Perspective lingvistico-pragmatice în abordarea textual-discursivă a referinţei (consideraţii teoretice, retrospective și de perspectivă)

Résumé La présente étude se propose tout d’abord une présentation des théories du signe linguistique: le paradigme structuraliste (le modèle binaire – F. de Saussure et L. Hjelmslev) et le modèle triadique (Odgen-Richards, Frege, Morris, Peirce). L’approche linguistico-pragmatique présente la référence comme un acte de langage qui, à partir de la théorie de J.C.Milner, fait la distinction entre la référence virtuelle, indépendante de l’expression verbale, équivalente à la signification lexicale de l’expression, et la référence actuelle, déterminée contextuellement. La perspective sémiotique de Peirce, avec la distinction entre Objet dynamique et Objet immédiat, nous permet aussi de faire une distinction entre la référence ponctuelle, au niveau de l’é- noncé, et la référence discursive, construite au niveau textuel. Rezumat Abordarea lingvistico-pragmatică prezintă referinţa ca un act de limbaj care, pornind de la teoria lingvistului J.C. Milner, face distincţia între referinţa virtuală, independentă de expresia lingvistică, echivalentă cu semnificaţia lexicală a expresiei, şi referinţa actuală, determinată, de fiecare dată, contextual. Perspectiva lingvistică are în vedere modelele semnului lingvistic: pe de o parte, cel binar (cu referire la cel structuralist – F. de Saussure şi L. Hjelmslev), iar pe de altă parte, modelul triadic (Odgen-Richards, Frege, Morris, Peirce). Contextul, în toate semnificaţiile pe care le acoperă, va avea un rol determinant în analiza/interpretarea fenomenelor textual-discursive

Intracranial pressure monitoring in neurosurgery department in Iasi – latest developments

Severe head trauma remains an important public health issue and the intracranial pressure monitoring is useful in indicating the patients prognosis, variation especially elevated intracranial pressure were associated with a poor prognosis. We illustrate some cases where we insert the monitoring system (intraparenchymal or intraventricular) and the neurological evolution

A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why

Medical professional societies each develop specific clinical practice guidelines (CPGs). Based on the best available evidence, CPGs are intended to control variability and optimize quality of care in clinical practice. Yet, healthcare providers often do not accept or adhere to guidelines, but their reasons are not fully understood. When providers opt to choose not to follow CPGs, unfavorable patient outcomes including unequal access to treatment become negative consequences. In this small qualitative study, we will explore what causes non-adherence to CPGs and what changes have been made to CPGs from when physicians completed their medical residencies to the present. We interviewed physicians from a variety of medical specialties to assess how these changes may influence guideline adherence as well as the consequences of not following them. We found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. In some specialties, physicians can develop a poor reputation if they do not adhere to the CPGs, and managed care agencies may deny reimbursement for care they provided. To best serve the physician and the patient, we need to find ways to improve CPG adherence. Tactics such as improving the methodology of CPG formation, using information technology, and creating ways to change physician attitudes and behavior are all viable options

AN IMPROVED 1-D SEISMIC VELOCITY MODEL FOR THE ACTIVE TECTONIC DEFORMATION AREA OF THE SOUTH WESTERN CARPATHIAN BEND ZONE (ROMANIA)

Book Chapter in INSIGHTS OF GEOSCIENCES FOR NATURAL HAZARDS AND CULTURAL HERITAGE, Editor: Florina CHITE

Analysis of isogrid reinforced cylindrical vessels in the case of axially symmetric buckling

Isogrid structures are a configuration of stiffeners of different sections, which make up a lattice placed on thin plates, with the aim of increasing the buckling factor of the overall structure. Because of the major benefits of isogrid structures when applied to increase the buckling factor and to decrease the mass of the structures the isogrid is placed on, its use has intensified until it has become a complete design technique for building cylindrical vessels under high compressive forces. Unfortunately, the detailed geometry of isogrid structures cannot be easily modelled or computed using FEM software, due to the high number of elements required to reliably mesh such a structure and the large amount of time taken to compute the results. This paper attempts to mitigate this problem by considering an analytical approach of sectioning the cylindrical vessel into component modules. These modules, consisting of a thin plate with isogrid stiffeners attached to it, are approximated as an overall thin plate with modified properties. The analytical algorithm is then implemented in a computed algebra system, which will quickly compute approximate values for the buckling factor and mass of the structure

