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The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity.Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal ischemic injury using multivariate regression analysis. We also compared the outcomes (organ failure during ICU stay and neurological status at hospital discharge) of the three groups of patients.Among the 214 patients included in the analysis, 121 (57%, 95% CI 50-63%) had an upper gastrointestinal ischemic lesion, most frequently on the fundus. Ischemic lesions were severe in 55/121 (45%) patients. In multivariate regression, higher adrenaline dose during cardiopulmonary resuscitation (OR 1.25 per mg (1.08-1.46)) was independently associated with increased odds of severe upper gastrointestinal ischemic lesions; previous proton pump inhibitor use (OR 0.40 (0.14-1.00)) and serum bicarbonate on day 1 (OR 0.89 (0.81-0.97)) were associated with lower odds of ischemic lesions. Patients with severe lesions had a higher SOFA score during the ICU stay and worse neurological outcome at hospital discharge.More than half of the patients successfully resuscitated from OHCA had upper gastrointestinal tract ischemic injury. Presence of ischemic lesions was independently associated with the amount of adrenaline used during resuscitation. Patients with severe lesions had higher organ failure scores during the ICU stay and a worse prognosis. Clinical Trial Registration NCT02349074 .

Acute severe injuries such as sepsis, trauma, severe hemorrhage, major surgery or cardiac arrest account for most of the ICU admission. Thanks to advances in life support tools and knowledge, to technical progress, a majority of patients now survive the first days of their injury but are then exposed to the development of ICU-acquired infections that are associated with significant morbidity and mortality [1, 2]. The increasing burden of nosocomial infections and the emergence of multidrug resistant bacteria call to urgent progress in preventive treatment of ICU-acquired infections. Although the prolonged use of invasive medical devices and the selection of resistant bacteria remain important determinants of ICU-acquired infections, there is increasing evidence that some acquired immune dysfunctions might contribute to the increased susceptibility to secondary infections despite recovery from the primary insult.

Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. Conclusions We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.

Klinefelter’s syndrome (KS) is associated with specific neurobehavioral features and personality traits. The aim of our study was to investigate fluid intelligence, personality traits and personality disorders (PD) and possible correlations with testosterone in a cohort of adult KS patients. We analyzed 58 adult KS patients with the classic 47, XXY karyotype. The Structured Clinical Interview for axis II disorders was used to assess DSM IV personality disorders. Personality traits were assessed using MMPI-2. Fluid intelligence was tested by using Raven’s Standard Progressive Matrices (SPM) Test. Testosterone blood concentration was measured by CMIA. PD prevalence was 31%. Four altered MMPI scales (Social Responsibility, Dominance, Ego Strength and Repression) were found in more than 40% of patients. Overcontrolled hostility and MacAndrew Alcoholism Scale-Revised scales were altered in the PD− group only. Biz-Odd Thinking and Post-Traumatic Stress Disorder scale were associated with the presence of personality disorder. The raw SPM score was 44 ± 10.8 without any significant correlation with testosterone. No significant difference in mean age, SPM raw score and MMPI score was observed between eugonadal, hypogonadal and treated patients. Most KS patients had average fluid intelligence. PD prevalence was higher than in the general population. Testosterone was not correlated with fluid intelligence, personality traits or PD, but a reduction in marital distress was observed in treated patients. This could suggest that testosterone therapy can improve physical symptoms and this effect could also improve relationship abilities and wellness awareness.

SummaryMicrotubule (MT) plus-end tracking proteins (+TIPs) preferentially localize to MT plus ends. End-binding proteins (EBs) are master regulators of the +TIP complex; however, it is unknown whether EBs are regulated by other +TIPs. Here, we show that cytoplasmic linker-associated proteins (CLASPs) modulate EB localization at MTs. In CLASP-depleted cells, EBs localized along the MT lattice in addition to plus ends. The MT-binding region of CLASP was sufficient for restoring normal EB localization, whereas neither EB-CLASP interactions nor EB tail-binding proteins are involved. In vitro assays revealed that CLASP directly functions to remove EB from MTs. Importantly, this effect occurs specifically during MT polymerization, but not at preformed MTs. Increased GTP-tubulin content within MTs in CLASP-depleted cells suggests that CLASPs facilitate GTP hydrolysis to reduce EB lattice binding. Together, these findings suggest that CLASPs influence the MT lattice itself to regulate EB and determine exclusive plus-end localization of EBs in cells.

