Imagen en retromodo para el diagnóstico de drusas del disco óptico: una serie de casos / Retro-mode imaging for the diagnosis of optic disc drusen: A case series

Objetivo: Nuestro principal objetivo es el de comparar la capacidad para detectar las drusas del disco óptico (DDO) utilizando diversas técnicas de imágenes no-invasivas, incluida la novedosa técnica de imagen de retromodo (RMI). Como segundo objetivo analizamos las características morfológicas de las DDO bajo esta última técnica. Materiales y métodos: Este estudio incluyó un total de 7 pacientes con DDO bilaterales, obteniendo un total de 14 ojos analizados. Se utilizaron técnicas no invasivas de imágenes multimodales, que incluyeron fotografía multicolor del fondo de ojo (MC), reflectancia en infrarrojo (NIR), autofluorescencia en luz verde y en luz azul (G-FAF y B-FAF, respectivamente) y RMI. La FAF se utilizó como el método principal para el diagnóstico de DDO. Dos observadores realizaron las comparaciones, obteniendo las tasas de detección de cada uno de los métodos. Las mediciones cuantitativas de las DDO incluyeron el número, el perímetro (P) y el área (A) de las DDO identificadas mediante la técnica de RMI. Resultado: La edad promedio de los pacientes incluidos fue de 49,28±23,16 años; 5 de los 7 pacientes fueron de sexo masculino. La técnica de RMI pudo detectar DDO en todos los casos, con una sensibilidad del 100%, en comparación con MC (sensibilidad del 60,71%), NIR (sensibilidad del 60,71%), B-FAF (sensibilidad del 100%), G-FAF (sensibilidad del 100%). RMI fue la única técnica de imagen capaz de evaluar morfológica y cuantitativamente las DDO. Conclusiones: RMI es una prometedora modalidad no-invasiva de imagen para diagnosticar DDO superficiales, proporcionando información valiosa sobre la distribución, la ubicación y el tamaño de estas. Por lo tanto, mediante nuestros resultados sugerimos la incorporación de la novedosa técnica de RMI como una herramienta complementaria para el diagnóstico y el seguimiento de DDO en combinación con los otros métodos de imagen multimodales.(AU)

Objective: We aimed to compare the detectability of optic disc drusen (ODD), using various non-invasive imaging techniques, including the novel retro-mode imaging (RMI), as well as to analyze the morphological characteristics of ODD on RMI. Methods: This study involved 7 patients with bilateral ODD, totaling 14 eyes. Multimodal imaging techniques, including multicolor fundus photography (MC), near-infrared reflectance (NIR), green and blue light fundus autofluorescence (G-FAF and B-FAF, respectively), and RMI were used to examine the eyes. FAF was used as the primary method of identifying ODD, and each method's detection rate was compared by two observers. Quantitative measurements of ODD included the number of ODD visualized by the RMI technique, the perimeter (P) and area (A) of ODD were identified. Results: The average age of the patients included was 49.28±23.16 years, with 5 of the 7 being men. RMI was able to detect ODD in all cases, with a sensitivity of 100%, compared to MC (sensitivity 60.71%), NIR (sensitivity 60.71%), B-FAF (sensitivity 100%), G-FAF (sensitivity 100%). RMI was the only imaging technique capable of assessing ODD morphology and quantifying ODD. Conclusions: RMI is a promising imaging modality for diagnosing superficial ODD, providing valuable information on the distribution, location, and size of ODD. We suggest the incorporation of RMI as a complementary tool for diagnosing and monitoring ODD in combination with other multimodal imaging methods.(AU)

Regularization mechanisms of spiking-bursting neurons.

An essential question raised after the observation of highly variable bursting activity in individual neurons of Central Pattern Generators (CPGs) is how an assembly of such cells can cooperatively act to produce regular signals to motor systems. It is well known that some neurons in the lobster stomatogastric ganglion have a highly irregular spiking-bursting behavior when they are synaptically isolated from any connection in the CPG. Experimental recordings show that periodic stimuli on a single neuron can regulate its firing activity. Other evidence demonstrates that specific chemical and/or electrical synapses among neurons also induce the regularization of the rhythms. In this paper we present a modeling study in which a slow subcellular dynamics, the exchange of calcium between an intracellular store and the cytoplasm, is responsible for the origin and control of the irregular spiking-bursting activity. We show this in simulations of single cells under periodic driving and in minimal networks where the cooperative activity can induce regularization. While often neglected in the description of realistic neuron models, subcellular processes with slow dynamics may play an important role in information processing and short-term memory of spiking-bursting neurons.