Immune Markers in Psoriasis

Psoriasis is a chronic inflammatory skin disorder with high immunological background caused by a complex interplay between an altered immune system, genetic factors, autoantigens, lifestyle, and environmental factors. Extensive literature in recent years highlighted the crucial role played by the immune system in the pathogenesis of this pathology. Although it is unequivocally accepted that psoriasis is a T-cell mediated autoimmune condition, both innate and specific immune cells are highly involved in the pathogenesis of psoriasis. The aberrant interactions between immune cells and resident hyper-proliferative keratinocytes are mediated by immune and non-immune related molecules which lead to amplification of the local immune responses, that maintain the chronic inflammatory status. In this chapter, we will highlight the immune molecules resident in the psoriatic tissue or appending to the blood circulation that can indicate the prognosis of this systemic autoimmune disease. Moreover, we will focus on immune cells resident or circulating ones that can pinpoint the clinical evolution of the psoriatic disease. All these data can be developed in immune markers patterns that aid psoriasis diagnosis and/or future (immune)therapies

Investigator and independent review committee exploratory assessment and verification of tumor response in a non-Hodgkin lymphoma study

Interpretation of endpoints (e.g. overall response rate) in clinical trials depends on the accurate and reliable measurement and identification of tumors. Regulatory agencies recommend blinded reviews of imaging data by independent review committees (IRCs). Differences in response outcomes that arise between IRCs and site investigators raise regulatory/sponsor concerns. Here, we evaluate discrepant tumor response assessments by the IRC and unblinded investigators (complete versus partial response, respectively) occurring in 52 (13% of 393 IRC-assessed responders) of 447 enrolled patients with treatment-naïve non-Hodgkin lymphoma from a randomized study. The IRC and investigators were \u27likely correct\u27 in 73% and 25% of cases, respectively (p \u3c .001). Investigators were more likely to make errors by misinterpreting lymph node data and not utilizing PET results. This post hoc finding suggests a possible role for post-training site evaluation/audit, with retraining as needed, and a specialized consensus committee for concurrent blinded review of site/central data

The Effects of SARS COV 2 Infection –Does a Depression Pandemic Follow?

Viral infections can be a cause of CNS infection, causing mental and neurological symptoms. Even under normal conditions, good mental health is of paramount importance to the functioning of society. Healthcare workers are critical to the COVID-19 pandemic and beyond, but may have to leave work if their mental health is affected.We  present the favorable evolution of a patient, a 55 year-old woman, medical staff with a history of viral infection with SARS CoV-2 (August 2020), which is brought by a crew of the Ambulance service in the emergency department (ED) service (December 2020) for multi-drug ingestion for suicide. After treatment and investigations she is transferred to the “Elena Doamna” Psychiatric Hospital. After 4 days of hospitalization, he returns to the emergency department by transfer from the Psychiatric Hospital for underlying seizures, confusion syndrome. During her admission to the neurology service of the “Sf Ap. Andrei” Emergency Clinical Hospital, the patient benefited from numerous clinical and paraclinical investigations, which provided information about the patient's neuropsychiatric evolution.</p

Роль МРТ сердца в оценке микрососудистой коронарной дисфункции и в диагностике других причин MINOCA у пациентов с NSTEMI