Introduction La rupture d’un anevrisme intracrânien est un accident devastateur qui perturbe en profondeur l’homeostasie cerebrale. La coagulation est fortement activee par la rupture arterielle, surtout dans les cas d’hemorragies sous-arachnoidiennes (HSA) les plus severes, ce qui peut en parallele entrainer une hypocoagulabilite par consommation des facteurs de la coagulation. Materiel et methodes Nous illustrons dans ce travail cet etat mixte prothrombotique-prohemorragique dont la prise en charge reste particulierement complexe. Cas cliniques Deux patients presenterent une rupture d’anevrisme de l’artere communicante anterieure, traitee par embolisation, causant une HSA (Fisher IV-Hunt and Hess V) avec hemorragie intraventriculaire entrainant une hydrocephalie aigue traitee par derivation ventriculaire externe (DVE). Leur evolution fut marquee par le developpement d’un vasospasme severe et en parallele par, d’une part, des obstructions repetees des DVE necessitant de nombreux remplacements et, d’autre part, par une diathese hemorragique cerebrale avec formation d’hematomes intraparenchymateux (HIP) a chaque changement de catheters (DVE ou moniteur de PbO2). Une thrombolyse intrathecale fut finalement realisee dans les 2 cas, sans augmentation problematique des HIP. Aucun trouble de coagulation systemique n’a ete retrouve chez l’un des patients, alors que le second a developpe en cours d’hospitalisation un deficit en facteur XI (normal initialement). Aucune hemorragie n’a ete constatee en dehors du systeme nerveux central lors des differentes procedures invasives. L’evolution fut fatale pour l’un des 2 patients et favorable (GOS 4 a 3 mois) pour l’autre. Discussion et revue de litterature Nous avons observe un tableau inhabituel associant une hypercoagulabilite du LCR et une diathese hemorragique cerebrale. Nous n’avons pas trouve de cas similaires publies et des lors la prevalence de ce syndrome reste inconnue. Peu d’etudes decrivent les mecanismes des perturbations de la coagulation intracerebrale apres une rupture d’anevrisme. Un lien de causalite avec l’ischemie induite par le vasospasme peut etre discute.

Using computational modeling and laser microsurgery, we establish that neither the centrosomal microtubule array nor the Golgi-derived array is solely sufficient for correct Golgi assembly. Only the concerted effort of both MT arrays results in the integral, polarized Golgi complex necessary for polarized trafficking and cell motility., Assembly of an integral Golgi complex is driven by microtubule (MT)-dependent transport. Conversely, the Golgi itself functions as an unconventional MT-organizing center (MTOC). This raises the question of whether Golgi assembly requires centrosomal MTs or can be self-organized, relying on its own MTOC activity. The computational model presented here predicts that each MT population is capable of gathering Golgi stacks but not of establishing Golgi complex integrity or polarity. In contrast, the concerted effort of two MT populations would assemble an integral, polarized Golgi complex. Indeed, while laser ablation of the centrosome did not alter already-formed Golgi complexes, acentrosomal cells fail to reassemble an integral complex upon nocodazole washout. Moreover, polarity of post-Golgi trafficking was compromised under these conditions, leading to strong deficiency in polarized cell migration. Our data indicate that centrosomal MTs complement Golgi self-organization for proper Golgi assembly and motile-cell polarization.

The New World family Syringogastridae (Diptera, Acalyptratae) with the single genus Syringogaster is revised. Eleven new extant species are described in four newly recognized species groups to give a total of 20 extant species (S. brachypecta, S. apiculata and S. tenuipes in the rufa-group; S. atricalyx, S. figurata, S. plesioterga, and S. dactylopleura in the figurata-group; and S. nigrithorax, S. brunneina, S. sharkeyi and S. palenque in the brunnea-group; Marshall & Buck are the authors of all extant new species). The craigi-group includes two new fossil species, S. miocenecus Grimaldi and S. craigi Grimaldi, each described on the basis of a unique Miocene (ca. 17 myo) amber specimen from the Dominican Republic. Morphological and molecular characters are used to estimate phylogenetic relationships among species of Syringogastridae, and between Syringogastridae and related diopsids. The fossil species appear to form the sister group to the Central and South American figurata group, and reveal Antillean extinction of the family from earlier in the Tertiary.

