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Observing modern decompression protocols alone cannot fully prevent diving injuries especially in repetitive diving. Professional audio Doppler bubble measurements are not available to sports scuba divers. If those non-professionals were able to learn audio Doppler self-assessment for bubble grading, such skill could provide significant information on individual decisions with respect to diving safety. We taught audio Doppler self-assessment of subclavian and precordial probe position to 41 divers in a 45-min standardized, didactically optimized training. Assessment before and after air dives within sports diving limits was made through 684 audio Doppler measurements in dive-site conditions by both trained divers and a medical professional, plus additional 2D-echocardiography reference. In all dives (average maximum depth 22 m; dive time 44 min), 33% of all echocardiography measurements revealed bubbles. The specificity of audio bubble detection in combination of both detection sites was 95%, and sensitivity over all grades was 40%, increasing with higher bubble grades. Dive-site audio-Doppler-grading underestimated echo-derived bubble grades. Bubble detection sensitivity of audio Doppler self-assessments, compared to an experienced examiner, was 62% at subclavian and 73% at precordial position. 6 months after the training and 4.5 months after the last measurement, the achieved Doppler skill level remained stable. Audio Doppler self-assessment can be learned by non-professionals in a single teaching intervention. Despite accurate bubble grading is impossible in dive-site conditions, relevant high bubble grades can be detected by non-professionals. This qualitative information can be important in self-evaluating decompression stress and assessing measures for increased diving safety.

At the patient's bedside 24 hours a day, the nurse is at the heart of the rehabilitation management of the severely burnt patient: installation, technical dressings, supervision of postures and placement of compressors, to limit the functional consequences to the type of retractable and hypertrophic scars. The nurse takes care of the patient in this long journey leading to social reintegration; from accompaniment to autonomy and acceptance of self-image.

International audience; This study aims to describe the spinopelvic sagittal alignment in transfemoral amputees (TFAs) from a radiologic study of the spine with a postural approach to better understand the high prevalence of low back pain (LBP) in this population.METHODS:TFAs underwent X-rays with 3-D reconstructions of the full spine and pelvis. Sagittal parameters were analyzed and compared to the literature. Differences between TFAs with and without LBP were also observed.RESULTS:Twelve subjects have been prospectively included (TFA-LBP group (n = 5) and TFA-NoP group (n = 7)). Four of the five subjects of the TFA-LBP group and two of the seven in TFAs-NoP group had an imbalanced sagittal posture, especially regarding the T9-tilt, significantly higher in the TFA-LBP group than in the TFA-NoP (p = 0.046). Eight subjects (6 TFA-NoP and 2 TFA-LBP) had abnormal low value of thoracic kyphosis (TK). Moreover, the mean angle of TK in the TFA-NoP group was lower than in the TFA-LBP group (p = 0.0511).CONCLUSION:In the considered sample, TFAs often present a sagittal imbalance. A low TK angle seems to be associated with the absence of LBP. It can be hypothesized that this compensatory mechanism of the sagittal imbalance is the most accessible in this population. This study emphasizes the importance of considering the sagittal balance of the pelvis and the spine in patients with a TFA to better understand the high prevalence of LBP in this population. It should be completed by the analysis of the spinopelvic balance and the lower limbs in 3D. These slides can be retrieved under Electronic Supplementary Material.

We study the correlated transport of photons through a chain of three-level emitters that are coupled chirally to a photonic mode of a waveguide. It is found that this system can transfer a weak classical input into a strongly correlated state of light in a unitary manner. Our analysis reveals two-photon scattering eigenstates, that are akin to Fano resonances or shape resonances in particle collisions and facilitate the emergence of antibunched light with long-range correlations upon crossing a critical length of the chain. By operating close to conditions of electromagnetically induced transparency of the three-level medium, a high degree of antibunching and photon transmission can be maintained in the presence of moderate losses. These features suggest a promising mechanism for single-photon generation and may open the door to exploring correlated quantum many-body states of light with repulsively interacting photons.

In X-ray fluoroscopy, static overlays are used to visualize soft tissue. We propose a system for cardiac and respiratory motion compensation of these overlays. It consists of a 3-D motion model created from real-time magnetic resonance (MR) imaging. Multiple sagittal slices are acquired and retrospectively stacked to consistent 3-D volumes. Slice stacking considers cardiac information derived from the ECG and respiratory information extracted from the images. Additionally, temporal smoothness of the stacking is enhanced. Motion is estimated from the MR volumes using deformable 3-D/3-D registration. The motion model itself is a linear direct correspondence model using the same surrogate signals as slice stacking. In X-ray fluoroscopy, only the surrogate signals need to be extracted to apply the motion model and animate the overlay in real time. For evaluation, points are manually annotated in oblique MR slices and in contrast-enhanced X-ray images. The 2-D Euclidean distance of these points is reduced from 3.85 to 2.75 mm in MR and from 3.0 to 1.8 mm in X-ray compared with the static baseline. Furthermore, the motion-compensated overlays are shown qualitatively as images and videos.

