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Type 2 diabetes mellitus (T2DM) is associated with abnormal communication among large-scale brain networks, revealed by resting-state functional connectivity (rsFC), with inconsistent results between studies. We performed a meta-analysis of seed-based rsFC studies to identify consistent network connectivity alterations. Thirty-three datasets from 30 studies (1014 T2DM patients and 902 healthy controls [HC]) were included. Seed coordinates and between-group effects were extracted, and the seeds were divided into networks based on their location. Compared to HC, T2DM patients showed hyperconnectivity and hypoconnectivity within the DMN, DMN hypoconnectivity with the affective network (AN), ventral attention network (VAN) and frontal parietal network, and DMN hyperconnectivity with the VAN and visual network. T2DM patients also showed AN hypoconnectivity with the somatomotor network and hyperconnectivity with the VAN. T2DM illness durations negatively correlated with within-DMN rsFC. These DMN-centered impairments in large-scale brain networks in T2DM patients may help to explain the cognitive deficits associated with T2DM.

Objective Hemifacial spasm (HFS) associated with Chiari I malformation (CIM) is rare. This study aimed to analyze the frequency of HFS associated with CIM in our department and further to investigate the clinical characteristics, treatment strategies, and outcomes of these cases. Methods Twenty-eight of 831 patients with HFS who fulfilled the criteria for CIM were analyzed retrospectively. In this series, microvascular decompression (MVD) was performed in 23 patients (82.1%). The remaining 5 patients (17.9%) with obvious symptoms attributable to CIM were treated only with foramen magnum decompression. The mean follow-up period was 41 ± 21.7 months. Results The frequency of HFS associated with CIM was 3.4%. There were 19 women (67.9%) and 9 men (32.1%) with a mean age of 36.4 ± 7.5 years. The most common symptoms were headache, paraesthesias, and muscular weakness with the exception of typical HFS. Seventeen patients (73.9%) experienced immediate postoperative spasm relief, and 21 patients (91.3%) were spasm relief at discharge after MVD. However, 3 patients (14.3%) experienced delayed recurrence of HFS after successful MVD in the follow-up. After foramen magnum decompression, 3 of 5 patients experienced complete relief of the spasm, and 4 patients showed improvement in the CIM-related symptoms. Conclusions The results suggest that MVD can still be an effective treatment for HFS when it coexists with CIM. Furthermore, posterior fossa crowdedness may be a common risk factor for the 2 diseases, and foramen magnum decompression should be considered as the primary procedure in patients with HFS and symptomatic CIM.

Recently, the energy consumption of Ethernet has become one of the hottest topics focused by both academic committee and industry, especially with the increase of the link speed from 1Gbps to 10/40Gbps nowadays or even 100/400Gbps in the near future. To save the energy consumed by the Ethernet, the Energy Efficient Ethernet (EEE) is developed and standardized by the IEEE 802.3az work group. When there is no incoming traffic, the EEE can saves 90% of its energy consumption by entering into the Low Power Idle (LPI) mode. To maximize the energy saving of Ethernet, the Burst TRansmission (BTR) mechanism, which defines a new way to utilize the LPI mode, is developed as a mechanism for EEE. Prior work theoretically shows that the BTR mechanism makes a tradeoff between the energy saving and the queuing delay. However, the traffic pattern, on which the performance of EEE greatly depends, is assumed to be deterministic in their analyses. Besides, their models made estimation for many situations. In this paper, we model EEE with the BTR mechanism and provide analytical understanding on the BTR mechanism. We propose two actual models: one focuses on the buffer size limit, the other concentrates on tolerable packet delay additionally. We draw some guidelines of parameter selection and policies design for EEE from combination of theory conclusions and simulation results. The results show that the saved energy can be constrained by link occupancy even though the buffer size is variational. The buffer full triggered wake-up policy can achieve ideal ratio of energy consumption and arrival rate within the scope of the buffer as well. However, the tolerable delay cannot be guaranteed by any policies. The buffer size is even fixed, which affects the flexibility of demanded delay for different business. The policy considering tolerable delay is supposed to be a little better than the other policy, with a little more complicated design. Thus we design an adaptive mechanism both in quantitative and qualitative: detect the load utilization, apply the buffer full triggered wake-up policy for higher load utilization link, while applying the buffer full and timeout triggered wake-up policy for the delay sensitive business and tiny arrival rate.

