Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study

Contexte : Identifier les patients avec une hémorragie sous-arachnoïdienne spontanée chez qui l'angio-CT suffit pour exclure des anévrysmes rompus.Méthodes : Une étude rétrospective a été effectuée de tous les patients avec une hémorragie sous-arachnoïdienne qui ont eu un angio-CT ainsi qu'une angiographie par cathéter dans le but d'exclure un anévrysme. Les cas négatifs de l'angio-CT (sans anévrysmes) ont été classés d'après leur schéma hémorragique au CT dans les catégories suivantes : « anévrysmale », « périmésencéphalique » puis « sans hémorragie ».Résultats : Deux-cent-quarante-et-un patients ont été inclus. Une sensibilité de 96.4% et une spécificité de 96.0% ont été observée pour l'exclusion d'anévrysmes par l'angio-CT. Parmi les 78 cas négatifs de l'angio-CT, chacun des 35 cas avec un motif hémorragique périmésencéphalique ou sans hémorragie au CT n'ont pas eu d'anévrysmes démontrés à l'angiographie par cathéter.Conclusions: L'angio-CT est fiable pour exclure les anévrysmes rompus lorsqu'un motif hémorragique périmésencéphalique ou pas d'hémorragie sont visibles au CT à une semaine depuis le début des symptômes.

Power quality improving with virtual flux-based voltage source line converter

Line converters have become an attractive AC/DC power conversion solution in industrial applications. Line converters are based on controllable semiconductor switches, typically insulated gate bipolar transistors. Compared to the traditional diode bridge-based power converters line converters have many advantageous characteristics, including bidirectional power flow, controllable de-link voltage and power factor and sinusoidal line current. This thesis considers the control of the lineconverter and its application to power quality improving. The line converter control system studied is based on the virtual flux linkage orientation and the direct torque control (DTC) principle. A new DTC-based current control scheme is introduced and analyzed. The overmodulation characteristics of the DTC converter are considered and an analytical equation for the maximum modulation index is derived. The integration of the active filtering features to the line converter isconsidered. Three different active filtering methods are implemented. A frequency-domain method, which is based on selective harmonic sequence elimination, anda time-domain method, which is effective in a wider frequency band, are used inharmonic current compensation. Also, a voltage feedback active filtering method, which mitigates harmonic sequences of the grid voltage, is implemented. The frequency-domain and the voltage feedback active filtering control systems are analyzed and controllers are designed. The designs are verified with practical measurements. The performance and the characteristics of the implemented active filtering methods are compared and the effect of the L- and the LCL-type line filteris discussed. The importance of the correct grid impedance estimate in the voltage feedback active filter control system is discussed and a new measurement-based method to obtain it is proposed. Also, a power conditioning system (PCS) application of the line converter is considered. A new method for correcting the voltage unbalance of the PCS-fed island network is proposed and experimentally validated.

Évaluation de la perfusion myocardique par TEP-TDM. [Myocardial perfusion imaging using PET/CT.]

For the past decade, PET and PET/CT have been widely studied for myocardial perfusion imaging. Several studies demonstrated the incremental value of PET for the diagnostic and prognostic assessment of patients with coronary artery disease. Moreover, PET allows for non-invasively quantifying myocardial blood flow and myocardial flow reserve, that both are recognized as surrogate marker of cardiac event free survival. By enabling the exploration of epicardial disease and the microvasculature, PET constitutes a unique tool to study pathophysiogical mechanisms leading to atherosclerosis genesis. The recent emergence of high-tech hybrid machines may even provide further incremental information about coronary function and morphology. By taking the best of each modality, a better assessment of patients with coronary artery disease is expected. (C) 2011 Elsevier Masson SAS. All rights reserved.

Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. RESULTS: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at < 50 years. EPAGE II considered screening colonoscopy appropriate above 50 years in average-risk individuals. Panelists deemed screening colonoscopy appropriate for younger patients, with shorter surveillance intervals, where family or personal risk of colorectal cancer is higher. A positive FOBT or the discovery of adenomas at sigmoidoscopy are considered appropriate indications. CONCLUSIONS: Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (http://www.epage.ch), as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.

Reinforcement learning utilizes proxemics: an avatar learns to manipulate the position of people in immersive virtual reality

A reinforcement learning (RL) method was used to train a virtual character to move participants to a specified location. The virtual environment depicted an alleyway displayed through a wide field-of-view head-tracked stereo head-mounted display. Based on proxemics theory, we predicted that when the character approached within a personal or intimate distance to the participants, they would be inclined to move backwards out of the way. We carried out a between-groups experiment with 30 female participants, with 10 assigned arbitrarily to each of the following three groups: In the Intimate condition the character could approach within 0.38m and in the Social condition no nearer than 1.2m. In the Random condition the actions of the virtual character were chosen randomly from among the same set as in the RL method, and the virtual character could approach within 0.38m. The experiment continued in each case until the participant either reached the target or 7 minutes had elapsed. The distributions of the times taken to reach the target showed significant differences between the three groups, with 9 out of 10 in the Intimate condition reaching the target significantly faster than the 6 out of 10 who reached the target in the Social condition. Only 1 out of 10 in the Random condition reached the target. The experiment is an example of applied presence theory: we rely on the many findings that people tend to respond realistically in immersive virtual environments, and use this to get people to achieve a task of which they had been unaware. This method opens up the door for many such applications where the virtual environment adapts to the responses of the human participants with the aim of achieving particular goals.

Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments

In this paper address we the question as to why participants tend to respond realistically to situations and events portrayed within an Immersive Virtual Reality (IVR) system. The idea is put forward, based on experience of a large number of experimental studies, that there are two orthogonal components that contribute to this realistic response. The first is"being there", often called"presence", the qualia of having a sensation of being in a real place. We call this Place Illusion (PI). Second, Plausibility Illusion (Psi) refers to the illusion that the scenario being depicted is actually occurring. In the case of both PI and Psi the participant knows for sure that that they are not"there" and that the events are not occurring. PI is constrained by the sensorimotor contingencies afforded by the virtual reality system. Psi is determined by the extent to which the system can produce events that directly relate to the participant, and the overall credibility of the scenario being depicted in comparison with expectations. We argue that when both PI and Psi occur, participants will respond realistically to the virtual reality.

Correlations between vocal input and visual response apparently enhance presence in a virtual environment

This work investigates novel alternative means of interaction in a virtual environment (VE).We analyze whether humans can remap established body functions to learn to interact with digital information in an environment that is cross-sensory by nature and uses vocal utterances in order to influence (abstract) virtual objects. We thus establish a correlation among learning, control of the interface, and the perceived sense of presence in the VE. The application enables intuitive interaction by mapping actions (the prosodic aspects of the human voice) to a certain response (i.e., visualization). A series of single-user and multiuser studies shows that users can gain control of the intuitive interface and learn to adapt to new and previously unseen tasks in VEs. Despite the abstract nature of the presented environment, presence scores were generally very high.

The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study

Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant betweengroup differences were noted between Groups D (p = 0.001) and D1 (p = 0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p = 0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p = 0.07). Conclusion: Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.

Drift and ownership toward a distant virtual body.

In body ownership illusions participants feel that a mannequin or virtual body (VB) is their own. Earlier results suggest that body ownership over a body seen from behind in extra personal space is possible when the surrogate body is visually stroked and tapped on its back, while spatially and temporal synchronous tactile stimulation is applied to the participant's back. This result has been disputed with the claim that the results can be explained by self-recognition rather than somatic body ownership. We carried out an experiment with 30 participants in a between-groups design. They all saw the back of a VB 1.2 m in front, that moved in real-time determined by upper body motion capture. All felt tactile stimulation on their back, and for 15 of them this was spatially and temporally synchronous with stimulation that they saw on the back of the VB, but asynchronous for the other 15. After 3 min a revolving fan above the VB descended and stopped at the position of the VB neck. A questionnaire assessed referral of touch to the VB, body ownership, the illusion of drifting forwards toward the VB, and the VB drifting backwards. Heart rate deceleration (HRD) and the amount of head movement during the threat period were used to assess the response to the threat from the fan. Results showed that although referral of touch was significantly greater in the synchronous condition than the asynchronous, there were no other differences between the conditions. However, a further multivariate analysis revealed that in the visuotactile synchronous condition HRD and head movement increased with the illusion of forward drift and decreased with backwards drift. Body ownership contributed positively to these drift sensations. Our conclusion is that the setup results in a contradiction-somatic feelings associated with a distant body-that the brain attempts to resolve by generating drift illusions that would make the two bodies coincide.

Touching the void: exploring virtual objects through a vibrotactile glove

This paper describes a simple low-cost approach toadding an element of haptic interaction within a virtualenvironment. Using off-the-shelf hardware and software wedescribe a simple setup that can be used to explore physically virtual objects in space. This setup comprises of a prototype glove with a number of vibrating actuators to provide the haptic feedback, a Kinect camera for the tracking of the user's hand and a virtual reality development environment. As proof of concept and to test the efficiency of the system as well as its potential applications, we developed a simple application where we created 4 different shapes within a virtual environment in order to try toexplore them and guess their shape through touch alone.

Proxemics with multiple dynamic characters in an immersive virtual environment

An experiment was carried out to examine the impact on electrodermal activity of people when approached by groups of one or four virtual characters at varying distances. It was premised on the basis of proxemics theory that the closer the approach of the virtual characters to the participant, the greater the level of physiological arousal. Physiological arousal was measured by the number of skin conductance responses within a short time period after the approach, and the maximum change in skin conductance level 5 s after the approach. The virtual characters were each either female or a cylinder of human size, and one or four characters approached each subject a total of 12 times. Twelve male subjects were recruited for the experiment. The results suggest that the number of skin conductance responses after the approach and the change in skin conductance level increased the closer the virtual characters approached toward the participants. Moreover, these response variables were inversely correlated with the number of visits, showing a typical adaptation effect. There was some evidence to suggest that the number of characters who simultaneously approached (one or four) was positively associated with the responses. Surprisingly there was no evidence of a difference in response between the humanoid characters and cylinders on the basis of this physiological data. It is suggested that the similarity in this quantitative arousal response to virtual characters and virtual objects might mask a profound difference in qualitative response, an interpretation supported by questionnaire and interview results. Overall the experiment supported the premise that people exhibit heightened physiological arousal the closer they are approached by virtual characters.