Time-division multiplexing for cable reduction in ultrasound imaging catheters

In ultrasound imaging catheter applications, gathering the data from multi-element transducer arrays is difficult as there is a restriction on cable count due to the diameter of the catheter. In such applications, CMUT-on-CMOS technology allows for 2D arrays with many elements to be designed and bonded directly onto CMOS circuitry. This allows for complex electronics to be placed at the tip of the catheter which leads to the possibility to include electronic multiplexing techniques to greatly reduce the cable count required for a large element array. Current approaches to cable reduction tend to rely on area and power hungry circuits to function, making them unsuitable for use in catheters. Furthermore the length requirement for catheters and lack of power available to on-chip cable drivers leads to limited signal strength at the receiver end. In this paper an alternative approach using Analogue Time Division Multiplexing (TDM) is presented, which addresses the cable restrictions of the catheter and, using a novel digital demultiplexing technique, allows for a reduction in the number of analogue signal processing stages required

Direct Digital Demultiplexing of Analog TDM Signals for Cable Reduction in Ultrasound Imaging Catheters.

In real-time catheter based 3D ultrasound imaging applications, gathering data from the transducer arrays is difficult as there is a restriction on cable count due to the diameter of the catheter. Although area and power hungry multiplexing circuits integrated at the catheter tip are used in some applications, these are unsuitable for use in small sized catheters for applications like intracardiac imaging. Furthermore, the length requirement for catheters and limited power available to on-chip cable drivers leads to limited signal strength at the receiver end. In this paper an alternative approach using Analog Time Division Multiplexing (TDM) is presented which addresses the cable restrictions of ultrasound catheters. A novel digital demultiplexing technique is also described which allows for a reduction in the number of analog signal processing stages required. The TDM and digital demultiplexing schemes are demonstrated for an intracardiac imaging system that would operate in the 4 MHz to 11 MHz range. A TDM integrated circuit (IC) with 8:1 multiplexer is interfaced with a fast ADC through a micro-coaxial catheter cable bundle, and processed with an FPGA RTL simulation. Input signals to the TDM IC are recovered with -40 dB crosstalk between channels on the same micro-coax, showing the feasibility of this system for ultrasound imaging applications

Single-Chip Reduced-Wire Active Catheter System with Programmable Transmit Beamforming and Receive Time-Division Multiplexing for Intracardiac Echocardiography

Intracardiac echocardiography (ICE) provides real-time ultrasound imaging of the heart anatomy from inside, guiding interventions like valve repair, closure of atrial septal defects (ASD) and catheter-based ablation to treat atrial fibrillation. With its better image quality and ease of use, ICE is becoming the preferred imaging modality over transesophageal echography (TEE) for structural heart interventions. The existing commercial ICE catheters, however, offer a limited 2-D or 3-D field of view despite catheters utilizing large number of wires. In these catheters, each element in the ICE array is connected to the backend data-acquisition channel with a separate wire, which is a critical barrier for improving image quality and widening the field of view. In order to use ICE catheters under MRI instead of the ionizing X-ray radiation-based angiography, the number of interconnect wires in the catheter should be minimized to reduce RF-induced heating. Furthermore, reducing the number of wires improves the flexibility and lowers the cost of the single-use ICE catheters

Streptococcus intermedius causing infective endocarditis and abscesses: a report of three cases and review of the literature

<p>Abstract</p> <p>Background</p> <p><it>Streptococcus intermedius </it>is a member of the Streptococcus anginosus group. Clinical disease with <it>S. intermedius </it>is characterized by abscess formation and rarely endocarditis. Identification of <it>Streptococcus intermedius </it>is difficult, leading to the development of molecular methods to more accurately identify and characterize this organism.</p> <p>Case presentation</p> <p>Over a period of 6 months we encountered three cases of invasive <it>Streptococcus intermedius </it>infection presenting as hepatic abscesses, brain abscess, and endocarditis. We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case.</p> <p>Conclusion</p> <p>Our report illustrates three different clinical manifestations due to <it>Streptococcus intermedius </it>infection that can be encountered in healthy individuals in a community hospital setting. To our knowledge, this is the first case of <it>Streptococcus intermedius </it>endocarditis confirmed by 16S sequencing analysis. The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.</p

Therapeutic potential of transdermal glyceryl trinitrate in the management of acute stroke

The nitric oxide donor, glyceryl trinitrate (GTN), is a candidate treatment for the management of acute stroke with haemodynamic and potential reperfusion and neuroprotective effects. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within 6 h of stroke onset, GTN reduced death and dependency (odds ratio 0.52; 95% confidence interval 0.34–0.78), death, disability, cognitive impairment and mood disturbance, and improved quality of life (data from two trials, n = 312). In a pooled analysis of four studies (n = 186), GTN reduced between-visit systolic blood pressure variability over days 1–7 compared with no GTN (mean difference -2.09; 95% confidence interval -3.83 to -0.35; p = 0.019). The efficacy of GTN given in the ultra-acute/pre-hospital setting is currently being assessed and, if found to be beneficial, the implications for hyperacute stroke practice are significant. Here, we discuss the evidence to date, potential mechanisms of action and future possibilities, including unanswered questions, for the therapeutic potential of GTN in acute stroke

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

Influenza Outbreak during Sydney World Youth Day 2008: The Utility of Laboratory Testing and Case Definitions on Mass Gathering Outbreak Containment

BACKGROUND:Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown. METHODS AND RESULTS:An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT) demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy. CONCLUSIONS:Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings

Diagnosis of pancreaticobiliary malignancy by detection of minichromosome maintenance protein 5 in bile aspirates

Biliary brush cytology is the standard method of sampling a biliary stricture but has a low sensitivity for the detection of malignancy. We have previously shown that minichromosome maintenance (MCM) replication proteins (Mcm2–7) are markers of dysplasia and have utilised these novel biomarkers of growth for the diagnosis of cervical and bladder cancer. We aimed to determine if MCM proteins are dysregulated in malignant pancreaticobiliary disease and if levels in bile are a sensitive marker of malignancy. In 30 tissue specimens from patients with malignant/benign biliary strictures, we studied Mcm2 and -5 expression by immunohistochemistry. Bile samples were also collected prospectively at endoscopic retrograde cholangiopancreatography from 102 consecutive patients with biliary strictures of established (n=42) or indeterminate aetiology (n=60). Patients with indeterminate strictures also underwent brush cytology as part of standard practice. Bile sediment Mcm5 levels were analysed using an automated immunofluorometric assay. In benign biliary strictures, Mcm2 and -5 protein expression was confined to the basal epithelial proliferative compartment – in contrast to malignant strictures where expression was seen in all tissue layers. The percentage of nuclei positive for Mcm2 was higher in malignant tissue (median 76.5%, range 42–92%) than in benign tissue (median 5%, range 0–33%) (P<0.0005), with similar results for Mcm5. Minichromosome maintenance protein 5 levels in bile were significantly more sensitive than brush cytology (66 vs 20%; P=0.004) for the detection of malignancy in patients with an indeterminate stricture, with a comparable positive predictive value (97 vs 100%; P=ns). In this study, we demonstrate that Mcm5 in bile detected by a simple automated test is a more sensitive indicator of pancreaticobiliary malignancy than routine brush cytology