Resume Introduction La secheresse buccale et oculaire sont des effets secondaires frequents des traitements anticholinergiques a visee urinaire, chez les patients atteints de sclerose en plaques (SEP). Nous avons evalue de facon systematique leur prevalence et leur modification apres leur prescription. Methode Les patients atteints de SEP consultant pour hyperactivite vesicale etaient inclus. La xerostomie etait evaluee par auto-questionnaires (Xerostomia Quality of Life [X-Qol] et Xerostomia Questionnaire [XQ]), debitmetrie salivaire et test au sucre, la xerophtalmie par autoquestionnaire (Ocular Surface Disease Index [OSDI]) et test de Schirmer. La charge anticholinergique iatrogene etait evaluee par l’echelle Anticholinergic Drug Scale. Les evaluations etaient repetees trente jours apres le debut du traitement (j30). Resultats De janvier a decembre 2014, 35 patients ont ete inclus, d’âge moyen 50,1 ± 10,2 ans, EDSS moyen = 4,9. Avant traitement, aucune correlation n’etait retrouvee entre ces parametres et la charge anticholinergique. Vingt-deux patients ont ete analyses apres traitement. A j30, les scores des auto-questionnaires etaient passes de 0,8 ± 0,5 a 0,73 ± 0,43 ( p = 0,67) pour X-Qol, de 9,2 ± 11,7 a 7,03 ± 11,4 ( p = 0,32) pour XQ et de 13,9 ± 11,6 a 18,8 ± 14 ( p = 0,06) pour OSDI. La debitmetrie salivaire etait passee de 1,5 ± 1,1 a 1,22 ± 1,3 ( p = 0,53), et le nombre de tests de Schirmer pathologiques etait reste a 50 %. Conclusion Dans notre petit echantillon de patient avec SEP, les secheresses buccale et oculaire preexistent avant l’instauration d’un traitement anticholinergique, et ne sont pas modifiees par ce traitement. Il convient donc de ne pas se passer a tort d’un traitement efficace et de prendre en charge au prealable ces symptomes. Niveau de preuve 4.

International audience; Background: The compensations occurrence due to the alteration of the posture and the gait of persons with lower limb amputation is still an issue in prosthetic fitting. Recently, prosthetic feet designed to reproduce the physiological behaviour of the ankle using a microprocessor control have been commercialized to address this issue.Objectives: Investigate the relevance of these microprocessor prosthetic ankles (MPAs) in the ability of standing on both level and inclined surfaces.Methods: Six persons with transtibial amputation usually fitted with energy storing and returning (ESR) foot tested three MPAs: ElanVR Endolite (MPA1), MeridiumV Ossur (MPA3). Each MPA data acquisition was preceded of a 2 weeks adaptation period at home and followed by a 3-weeks wash-out period with their ESR. Lower limb angular position and moment, Centre of Pressure (CoP) position, Ground Reaction Forces (GRF) and functional scores were collected in static, on level ground and 12% inclined slope.Results: MPAs allowed a better posture and a reduction of residual knee moment on positive and/or negative slope compared to ESR. Results also reflect that the MPA2 allows the best control of the CoP in all situations. Conclusions: An increased ankle mobility is associated with a better posture and balance on slope. Gait analysis would complete these outcomes.Clinical relevance: This study compares three MPAs to ESR analysing static posture. Static analysis on level ground and slope represents the challenging conditions people with amputation have to cope with in their daily life, especially outdoors. Having a better understanding of the three MPAs behaviour could help to adequately fit the prosthesis to each patient.

We report on a prototyping platform for antenna design at millimeter wave frequencies with a steerable beam. The antenna beam is formed by a designed aperture in a hollow metallic half-sphere (“shell”) on a circular ground plane which forms a cavity around the antenna feed. The aperture is rotatable around the fixed antenna feed which allows mechanical beam steering without the need for a millimeter wave rotary joint. The shell with the designed aperture is easily replaced by different designs to enable experiments with various beam shapes. Scanning is achieved by rotating the shell around a fixed monopole antenna feed at the center of the platform. Although our setup consists of several resonant parts, there are large enough regions of bandwidth with only a small variation in the antenna pattern.

From the current perspectives of urban health and environmental justice research, health is the result of a combination of individual, social and environmental factors. Yet, there are only few attempts to determine their joint influence on health and well-being. Grounded in debates surrounding conceptual models and based on a data set compiled for the city of Hamburg, this paper aims to provide insights into the most important variables influencing urban health. Theoretically, we are primarily referring to the conceptual model of health-related urban well-being (UrbWellth), which systemizes urban influences in four sectors. The systematization of the conceptual model is empirically confirmed by a principal component analysis: the factors derived from the data correspond well with the deductively derived model. Additionally, a multiple linear regression analysis was used to identify the most important variables influencing the participant&rsquo, s self-rated health (SRH): rating of one&rsquo, s social network, rating of neighborhood air quality, rating of neighborhood health infrastructure, heat stress (day/outdoors), cold stress (night/indoors). When controlling for age, income and smoking behavior, these variables explain 12% of the variance of SRH. Thus, these results support the concept of UrbWellth empirically. Finally, the study design helped to identify hotspots with negative impact on SRH within the research areas.

