Cytomegalovirus remains latent in a common precursor of dendritic and myeloid cells

Hematopoietic cells and their progenitors play important roles in human cytomegalovirus latency and reactivation. Latent infection has been evaluated in defined populations of myeloid-lineage-committed progenitor cells coexpressing CD33 and CD15 or CD33 and CD14 along with the dendritic cell markers CD1a and CD10. These CD33+ cell populations were found to support latency and expression of viral latency-associated transcripts and to undergo reactivation of productive viral replication when differentiated in the presence of human fibroblasts. Reactivation was also observed when myeloid cells were carried in the presence of fibroblast-conditioned medium or medium supplemented with certain cytokines (interferon gamma, tumor necrosis factor alpha, interleukin 4, or granulocyte-macrophage colony-simulating factor), suggesting that cell differentiation pathways act as determinants of reactivation. More primitive CD34+ hematopoietic cells were also found to be susceptible to viral infection and latency was maintained as these cells differentiated into CD33+-lineage-committed populations. Between 0.01% and 0.001% of CD33+ CD14+ or CD33+ CD15+ bone marrow mononuclear cells isolated from naturally infected individuals were found to express latent transcripts. Thus, cytomegalovirus is carried within a small percentage of myeloid and dendritic cell progenitors in the healthy seropositive host. Virus reactivation may be triggered by factors associated with the inflammatory response.

Cloning of the human cytomegalovirus (HCMV) genome as an infectious bacterial artificial chromosome in Escherichia coli: a new approach for construction of HCMV mutants

We have recently introduced a novel procedure for the construction of herpesvirus mutants that is based on the cloning and mutagenesis of herpesvirus genomes as infectious bacterial artificial chromosomes (BACs) in Escherichia coli (M. Messerle, I. Crnkovic, W. Hammerschmidt, H. Ziegler, and U. H. Koszinowski, Proc. Natl. Acad. Sci. USA 94:14759-14763, 1997). Here we describe the application of this technique to the human cytomegalovirus (HCMV) strain AD169. Since it was not clear whether the terminal and internal repeat sequences of the HCMV genome would give rise to recombination, the stability of the cloned HCMV genome was examined during propagation in E. coli, during mutagenesis, and after transfection in permissive fibroblasts. Interestingly, the HCMV BACs were frozen in defined conformations in E. coli. The transfection of the HCMV BACs into human fibroblasts resulted in the reconstitution of infectious virus and isomerization of the reconstituted genomes. The power of the BAC mutagenesis procedure was exemplarily demonstrated by the disruption of the gpUL37 open reading frame. The transfection of the mutated BAC led to plaque formation, indicating that the gpUL37 gene product is dispensable for growth of HCMV in fibroblasts. The new procedure will considerably speed up the construction of HCMV mutants and facilitate genetic analysis of HCMV functions.

Fast screening procedures for random transposon libraries of cloned herpesvirus genomes: mutational analysis of human cytomegalovirus envelope glycoprotein genes

We have cloned the human cytomegalovirus (HCMV) genome as an infectious bacterial artificial chromosome (BAC) in Escherichia coli. Here, we have subjected the HCMV BAC to random transposon (Tn) mutagenesis using a Tn1721-derived insertion sequence and have provided the conditions for excision of the BAC cassette. We report on a fast and efficient screening procedure for a Tn insertion library. Bacterial clones containing randomly mutated full-length HCMV genomes were transferred into 96-well microtiter plates. A PCR screening method based on two Tn primers and one primer specific for the desired genomic position of the Tn insertion was established. Within three consecutive rounds of PCR a Tn insertion of interest can be assigned to a specific bacterial clone. We applied this method to retrieve mutants of HCMV envelope glycoprotein genes. To determine the infectivities of the mutant HCMV genomes, the DNA of the identified BACs was transfected into permissive fibroblasts. In contrast to BACs with mutations in the genes coding for gB, gH, gL, and gM, which did not yield infectious virus, BACs with disruptions of open reading frame UL4 (gp48) or UL74 (gO) were viable, although gO-deficient viruses showed a severe growth deficit. Thus, gO (UL74), a component of the glycoprotein complex III, is dispensable for viral growth. We conclude that our approach of PCR screening for Tn insertions will greatly facilitate the functional analysis of herpesvirus genomes.

