99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: compared with CT--a prospective study

Single photon emission computed tomography (SPECT) with Technetium-99m hexamethyl propylenamine oxime (Tc-99m-HMPAO) was used in 20 patients with mild to moderate traumatic brain injury (TBI) to evaluate the effects of brain trauma on regional cerebral blood flow (rCBF). SPECT scan was compared with CT scan in 16 patients. SPECT showed intraparenchymal differences in rCBF more often than lesions diagnosed with CT scans (87.5% vs. 37.5%). In five of six patients with lesions in both modalities, the area of involvement was relatively larger on SPECT scans than on CT scans. Contrecoup changes were seen in five patients on SPECT alone, two patients with CT alone and one patient had contrecoup lesions on CT and SPECT. Of the eight patients (50%) with skull fractures, seven (43.7%) had rCBF findings on SPECT scan and five (31.3%) demonstrated decrease in rCBF in brain underlying the fracture. All these patients with fractures had normal brain on CT scans. Conversely, extra-axial lesions and fractures evident on CT did not visualize on SPECT, but SPECT demonstrated associated changes in rCBF. Although there is still lack of clinical and pathological correlation, SPECT appears to be a promising method for a more sensitive evaluation of axial lesions in patients with mild to moderate TBI.     

Design and analysis of very high-speed network architectures

Communication architectures for very-high-speed networks are dealt with. The use of high communication speed increases the ratio between the end-to-end propagation delay and the packet transmission time. This increase restricts the utilization of the high system bandwidth in broadcast channel-based systems, causing a rapid performance deterioration. A communication system architecture characterized by the use of several parallel channels and design of the nodes' channel interface is presented. The channel-division approach is introduced, showing that for a given system bandwidth the total system capacity will be increased by bandwidth division and parallel communication. An analytic model of this system is developed, from which the proposed system's performance is obtained and performance bounds determined for multichannel slotted finite systems. The results show that the architecture has a potential to improve significantly the system performance compared to conventional single-channel-based systems. Furthermore, for a given network configuration an optimal architecture can be found which simultaneously maximizes the system throughput and minimizes the average packet delay     

Protection of a Narrow-Band BPSK Communication System with an Adaptive Array

This paper describes the performance of an adaptive array when used with narrow-band BPSK communication signals; A previous paper [11] described the performance of an adaptive array with a standard BPSK signal when the array bandwidth is several times the signal bandwidth. These earlier results are extended to the case where the array bandwidth is as small as possible, equal to the desired signal symbol rate. To realize such a bandwidth reduction, it is necessary to reshape the BPSK signaling waveform before transmission to prevent intersymbol interference. This is done by passing the BPSK signal through a pulseshaping filter at the transmitter. The performance of the optimal detector for the narrow-band BPSK signal is determined when this detector operates behind an adaptive array that is subjected to CW interference. The bit error probability is obtained as a function of the desired signal and interference powers and arrival angles as well as the array bandwidth.     

An in-band signaling protocol for optical packet switching networks

Advances in optical networking reveal that all optical networks offering a multigigabit rate per wavelength will soon become economical as the underlying backbone in wide-area networks, in which the optical switch plays a central role. One of the central issues is the design of efficient signaling protocols which can support diversified traffic types, in particular the bursty IP traffic. This paper introduces a novel signaling protocol called the sampling probe algorithm (or SPA) to be used in a class of optical packet switching systems based on wavelength division multiplexing (WDM). The proposed scheme takes a drastically different approach from all existing signaling protocols. The salient features are 1) the pretransmission coordination is using an in-band signaling protocol, and thus does not require separate control channel(s) for transmission coordination; 2) the protocol is based on a reservation (connection) scheme which is capable of supporting multimedia traffic; 3) a gated service is adopted in which each successful reservation allows multiple packets (train of packets) to be transmitted, which can significantly reduce the per packet overhead; 4) the scheduling algorithm is adaptive by allowing flexible assignment of bandwidth on-demand; 5) the channel status gathering is done in a distributed fashion, and uses a passive listening mechanism, which itself does not interfere with packet transmissions. The results demonstrate that the proposed in-band signaling protocol can achieve high throughput and stability under heavy traffic condition.     

Associations of microvascular dysfunction with cardiovascular outcomes: The cardiac,endothelial function and arterial stiffness in ESRD (CERES) cohort

Introduction: Patients with end‐stage renal disease (ESRD) have reduced endothelial function, but whether macro‐ and microvascular endothelial function correlate with baseline risk factors and cardiovascular outcomes in this population is not well understood. Methods: Among 146 participants of the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study, we evaluated macro‐ and microvascular endothelial dysfunction as flow‐mediated dilation (FMD) and velocity time integral (VTI), respectively. We examined cross‐sectional correlations of baseline characteristics, inflammatory and cardiac markers with FMD and VTI. We followed participants for the composite outcome of cardiovascular hospitalization or all‐cause death over fourteen months. Cox survival analyses were adjusted for demographics, comorbidities, medications, systolic blood pressure, inflammation, high‐sensitivity troponin T (hs‐TnT), and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP). Findings: Impaired VTI was associated with older age and Black race (P < 0.05), as well as female gender, atherosclerosis, and hemodialysis (as opposed to peritoneal dialysis) (P < 0.2). Myocardial injury, measured as hs‐TnT, inflammatory markers and NT‐proBNP correlated with impaired VTI. In unadjusted analyses, VTI was significantly associated with the composite outcome (HR per SD VTI 0.65 [95%CI 0.45, 0.95]), but FMD was not (HR per SD FMD 0.97 [95%CI 0.69, 1.4]). When VTI was calculated as the ratio of (hyperemic VTI‐baseline VTI)/baseline VTI, its association with the outcome persisted after multivariable adjustment. Discussion: Microvascular function was associated with higher rates of cardiovascular hospitalizations and all‐cause mortality among individuals with ESRD on dialysis. Further research is needed to learn whether novel therapies that target microvascular endothelial function could improve outcomes in this high‐risk population.