Aims Potential advantages of real-time magnetic resonance imaging (MRI)-guided electrophysiology (MR-EP) include contemporaneous three-dimensional substrate assessment at the time of intervention, improved procedural guidance, and ablation lesion assessment. We evaluated a novel real-time MR-EP system to perform endocardial voltage mapping and assessment of delayed conduction in a porcine ischaemia–reperfusion model. Methods and results Sites of low voltage and slow conduction identified using the system were registered and compared to regions of late gadolinium enhancement (LGE) on MRI. The Sorensen–Dice similarity coefficient (DSC) between LGE scar maps and voltage maps was computed on a nodal basis. A total of 445 electrograms were recorded in sinus rhythm (range: 30–186) using the MR-EP system including 138 electrograms from LGE regions. Pacing captured at 103 sites; 47 (45.6%) sites had a stimulus-to-QRS (S-QRS) delay of ≥40 ms. Using conventional (0.5–1.5 mV) bipolar voltage thresholds, the sensitivity and specificity of voltage mapping using the MR-EP system to identify MR-derived LGE was 57% and 96%, respectively. Voltage mapping had a better predictive ability in detecting LGE compared to S-QRS measurements using this system (area under curve: 0.907 vs. 0.840). Using an electrical threshold of 1.5 mV to define abnormal myocardium, the total DSC, scar DSC, and normal myocardium DSC between voltage maps and LGE scar maps was 79.0 ± 6.0%, 35.0 ± 10.1%, and 90.4 ± 8.6%, respectively. Conclusion Low-voltage zones and regions of delayed conduction determined using a real-time MR-EP system are moderately associated with LGE areas identified on MRI.

The realization of exciton-polaritons -- hybrid excitations of semiconductor quantum well excitons and cavity photons -- has been of great technological and scientific significance. In particular, the short-range collisional interaction between excitons has enabled explorations into a wealth of nonequilibrium and hydrodynamical effects that arise in weakly nonlinear polariton condensates. Yet, the ability to enhance optical nonlinearities would enable quantum photonics applications and open up a new realm of photonic many-body physics in a scalable and engineerable solid-state environment. Here we outline a route to such capabilities in cavity-coupled semiconductors by exploiting the giant interactions between excitons in Rydberg-states. We demonstrate that optical nonlinearities in such systems can be vastly enhanced by several orders of magnitude and induce nonlinear processes at the level of single photons., 17 pages, 5 figures

Resume La difficulte d’acces au meat uretral est une realite rencontree chez la femme en rapport avec des anomalies morphologiques de la sphere urogenitale ou des localisations ectopiques du meat, qu’elles soient acquises (meat uretral enfoui [MUE]) ou congenitales (uretre hypospade [UH]). L’etiopathogenie n’est pas univoque avec absence de definition claire et d’etudes specifiques. But Verifier l’existence de troubles fonctionnels specifiques, apprecier la prevalence et preciser les caracteristiques anatomiques des concepts MUE et UH. Materiel Les termes MUE et UH ont ete cherches dans une base de donnees informatisee repertoriant les patients consultant dans un service de neurourologie entre 2000 et 2014 pour une pathologie pelvi-perineale. Chaque dossier a ete analyse a la recherche d’atteintes specifiques : fuites, infections urinaires et difficultes de catheterisme. Resultats Parmi les 12 739, 131 patientes (1 %) repondaient aux criteres d’inclusions dont 18 UH et 113 MUE. Quatre-vingt onze patientes consultaient pour des troubles urinaires d’origine neurologique. Les circonstances de decouverte de MUE et UH ont ete : l’examen perineal systematique dans 63 cas (48 %) ; des difficultes de catheterisme uretral dans 65 cas (49 %) ; une incontinence urinaire pour 3 patientes (3 %). Les difficultes de localisation du meat uretral etaient d’origine congenitale (UH) dans 18 cas (13 %). Dans 113 cas (87 %), il s’agissait d’une anomalie acquise (MUE) : surpoids pour 16 patientes (12 %), spasticite genante des muscles adducteurs dans 18 situations (14 %), atrophie vulvovaginale dans 5 cas (4 %) et une patiente (1 %) presentant un prolapsus pelvien. Aucune precision n’etait donnee quand aux particularites du MUE pour les 72 patientes restantes (54 %). Conclusion La difficulte d’acces au meat uretral secondaire a un MUE ou un UH peut etre rencontree dans un service specialise mais le concept exact de MUE reste a definir. Il peut etre considere comme un meat uretral difficile d’acces, dont la cause est acquise. Le retentissement fonctionnel peut etre majeur notamment chez les patientes necessitant une vidange vesicale par autosondage. Niveau de preuve 4.

Segmentation is one of the most important parts of medical image analysis. Manual segmentation is very cumbersome, time-consuming, and prone to inter-observer variability. Fully automatic segmentation approaches require a large amount of labeled training data and may fail in difficult or abnormal cases. In this work, we propose a new method for 2D segmentation of individual slices and 3D interpolation of the segmented slices. The Smart Brush functionality quickly segments the region of interest in a few 2D slices. Given these annotated slices, our adapted formulation of Hermite radial basis functions reconstructs the 3D surface. Effective interactions with less number of equations accelerate the performance and, therefore, a real-time and an intuitive, interactive segmentation of 3D objects can be supported effectively. The proposed method is evaluated on 12 clinical 3D magnetic resonance imaging data sets and are compared to gold standard annotations of the left ventricle from a clinical expert. The automatic evaluation of the 2D Smart Brush resulted in an average Dice coefficient of 0.88 ± 0.09 for the individual slices. For the 3D interpolation using Hermite radial basis functions, an average Dice coefficient of 0.94 ± 0.02 is achieved.

