Multicenter study on the clinical value of fetal pulse oximetry. I. Methodologic evaluation. The French Study Group on Fetal Pulse Oximetry

OBJECTIVE: Our purpose was to evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relationship with the neonatal outcome in a population with an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was performed from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with use of a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values, and relationship with neonatal outcome were assessed. RESULTS: One hundred seventy-four patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than an attempt at fetal blood analysis (easy in 87.5% vs 78.9% for fetal blood analysis, p = 0.03). The mean reliable signal time (+/- SD) was 64.7% +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2% +/- 8.0% (10th to 90th percentile range 30% to 53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29, p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between low fetal oxygen saturation (< 30%) and poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.     

Large cell neuroendocrine carcinoma of the thymus

AIM: We highlight the occurrence of an unusual neuroendocrine tumour, a large cell neuroendocrine carcinoma, arising from the thymus. CASE DETAILS: A 68-year-old man with a history of cigarette smoking had a large mediastinal tumour arising from the thymus removed. Two years later the tumour recurred; it was debulked surgically but the patient died 2 months later: Histological examination of both tumour specimens revealed a tumour with an endocrine pattern, composed of large pleomorphic cells with large nuclei and prominent nucleoli. The mitotic count ranged from 19 to 26 per 10 high-power fields and large tracks of coagulative tumour necrosis were present. The tumour cells were strongly positive for neuron-specific enolase (NSE), chromogranin, CAM5.2 and AE1/3, with cytoplasmic dot-like accentuation for the latter three markers. The tumour fulfilled the criteria for a diagnosis of large cell neuroendocrine carcinoma. CONCLUSIONS: Large cell neuroendocrine carcinoma should be distinguished from atypical carcinoid and small cell carcinoma. It is a distinctive neuroendocrine malignancy with a prognosis between that of atypical carcinoid and small cell carcinoma, and needs to be treated aggressively.     

Evaluation of multicast routing algorithms for real-timecommunication on high-speed networks

Multicast (MC) routing algorithms capable of satisfying the quality of service (QoS) requirements of real-time applications will be essential for future high-speed networks. We compare the performance of all of the important MC routing algorithms when applied to networks with asymmetric link loads. Each algorithm is judged based on the quality of the MC trees it generates and its efficiency in managing the network resources. Simulation results over random networks show that unconstrained algorithms are not capable of fulfilling the QoS requirements of real-time applications in wide-area networks. Simulations also reveal that one of the unconstrained algorithms, reverse path multicasting (RPM), is quite inefficient when applied to asymmetric networks. We study how combining routing with resource reservation and admission control improves the RPM's efficiency in managing the network resources. The performance of one semiconstrained heuristic, MSC, three constrained Steiner tree (CST) heuristics, Kompella, Pasquale, and Polyzos (1992), constrained adaptive ordering (CAO), and bounded shortest multicast algorithm (BSMA), and one constrained shortest path tree (CSPT) heuristic, the constrained Dijkstra heuristic (CDKS) are also studied. Simulations show that the semiconstrained and constrained heuristics are capable of successfully constructing MC trees which satisfy the QoS requirements of real-time traffic. However, the cost performance of the heuristics varies. The BSMA's MC trees are lower in cost than all other constrained heuristics. Finally, we compare the execution times of all algorithms, unconstrained, semiconstrained, and constrained     

Fracture mechanics of oilseed rape pods

The basic theory of linear elastic fracture mechanics was applied to the fracture of pods from six genetic lines of oilseed rape (Brassica napus). An experiment was designed to allow the energetics of the fracture process to be accurately determined. The work of fracture, toughness and fracture toughness of five experimental varieties and one common commercial variety (Apex) were measured. The values for the toughness (0.006–0.271 kJ m-2) and fracture toughness (0.026–0.233 MN m-3/2) obtained from each line were distinct from each other but broadly similar to those of other brittle materials. The toughness and fracture toughness of Apex were approximately midway between the lowest and highest values measured. This result indicates that there is scope for improving the fracture resistance of oilseed rape crops so as to reduce seed loss before and during harvest. The approach described would be useful in selecting fracture-resistant genetic lines to help to develop such crops. This revised version was published online in November 2006 with corrections to the Cover Date.     