Idiopathic trigeminal neuralgia (TN) is caused by neurovascular compression and is often related to morphological changes in the trigeminal nerve. The aim of this study was to quantitatively measure atrophic changes of trigeminal nerves in patients with TN, and to further investigate whether nerve atrophy affected the efficacy of microvascular decompression (MVD). We conducted a prospective case-control study of 60 consecutive patients with TN and 30 sex- and age-matched healthy controls. All subjects underwent high-resolution three-dimensional MRI. The volume of the cisternal segment of trigeminal nerves was measured and compared using 3D Slicer software. Patients with TN underwent primary MVD and regular follow-up for at least 2 years. Associations of nerve atrophy with patient characteristics and operative outcomes were analyzed. The mean volume of the affected trigeminal nerve was significantly reduced in comparison to that of the nonaffected side (65.8 ± 21.1 versus 77.9 ± 19.3 mm3, P = 0.001) and controls (65.8 ± 21.1 versus 74.7 ± 16.5 mm3, P = 0.003). Fifty-two patients (86.7%) achieved complete pain relief without medication immediately after surgery, and 77.6% of patients were complete pain relief at the 2-year follow-up. The Spearman correlation test showed that there was a positive correlation (r = 0.46, P = 0.018) between the degree of trigeminal nerve indentation and nerve atrophy. In multivariate logistic regression analysis, two factors, indentation on nerve root (OR = 2.968, P = 0.022) and degree of nerve atrophy (OR = 1.18, P = 0.035), were associated with the long-term outcome. TN is associated with atrophy on the affected nerve. Furthermore, greater nerve atrophy is associated with more severe trigeminal nerve indentation and better long-term outcome following MVD.

Patients with persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD) are frequently difficult to manage. This study aimed to analyze the safety and efficiency of repeat MVD, with the main focus on prognostic factors and long-term outcomes. We performed a retrospective study of 41 TN patients (19 men, 22 women) who underwent repeat MVD due to persistent or recurrent pain from January 2008 to January 2016. These patients were followed up from 12 to 96 months (mean, 42 ± 17.3 months). Univariate analysis by Spearman's rank correlation coefficient was used for analysis of prognostic factors. During the repeat MVD, compression of the trigeminal nerve was noted by an artery in 15 patients (36.6%), vein in 6 patients (14.6%), Teflon in 8 patients (19.5%), and no compression in 12 patients (29.3%). Twenty-one patients (51.2%) had already undergone 1 or more previous ablative procedures, either before the first MVD or between the surgeries. The complete pain relief rates of repeat MVD were 87.8% immediately after surgery and 75% at last follow-up. Thirteen patients (31.7%) had new or increased facial numbness after repeat surgery. Univariate analysis revealed 2 prognostic factors, negative finding during reoperation (P = .021) and no pain relief after the initial surgery (P = .038), that showed a negative influence on success rates after repeat MVD. Repeat MVD can still achieve an excellent outcome in patients with persistent or recurrent pain. However, the risk of facial numbness is increased. Surgeons should be selective in performing repeat MVD, priority should be given to patients who have a pain-free interval after initial MVD or show demonstrable compression on imaging studies.

Rationale: Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. Patient concerns: A 70-year-old male presenting with progressive headache and gait disturbance. Diagnosis: According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. Interventions: A complete resection, including the part of the solid mass together with cyst, was performed. Outcomes: The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period. Lessons: Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.

Neurovascular conflict (NVC) has been postulated to be the underlying cause of trigeminal neuralgia (TN). Does the posterior fossa crowdedness increase the chance of NVC? The aim of this study was to quantitatively measure the posterior fossa crowdedness in patients with TN and to perform a comparison with healthy controls. We conducted a prospective case-control study of 46 patients diagnosed with primary TN and 46 sex- and age-matched healthy controls. All subjects underwent high-resolution three-dimensional MRI, and the 3D Slicer software was used to measure the posterior fossa volume (PFV) and hindbrain volume (HBV). The posterior fossa crowdedness index (PFCI) was calculated as HBV/PFV × 100%. The results showed that patients with TN had a larger HBV (155.4 ± 23.2 cm3 versus 152.9 ± 13.5 cm3, P = .16) and a smaller PFV (182.7 ± 18.3 cm3 versus 186.1 ± 11.7 cm3, P = .42) as compared to control subjects, but these values were not significantly different. The mean PFCI was significantly higher in patients with TN than in controls (85.1% ± 3.4% versus 82.2% ± 5.3%; P = .03). Women had a more crowded posterior fossa than men (85.8% ± 2.1% versus 84.1% ± 2.6%; P = .023) in patients with TN. The correlation analysis showed that a higher PFCI was associated with younger age (P = .02), woman (P = .014), and TN disease (P = .001). From this study, we conclude that patients with TN have a more crowded posterior fossa than healthy subjects. Women, younger age and TN disease are associated with a higher PFCI. The posterior fossa crowdedness may be a risk factor of NVC, and thus more likely to result in the genesis of TN.