Layered motion estimation (LME) in X-ray fluoroscopy is a challenging, ill-posed and non-convex problem due to transparency effects and the way the image is defined. Minimizing an energy formulation of layered motion estimation is computationally expensive. For clinical usability of this approach, we propose to use primal-dual optimization parallelized using a graphical processing unit (GPU) to reduce the overall run-time of this algorithm. Experimentally this method is able to substantially reduce target registration error by 70% on manually annotated landmarks on five distinct image sequences compared to the static baseline, similar to prior work on this domain. However, the overall runtime of our method on a conventional GPU is less than 3.3 seconds compared to several minutes for the state of the art. Considering typical framerates of X-ray fluoroscopy devices, this runtime makes the application of layered motion estimation feasible for many clinical workflows.

Segmentation is one of the most important parts of medical image processing. Manual segmentation is very cumbersome and time-consuming. Fully automatic segmentation approaches require a large amount of labeled training data and may fail in difficult cases. In this paper, we propose a new method for 2-D segmentation and 3-D interpolation. The Smart Brush functionality quickly segments the ROI in a few 2-D slices. Given these annotated slices, our adapted formulation of Hermite Radial Basis Functions reconstructs the 3-D surface. Effective interactions with less number of equations accelerate the performance and therefore, a real-time and an intuitive, interactive segmentation can be supported effectively. The proposed method was evaluated on 12 clinical 3-D MRI data sets from individual patients and were compared to gold standard annotations of the left ventricle from a clinical expert. The 2-D Smart Brush resulted in an average Dice coefficient of \(0.88\pm 0.09\) for individual slices. For the 3-D interpolation using Hermite Radial Basis Functions an average Dice coefficient of \(0.94\pm 0.02\) was achieved.

Resume But Decrire les reponses cutanees sympathiques (RCS), reflet de l’activite sudoripare mediee par le systeme nerveux sympathique, chez des patients atteints de sclerose en plaques (SEP) suivis pour troubles vesicosphincteriens et associer les anomalies des RCS aux troubles neuroperineaux. Methode Etude monocentrique prospective d’une population de SEP, ayant eu des scores de symptomes (Expanded Disability Status Scale [EDSS], Urinary Symptoms Profile [USP], Neurogenic Bowel Dysfunction [NBD], International Index of Erectile Function [IIEF] et Female Sexual Function Index [FSFI]) et un recueil des RCS a la paume, a la plante des pieds et au perinee, declenchees par stimulation mecanique, avant et apres traitement anticholinergique. Resultats Vingt-huit patients ont ete inclus. Parmi eux, 18 avaient une abolition des RCS, respectivement 10, 14 et 17 sur la paume, le perinee et la plante des pieds. L’absence de RCS n’etait pas reliee ( p > 0,05) avec la duree de la maladie, les scores EDSS, USP, NBD ou IIEF15. Il existait une relation statistiquement significative entre l’abolition des RCS au perinee et les troubles genito-sexuels de la femme ( p = 0,01). Le traitement anticholinergique a aboli 40 % des RCS aux mains et 67 % a la plante des pieds. L’abolition des RCS au perinee etait associee a l’abolition des RCS a la plante des pieds ( p = 4 × 10 −5 ). Conclusion Chez ces patients SEP consultant pour troubles neuroperineaux, plus de la moitie avaient des anomalies des RCS, qui ne semblaient pas etre associees aux troubles vesicosphincteriens ou anorectaux, mais aux troubles genito-sexuels chez la femme. La prise d’anticholinergique faisait frequemment disparaitre les RCS a la paume et a la plante des pieds. Niveau de preuve 4.

With more than 8000 new amputees each year in France, mostly as a result of a trauma or vascular problem, the challenges are both surgical and technological. The success of the rehabilitation and readjustment of the patient is the fruit of multidisciplinary care.

Respiratory signals are required for image gating and motion compensation in minimally invasive interventions. In X-ray fluoroscopy, extraction of a respiratory signal can be challenging due to characteristics of interventional imaging, in particular injection of contrast agent and automatic exposure control. We present a novel method for respiratory signal extraction based on dimensionality reduction that can tolerate these events. Images are divided into patches of multiple sizes. Low-dimensional embeddings are generated for each patch using illumination-invariant kernel PCA. Patches with respiratory information are selected automatically by agglomerative clustering. The signals from this respiratory cluster are combined robustly to a single respiratory signal. In the experiments, we evaluate our method on a variety of scenarios. If the diaphragm is visible, we track its superior-inferior motion as ground truth. Our method has a correlation coefficient of more than 91% with the ground truth irrespective of whether or not contrast agent injection or automatic exposure control occur. Additionally, we show that very similar signals are estimated from biplane sequences and from sequences without visible diaphragm. Since all these cases are handled automatically, the method is robust enough to be considered for use in a clinical setting.