End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change

OBJECTIVE

The aim of the study was to investigate the effect of lung volume changes on end-expiratory lung impedance change (ELIC) in mechanically ventilated patients, since we hypothesized that ELIC may be a suitable parameter to monitor lung volume change at the bedside.

DESIGN

Clinical trial on patients requiring mechanical ventilation.

SETTINGS

Intensive care units of a university hospital.

PATIENTS

Ten mechanically ventilated patients were included in the study.

INTERVENTION

Patients were ventilated in volume-controlled mode with constant flow and respiratory rate. In order to induce changes in the end-expiratory lung volume (EELV), PEEP levels were increased from 0 mbar to 5 mbar, 10 mbar, and 15 mbar. At each PEEP level EELV was measured by an open-circuit nitrogen washout manoeuvre and ELIC was measured simultaneously using Electrical Impedance Tomography (EIT) with sixteen electrodes placed on the circumference of the thorax and connected with an EIT device. Cross-sectional electro-tomographic measurements of the thorax were performed at each PEEP level, and a modified Sheffield back-projection was used to reconstruct images of the lung impedance. ELIC was calculated as the average of the end-expiratory lung impedance change. RESULTS. Increasing PEEP stepwise from 0 mbar to 15 mbar resulted in an linear increase of EELV and ELIC according to the equation: y =0.98 x -0.68, r(2)=0.95.

CONCLUSION

EIT is a simple bedside technique which enables monitor lung volume changes during ventilatory manoeuvres such as PEEP changes.

Neuronal avalanches in spontaneous activity in vivo

Many complex systems give rise to events that are clustered in space and time, thereby establishing a correlation structure that is governed by power law statistics. In the cortex, such clusters of activity, called "neuronal avalanches," were recently found in local field potentials (LFPs) of spontaneous activity in acute cortex slices, slice cultures, the developing cortex of the anesthetized rat, and premotor and motor cortex of awake monkeys. At present, it is unclear whether neuronal avalanches also exist in the spontaneous LFPs and spike activity in vivo in sensory areas of the mature brain. To address this question, we recorded spontaneous LFPs and extracellular spiking activity with multiple 4 × 4 microelectrode arrays (Michigan Probes) in area 17 of adult cats under anesthesia. A cluster of events was defined as a consecutive sequence of time bins Δt (1-32 ms), each containing at least one LFP event or spike anywhere on the array. LFP cluster sizes consistently distributed according to a power law with a slope largely above -1.5. In two thirds of the corresponding experiments, spike clusters also displayed a power law that displayed a slightly steeper slope of -1.8 and was destroyed by subsampling operations. The power law in spike clusters was accompanied with stronger temporal correlations between spiking activities of neurons that spanned longer time periods compared with spike clusters lacking power law statistics. The results suggest that spontaneous activity of the visual cortex under anesthesia has the properties of neuronal avalanches.

Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography

BACKGROUND

Electrical impedance tomography (EIT) is a noninvasive technique providing cross-sectional images of the thorax. We have tested an extended evaluation procedure, the functional EIT (f-EIT), to identify the local shifts of ventilation known to occur during the transition between spontaneous, controlled and assisted ventilation modes.

METHODS

Ten patients scheduled for elective laparotomy were studied in the surgical ward, operating theatre and ICU during spontaneous and different modes of mechanical ventilation. Sixteen ECG electrodes were placed on the circumference of the thorax and connected with an EIT device (APT System Mark I, IBEES, Sheffield, UK). Measurements lasting 180 s were performed and f-EIT images of regional ventilation computed. The geometrical centre of ventilation was determined to quantify the regional distribution of lung ventilation during individual modes of ventilation.

