Indocyanine-green videoangiography of drusen as a possible predictive indicator of exudative maculopathy

OBJECTIVE: Recent studies have shown that indocyanine-green videoangiography (ICG-V) is useful to image occult choroidal neovascularization. The authors studied the ICG-V findings in fellow drusen eyes of patients with unilateral exudative age-related macular degeneration (AMD). The authors also studied the occurrence of exudative changes to determine whether ICG-V is useful in predicting future exudative changes in these eyes with only drusen. DESIGN: Cohort study. PARTICIPANTS: The authors studied 432 consecutive patients diagnosed with unilateral exudative AMD in whom the fellow eye had only drusen by clinical fundus examination and fluorescein angiography. All of these eyes had ICG-V performed. Follow-up data were obtained in all eyes with abnormal indocyanine-green (ICG) angiograms and randomly sampled ICG angiograms of normal eyes. MAIN OUTCOME MEASURES: The initial ICG findings were classified as showing normal or abnormal hyperfluorescence. Abnormal hyperfluorescence eyes were subdivided into focal spots (focal areas of hyperfluorescence < 1 disc area in size) and plaques (areas of hyperfluorescence > 1 disc area). The development of exudative changes in eyes with normal and abnormal hyperfluorescence was compared. RESULTS: Of the 432 fellow eyes, 386 (89%) eyes with drusen had a normal ICG-V study, whereas 46 (10 focal spots and 36 plaques) (11%) eyes had an abnormal ICG-V. Exudative changes occurred in 6 (10%) of 58 normal ICG eyes and 9 (24%) of 38 eyes with abnormal ICG findings during a mean follow-up period of 21.7 months. The difference between drusen eyes with normal ICG angiograms and those with plaques on ICG-V regarding future exudative changes (10% vs. 27%, respectively) was statistically significant (P = 0.038). CONCLUSIONS: Abnormal ICG findings were found in 11% of eyes with clinically and fluorescein angiographically nonsuspicious drusen. The subgroup of patients with plaques on ICG-V had a higher chance of having exudative changes develop. Indocyanine-green videoangiography may be a predictive indicator of future exudative changes in eyes with drusen. A much larger prospective study seems justified.     

The EuQoS system: a solution for QoS routing in heterogeneous networks [Quality of Service based Routing Algorithms for Heterogeneous Networks]

EuQoS is the acronym for "end-to-end quality of service support over heterogeneous networks", which is a European research project aimed at building an entire QoS framework, addressing all the relevant network layers, protocols, and technologies. This framework, which includes the most common access networks (xDSL, UMTS, WiFi, and LAN) is being prototyped and tested in a multidomain scenario throughout Europe, composing what we call the EuQoS system. In this article we present the novel QoS routing mechanisms that are being developed and evaluated in the framework of this project. The preliminary performance results validate the design choices of the EuQoS system, and confirm the potential impact this project is likely to have in the near future     

Digital subtraction indocyanine green angiography of occult choroidal neovascularization

OBJECTIVE: This study aimed to use a new technique for ocular imaging, digital subtraction indocyanine green angiography (DS-ICGA), to evaluate patients with occult choroidal neovascularization (CNV). DESIGN: The design was a cross-sectional study of patients with occult CNV. PARTICIPANTS: A total of 31 eyes of 31 patients were studied. INTERVENTION: Digital subtraction of sequentially acquired indocyanine green angiographic frames was used to image the progression of the dye front in eyes with occult CNV. A method of pseudocolor imaging of the choroid was developed that allows differentiation and identification of underlying choroidal arteries and veins. RESULTS: The DS-ICGA of occult CNV showed consistent findings. Occult CNV was imaged with greater detail and in a shorter period of time than with conventional indocyanine green angiography. The fundus landmarks were retained with DS-ICGA much better than with conventional indocyanine green angiography. CONCLUSIONS: The DS-ICGA uses time to dissect the choroidal circulation. With DS-ICGA, occult CNV could be imaged more quickly and in greater detail than with conventional imaging techniques. The DS-ICGA may improve the authors ability to image, and subsequently treat, occult CNV.     