Objective Even if properly fitted, the posture and gait of amputee people are disturbed, leading to compensations and over-solicitations of the contralateral limb. The recent commercialization of new generation ankle-foot (NG) prosthesis is not covered by French social security insurance. The evaluation of the service delivered by these medical devices was until now a combination of multidisciplinary evaluations and patient assessments, but needs objective evaluation. Several teams reported a benefit of NG feet, mainly in terms of joint mobility, walking speed and reduction in compensations. But the main subjective improvement is in balance, both in static (more comfortable waiting position) as well as in dynamic (quality and fluidity of walking), which was poorly evaluated in amputees with NG feet. The main objective of this research is to evaluate the relevance of these NG feet in terms of static stability, on both flat and inclined surfaces. Material/patients and methods Six transtibial subjects were included. Three NG feet (Elan®, Propriofoot®, Meridium®) and the patient's usual foot were successively tested. For each foot type, after socket and alignment validation by an expert prosthetist, an acclimatization period of 15 days at home was observed. After this period, clinical, instrumental (static acquisitions of 20 s on two force platforms, eyes open and closed, on flat ground and on 12% inclined slope uphill and downhill) and functional evaluations (Berg Balance Scale and Activity Specific Balance Scale) were performed. Participants observed a wash out period of 3 weeks with the usual foot before testing each NG foot. The static parameters collected were: lower limb joint angles, Center of Pressure (COP) variation, ground reaction forces (GRF), and functional scores. Results In static position, a larger prosthetic ankle dorsiflexion, less compensations of the amputed lower limb, better symmetry of the GRF and increase of CoP parameters (as length of trajectory and range) were found with NG feet, compared to ESR. Discussion, conclusion The absence of postural control leads to asymmetrical posture, leading to osteoarticular complications. Ankle mobility of NG feet may allow a better balance and improve destabilizations adaptations, above all on slope, and may reduce sound limb compensations.

Introduction/Background Since ancient civilizations, health through sports is a fundamental military rule. Bonaparte first integrates by law sports education in military schools. After word war I and II, a collective awareness has emerged, often under the impulse of mutilated warriors. Then, military sport then became a strong tool of peace among nations, and the awareness of this lever led to the creation of the CISM (International Military Sports Council) in 1948. Material and method France has developed a strong link between each steps of military sports management. The aim of this presentation is to sum up the military PMR French departments organisation and missions. Its strong links with the military forces, including Navy and Air forces, has strengthened since the recent conflicts in Afghanistan, Middle East and terrorists attacks. Since the use of Improvised Explosive Devices, major limb injuries and traumatic amputations have emerged. The multidisciplinary approach of Percy Military hospital, is now highlighting a category of high-level expectations young wounded soldiers, whose aim is to go back to duty, and to get back to their former sporty way of life. Results Since 2001, a French multidisciplinary process is improving, including military PMR, psychiatry practitioners, social workers, and headquarters, leading to the creation of wounded aid cells, and reconstruction courses by adapted sports. The global reflection around the recovery of a sport with a residual disability is a fundamental mission of PMR military departments. Thanks to the implementation of financial means, (including possibility of purchasing electronical high technologies prostheses), there is now a high lightening of these wounded soldiers, through local and international events like Invictus games or Ad victoriam. Conclusion Thanks to the multidisciplinary approach of the wounded soldier, and the inclusion of adapted sport has a way of life, the glimpse at these soldiers is changing, in French armed forces but also in French population.

In urban and regional research, planning practice, and urban policy, the spatial distribution of creativity and openness to diversity is increasingly receiving attention. However, to date, there have been few empirical findings concerning the local distribution of these dimensions of socio-spatial differentiation hardly. Using the example of Hamburg, Germany, we try to measure the socio-spatial distribution of these dimensions by secondary data analysis and analyze the patterns of segregation. The socio-spatial development in Hamburg's neighbourhoods in the recent years is analyzed in order to address the issue of whether urban quarters that are very open to diversity in lifestyles show tendencies of revaluation. Our findings show that the socio-cultural symbols of the creative class do play an important role for the socio-spatial structure of the city today, but that a high rate of openness to diversity does not entail improvements in socio-spatial development.

Motion estimation in X-ray images is a challenging task due to transparently overlapping structures from different depths. We propose to separate an X-ray sequence into a static and a dynamic layer to facilitate motion estimation. The method exploits the idea to use the minimum intensity over time and a spatial smoothness prior for both layers. For numerical optimization, we propose a conditional Markov random field. In experiments on synthetic data, we achieve a root mean squared intensity difference of 36.7±8.4 to the ground truth static layer. In addition, we show qualitative results that demonstrate an improved layer separation compared to state-of-the-art algorithms.

Fluoroscopic images are characterized by a transparent projection of 3-D structures from all depths to 2-D. Differently moving structures, for example due to breathing and heartbeat, can be described approximately using independently moving 2-D layers. Separating the fluoroscopic images into the motion layers is desirable to facilitate interpretation and diagnosis. Given the motion of each layer, it is state of the art to compute the layer separation by minimizing a least-squares objective function. However, due to high noise levels and inaccurate motion estimates, the results are not satisfactory in X-ray images.

Dense motion estimation in X-ray fluoroscopy is challenging due to low soft-tissue contrast and the transparent projection of 3-D information to 2-D. Motion layers have been introduced as an intermediate representation, but so far failed to generate plausible motions because their estimation is ill-posed. To attain plausible motions, we include prior information for each motion layer in the form of a surrogate signal. In particular, we extract a respiratory signal from the images using manifold learning and use it to define a surrogate-driven motion model. The model is incorporated into an energy minimization framework with smoothness priors to enable motion estimation. Experimentally, our method estimates 48% of the 2-D motion field on XCAT phantom data. On real X-ray sequences, the target registration error of manually annotated landmarks is reduced by 52%. In addition, we qualitatively show that a meaningful separation into motion layers is achieved.