Resume Introduction Le diagnostic d’anemie hemolytique auto-immune repose sur la mise en evidence d’autoanticorps fixes a la membrane des hematies a l’aide d’un test de Coombs direct. Dans la pratique, le test de Coombs (IgG et/ou complement) peut neanmoins se reveler exceptionnellement negatif notamment lorsque l’autoanticorps est de type IgA. Exegese Nous rapportons le cas d’une femme de 41 ans presentant une anemie hemolytique severe a test de Coombs negatif en IgG et complement, rattachee a une anemie hemolytique auto-immune a autoanticorps chauds de type IgA, ayant, par ailleurs, revele une infection par le virus de l’hepatite C. Conclusion Un test de Coombs direct negatif en IgG et complement (C3) ne suffit pas a eliminer de facon formelle l’existence d’une anemie hemolytique auto-immune. La strategie diagnostique en presence d’une anemie hemolytique a Coombs negatif ainsi que les liens potentiels entre anemie hemolytique auto-immune et infection par le virus de l’hepatite C sont ici discutes.

Since their initial discovery, the intriguing proteins of the +TIP network have been the focus of intense investigation. Although many of the individual +TIP functions have been revealed, the capacity for +TIP proteins to regulate each other has not been widely addressed. Importantly, recent studies involving EBs, the master regulators of the +TIP complex, and several TOG-domain proteins have uncovered a novel mechanism of mutual +TIP regulation: allosteric interactions through changes in microtubule structure. These findings have added another level of complexity to the existing evidence on +TIP regulation and highlight the cooperative nature of the +TIP protein network.

Resume Introduction La maladie de Whipple est une affection multisystemique liee au bacille non cultivable Tropheryma whipplei. Nous rapportons un cas trompeur de “sarcoidose” devenant “maladie de Whipple” avec endocardite. Observation Le diagnostic de sarcoidose a ete porte chez un patient de 61 ans sur des donnees cliniques, radiographiques, endoscopiques et histologiques. La reponse initiale a la corticotherapie a ete bonne mais le patient restait dependant de 35 mg/j de prednisone. L’apparition d’un syndrome inflammatoire clinique et biologique majeur a fait douter du diagnostic. Le diagnostic d’une endocardite a hemocultures negatives, sans possibilite de “decapitation” par antibiotherapie prealable a ete pose, avec mise en evidence echographique d’une masse arrondie de 1 cm de diametre appendue a la grande valve mitrale avec insuffisance mitrale grade 2. Les autres causes d’endocardites a hemocultures negatives ont ete ecartees. La maladie de Whipple a ete envisagee et le diagnostic retenu sur la positivite d’une biopsie duodenale en PCR pour Tropheryma whipplei, l’histologie restant negative. Un traitement par gentamycine et amoxicilline en intra-veineux a ete poursuivi 3 semaines, remplace par cotrimoxazole oral. L’echographie transoesophagienne de controle ne montrait plus la masse mitrale. Le patient, sous cotrimoxazole, sevre depuis 13 mois de prednisone, reste asymptomatique. Conclusion Ce cas illustre les difficultes de diagnostic differentiel entre sarcoidose et maladie de Whipple, mais aussi l’importance de cette distinction.

This paper presents an efficient method for evaluating the carrier frequency error in Gaussian minimum shift-keying (GMSK) communication systems. This method operates in a nonintrusive way. It uses the learning vector quantization neural network-based demodulator for reconstructing the transmitted phases. From these and the expected phases, the carrier frequency error is estimated. The method is able to operate both in static and multipath propagation cases, and as the base-band signal is processed, it does not require a high-frequency sampling rate. In order to apply the method, two procedures, a procedure for static propagation and a procedure for multipath propagation, are set up. Tests performed on GMSK signals show that the method is attractive, fast, and more accurate if compared with other approaches.