Nonlinear behavior of sinusoidally forced pyloric pacemaker neurons.

Periodic current forcing was used to investigate the intrinsic dynamics of a small group of electrically coupled neurons in the pyloric central pattern generator (CPG) of the lobster. This group contains three neurons, namely the two pyloric dilator (PD) motoneurons and the anterior burster (AB) interneuron. Intracellular current injection, using sinusoidal waveforms of varying amplitude and frequency, was applied in three configurations of the pacemaker neurons: 1) the complete pacemaker group, 2) the two PDs without the AB, and 3) the AB neuron isolated from the PDs. Depending on the frequency and amplitude of the injected current, the intact pacemaker group exhibited a wide variety of nonlinear behaviors, including synchronization to the forcing, quasiperiodicity, and complex dynamics. In contrast, a single, broad 1:1 entrainment zone characterized the response of the PD neurons when isolated from the main pacemaker neuron AB. The isolated AB responded to periodic forcing in a manner similar to the complete pacemaker group, but with wider zones of synchronization. We have built an analog electronic circuit as an implementation of a modified Hindmarsh-Rose model for simulating the membrane potential activity of pyloric neurons. We subjected this electronic model neuron to the same periodic forcing as used in the biological experiments. This four-dimensional electronic model neuron reproduced the autonomous oscillatory firing patterns of biological pyloric pacemaker neurons, and it expressed the same stationary nonlinear responses to periodic forcing as its biological counterparts. This adds to our confidence in the model. These results strongly support the idea that the intact pyloric pacemaker group acts as a uniform low-dimensional deterministic nonlinear oscillator, and the regular pyloric oscillation is the outcome of cooperative behavior of strongly coupled neurons, having different dynamical and biophysical properties when isolated.

Topology selection by chaotic neurons of a pyloric central pattern generator.

The pyloric Central Pattern Generator (CPG) in the lobster has an architecture in which every neuron receives at least one connection from another member of the CPG. We call this a "non-open" network topology. An "open" topology, where at least one neuron does not receive synapses from any other CPG member, is found neither in the pyloric nor in the gastric mill CPG. Here we investigate a possible reason for this topological structure using the ability to perform a biologically functional task as a measure of the efficacy of the network. When the CPG is composed of model neurons that exhibit regular membrane voltage oscillations, open topologies are as able to maximize this functionality as non-open topologies. When we replace these models by neurons which exhibit chaotic membrane voltage oscillations, the functional criterion selects non-open topologies. As isolated neurons from invertebrate CPGs are known in some cases to undergo chaotic oscillations, this suggests that there is a biological basis for the class of non-open network topologies that we observe.

Dynamics of two electrically coupled chaotic neurons: experimental observations and model analysis.

Conductance-based models of neurons from the lobster stomatogastric ganglion (STG) have been developed to understand the observed chaotic behavior of individual STG neurons. These models identify an additional slow dynamical process calcium exchange and storage in the endoplasmic reticulum as a biologically plausible source for the observed chaos in the oscillations of these cells. In this paper we test these ideas further by exploring the dynamical behavior when two model neurons are coupled by electrical or gap junction connections. We compare in detail the model results to the laboratory measurements of electrically-coupled neurons that we reported earlier. The experiments on the biological neurons varied the strength of the effective coupling by applying a parallel, artificial synapse, which changed both the magnitude and polar-of the conductance between the neurons. We observed a sequence of bifarctions that took the neurons from strongly synchronized in-phase behavior. through uncorrelated chaotic oscillations to strongly synchronized and now regular out-of-phase behavior. The model calculations reproduce these observations quantitatively, indicating that slow subcellular processes could account for the mechanisms involved in the synchronization and regularization of the otherwise individual chaotic activities.

Synchronous behavior of two coupled electronic neurons.

We report on experimental studies of synchronization phenomena in a pair of analog electronic neurons (ENs). The ENs were designed to reproduce the observed membrane voltage oscillations of isolated biological neurons from the stomatogastric ganglion of the California spiny lobster Panulirus interruptus. The ENs are simple analog circuits which integrate four-dimensional differential equations representing fast and slow subcellular mechanisms that produce the characteristic regular/chaotic spiking-bursting behavior of these cells. In this paper we study their dynamical behavior as we couple them in the same configurations as we have done for their counterpart biological neurons. The interconnections we use for these neural oscillators are both direct electrical connections and excitatory and inhibitory chemical connections: each realized by analog circuitry and suggested by biological examples. We provide here quantitative evidence that the ENs and the biological neurons behave similarly when coupled in the same manner. They each display well defined bifurcations in their mutual synchronization and regularization. We report briefly on an experiment on coupled biological neurons and four-dimensional ENs, which provides further ground for testing the validity of our numerical and electronic models of individual neural behavior. Our experiments as a whole present interesting new examples of regularization and synchronization in coupled nonlinear oscillators.