Objective To prospectively evaluate the morphological and structural changes in the trigeminal nerve in patients with trigeminal neuralgia (TN) compared with healthy controls. Methods We conducted a prospective case-control study of 60 consecutive patients diagnosed with TN and 30 sex-and age-matched healthy controls. All subjects underwent high-resolution 3-dimensional magnetic resonance imaging (MRI). The volume and length of the cisternal segment of the trigeminal nerve and the angle between the trigeminal nerve and the anterior surface of the pons (trigeminal pontine angle) were measured and compared. Results The mean volume of the affected trigeminal nerve was significantly reduced compared with that of the nonaffected side (65.8 ± 21.1 mm 3 vs. 77.9 ± 19.3 mm 3 ; P = 0.001) and controls (65.8 ± 21.1 mm 3 vs. 74.7 ± 16.5 mm 3 ; P = 0.003). The mean trigeminal pontine angle was 42.4 ± 8.7° on the affected side, 47.6 ± 9.2° on the nonaffected side, and 46.0 ± 7.2° in the controls. The trigeminal pontine angle on the affected side was significantly smaller than that on the nonaffected side ( P = 0.005) and in controls ( P = 0.01). There the was no statistically significant difference in the mean length of the cisternal segment of trigeminal nerve between the affected and nonaffected sides ( P = 0.46). Conclusions TN is associated with atrophy and a small trigeminal pontine angle in the affected nerve. Nerve atrophy may be a late consequence of chronic physical stress and is likely involved in the pathogenesis of TN. A small trigeminal pontine angle may increase the risk of neurovascular conflict, and thus more likely to result in the genesis of TN.

To demonstrate the value of diffusion-weighted imaging (DWI) in the characterisation of mastitis lesions. Sixty-one non-puerperal patients with pathologically confirmed single benign mastitis lesions underwent preoperative examinations with conventional MRI and axial DWI. Patients were categorised into three groups: (1) periductal mastitis (PDM), (2) granulomatous lobular mastitis (GLM), and (3) infectious abscess (IAB). Apparent diffusion coefficient (ADC) values of each lesion were recorded. A one-way ANOVA with logistic analysis was performed to compare ADC values and other parameters. Discriminative abilities of DWI modalities were compared using the area under the receiver operating characteristic curve (AUC). P < 0.05 was considered statistically significant. ADC values differed significantly among the three groups (P = 0.003) as well as between PDM and IAB and between PDM and GLM. The distribution of non-mass enhancement on dynamic contrast-enhanced (DCE) MRI differed significantly among the three groups (P = 0.03) but not between any two groups specifically. There were no differences in lesion location, patient age, T2WI or DWI signal intensity, enhancement type, non-mass internal enhancement, or mass enhancement characteristics among the three groups. ADC values and the distribution of non-mass enhancement are valuable in classifying mastitis subtypes. • Mastitis subtypes exhibit different characteristics on DWI and DCE MRI. • ADC values are helpful in isolating PDM from other mastitis lesions. • Distribution of non-mass enhancement also has value in comparing mastitis subtypes.

A 37-year-old Tibetan shepherdess presented with headache and weakness of the lower limbs for 10 months. Examination disclosed a positive straight-leg-raising test. Neuroimaging showed a heterogeneous mass in the left temporal lobe (figure 1) and an intradural mass in the lumbosacral canal with L4 vertebral body destruction (figure 2). Chest and abdominal CT scans were negative. Two operations yielded a tissue diagnosis of alveolar echinococcosis and postoperative albendazole therapy was started. Simultaneous involvement of brain and the spinal cord in primary extrahepatic alveolar echinococcosis is rare. Early diagnosis and radical surgery followed by continuous benzimidazole treatment are crucial.1

A novel radar adaptive jamming suppression method based on joint time-frequency transformation is proposed. Confronting the challenges of non-stationary jamming signals that radar receives, a new technique is presented to deal with them. Firstly, the time-frequency characteristics of radar received signal are analyzed by short-time Fourier transform (STFT). Secondly, an adaptive filter function is constructed in STFT domain. By applying a proper threshold to the time-frequency modulus spectrum (TFMS), strong jamming signal can be adaptively eliminated, polluted signal can be shrunk slightly and the useful signals can be retained. Finally, simulations validate the efficiency of our new method.

In this paper, we first study the scenario where N sensors are with the same carrier frequency. Interference appears between each two sensors. An interference signal cancellation method based on multiple parameters estimation is proposed. Through the accurate estimation, the interference is reconstructed and eliminated from the received signal. Simulation is also provided to demonstrate the performance of the proposed scheme.

Providing secure, reliable communications is a big challenge to guarantee confidentiality, integrity, and anti-replay protection, especially between endpoints in current Internet. As one of the popular secure communication protocol, IPsec usually limits the throughput and increases the latency due to its heavy encryption/decryption processing. In this paper, we propose a hardware solution to accelerate it. To achieve high performance processing, we have successfully designed and implemented IPsec on Cavium OCTEON 5860 multi-core network processor platform. We also compare the performance under different processing mechanisms and discover that pipleline works better than run-to-completion for different sizes of packets in our experiments. In order to achieve the best performance, we select different encryption algorithms and core numbers. Experimental results on 5860 processors show that our work achieves 20 Gbps throughput with AES128 encryption, 16 cores for 512-byte packet traffic.