Analisis Simulasi Penerapan Algoritma OSPF Menggunakan RouteFlow Pada Jaringan Software Defined Network (SDN)

Pada jaringan konvensional, konfigurasi protocol routing sangat tidak fleksibel, tidak efisien dan konfigurasi dilakukan pada tiap perangkat. Hal ini tentu saja tidak dapat memenuhi tuntutan operasional saat ini yang rata-rata memiliki jaringan yang besar dan perangkat jaringan yang memiliki spesifikasi berbeda. Software Defined Network (SDN) muncul sebagai harapan untuk permasalahan kompleksitas jaringan konvensional. Paradigma baru SDN melakukan pemisahan antara control plane dan forwarding plane. RouteFlow merupakan salah satu komponen berbasis software yang dapat mengaplikasikan protocol routing konvensional pada jaringan SDN. Open Shortest Path First (OSPF) merupakan sebuah protokol routing konvensional yang memiliki kemampuan untuk mendeteksi Perubahan topologi jaringan dengan cepat dalam sebuah jaringan yang besar. Protokol routing OSPF diterapkan pada teknologi SDN menggunakan RouteFlow dengan tujuan untuk mempermudah dalam mengontrol jaringan dengan sistem terpusat. Convergence time dan parameter Quality of Service (Throughput, Delay, Jitter dan Packet Loss) diukur dengan skenario pemutusan link, penambahan jumlah switch dan background traffic.  Hasil pengukuran convergence time menunjukan bahwa penambahan jumlah switch mempengaruhi pertambahan waktu konvergensi, sedangkan untuk parameter Quality of Service (QoS) pada peningkatan topologi switch didapatkan hasil yang masih sesuai dengan standar ITU-T G.1010 namun apabila ditambahkan background traffic yang memenuhi 50% bandwidth jaringan maka QoS memburuk

Simulasi Virtual Local Area Network (VLAN) Berbasis Software Defined Network (SDN) Menggunakan POX Controller

VLAN (Virtual LAN) merupakan sebuah teknologi yang dapat mengkonfigurasi jaringan logis independen dari struktur jaringan fisik. Hasil dari penelitian sebelumnya sudah diprediksi bahwa dibutuhkan Virtual Network yang akhirnya terciptalah VLAN. Namun paradigma jaringan saat ini tidak flexible, ketergantungan terhadap vendor sangat besar karena fungsi data plane dan control plane berada dalam satu paket device. SDN (Software defined network) yang merupakan salahsatu evolusi teknologi jaringan sesuai dengan tuntutan yang berkembang dimana memisahkan fungsi data plane dan control plane pada suatu perangkat. POX Controller digunakan untuk men-simulasikan dan menguji Platform SDN (Software defined network). Pada penelitian ini menggunakan Openflow versi 1.0 untuk memasang header VLAN sehingga penelitian ini difokuskan untuk mengevaluasi performa forwarding VLAN yang memanfaatkan Openflow sebagai control plane dapat berfungsi dengan baik. Hasil penelitian ini mengusulkan penerapan karakteristik teknologi VLAN pada SDN karena telah berjalan dengan benar sesuai hasil pengujian konektifitas, verifikasi dan keamanan. Kemudian hasil pengujian lanjutan untuk melihat pengaruh SDN dengan skenario penambahan jumlah VLAN ID didapatkan bahwa set-up time akan bertambah seiring meningkatnya jumlah host dan dengan menggunakan protokol OpenFlow, latency yang terjadi di jaringan dapat dipantau dengan parameter round trip time (RTT) yang stabil direntang 0,2 sampai 6 second walaupun jumlah vlan_id dan background traffic bertambah

Cortisol/Cortisone Levels and Quality of Life in Individuals with Pulmonary Arterial Hypertension (PAH).

Individuals with pulmonary arterial hypertension experience debilitating symptoms and psychological distress which may influence their cortisol regulation. We describe associations between diurnal salivary cortisol/cortisone levels and quality of life in adults with pulmonary arterial hypertension. Findings suggest potential clinical utility of cortisol/cortisone assessment as applied to a pulmonary arterial hypertension population

Management of Kawasaki disease

Kawasaki disease (KD) is an acute self-limiting inflammatory disorder, associated with vasculitis, affecting predominantly medium-sized arteries, particularly the coronary arteries. In developed countries KD is the commonest cause of acquired heart disease in childhood. The aetiology of KD remains unknown, and it is currently believed that one or more as yet unidentified infectious agents induce an intense inflammatory host response in genetically susceptible individuals. Genetic studies have identified several susceptibility genes for KD and its sequelae in different ethnic populations, including FCGR2A, CD40, ITPKC, FAM167A-BLK and CASP3, as well as genes influencing response to intravenous immunoglobulin (IVIG) and aneurysm formation such as FCGR3B, and transforming growth factor (TGF) β pathway genes. IVIG and aspirin are effective therapeutically, but recent clinical trials and meta-analyses have demonstrated that the addition of corticosteroids to IVIG is beneficial for the prevention of coronary artery aneurysms (CAA) in severe cases with highest risk of IVIG resistance. Outside of Japan, however, clinical scores to predict IVIG resistance perform suboptimally. Furthermore, the evidence base does not provide clear guidance on which corticosteroid regimen is most effective. Other therapies, including anti-TNFα, could also have a role for IVIG-resistant KD. Irrespective of these caveats, it is clear that therapy that reduces inflammation in acute KD, improves outcome. This paper summarises recent advances in the understanding of KD pathogenesis and therapeutics, and provides an approach for managing KD patients in the UK in the light of these advances

