Role of pulmonary ultrasound in the diagnosis of acute respiratory failure

Dyspnea is the main clinical manifestation of acute respiratory failure; however, it can be induced by different causes that require differential diagnosis. In elderly patients, the medical examination is limited by cognitive and physical deficits and the genesis of dyspnea is often multifactorial; therefore, the definition of the causes is more complex. In recent years, among the various diagnostic methods, pulmonary ultrasonography has found increasing interest and the main patterns of ultrasound semeiotics have been described, specially in the emergency and critical care setting, as for pneumonia, pleural effusion, pneumothorax, pulmonary infarction, interstitial pathology. The most recent Literature emphasizes the role of multi-organ ultrasound (pleuro-pulmonar; cardiac; caval and iliac-femoral venous), to diagnose with good accuracy the causes of dyspnea. In this review we report the lung ultrasound semeiotic patterns, useful for the bedside or pointof- care detection of the cause of dyspnea, particularly respiratory and/or cardiac, during the medical examination

Laicità e principi costituzionali

Per gentile concessione dell’Editore G. Giappichelli, al quale va il vivo ringraziamento della Rivista, si pubblica la Sezione I dell’opera monografica di L. RISICATO, Dal “diritto di vivere” al “diritto di morire”. Riflessioni sul ruolo della laicità nell’esperienza penalistica (collana “Itinerari di diritto penale” – Sezione Saggi, Giappichelli ed., Torino, 2008). SOMMARIO: 1. La deriva della laicità nella società post-secolare e le sue possibili conseguenze - 2. La definizione di “laicità” ed i suoi livelli di rilevanza. Suo radicamento costituzionale. La storica ambiguità dell’art. 7 Cost. - 3. Segue: le norme costituzionali fondanti il carattere laico del diritto penale moderno. Ricostruzione dei confini della tutela costituzionale della vita: primi profili di illegittimità della l. 40/2004

Optimisation of yarn path structure within a 3D textile reinforcement for composite part

Dans le cadre du projet RaidOUTILS, un nouveau procédé de production de renforts textiles pour pièces composites est conçu. Il permet de réaliser des pièces profilées à section constantes ou non avec des orientations et liages multiples dans l'épaisseur. Un large choix de géométries est possible, il est donc nécessaire d'anticiper la structure à partir de la cinématique du procédé. Une modélisation permet cette anticipation. La technologie RaidOUTILS est une hybridation entre les procédés de tissage et de tressage. La combinaison des caractéristiques de ces deux technologies vise à éviter les découpes, les assemblages ou la mise en forme qui sont des manipulations sources de défaut. Les entrelacements peuvent se faire sur plusieurs couches comme sur un interlock. L'indépendance des guide-fils permet des entrelacements dans toute la structure. Elle perme enfin de proposer des structures à section évolutives par le choix d'une cinématique adaptée. La modélisation géométrique est basée sur une détection de rencontre des fils les uns par rapport aux autres et ne fait pas intervenir de notions mécaniques telles que le contact ou le frottement. La structure est définit par les fils, à section circulaire et constante, et par une ligne moyenne passant par les nœuds. Le temps de calcul est réduit pour obtenir une première estimation de la structure à l'échelle macro en termes de géométrie globale : orientation et entrelacement des fils. Le but est de permettre de faire le lien entre un moyen de production de renfort textile 3D, sa compréhension et l'optimisation de son utilisation selon des critères utiles à la réalisation de pièces composites élancées.The RaidOUTILS project aims the production of textile reinforcement for composite parts. Manufacturing of stiffeners with constant, as well as variable, cross sectional shape is possible. Interlacing is possible trough the thickness of the material and leads to a wide range of fibre orientation within the textile reinforcement. The RaidOUTILS technology is a hybridisation of braiding and weaving manufacturing. By combining properties from both technologies, steps such as cutting, joining and forming can be avoid. Those steps introduce defect in traditional reinforcement manufacturing cycle. Based on independent motion for each yarn within the structure it is possible to control interlacing and modify cross section. Modelling is also proposed for this process. It represents the yarn kinematic based on the existing machinery. The simple model is necessary to have a low calculation time to get the virtual skeleton of the structure. This skeleton returns data such as interlacing, orientation of the preform. The aim of the project is the creation of a new 3D textile manufacturing process and also to make the link between a product (textile) and the process by modelling

Optimisation de l'architecture des fils dans une structure textile 3D pour le renforcement de pièces composites

