Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion

BACKGROUND/PURPOSE: Fetuses with congenital diaphragmatic hernia (CDH) who have a "poor prognosis" with postnatal treatment now can be identified on the basis of liver herniation, early diagnosis (before 25 weeks' gestation) and a low lung-to-head ratio (LHR). Because complete in utero repair proved unsuccessful for this group, the strategy of temporary tracheal occlusion was developed to gradually enlarge the hypoplastic fetal lung. The purpose of this study is to compare the outcome of patients in the poor-prognosis group treated by one of three methods: (1) standard postnatal care, (2) fetal tracheal occlusion via open hysterotomy, and (3) the recently developed video-fetoscopic (Fetendo) technique of tracheal occlusion without hysterotomy. METHODS: In the past 3 years, 34 of 86 fetuses with an isolated left CDH met criteria for the poor-prognosis group. Thirteen families chose postnatal treatment at an extracorporeal membrane oxygenation (ECMO) center, 13 underwent open fetal tracheal occlusion, and eight underwent fetoscopic tracheal occlusion. RESULTS: The survival rate was 38% in the group treated by standard postnatal therapy, 15% in the open tracheal occlusion group, and 75% in the Fetendo group. There were less postoperative pulmonary complications noted in mothers who underwent the Fetendo procedure versus the open tracheal occlusion. All but one Fetendo clip patient had a striking physiological response demonstrated by sonographic enlargement of the small left lung that was documented postnatally by plain radiographs and its subjective appearance during repair of the CDH. In contrast, only 5 of the 13 open tracheal occlusion patients demonstrated lung growth. CONCLUSION: Fetuses with a left CDH who have liver herniation and a low LHR are at high risk of neonatal demise and appear to benefit from temporary tracheal occlusion when performed fetoscopically, but not when performed by open fetal surgery.     

Flux line lattice states and pinning in niobium wire networks in high magnetic fields

The properties of the flux line lattice in the thin strands of superconducting niobium wire networks with thickness and width comparable to the penetration depth are investigated in the limit of very few flux lines. An angle dependent upper critical field is observed that is consistent with the existence of surface superconductivity. Our results indicate the existence of a flux line lattice in the complete field range B_c1 B B_c 1.4 B_c2. The flux line lattice undergoes a dimensional crossover when the transversal correlation length R_c is of the order of the strand width. The field dependence of the Labusch parameter due to surface pinning is determined and compared to a model for surface pinning by Bean-Livingston barriers.     

Somatic mosaicism in a patient with neurofibromatosis type 1

Using loss of heterozygosity analysis, a method designed to detect moderate to large gene deletions, we have identified a new-mutation neurofibromatosis type 1 (NF1) patient who is somatically mosaic for a large maternally derived deletion in the NF1 gene region. The deletion extends at least from exon 4 near the 5' end of the gene to intron 39 near the 3' end. The gene-coding region is, therefore, mostly or entirely deleted, encompassing a loss of > or = 100 kb. We hypothesize that the deletion occurred at a relatively early developmental timepoint, since signs of NF1 in this patient are not confined to a specific body region, as seen in "segmental" NF, and since both mesodermally and ectodermally derived cells are affected. This report provides the first molecular evidence of somatic mosaicism in NF1 and, taken together with a recent report of germ-line mosaicism in NF1, adds credence to the concept that mosaicism plays an important role in phenotypic and genetic aspects of NF1 and may even be a relatively common phenomenon.     

Influence of hypertonic saline solution infusion on defibrillation efficacy

BACKGROUND: Transplantation of lung allografts from the same donor into 2 recipients ("twinning") provides an opportunity to study recipient and donor factors that influence early allograft function. METHODS: Twenty-seven pairs of recipients were identified and evaluated using multivariate logistic regression analysis (p < 0.05). Four measures of early graft function were analyzed: alveolar-arterial gradient in the operating room, first alveolar-arterial gradient in the intensive care unit, alveolar-arterial gradient at 24 hours, and days of mechanical ventilation. RESULTS: Analysis of the pooled data without regard to pairing showed that alveolar-arterial gradient in the operating room was influenced by donor age, length of donor hospitalization, recipient mean pulmonary artery (PA) pressure at unclamping, and transplantation of a left lung. The alveolar-arterial gradient in the intensive care unit was correlated with donor age, donor cause of death, and mean PA pressure on arrival in that unit. Only mean PA pressure remained significant at 24 hours. Days of mechanical ventilation was determined by mean PA pressure on arrival in the intensive care unit, drop in mean PA pressure during operation, and diagnosis of the recipient. In the paired analysis, receiving a left lung, recipient diagnosis (pulmonary hypertension worse than others), and need of cardiopulmonary bypass were significantly associated with immediate graft dysfunction, although these influences did not persist beyond the immediate postoperative period. Donor arterial oxygen tension and time of ischemia were not significant predictors in any analysis. CONCLUSIONS: Immediate allograft function was associated with donor-related characteristics initially, but these lost importance over the ensuing 24 hours. Recipient PA pressure was an immediate and persisting influence. In the analysis of differences in function between the members of each pair, transplantation of the left lung, recipient diagnosis, and cardiopulmonary bypass were identified, but their influence did not persist beyond the first 6 hours.     