Modeling observed chaotic oscillations in bursting neurons: the role of calcium dynamics and IP3.

Chaotic bursting has been recorded in synaptically isolated neurons of the pyloric central pattern generating (CPG) circuit in the lobster stomatogastric ganglion. Conductance-based models of pyloric neurons typically fail to reproduce the observed irregular behavior in either voltage time series or state-space trajectories. Recent suggestions of Chay [Biol Cybern 75: 419-431] indicate that chaotic bursting patterns can be generated by model neurons that couple membrane currents to the nonlinear dynamics of intracellular calcium storage and release. Accordingly, we have built a two-compartment model of a pyloric CPG neuron incorporating previously described membrane conductances together with intracellular Ca2+ dynamics involving the endoplasmic reticulum and the inositol 1,4,5-trisphosphate receptor IP3R. As judged by qualitative inspection and quantitative, nonlinear analysis, the irregular voltage oscillations of the model neuron resemble those seen in the biological neurons. Chaotic bursting arises from the interaction of fast membrane voltage dynamics with slower intracellular Ca2+ dynamics and, hence, depends on the concentration of IP3. Despite the presence of 12 independent dynamical variables, the model neuron bursts chaotically in a subspace characterized by 3-4 active degrees of freedom. The critical aspect of this model is that chaotic oscillations arise when membrane voltage processes are coupled to another slow dynamic. Here we suggest this slow dynamic to be intracellular Ca2+ handling.

Interacting biological and electronic neurons generate realistic oscillatory rhythms.

Small assemblies of neurons such as central pattern generators (CPG) are known to express regular oscillatory firing patterns comprising bursts of action potentials. In contrast, individual CPG neurons isolated from the remainder of the network can generate irregular firing patterns. In our study of cooperative behavior in CPGs we developed an analog electronic neuron (EN) that reproduces firing patterns observed in lobster pyloric CPG neurons. Using a tuneable artificial synapse we connected the EN bidirectionally to neurons of this CPG. We found that the periodic bursting oscillation of this mixed assembly depends on the strength and sign of the electrical coupling. Working with identified, isolated pyloric CPG neurons whose network rhythms were impaired, the EN/biological network restored the characteristic CPG rhythm both when the EN oscillations are regular and when they are irregular.

Reliable circuits from irregular neurons: a dynamical approach to understanding central pattern generators.

Central pattern generating neurons from the lobster stomatogastric ganglion were analyzed using new nonlinear methods. The LP neuron was found to have only four or five degrees of freedom in the isolated condition and displayed chaotic behavior. We show that this chaotic behavior could be regularized by periodic pulses of negative current injected into the neuron or by coupling it to another neuron via inhibitory connections. We used both a modified Hindmarsh-Rose model to simulate the neurons behavior phenomenologically and a more realistic conductance-based model so that the modeling could be linked to the experimental observations. Both models were able to capture the dynamics of the neuron behavior better than previous models. We used the Hindmarsh-Rose model as the basis for building electronic neurons which could then be integrated into the biological circuitry. Such neurons were able to rescue patterns which had been disabled by removing key biological neurons from the circuit.

Dynamic control of irregular bursting in an identified neuron of an oscillatory circuit.

In the oscillatory circuits known as central pattern generators (CPGs), most synaptic connections are inhibitory. We have assessed the effects of inhibitory synaptic input on the dynamic behavior of a component neuron of the pyloric CPG in the lobster stomatogastric ganglion. Experimental perturbations were applied to the single, lateral pyloric neuron (LP), and the resulting voltage time series were analyzed using an entropy measure obtained from power spectra. When isolated from phasic inhibitory input, LP generates irregular spiking-bursting activity. Each burst begins in a relatively stereotyped manner but then evolves with exponentially increasing variability. Periodic, depolarizing current pulses are poor regulators of this activity, whereas hyperpolarizing pulses exert a strong, frequency-dependent regularizing action. Rhythmic inhibitory inputs from presynaptic pacemaker neurons also regularize the bursting. These inputs 1) reset LP to a similar state at each cycle, 2) extend and further stabilize the initial, quasi-stable phase of its bursts, and 3) at sufficiently high frequencies terminate ongoing bursts before they become unstable. The dynamic time frame for stabilization overlaps the normal frequency range of oscillations of the pyloric CPG. Thus, in this oscillatory circuit, the interaction of rhythmic inhibitory input with intrinsic burst properties affects not only the phasing, but also the dynamic stability of neural activity.