CLIP-associated proteins CLASPs are mammalian microtubule (MT) plus-end tracking proteins (+ TIPs) that promote MT rescue in vivo. Their plus-end localization is dependent on other + TIPs, EB1 and CLIP-170, but in the leading edge of the cell, CLASPs display lattice-binding activity. MT association of CLASPs is suggested to be regulated by multiple TOG (tumor overexpressed gene) domains and by the serine-arginine (SR)-rich region, which contains binding sites for EB1. Here, we report the crystal structures of the two TOG domains of CLASP2. Both domains consist of six HEAT repeats, which are similar to the canonical paddle-like tubulin-binding TOG domains, but have arched conformations. The degrees and directions of curvature are different between the two TOG domains, implying that they have distinct roles in MT binding. Using biochemical, molecular modeling and cell biological analyses, we have investigated the interactions between the TOG domains and αβ-tubulin and found that each domain associates differently with αβ-tubulin. Our findings suggest that, by varying the degrees of domain curvature, the TOG domains may distinguish the structural conformation of the tubulin dimer, discriminate between different states of MT dynamic instability and thereby function differentially as stabilizers of MTs.

The kinesin KIF1C is known to regulate podosomes, actin-rich adhesion structures that remodel the extracellular matrix during physiological processes. Here, we show that KIF1C is a player in the podosome-inducing signaling cascade. Upon induction of podosome formation by protein kinase C (PKC), KIF1C translocation to the cell periphery intensifies and KIF1C accumulates both in the proximity of peripheral microtubules that show enrichment for the plus-tip-associated proteins CLASPs and around podosomes. Importantly, without CLASPs, both KIF1C trafficking and podosome formation are suppressed. Moreover, chimeric mitochondrially targeted CLASP2 recruits KIF1C, suggesting a transient CLASP–KIF1C association. We propose that CLASPs create preferred microtubule tracks for KIF1C to promote podosome induction downstream of PKC.

The UMTS appear to be the communication system of the next future. In this system all the communication services will be included. This means that the Quality of Service (QoS) will have a great importance. So is envisaged that the management of the system will take in account the momentary system capabilities continually determined in real time. Until now, the quality of the links is determined by end-to-end in line procedures based on Bit Error Rate (BER) measurements. It is clear that an end-to-end procedure cannot detect the worse section of the link. To overcome this inconvenient the more recent trend of QoS management is to realise a distributed monitoring of the whole system. Following this last trend this paper proposes a distributed off-line monitoring of the system based on the analysis of the Quality of Analog Signal (QoAS). This proposed analysis implies a high-speed analog to digital conversion of the Intermediate Frequency signal and a very complex processing. In this paper, the state-of-the-art researches performed in this perspective are described.

Detection of high-energy neutrinos from distant astrophysical sources will open a new window on the Universe. The detection principle exploits the measurement of Cherenkov light emitted by charged particles resulting from neutrino interactions in the matter containing the telescope. A novel multi-PMT digital optical module (DOM) was developed to contain 31 3-inch photomultiplier tubes (PMTs). In order to maximize the detector sensitivity, each PMT will be surrounded by an expansion cone which collects photons that would otherwise miss the photocathode. Results for various angles of incidence with respect to the PMT surface indicate an increase in collection efficiency by 30% on average for angles up to 45° with respect to the perpendicular. Ray-tracing calculations could reproduce the measurements, allowing to estimate an increase in the overall photocathode sensitivity, integrated over all angles of incidence, by 27% (for a single PMT). Prototype DOMs, being built by the KM3NeT consortium, will be equipped with these expansion cones.© 2013 IOP Publishing Ltd and Sissa Medialab srl.