Comparison of disability behavior after different sites and types of injury in a workers' compensation population

In this study, an extensive data set from a regional workers' compensation system was analyzed to determine whether particular sites or types of injury were associated with prolonged disability. This data shows a similar pattern of vocational disability for almost all sites and types of injury. A workers' compensation carrier collects data for financial purposes related to insurance, and such data therefore has several serious potential deficiencies when used for clinical research. However, published data on disablement after nonoccupational trauma shows similar patterns of vocational and nonvocational disability, and also shows dependence on severity of injury. In both settings, head injury is associated with greater occupational disability. Because treatment, policy, and medicolegal decisions are based on the impression of "typical disability" for particular sites and types of injury, there is a need for better documentation of post-traumatic disablement in compensation settings and in noncompensation settings. This should include better classification of the cause, type, and severity of the injury, and of the functional outcome in terms of both the resumption of occupational and nonoccupational roles, and of persistence in these roles.     

Non-functional properties in the model-driven development of service-oriented systems

Systems based on the service-oriented architecture (SOA) principles have become an important cornerstone of the development of enterprise-scale software applications. They are characterized by separating functions into distinct software units, called services, which can be published, requested and dynamically combined in the production of business applications. Service-oriented systems (SOSs) promise high flexibility, improved maintainability, and simple re-use of functionality. Achieving these properties requires an understanding not only of the individual artifacts of the system but also their integration. In this context, non-functional aspects play an important role and should be analyzed and modeled as early as possible in the development cycle. In this paper, we discuss modeling of non-functional aspects of service-oriented systems, and the use of these models for analysis and deployment. Our contribution in this paper is threefold. First, we show how services and service compositions may be modeled in UML by using a profile for SOA (UML4SOA) and how non-functional properties of service-oriented systems can be represented using the non-functional extension of UML4SOA (UML4SOA-NFP) and the MARTE profile. This enables modeling of performance, security and reliable messaging. Second, we discuss formal analysis of models which respect this design, in particular we consider performance estimates and reliability analysis using the stochastically timed process algebra PEPA as the underlying analytical engine. Last but not least, our models are the source for the application of deployment mechanisms which comprise model-to-model and model-to-text transformations implemented in the framework VIATRA. All techniques presented in this work are illustrated by a running example from an eUniversity case study.     

Review Paper: A critical review of the present and future prospects for electronic paper

Abstract— The commercial success of monochrome electronic paper (e‐Paper) is now propelling the development of next‐generation flexible, video, and color e‐Paper products. Unlike the early battles in the 1980s and 1990s between transmissive and emissive display technologies, there is a extraordinary diversity of technologies vying to become the next generation of e‐Paper. A critical review of all major e‐Paper technologies, including a technical breakdown of the performance limitations based on device physics and commentary on possible future breakthroughs, is presented. In addition, the visual requirements for color e‐Paper are provided and compared to standards used in conventional print. It is concluded that researchers have much work remaining in order to bridge the significant gap between reflective electronic displays and print‐on‐paper.     

Experimental test of a robust formation controller for marine unmanned surface vessels

Experiments with two formation controllers for marine unmanned surface vessels are reported. The formation controllers are designed using the nonlinear robust model-based sliding mode approach. The marine vehicles can operate in arbitrary formation configurations by using two leader-follower control schemes. For the design of these controller schemes 3 degrees of freedom (DOFs) of surge, sway, and yaw are assumed in the planar motion of the marine surface vessels. Each vessel only has two actuators; therefore, the vessels are underactuated and the lack of a kinematic constraint puts them into the holonomic system category. In this work, the position of a control point on the vessel is controlled, and the orientation dynamics is not directly controlled. Therefore, there is a potential for an oscillatory yaw motion to occur. It is shown that the orientation dynamics, as the internal dynamics of this underactuated system, is stable, i.e., the follower vehicle does not oscillate about its control point during the formation maneuvers. The proposed formation controller relies only on the state information obtained from the immediate neighbors of the vessel and the vessel itself. The effectiveness and robustness of formation control laws in the presence of parameter uncertainty and environmental disturbances are demonstrated by using both simulations and field experiments. The experiments were performed in a natural environment on a lake using a small test boat, and show robust performance to parameter uncertainty and disturbance. This paper reports the first experimental verification of the above mentioned approach, whose unique features are the use of a control point, the zero-dynamic stability analysis, the use of leader-follower method and a nonlinear robust control approach.