RESULTS

F-EIT confirmed the differences in the distribution of ventilation associated with various modes of artificial ventilation. Accentuated ventilation of the dependent lung regions was observed during spontaneous breathing, whereas a shift of the centre of ventilation to the nondependent regions was found during controlled ventilation. In the course of assisted ventilation a continuous displacement of the centre of ventilation back towards the dependent lung regions, consistent with an increased proportion of spontaneous breathing, was detected. Unassisted spontaneous breathing after weaning from mechanical ventilation resulted in a similar ventilation distribution as during tidal breathing prior to surgery.

CONCLUSION

F-EIT determined the redistribution of lung ventilation during different modes of mechanical ventilation. We expect that f-EIT will become a useful noninvasive bedside monitoring technique for imaging regional ventilation in pulmonary diseased patients during mechanical ventilation.

Changes in the thoracic impedance distribution under different ventilatory conditions

The present study was performed with the aim of checking the suitability of EIT in imaging regional thoracic impedance variations during lung ventilation under predefined conditions and to compare EIT with established reference techniques. A new technique of functional EIT imaging designed to visualize physiologically relevant information from the sequentially registered series of thoracic distributions was introduced. Experiments were performed on five spontaneously breathing healthy subjects and on 12 anaesthetized supine pigs. 16 electrodes were placed around the thorax and consecutive transthoracic impedance distributions were measured at a rate of 1 Hz (Sheffield APT system mark I, IBEES, Sheffield, UK). Several voluntary breathing manoeuvres were performed in human subjects and the tracings of local impedance were compared with standard spirometry. In animal experiments EIT was applied during artificial ventilation at different ventilation rates and during stepwise passive emptying and filling of either one or both lungs while the respiratory muscles were relaxes. Further, selective blockade of lung regions resulting in regionally reduced ventilation was performed and the capability of EIT to follow and differentiate local ventilatory disturbances was checked by reference techniques (x-ray and staining methods). The experiments revealed an overall agreement between the spirometric and impedance data in all breathing patterns performed. A linear relationship between changes of the air content of the lungs and the regional thoracic impedance was shown (intraindividual correlation coefficient range, 0.986-0.999; n = 12 animals). The functional images of the impedance distribution across the thorax reproduced adequately the typical anatomical characteristics of the pig and the human thorax. The spatial resolution of EIT functional images was sufficient to differentiate lung areas corresponding to approximately 20 ml tissue volume. EIT with the additional evaluation procedure of functional imaging was shown to be a suitable and reliable method of imaging different ventilatory conditions with the potential to become a useful tool for monitoring respiratory function.

Persistence of Borrelia burgdorferi in ligamentous tissue from a patient with chronic Lyme borreliosis

OBJECTIVE

To document the persistence of Borrelia burgdorferi in ligamentous tissue samples obtained from a woman with chronic Lyme borreliosis.

METHODS

Spirochetes were isolated from samples of ligamentous tissue, and the spirochetes were characterized antigenetically and by molecular biology techniques. The ligamentous tissue was examined by electron microscopy. Humoral and cellular immune responses were analyzed.

RESULTS

Choroiditis was the first recognized manifestation of Lyme disease in this patient. Despite antibiotic therapy, there was progression to a chronic stage, with multisystem manifestations. The initially significant immune system activation was followed by a loss of the specific humoral immune response and a decrease in the cellular immune response to B burgdorferi over the course of the disease. "Trigger finger" developed, and a portion of the flexor retinaculum obtained at surgery was cultured. Viable spirochetes were identified. Ultramorphologically, the spirochetes were situated between collagen fibers and along fibroblasts, some of which were deeply invaginated by these organisms. The cultured bacteria were identified as B burgdorferi by reactions with specific immune sera and monoclonal antibodies, and by polymerase chain reaction amplification and Southern blot hybridization techniques.

CONCLUSION

To our knowledge, this is the first report of the isolation of B burgdorferi from ligamentous tissue. This suggests that tendon tissues serve as a specific site of spirochete residence in human hosts.