Proper organization of the microtubule cytoskeleton is essential for many cellular processes including maintenance of Golgi organization and cell polarity. Traditionally, the centrosome is considered to be the major microtubule organizing center (MTOC) of the cell; however, microtubule nucleation can also occur through centrosome-independent mechanisms. Recently, the Golgi has been described as an additional, centrosome-independent, MTOC with distinct cellular functions. Golgi-derived microtubules contribute to the formation of an asymmetric microtubule network, control Golgi organization, and support polarized trafficking and directed migration in motile cells. In this chapter, we present an assay using recovery from ice treatment to evaluate the potential of the Golgi, or other MTOCs, to nucleate microtubules. This technique allows for clear separation of distinct MTOCs and observation of newly nucleated microtubules at these locations, which are normally obscured by the dense microtubule network present at steady-state conditions. This type of analysis is important for discovery and characterization of noncentrosomal MTOCs and, ultimately, understanding of their unique cellular functions.

A recent analysis of the Fermi Large Area Telescope data provided evidence for a high-intensity emission of high-energy gamma rays with a E-2 spectrum from two large areas, spanning 50° above and below the Galactic centre (the "Fermi bubbles"). A hadronic mechanism was proposed for this gamma-ray emission making the Fermi bubbles promising source candidates of high-energy neutrino emission. In this work Monte Carlo simulations regarding the detectability of high-energy neutrinos from the Fermi bubbles with the future multi-km3 neutrino telescope KM3NeT in the Mediterranean Sea are presented. Under the hypothesis that the gamma-ray emission is completely due to hadronic processes, the results indicate that neutrinos from the bubbles could be discovered in about one year of operation, for a neutrino spectrum with a cutoff at 100 TeV and a detector with about 6 km3 of instrumented volume. The effect of a possible lower cutoff is also considered. © 2012 Elsevier B.V. All rights reserved.

The aim of this study was to compare intravenous regional anesthesia (IVRA) and brachial plexus block (BPB) for intra-operative analgesia in dogs undergoing pancarpal arthrodesis (PA). Twenty dogs scheduled for PA were intramuscularly sedated with acepromazine (0.03 mg/kg), general anesthesia was intravenously (IV) induced with thiopental (10 mg/kg) and, after intubation, maintained with isoflurane in oxygen. In 10 dogs (GIVRA) IVRA was performed on the injured limb administering 0.6 ml/kg of 0.5% lidocaine. In 10 dogs (GBPB) the BPB was performed at the axillary level with the help of a nerve stimulator and 0.3 ml/kg of a 1:1 solution of 2% lidocaine and 1% ropivacaine was injected. During surgery fentanyl (0.002 mg/kg IV) was administered if there was a 15% increase of HR and/or MAP compared to the values before surgical stimulation. All the standard cardiovascular and respiratory parameters were continuously monitored during surgery. The duration of surgery and the time of extubation were recorded. Data were compared with a 1-way ANOVA test (P0.05). No patients required fentanyl administration during surgery. All the recorded parameters were similar in the two groups. The two techniques were similar in providing intra-operative analgesia in dogs undergoing orthopaedic surgery.

Two species of fossil mushrooms that are similar to extant Tricholomataceae are described from Cretaceous and Miocene ambers. Archaeomarasmius leggetti gen. et sp. nov., from mid-Cretaceous amber of New Jersey, resembles the extant genera Marasmius and Marasmiellus. Two fruiting bodies of Archaeomarasmius were found. One consists of a complete pileus with stipe, and the other consists of a fragment of a pileus. The latter was accidentally exposed, and zxsubsequently was used for molecular systematics studies (attempts to amplify ribosomal DNA were unsuccessful) and electron microscopy. The spores are smooth and broadly elliptic with a distinct hilar appendage. Protomycena electra gen. et sp. nov., which is represented by a single complete fruiting body from Miocene amber of the Dominican Republic, is similar to the extant genus Mycena. Based on comparison to extant Marasmieae and Myceneae, Archaeomarasmius and Protomycena were probably saprophytes of leaf litter or wood debris. The poor phylogenetic resolution for extant homobasidiomycetes limits the inferences about divergence times of homobasidiomycete clades that can be drawn from Archaeomarasmius and Protomycena. The ages of these fossils lend support to hypotheses that the cosmopolitan distributions of certain mushroom taxa could be due to fragmentation of ancestral ranges via continental drift. Anatomical and molecular studies have suggested that there has been extensive convergence and parallelism in the evolution of homobasidiomycete fruiting body form. Nevertheless, the striking similarity of these fossils to extant forms suggests that in certain lineages homobasidiomycete macroevolution has also involved long periods during which there has been little morphological change.