Myocardial infarction without coronary artery obstruction (MINOCA) is 3 times more common in patients with NSTEMI compared to STEMI. The potential etiology of MINOCA can be divided in coronary and non-coronary causes. At the same time, an important role in its etiopathogenesis is played by microvascular coronary dysfunction (DCM). The aim of the study is to assess the feasibility of cardiac magnetic resonance (CMR) as a non-invasive method of evaluating DCM in patients with NSTEMI and in addition, to verify the substrate of MINOCA according to CMR. A diagnostic examination was carried out in 16 patients, of which coronary etiology was confirmed only in 1/3, the rest of the patients had a non-coronary etiology of the disease (myocarditis, hypertrophic cardiomyopathy and dilated cardiomyopathy). Microvascular coronary dysfunction (CDM) was determined in 30% of patients with non-coronary impairment (group I) and in 50% of those with coronary heart disease (group II) (χ² = 0.64, p&gt; 0.05). Significant differences between groups were observed in the localization of fibrosis, so in group II, according to CMR, all patients had subendocardial fibrosis - 100%, while in group I, intramural fibrosis prevailed in 50% (n = 5), subepicardial fibrosis - 20% (n = 2) and in 20% (n = 2) both types of contrast enhancement were noted, χ² = 12.44 p &lt; 0.05. In conclusion, CMR is an important diagnostic tool both in assessing the causes of MINOCA and in evaluating DCM in this category of patients. However, further studies are needed to improve the diagnostic accuracy of this method in the study of coronary microcirculation.Infarctul miocardic fără obstrucția arterelor coronare (MINOCA) se întâlnește de 3 ori mai frecvent la pacienții cu NSTEMI comparativ cu STEMI. Cauzele potențiale MINOCA pot fi coronariene și non-coronariene, iar un rol important în etiopatogenia sa îl are disfuncția coronariană microvasculară (DCM). Scopul studiului este de a aprecia fezabilitatea RMN cardiace ca metodă non-invazivă de evaluare a DCM la pacienții cu NSTEMI cât și de a determina rolul său în stabilirea cauzelor MINOCA. Conform rezultatelor RMN cardiace, dintre cei 16 pacienți incluși în studiu, etiologia coronariană a fost confirmată la doar 1/3, restul prezentând cauze non-coronariene (miocardita, cardiomiopatia hipertrofică și cardiomiopatia dilatativă). Disfuncția coronariană microvasculară (DCM) a fost determinată la 30 % dintre pacienții cu afectare non-coronariană (lotul I) și la 50% dintre cei cu afectare coronariană (lotul II), (χ²=0.64, p&gt;0.05). Diferențe semnificative între loturi s-au observat în localizarea fibrozei, astfel în lotul II toți pacienții au avut fibroză subendocardică- 100 %, în timp ce în lotul I a predominat fibroza intramurală în 50% (n=5) cazuri, urmată de fibroza subepicardică- 20% (n=2) și ambele tipuri de acumulare a contrastului în 20% (n=2) dintre pacienți, χ² =12.44 p&lt;0.05. În concluzie, RMN cardiacă reprezintă un instrument diagnostic important atât în aprecierea cauzelor MINOCA, cât și în evaluarea DCM la această categorie de pacienți. Totuși, sunt necesare studii ulterioare pentru a îmbunătăți acuratețea diagnostică a acestei metode în ceea ce privește studiul microcirculației coronariene.Известен факт, что инфаркт миокарда без обструкции коронарных артерий (MINOCA) встречается в 3 раза чаще у пациентов с NSTEMI по сравнению с пациентами STEMI. Принято выделять коронарную и не коронарную этиологию MINOCA, в тоже время важную роль в патогенезе заболевания играет микрососудистая коронарная дисфункция. Цель нашего исследования была, определить роль МРТ сердца в оценке микрососудистой коронарной дисфункции у больных с NSTEMI без обструкции коронарных артерий, а кроме того, верифицировать субстрат MINOCA по данным МРТ. Проведено диагностическое обследование 16 пациентам, из них коронарная этиология была подтверждена только лишь у 1/3, остальные пациенты имели не коронарную этиологию заболевания (миокардит, гипертрофическая кардиомиопатия и дилатационная кардиомиопатия). Микрососудистая коронарная дисфункция (МКД) определялась у 30% больных с не коронарной недостаточностью (I группа) и у 50% больных с ишемической болезнью сердца (II группа) (χ² = 0,64, p&gt;0,05). Значимые различия между группами наблюдались в локализации фиброза, так во II группе у всех больных по данным МРТ отмечался субэндокардиальный фиброз 100%, тогда как в I группе преобладал интрамуральный фиброз в 50% (n = 5) и субэпикардиальный фиброз 20% ( n = 2) , в 20% (n = 2) - отмечался оба типа наклонения контраста χ² = 12,44 p &lt; 0,05. Таким образом, МРТ сердца является важным диагностическим инструментом как при оценке причин MINOCA, так и при оценке МКД у этой категории пациентов. Однако необходимы дальнейшие исследования для повышения диагностической точности этого метода при изучении коронарной микроциркуляции