project, run over three years, was to develop functional vascular imaging techniques based on the combination of magnetic resonance (MR) and computed tomography (CT) with the CFD technology for the analysis of the thoracic aortic haemodynamics before and after the implantation of an endograft. Two main research lines have been followed: the first one was focused on the MRI-CFD combination for performing virtual simulations of the flow behaviour based on realistic patient-specific conditions. The multidisciplinary team of the OCFIA research laboratory implemented the methodology that was tested in vivo for the application in the thoracic aorta. Three-dimensional functional maps of the flow patterns were obtained and different parameters such as the velocity, vorticity and wall shear stress were qualitatively analyzed. The functional maps were compared with the morphologic images to assess their reliability. The second research line was dedicated to the application of the CFD-vascular imaging to a clinical study. The Xflow code was used with a CT combined approach for a systematic quantitative evaluation on a series of 30 patients; pre and post operative geometries were extracted and analyzed in order to detect the anatomical modifications before and after the implantation. The 3D image dataset was thereafter used for launching the CFD runs by a lagrangian approach. A quantitative comparative analysis of the wall shear stress and the vorticity was focused on the landing zones by means of two different tools. The outcomes confirmed the hypothesis of the impact of the endovascular treatment on the aortic status in terms of anatomy and functional changes. The application of the CFD methods for the functional evaluation of the thoracic aorta appeared feasible both before and after a stent-graft implantation. Over the three years two different papers have been accomplished and gained attention for publication on international journals. An implementation of the techniques is necessary to develop the clinical application of the CFD methods and weigh up their role in the whole patient management

BIFOCAL PAIRS OF IMAGES FOR LOW-COST SURVEY IN CLOSE RANGE PHOTOGRAMMETRY

Abstract. This paper present a method for close range photogrammetry based on an camera positioning scheme in which two cameras capture an equal portion of an object at the same scale, but have different focal lengths and camera-to-object distances. This scheme is alternative to the stereoscopic scheme and is associated with a system of equations which permits one to calculate first the relief displacement of points on a photograph and then their relief relative to a reference plane. The obtained relief and relief displacement values can be used to produce low-cost orthophotographs by using software for image processing, which doesn't need to be dedicated, but has to provide measurement and calculation functions. Moreover, this method also allows one to obtain three-dimensional coordinates, through further calculations

PROPOSAL FOR A LANDSCAPE EVALUATION SYSTEM

This paper describes a system, currently being designed, for both perceptual analysis and aesthetic evaluation of a landscape. The choice of this topic is motivated by the fact that systems related to landscape visibility (e.g. Geographical Information Systems (GIS) for visual impact assessment) are not fully satisfactory when it comes to assessing the aesthetic appearance. They mainly analyse geometric aspects, such as the width of visual basins or the interference of visual trajectories, which can be expressed by objective and comparable parameters. Instead, for effective landscape knowledge and protection, it is important to consider other factors that cannot be easily measured, namely the quality of human perception, i.e. the aesthetic judgements that people can express about a landscape. Based on these considerations, a system has been designed in order to analyse the elements that can influence the aesthetic judgement of a landscape and therefore simulate the more probable aesthetic judgement. Unlike GIS generally works, this system does not use maps, but perspective views obtained by means of vehicle-mounted cameras, as in mobile mapping technology (MMT). Research into the system described below consisted of two parts: firstly how to form the database on which the system is based and secondly how to use the system. The database contains a large number of views analysed in terms of geometric, qualitative, thematic, topological and gestalt aspects; the results of these analyses are recorded in tables and improved through a parameter expressing an aesthetic judgement. This aesthetic judgement is obtained by processing the responses of a group of participants to a sociological and/or neurological survey (i.e. Functional Magnetic Resonance Imaging). In the operational phase, a new view will be evaluated by comparison with the views stored in the database The new view will be given a judgment, obtained by processing the judgments of the most similar views. The idea of this system applies both to the assessment of a single view and to the evaluation of territorial contexts. Once this system has been defined, it will have to be tested through practical application

Gelatin tannate for acute childhood gastroenteritis: a randomized, single-blind controlled trial