Outcomes following aortic valve procedures in 201 complex congenital heart disease cases:results from the UK National Audit

OBJECTIVES: Some patients with complex congenital heart disease (cCHD) also require aortic valve (AoV) procedures. These cases are considered high risk but their outcome has not been well characterized. We aim to describe these scenarios in the current practice, and provide outcome data for counselling and decision-making. METHODS: This was a retrospective study using the UK National Congenital Heart Disease Audit data on cCHD patients undergoing aortic valve replacement, balloon dilation (balloon aortic valvuloplasty) or surgical repair (surgical aortic valve repair) between 2000 and 2012. Coarsened exact matching was used to pair cCHD with patients undergoing AoV procedures for isolated valve disease. RESULTS: A total of 201 patients with a varied spectrum of cCHD undergoing 242 procedures were included, median age 9.4 years (1 day–65 years). Procedure types were: balloon aortic valvuloplasty (n = 31, 13%), surgical aortic valve repair (n = 57, 24%) and aortic valve replacement (n = 154, 63%). Mortality at 30 days was higher in neonates (21.8% vs 5.3%, P = 0.02). Survival at 10 years was 83.1%, freedom from aortic valve replacement 83.8% and freedom from balloon aortic valvuloplasty/surgical aortic valve repair 86.3%. Neonatal age (P < 0.001), single ventricle (P = 0.08), concomitant Fontan/Glenn (P = 0.002) or aortic arch procedures (0.02) were associated with higher mortality. cCHD patients had lower survival at 30 days (93% vs 100%, P = 0.003) and at 10 years (86.4% vs 96.1%, P = 0.005) compared to matched isolated AoV disease patients. CONCLUSIONS: AoV procedures in cCHD can be performed with good results outside infancy, but with higher mortality than in isolated AoV disease. Neonates and patients with single ventricle defects, especially those undergoing concomitant Fontan/Glenn, have worse outcomes

Changes in contractile protein expression are linked to ventricular stiffness in infants with pulmonary hypertension or right ventricular hypertrophy due to congenital heart disease

Background The right ventricle (RV) is not designed to sustain high pressure leading to failure. There are no current medications to help RV contraction, so further information is required on adaption of the RV to such hypertension. Methods The Right Ventricle in Children (RVENCH) study assessed infants with congenital heart disease undergoing cardiac surgery with hypertensive RV. Clinical and echocardiographic data were recorded, and samples of RV were taken from matched infants, analysed for proteomics and compared between pathologies and with clinical and echocardiographic outcome data. Results Those with tetralogy of Fallot (TOF) were significantly more cyanosed than those with ventricular septal defect (median oxygen saturation 83% vs 98%, P=0.0038), had significantly stiffer RV (tricuspid E wave/A wave ratio 1.95 vs 0.84, P=0.009) and had most had restrictive physiology. Gene ontology in TOF, with enrichment analysis, demonstrated significant increase in proteins of contractile mechanisms and those of calmodulin, actin binding and others associated with contractility than inventricular septal defect. Structural proteins were also found to be higher in association with sarcomeric function: Z-disc, M-Band and thin-filament proteins. Remaining proteins associated with actin binding, calcium signalling and myocyte cytoskeletal development. Phosphopeptide enrichment led to higher levels of calcium signalling proteins in TOF. Conclusion This is the first demonstration that those with an RV, which is stiff and hypertensive in TOF, have a range of altered proteins, often in calcium signalling pathways. Information about these alterations might guide treatment options both in terms of individualised therapy or inotropic support for the Right ventricle when hypertensive due to pulmoanry hypertension or congenital heart disease

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

OBJECTIVES: Kawasaki disease (KD) is an increasingly common vasculitis with risk of coronary artery aneurysms (CAAs). The last UK survey was in 1990, whereas current epidemiology, treatment patterns and complication rates are unknown. The aim of this study was to address this knowledge gap. METHODS: A British Paediatric Surveillance Unit survey in the UK and Ireland from 1 January 2013 to 28 February 2015 ascertained demographics, ethnicity, seasonal incidence, treatment and complication rates. RESULTS: 553 cases were notified: 389 had complete KD, 46 had atypical KD and 116 had incomplete KD; 2 were diagnosed at postmortem with an incidence of 4.55/100 000 children under 5 years, with a male to female ratio of 1.5:1 and a median age of 2.7 years (2.5 months–15 years). Presentation was highest in January and in rural areas. Most were white (64%), and Chinese and Japanese Asians were over-represented as were black African or African mixed-race children. 94% received intravenous immunoglobulin (IVIG). The overall CAA rate was 19%, and all-cardiac complications affected 28%. Those with CAA received IVIG later than in those without (median 10 days vs 7 days). Those under 1 year had fewer symptoms, but the highest CAA rate (39%). Overall 8 of 512 cases (1.6%) had giant CAA, and 4 of 86 cases (5%) under 1 year of age developed giant CAA. Mortality from KD was 0.36%. CONCLUSIONS: The UK and Ireland incidence of KD has increased and is more frequently seen in winter and rural areas. Delayed IVIG treatment is associated with CAA, suggesting earlier and adjunctive primary treatment might reduce complications to prevent CAA, particularly in the very young