[From symptom to diagnosis-symptom checkers re-evaluated : Are symptom checkers finally sufficient and accurate to use? An update from the ENT perspective]. / Vom Symptom zur Diagnose ­ Tauglichkeit von Symptom-Checkern : Update aus Sicht der HNO.

BACKGROUND: Every seventh diagnosis is a misdiagnosis. Each year, 1.5 million lives could be saved worldwide with the correct diagnosis. Physicians have to consider over 20,000 diseases. A study from Harvard University published in 2015 tested 19 symptom checkers and found them to be insufficient, with only 29-71% accuracy in diagnosis. OBJECTIVE: The current study investigates the diagnostic accuracy of new symptom checkers from an ENT perspective. MATERIALS AND METHODS: The authors update the abovenamed diagnostic accuracy comparison by (1) including the five new symptom checkers Symptoma, Ada, FindZebra, Mediktor, and Babylon; and (2) normalizing results of the previously tested symptom checkers as to reflect each diagnostic accuracy based on the same set of patient vignettes. The winner is then compared to the two symptom checkers with the most scientific evidence, namely Isabel and FindZebra, on the basis of an ENT-specific test with patient vignettes sourced from the British Medical Journal. RESULTS: Most of the new symptom checkers demonstrated diagnostic accuracy rates within the previously established range, with the exception of Symptoma, which scored the right diagnosis in 82.2% of cases at the top of the list (+38% points), and in 100% of cases in the top 3 (+29% points) and the top 10 (+16% points), thus raising the bar in this field. The cross-validation with ENT cases resulted in a diagnostic accuracy of 64.3 vs. 21.4 vs. 26.2% (top 1), 92.9 vs. 40.5 vs. 42.9% (top 3), and 100 vs. 61.9 vs. 54.8% (top 10) for Symptoma vs. Isabel vs. FindZebra, respectively. CONCLUSIONS: Symptoma is the first and only viable solution in this market. Large-scale studies should be conducted to further validate these results as well as to assess the actual practical performance of the symptom checkers and their ability to diagnose rare diseases.

recoveriX: a new BCI-based technology for persons with stroke.

Brain-computer interface (BCI) systems have been used primarily to provide communication for persons with severe movement disabilities. This paper presents a new system that extends BCI technology to a new patient group: persons diagnosed with stroke. This system, called recoveriX, is designed to detect changes in motor imagery in real-time to help monitor compliance and provide closed-loop feedback during therapy. We describe recoveriX and present initial results from one patient.

Online control of a humanoid robot through hand movement imagination using CSP and ECoG based features.

Intention recognition through decoding brain activity could lead to a powerful and independent Brain-Computer-Interface (BCI) allowing for intuitive control of devices like robots. A common strategy for realizing such a system is the motor imagery (MI) BCI using electroencephalography (EEG). Changing to invasive recordings like electrocorticography (ECoG) allows extracting very robust features and easy introduction of an idle state, which might simplify the mental task and allow the subject to focus on the environment. Especially for multi-channel recordings like ECoG, common spatial patterns (CSP) provide a powerful tool for feature optimization and dimensionality reduction. This work focuses on an invasive and independent MI BCI that allows triggering from an idle state, and therefore facilitates tele-operation of a humanoid robot. The task was to lift a can with the robot's hand. One subject participated and reached 95.4 % mean online accuracy after six runs of 40 trials. To our knowledge, this is the first online experiment with a MI BCI using CSPs from ECoG signals.

Single trial detection of hand poses in human ECoG using CSP based feature extraction.

Decoding brain activity of corresponding highlevel tasks may lead to an independent and intuitively controlled Brain-Computer Interface (BCI). Most of today's BCI research focuses on analyzing the electroencephalogram (EEG) which provides only limited spatial and temporal resolution. Derived electrocorticographic (ECoG) signals allow the investigation of spatially highly focused task-related activation within the high-gamma frequency band, making the discrimination of individual finger movements or complex grasping tasks possible. Common spatial patterns (CSP) are commonly used for BCI systems and provide a powerful tool for feature optimization and dimensionality reduction. This work focused on the discrimination of (i) three complex hand movements, as well as (ii) hand movement and idle state. Two subjects S1 and S2 performed single `open', `peace' and `fist' hand poses in multiple trials. Signals in the high-gamma frequency range between 100 and 500 Hz were spatially filtered based on a CSP algorithm for (i) and (ii). Additionally, a manual feature selection approach was tested for (i). A multi-class linear discriminant analysis (LDA) showed for (i) an error rate of 13.89 % / 7.22 % and 18.42 % / 1.17 % for S1 and S2 using manually / CSP selected features, where for (ii) a two class LDA lead to a classification error of 13.39 % and 2.33 % for S1 and S2, respectively.

Performance of a tactile P300 speller for healthy people and severely disabled patients.

P300 based Brain-Computer Interfaces (BCIs) for communication are well known since many years. Most of them use visual stimuli to elicit evoked potentials because it is easy to integrate a high number of different classes into the paradigm. Nevertheless, a BCI that depends on visual stimuli is sometimes not feasible due to the presence of visual impairment in patients with severe brain injuries. In this case, it could be possible to use auditory or somatosensory stimulation. In this publication a vibrotactile P300 based BCI is introduced. Two different approaches were tested: a first approach using two stimulators and a second one that utilizes three stimulators for emitting the stimuli. The two paradigms were tested on 16 users: A group of ten healthy users and a second group comprising of 6 patients suffering Locked-In Syndrome. The control accuracy was calculated for both groups and both approaches, proving the feasibility of the device, not only for healthy people but also in severely disabled patients. In a second step we evaluated the influence of the number of stimuli on the accuracy. It was shown that in many cases the maximum accuracy was already reached with a small number of stimuli, this could be used in future tests to speed up the Information transfer rate.