Basic principles for generating motor output in the stomatogastric ganglion.

The lobster stomatogastric ganglion contains 30 neurons and when modulated can produce two distinct rhythmic motor patterns--the gastric mill and the pyloric. The complete neural circuitry underlying both patterns is well known. Without modulatory input no patterns are produced, and the neurons fire tonically or are silent. When neuromodulators are released into the ganglion from specific neurons or are delivered as hormones, the properties of the neurons and synapses change dramatically and modulator-specific gastric mill and pyloric patterns are produced. In general the rhythmicity derives from the induced burstiness of the neurons, and the pattern from the strengths of the electrical and chemical synapses. The organized activity can be traced to a marked reduction of chaotic activity in individual neurons when they shift from the unmodulated to the modulated state.

Synchronized action of synaptically coupled chaotic model neurons.

Experimental observations of the intracellular recorded electrical activity in individual neurons show that the temporal behavior is often chaotic. We discuss both our own observations on a cell from the stomatogastric central pattern generator of lobster and earlier observations in other cells. In this paper we work with models with chaotic neurons, building on models by Hindmarsh and Rose for bursting, spiking activity in neurons. The key feature of these simplified models of neurons is the presence of coupled slow and fast subsystems. We analyze the model neurons using the same tools employed in the analysis of our experimental data. We couple two model neurons both electrotonically and electrochemically in inhibitory and excitatory fashions. In each of these cases, we demonstrate that the model neurons can synchronize in phase and out of phase depending on the strength of the coupling. For normal synaptic coupling, we have a time delay between the action of one neuron and the response of the other. We also analyze how the synchronization depends on this delay. A rich spectrum of synchronized behaviors is possible for electrically coupled neurons and for inhibitory coupling between neurons. In synchronous neurons one typically sees chaotic motion of the coupled neurons. Excitatory coupling produces essentially periodic voltage trajectories, which are also synchronized. We display and discuss these synchronized behaviors using two "distance" measures of the synchronization.

High-dose alpha-tocopherol as a preventive of doxorubicin-induced alopecia.

The effectiveness of alpha-tocopherol acetate as a preventive of doxorubicin-induced alopecia was evaluated in 20 patients with different types of solid tumors. All received therapy containing doxorubicin in a dose range of 50-60 mg/m2/cycle of treatment. The observed hair loss was severe in 90% and moderate in 10% of the patients. No protective activity of alpha-tocopherol was demonstrated in this trial.

Sequential therapy with methotrexate and 5-fluorouracil in the treatment of advanced colorectal carcinoma.

Twenty-nine patients with advanced colorectal carcinoma were entered in this study to evaluate the efficacy and toxicity of a sequential chemotherapeutic schedule with methotrexate (MTX), 200 mg/m2 intravenously (IV) (push injection) and 5-fluorouracil (5-FU), 1,200 mg/m2 in continuous IV infusion, using a 20-hour time interval. All patients received calcium leucovorin (LV), 25 mg, intramuscularly (IM) every six hours for eight doses beginning 24 hours after methotrexate administration. Courses were administered every 15 days. Of the 24 patients evaluable for response, 11 (46%) had major objective regressions (one complete remission [CR] and ten partial remissions [PR]). The survival rate of patients who responded to treatment was 60% at 16 months, whereas patients with no change and those in whom the disease progressed had a median survival of 9 months and 3 months, respectively. The median duration of response has not yet been reached in patients who presented objective tumor regression, and was 7.5 months in those with no change. Significant differences were found between objective regression and no change (P less than .0005) and between no change and tumor progression (P less than .05). All patients were evaluable for toxicity. There were three toxic-related deaths (10%) because of severe myelosuppresion, sepsis, and hemorrhage. These promising results, despite important toxicity, reveal the synergism between the two chemotherapeutic agents and also indicate that the response rate achieved could be a consequence of the 20-hour interval and high dose of 5-FU. Further studies are necessary to determine the optimal time interval and the adequate 5-FU dose.