Introduction L’obesite, (IMC ≥ 30 kg/m 2 ), est un enjeu majeur de sante publique qui concerne 15 % des adultes en France en 2012. Si un lien est etabli entre l’IMC et la mortalite generale notamment d’origine cardiovasculaire (JAMA 1999;28:1523–9), l’effet de l’obesite sur le pronostic des patients apres un arret cardiaque (AC) recupere demeure inconnu. Notre objectif etait d’evaluer l’impact de l’IMC sur le pronostic des patients admis en reanimation apres un AC recupere. Materiel et methodes Etude retrospective bicentrique 2005–2012 de donnees pre-hospitalieres et hospitalieres collectees prospectivement de maniere standardisee (criteres d’Utstein) des patients admis pour AC recupere. Analyse statistique uni- et multivariee des facteurs associes a la mortalite hospitaliere incluant l’IMC des patients. Accord des comites d’ethique dans les 2 centres. Resultats 1449 patients ont ete admis pendant la periode d’etude, 503 exclus pour donnees manquantes (taille/poids) et 946 patients ont ete inclus dans l’etude. Les patients se repartissaient dans les classes d’IMC de la facon suivante : n = 30 (3,2 %), 18–25 n = 446 (47 %), 25–30 n = 300 (31,7 %), 30–40 n = 145 (15,3 %), > 40 n = 25 (2,6 %). La mortalite en reanimation etait significativement influencee par l’IMC et apparait sous une forme de courbe en « J » ( Figure 1 ). Les caracteristiques des patients differaient en analyse univariee sur l’âge median : 59,2 ; 62,1 ; 65,1 et egalement sur le sexe masculin : 66,6 % ; 76,7 % ; 62,4 % et la survenue d’un choc post-AC : 57,1 % ; 59,1 % ; 68,3 % pour les classes d’IMC respectivement 30. L’analyse multivariee montrait qu’un IMC > 30 etait un facteur independamment associe a la mortalite : OR 2,17 (1,31–3,6), p Discussion Notre etude suggere que l’obesite est un facteur independant de la mortalite en reanimation des patients apres AC recupere. Le recueil de la survie a un an est en cours et apportera des elements importants sur l’effet a long terme de l’obesite dans cette pathologie. Nos resultats sont en accord avec l’impact de l’IMC sur le pronostic des AC intra-hospitaliers aux USA (Circ Cardiovasc Qual Outcomes 2010;3:490–7) et sur le pronostic des AC amenes aux urgences par des paramedicaux en Autriche (Resuscitation 2011;82:869–73). Cet effet sur le pronostic pourrait etre lie a la moindre efficacite des chocs electriques et/ou a la difficulte d’abord des voies aeriennes chez les patients obeses comme en temoigne la tendance a une duree de RCP specialisee plus longue mais egalement a la difficulte de la prise en charge post-ressuscitation avec une frequence accrue d’un etat de choc post-AC. L’impact de l’IMC sur la realisation de la revascularisation coronaire et de l’hypothermie therapeutique devrait etre analyses dans de futures etudes.

To test for the autonomic neuropathy in systemic sclerosis (SSc) using cardiovascular reflex evaluation including the "cold face test", which elicits forehead cold receptors (C-fibres). These tests examine the induced bradycardia-hypertensive response and the integrity of nociceptive afferent and parasympathetic-sympathetic efferent pathways.Twelve SSc patients were studied; including 5 with the limited cutaneous (lcSSc) involvement, and 7 with diffuse cutaneous involvement (dcSSc). All patients were matched with healthy controls. We performed cardiovascular autonomic tests (tilt-test, Valsalva manoeuver, deep breathing, sustained handgrip and cold face) with continuous monitoring of beat-to-beat blood pressure (BP) and heart rate (HR). Baroreceptor sensitivity index (BRSI) and power spectral analysis (PSA) of heart rate variability (HRV) were also evaluated.SSc patients showed a statistically significant higher HR at rest (p0.01), a lower increase of diastolic BP during tilt test (p0.01). They had suboptimal hypertensive and bradycardic response to the cold face test (Systolic BP: p0.05; Diastolic BP: p0.01; HR: p=0.08). The Valsalva manoeuver, deep breathing, isometric handgrip, BRSI and PSA of HRV results were within normal limits in the majority of SSc patients.In this group of SSc patients cardiovascular reflexes were normal, whereas the cold face test which acts through cutaneous nociceptive sensory fibres was abnormal in almost all patients. These results suggest that insufficiency of epidermal small fibres (C-fibres) is involved in SSc.