Changes in muscle blood flow distribution during hyperthermia

Blood flow is a critical parameter for obtaining satisfactory temperature distributions during clinical hyperthermia. This study examines the changes in blood flow distribution in normal porcine skeletal muscle before, during and after a period of regional microwave hyperthermia. The baseline blood flow distribution during general anaesthesia and after the insertion of the thermal probes was established independently in order to isolate the changes due to hyperthermia. General anaesthesia alone and thermocouple insertion during anesthesia had no significant effect on the muscle blood flow distribution. Regional microwave heating generated a non-uniform blood flow distribution which was a function of the tissue temperature distribution. Blood flow was greater in those tissues samples in which higher temperatures were recorded and less in those sampled further from the applicators peak SAR (Specific Absorption Rate). The increase in blood flow appears to be primarily a local phenomenon. Although muscle blood flow may be considered to be uniform prior to heating, this does not hold during hyperthermia treatment. Therefore, the non-uniform nature of the blood distribution during heating should be incorporated into any practical bioheat transfer model.     

Electric field effects on roto-vibrational transitions of13CD3OH1

We used a Stark-Optoacoustic cell and hybrid waveguide resonators to perform an Infrared and Far Infrared Stark Spectroscopy study on some transitions of¹³CD₃OH. Different behaviours of the transitions in the presence of a d.c. electric field were observed. The Stark splittings of six FIR laser lines ranging from 34 to 136 MHz/kVcm^?1 were determined. The analysis of the behaviour of the IR and FIR transitions in the presence of the external electric fields gives important and exclusive information on the levels involved in the transitions.     

Response of Plasmodium falciparum to chloroquine and Fansidar in vivo and chloroquine and amodiaquine in vitro in Uganda

The response of P. falciparum to chloroquine and pyrimethamine-sulfadoxine in vivo and chloroquine and amodiaquine in vitro was investigated in parasitaemic school children from six locations. Mean parasite sensitivity to chloroquine at day 7 was 74% (range 61-97) with parasite clearance rates between 2-3 days and complete defervescence in 85% of febrile children. Sensitivity declined in the four sites followed up to day 14 to 45% (range 37-53). Parasites were significantly more sensitive to pyrimethamine/sulfadoxine at 5/6 sites (100% day 7) but 5% of subjects became parasitaemic by day 14. In vitro isolates were significantly less sensitive to chloroquine than to amodiaquine with a mean 99% effective concentration of 348 mumol/L compared to 6.44 mumol/L. Clearly the role of chloroquine as the primary therapy for uncomplicated P. falciparum malaria should be reconsidered especially in the light of increasing disease severity and resurgence. Amodiaquine may be suitable alternative with pyrimethamine/sulfadoxine as second line and for more severe malaria prior to referral. The cost of alternative antimalarials and the dynamic and deteriorating pattern of resistance are powerful arguments for more objective slide diagnosis to minimise drug pressure and a regular drug sensitivity surveillance system. We believe that the latter should concentrate on measuring clinical drug efficacy in symptomatic outpatients rather than in asymptomatic children while the former needs more pragmatic and economical strategies possibly centred on seasonality and risk.     

Selective catalytic reduction of NOx by hydrocarbons on Pt/Al2O3 catalysts at low temperatures without the formation of N2O

The selective reduction of nitrogen oxides by hydrocarbons on a Pt catalyst has been investigated. Some variations are observed between different reductants. However, the most significant result is the observation that no N₂O is observed as a by-product when toluene is used as a reductant.     

An empirical study of information technology enabled business process redesign and corporate competitive strategy

Business process redesign (BPR) has been widely touted as a means for leveraging the power of information technology to change business processes radically, resulting in substantial improvements in organizational effectiveness and efficiency. This study represents an early attempt at examining the strategic nature of the phenomenon. Because BPR is radical change and has the ability to alter both the competitive and operational nature of the corporation, it is critical that BPR be coordinated with corporate strategy. Through a survey of information system executives, the relationships between corporate competitive strategy and three types of BPR – intrafunctional, interfunctional and interorganizational – were examined. It was found that organizations following a cost strategy tended to do more BPR projects on interfunctional processes. Furthermore, the positive effect of a cost strategy on interfunctional BPR was found to be strengthened by the degree of integration of IS and business planning. It was also found that while interorganizational BPR was not related to a specific strategy, it was strongly related directly with IS–business planning integration.