Idiopathic polypoidal choroidal vasculopathy of the macula

OBJECTIVE: The authors evaluated the clinical, fluorescein, and indocyanine green (ICG) angiographic characteristics of the macular variant of idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Observational case series. PARTICIPANTS: The records, photographs, and fluorescein and ICG angiograms of eight eyes of seven patients with IPCV lesions confined to the macula were reviewed. MAIN OUTCOME MEASURES: The visual acuity, fundus examination, fluorescein and ICG angiographic characteristics, and clinical course were compared. RESULTS: All patients demonstrated polypoidal lesions arising from macular choroidal vessels on ICG angiography. One patient had bilateral lesions. These lesions appeared hyperfluorescent in the early phases of both fluorescein and ICG angiography. Late-phase leakage was seen in cases associated with subretinal fluid or exudate. None of these patients demonstrated polypoidal lesions arising from the peripapillary choroidal circulation or peripapillary choroidal neovascularization. Three eyes with polypoidal lesions that were associated with subretinal fluid and exudates were treated with photocoagulation. Five eyes were not treated. Final visual acuity ranged from 20/20 to hand motions. Severe visual loss was associated with vitreous and subretinal hemorrhage, but this resolved without permanent severe visual loss in several cases. CONCLUSIONS: In the macular variant of IPCV, ICG and fluorescein angiography demonstrate characteristic macular polypoidal lesions without evidence of peripapillary lesions. The vascular origin of these polypoidal lesions appears to be the macular choroidal circulation. This is distinguished from classic IPCV, in which lesions appear to arise from the peripapillary choroidal circulation. Visual prognosis appears to be good, with most patients retaining visual acuity of 20/80 or better. If subretinal fluid or exudates reduce visual acuity, photocoagulation should be considered.     

Indocyanine green angiography of multifocal choroiditis

PURPOSE: The purpose of the study is to determine indocyanine green (ICG) angiographic characteristics of patients with multifocal choroiditis (MC) and to identify features that may assist in the differentiation of MC from other ocular inflammatory diseases. METHODS: After complete ophthalmologic examination, fluorescein angiography and ICG angiography were performed in a series of 14 patients with MC. The ICG findings were then correlated with the clinical and fluorescein angiographic appearance of these patients to determine specific characteristics and distinguishing features of the entity. These findings then were compared with those of angiographic patterns observed in patients with ocular histoplasmosis syndrome to determine whether differentiating features could be identified. RESULTS: Fourteen (50%) of the 28 eyes were found to have large hypofluorescent spots in the posterior pole on ICG angiography, which, in most cases, did not correspond to clinically or fluorescein angiographically detectable lesions. Seventeen (61%) had smaller hypofluorescent lesions (approximately 50 pm in size) in the posterior pole on the ICG study. In seven eyes exhibiting enlarged blind spots on visual field testing, ICG angiography showed confluent hypofluorescence surrounding the optic nerve. The ICG angiogram was found useful in evaluating the natural course in two patients with MC as well as a response to oral prednisone therapy in four others. The ICG angiographic findings differed from those seen in patients with ocular histoplasmosis. CONCLUSIONS: Indocyanine green angiography can provide information that is not detectable by clinical or fluorescein angiographic examination in patients with MC. This information may prove useful in differentiating this condition from the ocular histoplasmosis syndrome, provide a better understanding of the natural course and progression of the disease, and provide a potential adjunct in the clinical evaluation of patients undergoing therapeutic regimens for active inflammatory lesions.     

An efficient and lightweight method for Service Level Agreement assessment

Traditional approaches to on-line end-to-end Service Level Agreement (SLA) assessment have focused on the estimation of network QoS parameters. These approaches, however, face a trade-off between accuracy and the amount of resources needed to achieve such accuracy. This paper offers an alternative approach, where instead of estimating QoS parameters, we propose an effective and lightweight solution for directly detecting SLA violations. Our solution monitors the Inter-Packet Arrival Time (IPAT) at an end-point, wherein current IPAT distributions are periodically compared with a set of reference IPAT distributions as the main basis for detecting SLA violations. A mapping of the IPAT distribution with the current network conditions is derived, and a training algorithm that dynamically acquires the set of reference IPAT distributions is designed. For the comparison of the IPAT distributions, we propose a variant of the Hausdorff Distance algorithm. Our variant provides a better accuracy than the traditional Hausdorff Distance, while presenting linear complexity. Our proposal is validated in a real testbed, by comparing the SLA violations detected and the resources required in terms of bandwidth, with other existing alternatives as well as with perfect knowledge of current network QoS status.     

Managing interdomain traffic in Latin America: a new perspective based on LISP [Topics in Network and Service Management]

The characteristics of Latin American network infrastructures have global consequences, particularly in the area of interdomain traffic engineering. As an example, Latin America shows the largest de-aggregation factor of IP prefixes among all regional Internet registries, being proportionally the largest contributor to the growth and dynamics of the global BGP routing table. In this article we analyze the peculiarities of LA interdomain routing architecture, and provide up-to-date data about the combined effects of the multihoming and TE practices in the region. We observe that the Internet Research Task Force initiative on the separation of the address space into locators and identifiers can not only alleviate the growth and dynamics of the global routing table, but can also offer appealing TE opportunities for LA. We outline one of the solutions under discussion at the IRTF, the Locator/Identifier Separation Protocol, and examine its potential in terms of interdomain traffic management in the context of LA. The key advantage of LISP is its nondisruptive nature, but the existing proposals for its control plane have some problems that may hinder its possible deployment. In light of this, we introduce a promising control plane for LISP that can solve these issues, and at the same time has the potential to bridge the gap between intradomain and interdomain traffic management.     