We investigate the evanescent field at the surface of laser written waveguides. The waveguides are written by a direct femtosecond laser writing process into fused silica, which is then sanded down to expose the guiding layer. These waveguides support eigenmodes which have an evanescent field reaching into the vacuum above the waveguide. We study the governing wave equations and present solution for the fundamental eigenmodes of the modified waveguides.

In X-ray fluoroscopy-guided minimally invasive interventions, overlays of pre-procedurally acquired image data can be used to visualize soft-tissue. In the thoracic and abdominal regions, static overlays are inconsistent to the live X-ray images due to respiratory motion of the patient. This error can be reduced by dynamically adapting the overlay to the respiration. A first step in this direction is the real-time extraction of the respiratory state from the live X-ray images. The respiratory state can drive a motion model to compensate the breathing motion. We present a method to extract respiratory signals from X-ray sequences in real-time. Respiratory signal extraction is viewed as a dimensionality reduction problem, which is performed for each X-ray image using incremental Isomap. The method has a correlation of 0.97± 0.02 with internal breathing motion and an average runtime of 42 ms per image. The method is accurate, robust, and can be used in a wide range of clinical applications and fields of view.

Objective Ultra-endurance events may induce biological changes as a consequence of intense muscle stress and hormonal fluctuations. Two ultra-endurance athletes, one on treadmill, the other on a home trainer pinion, have attempted to break world records for greatest distance covered over 6 days in Paris on January 4–10, 2015 (“six extreme days”). We analyzed the hematological, hormonal and biochemical changes. Materials and methods Hematological, biochemical, hormonologic, metabolic and specific to oxidative stress analysis were conducted on fresh and frozen blood samples collected a week before (D-7), 30 minutes (D6) and 2 days (D8) after the event for both sportsmen. Periods of waking/sleep, cardiovascular data (pulse, saturation) and developed efforts (distance, speed) were monitored throughout the event. Results Hemoglobin, hematocrit and iron parameters (serum iron, ferritin, transferrin saturation coefficient) were found lower on D6, after 2750 km cycling or 713 km running, than on D-7 (hemoglobin decreased from 15.2 g/dl before the event to 13.3 g/dl just after). They start to increase back on D-8. Leukocytes (6.5 to 9.4 G/l between D-7 and D-6), haptoglobin (tripled between D-7 and D-8, from 1 to 3 g/l), liver enzymes, Creatine Phosphokinase, troponin, Brain Natriuretic Peptide and uric acid rose during the event before going back down on D8 without however reaching back initial levels. Discussion The observed transient anemia is multifactorial, inflammatory, iron deficiency but without here any element for hemolysis. Hepatic cytolysis and heart stress are commonly encountered [1] . No study however focuses on oxidative stress enzymes (glutathione, lipid peroxidation products, activation of xanthine oxidase) after such a long effort, for which mobilization of leukocytes and increased uric acid (antioxidant) are indirect markers [2] . Data from this exploration should help enhancing our understanding of the impact of very prolonged effort on the oxidative stress chain, and paves the way for potential improvement in the training methods of athletes.

Rigid registration is a key requirement to overlay anatomical structures from pre-operative magnetic resonance (MR) images onto live X-ray fluoroscopic images. Clinical applications are for instance radio frequency catheter ablation and transcatheter endomyocardial injection. We present a method for fully automatic marker-based detection and registration. The algorithm locates the markers in the MR volumetric data set automatically by combining homomorphic unsharp masking, adaptive thresholding, region growing, and shape analysis. In the X-ray images, the markers are localized in several 2-D images and then their 3-D positions are reconstructed. The 2-D X-ray localization is performed using adaptive thresholding and template matching. The 3-D X-ray marker positions are established using back projection. Rigid registration between the two 3-D point sets is performed by an iterative closest point algorithm. The 3-D registration error using a flat panel detector X-ray system is on average 1.5 ± 1.8 mm. The novelty of our approach is the incorporation of bundle adjustment to reduce the 2-D overlay errors. Bundle adjustment reduces the 2-D X-ray marker localization error from 0.6 ± 0.8 mm to 0.4 ± 0.5 mm. The target registration error of our proposed method evaluated on eight datasets is on average 1.4±3.5 mm. These targets were not used during registration. Accordingly, anatomical structures from MR are positioned more accurately.