Background Oral rehydration therapy is the recommended treatment for acute childhood gastroenteritis. The aim of this study was to assess the efficacy and safety of gelatin tannate plus oral rehydration compared with oral rehydration alone. Methods We conducted a multicenter, parallel, randomized, controlled, single-blind, prospective, open-label trial. A central randomization center used computer generated tables to allocate treatments. The study was performed in two medical centers in Italy. Sixty patients 3–72 months of age with acute gastroenteritis were recruited (median age 18 months; age range 3–66 months): 29 received an oral rehydration solution (ORS) and 31 an ORS plus gelatin tannate (ORS ? G). The primary outcome was the number of bowel movements 48 and 72 h after initiating treatment. Secondary outcomes were: duration of diarrhea, stool characteristics and adverse events. Results No patient was lost at follow-up. No significant difference in the number of bowel movements after 48 h was reported (2.7 ± 1.3 ORS ? G; 3.2 ± 0.8 ORS; p = 0.06), although the ORS ? G group showed a significant improvement in stool consistency (3.7 ± 1.0 vs. 4.3 ± 0.8; p = 0.005). At 72 h, a significant reduction in bowel movements was reported in the ORS ? G group compared with the ORS group (1.0 ± 1.4 vs. 2.0 ± 1.7; p = 0.01). Mean duration of diarrhea was significantly lower in the ORS ? G group than in the ORS only group (76.8 ± 19.2 vs. 108 ± 24.0 h; p.0001). No adverse events were reported. Conclusions Gelatin tannate added to oral rehydration in children with acute diarrhea was associated with a significant decrease in bowel movements at 72 h, with an early improvement in the stool consistency and shorter disease duration

Delayed eruption of permanent dentition and maxillary contraction in patients with cleidocranial dysplasia: review and report of a family

Introduction. Cleidocranial dysplasia (CCD) is an inherited disease caused by mutations in the RUNX2 gene on chromosome 6p21. This pathology, autosomal dominant or caused by a spontaneous genetic mutation, is present in one in one million individuals, with complete penetrance and widely variable expressivity. Aim. To identify the incidence of these clinical findings in the report of the literature by means of PubMed interface from 2002 to 2015, with the related keywords. The report of local patients presents a clinical example, related to the therapeutic approach. Results and Discussions. The PubMed research resulted in 122 articles. All the typical signs were reported in all presented cases. The maxilla was hypoplastic in 94% of the patients. Missing of permanent teeth was found in two cases: one case presented a class II jaw relationship, instead of class III malocclusion. Similar findings were present in our cohort. Conclusion. CCD is challenging for both the dental team and the patient. The treatment requires a multidisciplinary approach. Further studies are required to better understand the cause of this disease. According to this review, a multistep approach enhances the possibilities to achieve the recovery of the most possible number of teeth, as such to obtain a good occlusion and a better aesthetic

Laparoscopic Excision of a Large Hepatic Cyst

The authors suggest that laparoscopic techniques may be feasible in the pediatric patient with rare, benign hepatic cysts

Changes in total choline concentration in the breast of healthy fertile young women in relation to menstrual cycle or use of oral contraceptives: a 3-T 1H-MRS study

BACKGROUND: To evaluate changes in total choline (tCho) absolute concentration ([tCho]) in the breast of healthy fertile women in relation to menstrual cycle (MC) or use of oral contraceptives (OC). METHODS: After institutional review board approval, we prospectively evaluated 40 healthy fertile volunteers: 20 with physiological MC, aged 28 ± 3 years (mean ± standard deviation; nOC group); 20 using OC, aged 26 ± 3 years (OC group). Hormonal assays and water-suppressed single-voxel 3-T proton magnetic resonance spectroscopy (1H-MRS) were performed on MC days 7, 14, and 21 in the nOC group and only on MC day 14 in the OC group. [tCho] was measured versus an external phantom. Mann-Whitney U test and Spearman coefficient were used; data are given as median and interquartile interval. RESULTS: All spectra had good quality. In the nOC group, [tCho] (mM) did not change significantly during MC: 0.8 (0.3-2.4) on day 7, 0.9 (0.4-1.2) on day 14, and 0.4 (0.2-0.8) on day 21 (p = 0.963). In the OC group, [tCho] was 0.7 (0.2-1.7) mM. The between-groups difference was not significant on all days (p ≥ 0.411). All hormones except prolactin changed during MC (p ≤ 0.024). In the OC group, [tCho] showed a borderline correlation with estradiol (r = 0.458, p = 0.056), but no correlation with other hormones (p ≥ 0.128). In the nOC group, [tCho] negatively correlated with prolactin (r = -0.587, p = 0.006) on day 7; positive correlation was found with estradiol on day 14 (r = 0.679, p = 0.001). CONCLUSIONS: A tCho peak can be detected in the normal mammary gland using 3-T 1H-MRS. The [tCho] in healthy volunteers was 0.4-0.9 mM, constant over the MC and independent of OC use