In order to customize the measurement procedure operating on personal digital assistant (PDA), the dynamic measurement application repository server (D-MARS) is added into the software architecture of the wireless distributed measurement system. The D-MARS is designed to download on demand two different typologies of virtual instruments (VIs). The first one is the traditional VI concerning with all the functionalities of the measurement instrument (MI). The later is the innovative one and concerns with the specific functionalities of the MI. It is organised by self containing modules obtained by splitting up the traditional VI in several functional entities according with the characteristics of the MI. The selection among these modules allows to the user the dynamically configuration of the measurement procedure on PDA. The management policy ensuring the efficiency of the working operations of the D-MARS is pointed out. In order to evidence the innovative features, an applicative example is shown.

In order to relieve structural chromosome aberrations, a new architecture of flow cytometer measurement device able to recognize and automatic count the Micro Nucleuses (MNs) on the acquired images of human lymphocytes has been pointed out. The technique adopted to perform the MN detection is based on the pattern matching algorithm. Biologist experts recommend that the correct detection of MN must respect the condition that the MN's surface is in the range off [1/3, 1/16] of the nucleus. The pattern matching algorithm can give only a coarse evaluation of the MN dimension. On the basis of these considerations, the paper proposes to cascade the pattern matching algorithm and the blob analysis in order to achieve the accurate evaluation of the MN surface. In order to evaluate the valid gray level used to threshold the image the pattern matching algorithm furnishes: (i) the coordinate (x, y) and (ii) the parameter about the coarse evaluation of MN dimension. So the blob analysis can be applied and the surfaces of both the MN and the nucleuses are accurately evaluated.

Confirmation of autoimmune hemolytic anaemia usually relies on the detection of erythrocyte membrane-bound autoantibodies using a direct antiglobulin test. In the rare case of IgA autoantibodies-mediated autoimmune hemolytic anemia, the direct antiglobulin test can be negative, because routinely used polyspecific direct antiglobulin test reagents contain only anti-IgG and anticomplement antibodies.We report the case of a 41-year-old woman presenting a severe autoimmune hemolytic anaemia caused by the presence of warm autoantibodies of IgA type that revealed a chronic hepatitis C virus infection.A negative direct antiglobulin test does not completely rule out the diagnosis of autoimmune hemolytic anaemia especially in the rare case of IgA mediated immune hemolysis. The diagnosis strategy of autoimmune hemolytic anaemia associated with negative direct antiglobulin test and the potential links between autoimmune hemolytic anaemia and HCV are discussed.

In this paper, a new A D converter architecture is proposed which includes the benefits of the neural A D converters and advantages, in terms of speed and resolution, of traditional A D converters. This neural A D converter is characterized by a very simple circuit based on a cascade of 1-bit stages including only an analog comparator and an amplifier. The functional description of the new neural A D converter and some design considerations are discussed. Furthermore, the experimental results obtained with a discrete component prototype of the converter are given. Finally, tests used for the dynamic characterisation of conventional A D converters are performed on the prototype and the results are also given. © 1995.