Dans le cadre du projet RaidOUTILS, un nouveau procédé de production de renforts textiles pour pièces composites est conçu. Il permet de réaliser des pièces profilées à section constantes ou non avec des orientations et liages multiples dans l'épaisseur. Un large choix de géométries est possible, il est donc nécessaire d'anticiper la structure à partir de la cinématique du procédé. Une modélisation permet cette anticipation. La technologie RaidOUTILS est une hybridation entre les procédés de tissage et de tressage. La combinaison des caractéristiques de ces deux technologies vise à éviter les découpes, les assemblages ou la mise en forme qui sont des manipulations sources de défaut. Les entrelacements peuvent se faire sur plusieurs couches comme sur un interlock. L'indépendance des guide-fils permet des entrelacements dans toute la structure. Elle perme enfin de proposer des structures à section évolutives par le choix d'une cinématique adaptée. La modélisation géométrique est basée sur une détection de rencontre des fils les uns par rapport aux autres et ne fait pas intervenir de notions mécaniques telles que le contact ou le frottement. La structure est définit par les fils, à section circulaire et constante, et par une ligne moyenne passant par les nœuds. Le temps de calcul est réduit pour obtenir une première estimation de la structure à l'échelle macro en termes de géométrie globale : orientation et entrelacement des fils. Le but est de permettre de faire le lien entre un moyen de production de renfort textile 3D, sa compréhension et l'optimisation de son utilisation selon des critères utiles à la réalisation de pièces composites élancées.The RaidOUTILS project aims the production of textile reinforcement for composite parts. Manufacturing of stiffeners with constant, as well as variable, cross sectional shape is possible. Interlacing is possible trough the thickness of the material and leads to a wide range of fibre orientation within the textile reinforcement. The RaidOUTILS technology is a hybridisation of braiding and weaving manufacturing. By combining properties from both technologies, steps such as cutting, joining and forming can be avoid. Those steps introduce defect in traditional reinforcement manufacturing cycle. Based on independent motion for each yarn within the structure it is possible to control interlacing and modify cross section. Modelling is also proposed for this process. It represents the yarn kinematic based on the existing machinery. The simple model is necessary to have a low calculation time to get the virtual skeleton of the structure. This skeleton returns data such as interlacing, orientation of the preform. The aim of the project is the creation of a new 3D textile manufacturing process and also to make the link between a product (textile) and the process by modelling.LILLE1-Bib. Electronique (590099901) / SudocSudocFranceF

Increased Arterial Stiffness in Subjects with Stroke

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Subcellular changes and apoptosis induced by ethanol in rat liver.

The livers of rats given ethanol for 5 weeks showed marked structural alterations of hepatocytes of acinar zone 3 including mitochondrial pleomorphism, increased smooth endoplasmic reticulum and deposition of small (less than 0.5 micron) lipid droplets. In addition, apoptotic bodies involving altered parenchymal cells were frequently observed, together with prominent mononuclear infiltrates adjacent to the terminal hepatic veins. It is suggested that 'age' of liver cells may play a role in the preferential perivenular localization of early ethanol-induced liver damage

Fluid Assessment and Management in the Emergency Department

Evaluation of hydration state or water homeostasis is an important component in the assessment and treatment of critically ill patients in the emergency department (ED). The main purpose of ED physicians is to immediately distinguish between normal hydrated, dehydrated and hyperhydrated states. Fluid depletion may result from renal losses and extrarenal losses (from the GI tract, respiratory system, skin, fever, sepsis, third space accumulations). Total body fluid increase can result from heart failure, kidney disease, liver disease, malignant lymphoedema or thyroid disease. In patients with fluid overload due to acute heart failure, diuretics should be given when there is evidence of systemic volume overload, in a dose up-titrated according to renal function, systolic blood pressure, and history of chronic diuretic use. The bioelectrical impedance vector analysis (BIVA) is a noninvasive technique to estimate body mass and water composition by bioelectrical impedance measurements, resistance and reactance. In patients with hyperhydration state due to heart failure, some authors showed that reactance is strongly related to BNP values and the NYHA functional classes. Other authors found a correlation between impedance and central venous pressure in critically ill patients. We have been analyzing the hydration state at admission to the ED, 24,72 h after admission and at discharge, and found a significant and indirectly proportional correlation between BIVA hydration and the Caval index at the time of presentation to the ED and 24 and 72 h after hospital admission. Moreover, at admission we found an inverse relationship between BIVA hydration and reduced urine output that became directly proportional at 72 h. This confirms the good response to diuretic therapy with the shift of fluids from interstitial spaces. Copyright (C) 2010 S. Karger AG, Base

Association of diffuse liver glycogenosis and mild focal macrovesicular steatosis in a patient with poorly controlled type 1 diabetes

[No abstract available