Development of a comprehensive database for research on foetal acidosis.

OBJECTIVE: To develop a research database for mother-and-child clinical and laboratory data and digital foetal heart rate (FHR) recordings. METHODS: The Base Bien Naître (BBN) database was derived from a single-centre health data warehouse. It contains exhaustive data on all parturients with a singleton pregnancy, a vaginal or caesarean delivery in labour with a cephalic presentation after at least 37 weeks of amenorrhea, and a live birth between February 1st, 2011, and December 31st, 2018. On arrival in the delivery room, the FHR was recorded digitally for at least 30 min. A cord blood sample was always taken in order to obtain arterial pH (pHa). More than 6,000 recordings were analyzed visually for the risk of foetal acidosis and classified into five groups (according to the French College of Gynaecologists and Obstetricians (CNGOF) classification) or three groups (according to the International Federation of Gynaecology and Obstetrics (FIGO) classification). RESULTS: Of the 16,089 files in the health data warehouse, 11,026 were complete and met the BBN's inclusion criteria. The FHR digital recordings were of good quality, with low signal loss (median [interquartile range]: 7.0% [4.3;10.9]) and a median recording time of 304 min [190;438]). In 3.7% of the children, the pHa was below 7.10. We selected a subset of 6115 records with good-quality FHR recordings over 120 min and reliable cord blood gas data: 692 (11.3%) had at least a significant risk of acidosis (according to the CNGOF classification), and 1638 (26.8%) were at least suspicious (according to the FIGO classification). CONCLUSION: The BBN database has been designed as a searchable tool with data reuse. It currently contains over 11,000 records with comprehensive data.

Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth.

OBJECTIVE: To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. METHODS: Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. RESULTS: Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362-2.300]), a male fetus (1.408 [1.097-1.811]), and the term of the pregnancy (1.333 [1.189-1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012-1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174-1.424]), the baseline range (1.027 [1.014-1.040]), fetal bradycardia (1.038 [1.003-1.075]) and the late deceleration area (1.002 [1.000-1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. CONCLUSION: In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis.

Evaluation of semi-automatic image analysis tools for cerebrospinal fluid electrophoresis of IgG oligoclonal bands.

BACKGROUND: IgG concentrations in cerebrospinal fluid generally range from 20 to 45 mg/L. In multiple sclerosis immune reactions lead to intrathecal synthesis of specific IgGs that can be detected in biological fluid samples both quantitatively and qualitatively by isoelectric focusing of supplementary oligoclonal IgG bands. METHOD: A simple tool, using the MATLAB application, to facilitate and improve isoelectric focusing profile analysis is presented and evaluated in terms of its sensitivity, repeatability and reproducibility. A comparison between human readers and semi-automatic method has also been performed. RESULTS: Results from the semi-automatic method were found to be equivalent or superior to generally employed laboratory methods. Repeatability analysis for semi-automatic processing yielded coefficients of variation (CVs) in the 3-7% range, and using a sample with an estimated IgG concentration of 200 mg/L, four bands were still visible after dilution to 5 mg/L, corresponding to band concentrations of 1.1-1.6 mg/L. Discordances between visual inspection and automatic analysis only appear at threshold levels for interpretation (the gray zone). CONCLUSION: The semi-automatic method has acceptable performance for routine implementation.

Semi-automated image analysis of gel electrophoresis of cerebrospinal fluid for oligoclonal band detection.

Detection of oligoclonal electrophoretic bands in cerebrospinal fluid (CSF) is an important diagnostic tool for Multiple Sclerosis (MS). Electrophoretic profiles are difficult to interpret due to low contrast and artefacts. A semi-automated method to ease analysis and to reduce subjectivity is presented. The method sequentially converts color images to grayscale, realigns bands, removes artifacts, then converts 2D images to a signal, before detecting, thresholding and editing peaks to optimize profiles. Such treated profiles (21 positive and 15 negative) are compared to ground truth analysis of an expert biologist. 16 profiles over 21 are well detected positive and 12 profiles over 15 are detected negative, results seem similar to inter-experts variability reported in literature.

Experimental and theoretical study of electronic structure of lutetium bi-phthalocyanine.

Using Near Edge X-Ray Absorption Fine Structure (NEXAFS) Spectroscopy, the thickness dependent formation of Lutetium Phthalocyanine (LuPc2) films on a stepped passivated Si(100)2×1 reconstructed surface was studied. Density functional theory (DFT) calculations were employed to gain detailed insights into the electronic structure. Photoelectron spectroscopy measurements have not revealed any noticeable interaction of LuPc2 with the H-passivated Si surface. The presented study can be considered to give a comprehensive description of the LuPc2 molecular electronic structure. The DFT calculations reveal the interaction of the two molecular rings with each other and with the metallic center forming new kinds of orbitals in between the phthalocyanine rings, which allows to better understand the experimentally obtained NEXAFS results.

Improvements of Adaptive Filtering by Optimal Projection to filter different artifact types on long duration EEG recordings.

Adaptive Filtering by Optimal Projection (AFOP) is an automatic method for reducing ocular and muscular artifacts on electro-encephalographic (EEG) recordings. This paper presents two additions to this method: an improvement of the stability of ocular artifact filtering and an adaptation of the method for filtering electrode artifacts. With these improvements, it is possible to reduce almost all the current types of artifacts, while preserving brain signals, particularly those characterising epilepsy. This generalised method consists of dividing the signal into several time-frequency windows, and in applying different spatial filters to each. Two steps are required to define one of these spatial filters: the first step consists of defining artifact spatial projection using the Common Spatial Pattern (CSP) method and the second consists of defining EEG spatial projection via regression. For this second step, a progressive orthogonalisation process is proposed to improve stability. This method has been tested on long-duration EEG recordings of epileptic patients. A neurologist quantified the ratio of removed artifacts and the ratio of preserved EEG. Among the 330 artifacted pages used for evaluation, readability was judged better for 78% of pages, equal for 20% of pages, and worse for 2%. Artifact amplitudes were reduced by 80% on average. At the same time, brain sources were preserved in amplitude from 70% to 95% depending on the type of waves (alpha, theta, delta, spikes, etc.). A blind comparison with manual Independent Component Analysis (ICA) was also realised. The results show that this method is competitive and useful for routine clinical practice.

Hippocrate: a safe robot arm for medical applications with force feedback.

We have developed a robotic system to assist doctors when they are moving ultrasonic probes on a patient's skin while exerting a given effort. The probes are used to monitor arteries for cardiovascular disease prevention, namely to reconstruct the three-dimensional profile of arteries. A preliminary feasibility study making use of an industrial robot has been made to validate the force control scheme. It has proven the interest of the robotized approach for such medical applications where force control is needed. In order to comply with safety constraints, a dedicated robotic system 'Hippocrate' has been designed. This paper describes the arm and the controller architectures, with emphasis on design strategies selected to meet safety requirements. Preliminary in vivo results are presented as well as a possible new application of Hippocrate as a tool for reconstructive surgery.

[Parapharyngeal tumors. Apropos of 6 cases]. / Les tumeurs parapharyngées. A propos de 6 cas.

We conducted a retrospective study of six patients presenting a parapharyngeal tumor and an analysis of data of the literature and recall classification of these tumors and their anatomo-clinics characters, therapeutic and diagnostic problems highlighting. These tumors are rare and have various origins, their treatment is almost always surgical by cervical approach which can be undertaken only after a rigorous exploration, systematically associating computed tomography scan and magnetic resonance imaging. Transoral resection is strongly advised against as it is potentially harmful.