Whipple disease is a multisystem infectious disease caused by Tropheryma whipplei. We report a case in which an initial diagnosis of sarcoidosis was changed to Whipple disease endocarditis.Based on clinical, radiographic, endoscopic and histologic findings, this 61-year-old man was diagnosed with sarcoidosis. Initial response to corticotherapy was good, but the patient required 35 mg of prednisone daily. The subsequent onset of clinical and laboratory signs of inflammation cast doubt on the diagnosis. After cardiac ultrasound revealed a mass 1 cm in diameter on the mitral valve, apparently vegetation, we diagnosed culture-negative infective endocarditis and ruled out most possible causes. PCR of a duodenal biopsy sample showed Tropheryma whipplei, thus confirming the diagnosis of Whipple disease, despite normal histological findings. After 3 weeks of intravenous gentamicin and amoxicillin treatment, oral cotrimoxazole was substituted. Follow-up transesophageal ultrasound showed no mitral vegetation. The patient, still under cotrimoxazole, has been off prednisone for 13 months and is completely asymptomatic.This case is an illustration of the difficulty in distinguishing Whipple disease from sarcoidosis in practice and of the importance of that distinction.

The authors provide a method of evaluating two equivalent lumped capacitances by taking into account the physical effects of the stray capacitances in two coupled inductors. The lumped capacitance values are determined by means of a procedure based on the fitting eigenvalues of two equivalent circuits. The definitions and mathematical theory underlying the method are presented. The measurement system used and the parameter identification problem are discussed. The actual response of the two coupled inductors is compared with the response of the identified model. >

In this paper, the electrical circuit scheme for the Bit-Oriented A/D converter compatible with most CMOS process technologies is proposed. In order to overcome the problems of CMOS resistances implementation, further current is used as a processing signal. The most important factors affecting conversion resolution and speed are discussed. It is pointed out that a 3-/spl mu/m CMOS implementation of bit oriented A/D converter can achieve 8-bit resolution to maintain an absolute current error of half LSB. The bit-oriented converter can operate at a sampling rate of 8 MHz. The simple structure of the converter can give rise to other digital codes through variation of the reference voltages and current source connections. >

The paper presents an efficient method for evaluating the carrier frequency in GMSK communication systems. This method operates in a nonintrusive way. It utilizes the learning vector quantisation neural network based demodulator for reconstructing the transmitted phases. From these and the expected phases is estimated the carrier frequency error. The method is able to operate both in static and multipath propagation cases and it does not require a high frequency sampling rate because the base-band signal is processed. In order to apply the method two procedures, PSP (Procedure for Static Propagation) and PMP (Procedure for Multipath Propagation), are set-up. Tests performed on GMSK signals show that the method is quite attractive, fast and more accurate if compared with other approaches.

The main aim of study is the evaluation of water resuorces, the vulnerability and the definition of groundwater flow outline of carbonate aquifer of Volturino arid Calvelluzzo Mounts (Basilicata, Southern Italy). The aquifer vulnerability map is presented and discussed. Many parameters, as defined for SINTACS method, were used (lithology, fracture density, effective rainfall, slope, ...).

During the last years an analysis procedure and a general purpose computation program have been presented; they allow to determine the steady-state behaviour of any electrical or electromechanical system including static converters with short computing time and good accuracy.The present paper provides an extension of the analysis procedure, which also allows to evaluate the stability of the steady-state solution. In literature, this problem is already developed in relation to some particular conversion systems; on the contrary this paper shows a generalized formulation suitable for any conversion system.

Incorporation of labeled palmitate into triglycerides of incubated human placenta slices was investigated. Anaerobiosis reproduced by incubation in cyanide-containing buffer accelerated glucose disappearance from the solution and slightly decreased palmitate incorporation into tissue triglycerides. Inhibition of glycolysis by addition of sodium fluoride caused an almost complete cessation of glucose disappearance from the buffer and a marked decrease of palmitate incorporation into triglycerides. Glucose removal was greater when cyanide and fluoride were added to the medium than fluoride alone; however, triglyceride synthesis from palmitate did not show a parallel increase. It is concluded that fatty acid esterification by the placenta is resistant to anoxia but requires a functioning glycolytic pathway to produce α-glycerophosphate to which fatty acids are joined. The necessity of other energy-yielding processes was suggested by the lack of increase in esterification when the effects of cyanide and fluoride were compared to the effect of fluoride alone; since the combination of the two inhibitors actually increased glucose uptake from the medium, they probably increased glycerophosphate availability for esterification also.