Several cytokines are activated in chronic heart failure (CHF), including interleukin-2 (IL-2). IL-2 is important for the survival of regulatory T cells, as well as for the function of activated T cells. Its role in ischemic cardiomyopathy has not yet been investigated. We therefore studied left ventricular (LV) performance and remodeling in a rat model of myocardial infarction (MI) after treatment with an IL-2IgG2b fusion protein to stimulate IL-2 signaling. Spraque-Dawley rats (SD) were submitted to permanent ligation of the left descending artery (LAD) to induce a MI or to a sham operation. Twenty-four hours, 6 days and 3 weeks after MI, LV function was determined in vivo using a tip catheter. Cardiac IL-2 and IL-1beta content was measured by immunohistochemical staining on cryo-fixed heart cross sections at 24h and 6 days post MI. Total collagen content of the LV was determined by Sirius red stained formalin-stored sections under circularly polarized light 3 weeks post MI. Compared to sham-operated animals, IL-2 content was increased 13-fold (P

The lattice Boltzmann method is a popular method from computational fluid dynamics. An extension of this method handling liquid flows with free surfaces can be used to simulate bubbly flows. It is based on a volume-of-fluids approach and an explicit tracking of the interface, including a reconstruction of the curvature to model surface tension. When this algorithm is parallelized, complicated data exchange is required, in particular when bubbles extend across several subdomains and when topological changes occur through coalescence of bubbles. In a previous implementation this was handled by using all-to-all MPI communication in each time step, restricting the scalability of the simulations to a moderate parallelism on a small number of processors. In this paper, a new parallel bubble merge algorithm will be introduced that communicates updates of the bubble status only locally in a restricted neighborhood. This results in better scalability and is suitable for massive parallelism. The algorithm has been implemented in the lattice Boltzmann software framework waLBerla , resulting in parallel efficiency of 90% on up to 4080 cores.

The transpulmonary thermo-dye dilution technique enables assessment of cardiac index (CI) intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI). Since the extent of lung edema may influence the reliability of CI measurement by transpulmonary thermodilution due to loss of indicator, we analyzed the impact of EVLWI on transpulmonary thermodilution-derived CI in critically ill patients. Retrospective, clinical study. Surgical intensive care unit in a university hospital With ethics approval we analyzed data from 57 patients (38 men, 19 women; age range 18–79 years) who, for clinical indication, underwent hemodynamic monitoring by transpulmonary thermo-dye dilution and pulmonary artery thermodilution (572 measurements). All patients were mechanically ventilated and had received a femoral artery thermo-fiberoptic and pulmonary artery catheter which were connected to a computer system (Cold-Z021, Pulsion Medical Systems, Munich, Germany). For each measurement, 15–17 ml indocyanine green(4–6 °C) was injected central venously. Injections were made manually and independently from the respiratory cycle. Linear regression was used for statistical analysis. The difference between transpulmonary and pulmonary artery thermodilution CI was not correlated with EVLWIfor all measurements (n = 572, r = 0.01, p = 0.76) and when using only the first simultaneous measurement (n = 57, r = 0.08, p = 0.56). Furthermore, EVLWI was not correlated with transpulmonary thermodilution CI (n = 572, r = 0.07, p = 0.08). Coefficient of variation for transpulmonary thermodilution CI was 7.7 ± 4.3%. Measurement of cardiac output by transpulmonary thermodilution is not influenced by EVLWI in critically ill patients and loss of indicator as the underlying reason is probably overestimated.

Alternative pathways of angiotensin II biosynthesis play a significant role in the renin-angiotensin system. In this study porcine renal tissue was investigated for angiotensin II-generating enzymes.Protein extracts from porcine renal tissue were fractionated by liquid chromatography and tested for their angiotensin II-generating activity by the mass-spectrometry-assisted enzyme screening system (MES) and the active fractions were purified to near homogeneity. In one of these active fractions, inhibitable by an angiotensin-converting enzyme specific inhibitor, purified by anion-exchange chromatography, followed by hydroxyapatite chromatography, lectin affinity chromatography, size-exclusion chromatography and two-dimensional electrophoresis, angiotensin-converting enzyme was identified by a tryptic peptide matrix-assisted-laser-desorption/ionization (MALDI) mass fingerprint analysis. In a second active fraction, which was inhibited by chymostatin and antipain, yielded by anion-exchange chromatography, followed by hydroxyapatite chromatography, lectin affinity chromatography, chymostatin-antipain chromatography and one-dimensional electrophoresis, cathepsin G was identified by electro-spray ionization (ESI)-ion-trap mass spectrometry. The angiotensin-generating activities of the fraction containing angiotensin-converting enzyme and the fraction containing cathepsin G were in the same order of magnitude, thus showing that the contribution of cathepsin G towards the production of angiotensin II is significant.This is the first time that cathepsin G has been identified in mammalian renal tissue.

The lattice Boltzmann method (LBM) has evolved to a promising alternative to the well-established methods based on finite elements/volumes for computational fluid dynamics simulations. Ease of implementation, extensibility, and computational efficiency are the major reasons for LBM’s growing field of application and increasing popularity. In this paper we give a brief introduction to the involved theory and equations for LBM, present various techniques to increase the single-CPU performance, outline the parallelization of a standard LBM implementation, and show performance results. In order to demonstrate the straightforward extensibility of LBM, we then focus on an application in material science involving fluid flows with free surfaces. We discuss the required extensions to handle this complex scenario, and the impact on the parallelization technique.