A motor imagery based brain-computer interface for stroke rehabilitation.

Brain-Computer Interfaces (BCIs) have been used to assist people with impairments since many years. In most of these applications the BCI is intended to substitute functions the user is no longer able to perform without help. For example BCIs could be used for communication and for control of devices like robotic arms, wheelchairs or also orthoses and prostheses. Another approach is not to replace the motor function itself by controlling a BCI, but to utilize a BCI for rehabilitation that enables the user to restore normal or "more normal" motor function. Motor imagery (MI) itself is a common strategy for motor rehabilitation in stroke patients. The idea of this paper is it to assist the MI by presenting online feedback about the imagination to the user. A BCI is presented that classifies MI of the left hand versus the right hand. Feedback is given to the user with two different strategies. One time by an abstract bar feedback, and the second time by a 3-D virtual reality environment: The left and right hand of an avatar in the 1st person's perspective in presented to him/her. If a motor imagery is detected, the according hand of the avatar moves. Preliminary tests were done on three healthy subjects. Offline analysis was then performed to (1) demonstrate the feasibility of the new, immersive, 3-D feedback strategy, (2) to compare it with the quite common bar feedback strategy and (3) to optimize the classification algorithm that detects the MI.

Soluble-insoluble transition in binary heterogeneous nucleation.

In this Letter, we report the first experimental study of binary heterogeneous gas-liquid nucleation. Onset activities were obtained for nucleation of various n-propanol-water vapor mixtures on 6.9 nm NaCl particles soluble in water and practically insoluble in n-propanol. The Fletcher theory of vapor nucleation on insoluble particles provided a reasonable approximation for n-propanol rich mixtures only, whereas the Köhler theory of activation of soluble particles worked only for water rich mixtures. A new theory was formulated providing a satisfactory description of the transition from activation of soluble particles to vapor nucleation on insoluble particles.

[Pregnancy and substance dependency]. / Schwangerschaft und Substanzabhängigkeit.

Substance dependency in pregnancy leads to severe health risks for the expecting mother and for the foetus and the new-born. The problem of substance dependent pregnant women lies not only in the use of illegal substances but also to a high degree in the use of legal substances such as alcohol and nicotine. In contrast to most other substances of abuse, opioids do not show cytotoxic or teratogenic characteristics. The primary goal should be the stabilisation of the patient and a reduction of additional illicit consumption. The ideal goal of abstinence is difficult to reach and often puts the women under enhanced risks. Detoxification after week 32 should not be undertaken in order to avoid preterm delivery. It should be standardised that a multiprofessional and interdisciplinary therapeutical care leads to a stabilisation in opioid dependent pregnant addicts and therefore improves the outcome for neonates. Special awareness needs to be addressed towards the diversification of opioid maintenance therapy. Based on the positive results in opioid maintenance therapy in pregnant opioid dependent women, it will be required to establish standards. Furthermore there is a need to establish consistent guidelines for the treatment of the neonatal abstinence syndrome.

[Cocaine abuse in maintenance therapy with methadone in narcotic dependent patients]. / Kokainmissbrauch unter der Erhaltungstherapie mit Methadon bei opioidabhängigen PatientInnen.

INTRODUCTION: From a clinical point of view, additional consumption of cocaine by methadone maintained patients seems to have increased during the last few years. In order to verify this clinical impression, we carried out a retrospective analysis about cocaine abuse by opioid-dependent patients undergoing methadone maintenance therapy at the drug addiction clinic, Department of Psychiatry, University of Vienna. METHODS: Supervised urinalysis was performed on a frequent basis in 160 patients during the investigational time frame of 1997 and 1999. Concomitant consumption of opioids, cocaine and benzodiazepines in urine toxicology results (n = 2242) was compared in a post hoc analysis. RESULTS: In 1997, 45% of urine toxicology tests were positive for opioids, 14.1% for cocaine and 22.1% for benzodiazepines. In 1999, however, 33.1% urine toxicology tests showed positive results for opioids, 22.2% for cocaine and 24% for benzodiazepines. It could be shown that the number of cocaine positive toxicology results increased significantly (p < 0.05) over the course of two years, and that the number of opioid positive tests decreased significantly (p < 0.05), whereas benzodiazepine consumption did not change. Age, and the duration of opioid dependence showed a significant influence on cocaine positive urinalysis. DISCUSSION: The significant increase of additional cocaine consumption in methadone maintained patients reflects the enhanced availability of the substance in Austria, as it has been shown in other European countries and the USA. In addition, evidence based treatment trials are needed to prove the efficacy of alternative opioid maintenance therapy and to evaluate whether cocaine consumption is less of a problem.

[Pedicle flap-plasties of defects following tumor resection of the upper lip]. / Nahlappenplastiken bei Defekten nach Tumorresektion im lateralen Oberlippenbereich.

In the Case of tumor excision in the lateral parts of the upper lip, the ensuing defect is usually closed by a rotation flap from the cheek. As a rule this procedure results in altering the nasolabial sulcus--one of the very striking natural structures of the face. We describe and compare the outcome of 3 different techniques of flapping (Burow's method, Schrudde's rotation flap, and pedicled flapping).

[Tuberculous colitis--Crohn disease--a clinico-radiologic-endoscopic approach]. / Colitis tuberculosa--M. Crohn--Eine klinisch-radiologisch-endoskopische Aufgabe.

The authors report on a case of multifocal stenosing tuberculosis of the stomach, pointing out the difficulties in differential diagnosis especially against Crohn's disease. The importance of x-ray examination is discussed.