High performance 0.14 /spl mu/m gate-length AlGaN/GaN power HEMTs on SiC

High electron mobility transistors (HEMTs) were fabricated from AlGaN/GaN on semi-insulating SiC substrates with excellent performance and high yield. The devices had 0.14 /spl mu/m T-gates with a total width of 300 /spl mu/m. Extrinsic, unpassivated peak performance values for these HEMTs include transconductance of 338 mS/mm, maximum drain current of 1481 mA/mm, unity current gain cutoff frequency of 91 GHz, and maximum frequency of oscillation of 122 GHz. Saturated CW power measurements of these devices at 10 GHz result in 4.6 W/mm with PAE at 46% when optimized for power and 3.0 W/mm with PAE at 65% when optimized for efficiency.     

On the challenges of establishing disjoint QoS IP/MPLS paths across multiple domains

MPLS is being actively adopted as the core switching infrastructure at the intradomain level. This trend is mainly attributable to the undeniable potential of MPLS in terms of virtual private networks (VPNs) management, traffic engineering (TE), QoS delivery, path protection, and fast recovery from network failures. However, little progress has been made to attain the expected extension of MPLS label-switched paths (LSPs) across domain boundaries. Among the problems that remain unsolved is how to efficiently find and establish primary and protection interdomain LSPs for mission-critical services subject to QoS constraints. This article explores the major limitations hindering the deployment of these kinds of LSPs across multiple domains, in the context of the current interdomain network model. We describe the critical problems faced by the research community, and present our vision on how to rationally overcome some of the problems exposed. Our perspective is that we should be prepared for rather coarse-grained solutions as long as we need to coexist with the current interdomain network model     

Histologic localization of indocyanine green dye in aging primate and human ocular tissues with clinical angiographic correlation

OBJECTIVE: Because C5a induces tissue injury by activating polymorphonuclear leukocytes, the hypothesis was that inhibition of C5a activity would reduce cardioplegia-related injury. METHODS: Pigs were placed on cardiopulmonary bypass. The hearts were arrested for 1 hour with hyperkalemic cardioplegia. Pigs were then separated from bypass, and the hearts were reperfused for 2 hours. Anti-porcine C5a monoclonal antibody (1.6 mg/kg, intravenously; n = 6) was administered 20 minutes before the onset of cardiopulmonary bypass. Six pigs received saline solution vehicle. Reactivity of coronary arterioles was studied in vitro with videomicroscopy. Microvessels from uninstrumented pigs served as controls for vascular studies. RESULTS: Endothelium-dependent relaxation to adenosine diphosphate (percent relaxation of precontraction) was reduced after cardioplegic reperfusion (63% +/- 14% vs 77% +/- 10% in control at 10 micromol/L; P =.01). This impairment in endothelium-dependent relaxation was improved with anti-porcine C5a monoclonal antibody (80% +/- 22%; P =.01 vs saline solution), as was the impaired endothelium-dependent relaxation to clonidine (64% +/- 12% control; 26% +/- 17% saline solution; 55% +/- 24% anti-porcine C5a monoclonal antibody at 10 micromol/L; P =.01 saline solution vs control or anti-porcine C5a monoclonal antibody). Myeloperoxidase activity was significantly decreased (0.2 +/- 0.2 units/g protein; P =.04) in the anti-porcine C5a monoclonal antibody group compared with 5.2 +/- 2.7 in the saline solution group. CH50 2 hours after bypass was not statistically different (0.57 +/- 0.41 unit and 0.65 +/- 0.41 unit, respectively) between the anti-porcine C5a monoclonal antibody and saline solution groups. Despite less myocardial polymorphonuclear leukocyte infiltration after C5a inhibition, maximum rate of rise of left ventricular pressure, percent segmental shortening, and blood flow through the left anterior descending coronary artery were similar in the anti-porcine C5a monoclonal antibody and saline solution groups. CONCLUSIONS: Inhibition of C5a limits neutrophil-mediated impairment of endothelium-dependent relaxation after cardiopulmonary bypass and cardioplegic reperfusion, but it has no effect on short-term myocardial functional preservation.