When designing and implementing highly efficient scientific applications for parallel computers such as clusters of workstations, it is inevitable to consider and to optimize the single–CPU performance of the codes. For this purpose, it is particularly important that the codes respect the hierarchical memory designs that computer architects employ in order to hide the effects of the growing gap between CPU performance and main memory speed. In this paper, we present techniques to enhance the single–CPU efficiency of lattice Boltzmann methods which are commonly used in computational fluid dynamics. We show various performance results to emphasize the effectiveness of our optimization techniques.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 27 avril 2012

Data centers are facing serious energy challenges. Increasing energy costs make the operation and cooling of servers more significant cost factors. Furthermore, improvements in technology have led to processor chips and systems with rapidly increasing power density. The resulting power consumption and cooling requirements of these systems are pushing many existing data centers to the limits of their power distribution capability and cooling capacity. Improvements in energy efficiency and management are needed at the chip and the system level to counteract this trend. This paper provides a comprehensive description of the hardware and firmware improvements implemented with IBM zEnterprise® 196 to stop the growth of and even reduce its energy footprint compared with previous IBM System z® servers. These include more power-efficient chips; power conversion and distribution; new sensors; cooling control firmware; new energy management functions; integrated hybrid energy management for power saving and power capping across the whole hybrid system; and data center energy-efficiency improvements resulting from options for water cooling, high-voltage DC (HVDC) power, and overhead cabling.

In IBM zEnterprise® 196, we introduced another set of firmware verification environments to enhance the verification coverage. In this paper, we discuss four affected areas: 1) virtualization of the support element, the hardware management console, and the flexible support processor; 2) test cases; 3) simulation of input/output adapter firmware; and 4) static analysis for millicode. These start another round in increasing verification coverage with the final goal of having all firmware components under simulation and test before the final system becomes available.

We examine the dynamics of Rydberg polaritons with dipolar interactions that propagate in multiple spatial modes. The dipolar excitation exchange between different Rydberg states mediates an effective exchange between polaritons that enables photons to hop across different spatial channels. Remarkably, the efficiency of this photon exchange process can increase with the channel distance and becomes optimal at a finite rail separation. Based on this mechanism, we design a simple photonic network that realizes a two photon quantum gate with a robust $\ensuremath{\pi}$ phase, protected by the symmetries of the underlying photon interaction and the geometry of the network. These capabilities expand the scope of Rydberg electromagnetically induced transparency towards multidimensional geometries for nonlinear optical networks and explorations of photonic many-body physics.

In this study, we demonstrate that disruption of neuroendocrine signaling is a major factor driving disease progression in myelin oligodendrocyte glycoprotein-induced chronic relapsing experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis. Although the initial episode of chronic relapsing experimental autoimmune encephalomyelitis is associated with a robust hypothalamic-pituitary-adrenocortical axis response, we show that subsequent disease progression is associated with a selective desensitization of hypothalamic-pituitary-adrenocortical responsiveness to inflammatory mediators. Inflammatory activity in the central nervous system during relapse is therefore unable to produce an endogenous immunosuppressive corticosterone response, and disease progresses into an ultimately lethal phase. However, disease progression is inhibited if the circulating corticosterone level is maintained at levels seen during the initial phase of disease. The effect of hypothalamic-pituitary-adrenocortical axis desensitization on the clinical course of experimental autoimmune encephalomyelitis is aggravated by a marked reduction in proinflammatory cytokine synthesis in the central nervous system in the later stages of disease, reflecting an increasing involvement of antibody, rather than T cell-dependent effector mechanisms, in disease pathogenesis, with time. Thus, our data indicate that distinct immune-endocrine effects play a decisive role in determining disease progression in multiple sclerosis, a concept supported by reports that a subpopulation of multiple sclerosis patients shows evidence of hypothalamic-pituitary-adrenocortical axis desensitization.

Objective The perineal pressure ulcer is, from the outset, a serious bedsore as it exposes the patient to the risk of fistula in addition to the regular complications associated with bedsores. Treatments reported in the literature couple recovery by musculocutaneous flap combined either with urethroplasty or urinary diversion [1] , without decision-making criteria. The objective of this study is to analyze the management of perineal pressure ulcers in SCI patients and suggest a suitable therapeutic strategy. Materials and methods Retrospective, observational study of a group of SCI patients picked up at the Garches hospital and in the urology department at the Pitie-Salpetriere, between 2002 and 2014. Results The study includes 20 patients, of which 15 show urethrocutaneous fistula. Following a musculocutaneous flap combined or not with an urethroplasty, but without joint urological care, no patient recovered. None of the two urethral reconstructions have helped to heal the bedsores or enabled the reuse of urethra for self-catheterization. After cystoprostatectomy and Bricker, only 2 out of 15 patients relapsed, given a follow-up period between 1 and 6 years. Discussion Like any pressure ulcer, the treatment of perineal pressure ulcer requires a careful evaluation of the circumstances of occurrence and risk factors (history of ischiectomy, proximal hip removal, prolonged indwelling catheter), and a neuroperineal (bladder balance and voiding mode), skin, nutrition, neuro-orthopedic, seat, and socio-psychological assessment. In the presence of urethrocutaneous fistula, a urinary diversion seems absolutely necessary: usually a non-continent bypass with cystoprostatectomy and Bricker which remains surgically heavy and may negatively affects self-image exceptionally, a continent diversion may be considered with closure of the bladder neck. The urethroplasty by experienced urologists associated with bedsores surgery could have been discussed but was not be performed for technical reasons (surgeries on 2 different hospitals). In the absence of fistula, but the presence of chronic perineal maceration with bad management of bladder, trans-ileal cutaneous ureterostomy with cystoprostatectomy ensures the complete drying of the perineum.