Thoracic electrical impedance tomographic measurements during volume controlled ventilation-effects of tidal volume and positive end-expiratory pressure

The aim of the study was to analyze thoracic electrical impedance tomographic (EIT) measurements accomplished under conditions comparable with clinical situations during artificial ventilation. Multiple EIT measurements were performed in pigs in three transverse thoracic planes during the volume controlled mode of mechanical ventilation at various tidal volumes (V(T)) and positive end-expiratory pressures (PEEP). The protocol comprised following ventilatory patterns: 1) V(T)(400, 500, 600, 700 ml) was varied in a random order at various constant PEEP levels and 2) PEEP (2, 5, 8, 11, 14 cm H2O) was randomly modified during ventilation with a constant V(T). The EIT technique was used to generate cross-sectional images of 1) regional lung ventilation and 2) regional shifts in lung volume with PEEP. The quantitative analysis was performed in terms of the tidal amplitude of the impedance change, reflecting the volume of delivered gas at various preset V(T) and the end-expiratory impedance change, revealing the variation of the lung volume at various PEEP levels. The results showed: 1) an increase in the tidal amplitude of the impedance change, proportional to the delivered V(T) at all constant PEEP levels, 2) a rising end-expiratory impedance change, with PEEP reflecting an increase in gas volume, and 3) a PEEP-dependent redistribution of the ventilated gas between the planes. The generated images and the quantitative results indicate the ability of EIT to identify regional changes in V(T) and lung volume during mechanical ventilation.

Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children

Historically, osteomyelitis was considered an infectious disorder. More recently, inflammatory mechanisms were recognized causing a significant proportion of pediatric osteomyelitis. This study was to compare characteristics of children with chronic non-bacterial (CNO) and bacterial osteomyelitis (BOM). A chart review of osteomyelitis patients from the departments of pediatrics, pediatric surgery, orthopedic surgery, and oral and maxillofacial surgery was conducted in a tertiary referral center, covering the years 2004-2014. Institutional incidences of CNO (n = 49) and BOM (n = 56) were comparable. Differentiation between CNO and BOM based on clinical or laboratory findings was mostly impossible. However, children with BOM more frequently presented with local inflammatory signs (47 vs. 68 %, p = 0.040), fever (12 vs. 38 %, p = 0.003), and abscesses (0 vs. 39 %, p < 0.001). Peripheral arthritis (14 vs. 0 %, p < 0.001), inflammatory bowel disease (10 vs. 2 %, p = ns), and hyperostosis (29 vs. 4 %, p = 0.001) were more common in CNO. Whole-body MRI was performed in 76 % of CNO patients, unveiling multifocal lesions in 80 % (CRMO). Though considered a rare disorder, institutional incidences of CNO were comparable to BOM, and the discrimination between CNO and BOM solely based on clinical aspects was mostly impossible. This is of special interest, since a correct and timely diagnosis is of utmost importance for long-term outcomes in both disorders. Whole-body MRIs should be considered in chronic osteomyelitis to (1) detect clinically inapparent lesions in CNO and (2) indirectly exclude (usually unifocal) chronic bacterial infections. Prospective studies are warranted to establish evidence-based diagnostic and therapeutic approaches to CNO.

Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants

OBJECTIVE

Established techniques used to examine lung function in critically ill infants cannot continuously follow regional aspects of lung ventilation although this information would be beneficial for proper therapy planning. We have studied the applicability and clinical relevance of a relatively new non-invasive radiation-free imaging method, electrical impedance tomography (EIT), in monitoring regional lung function in paediatric intensive care patients.

DESIGN

Prospective study.

SETTING

Neonatal and paediatric intensive care unit (ICU) at a university hospital.

PATIENTS

Eight infants (1 day-7 years old) suffering from miscellaneous diseases requiring intensive care therapy.

INTERVENTIONS

Adjustment of ventilator settings, surfactant administration, and postural changes.

MEASUREMENTS AND RESULTS

Repeated EIT measurements were performed with the intention to monitor regional lung ventilation in mechanically ventilated and spontaneously breathing infants. The follow-up time ranged between 1 and 11 days. During individual EIT measurements of 100-s duration electrical voltages resulting from repetitive injection of small electrical currents were continuously measured on the thoracic circumference using conventional surface electrodes. Acquired data were used to generate functional cross-sectional thoracic images of regional lung ventilation. A total of 638 EIT measurements were performed. The redistribution of lung ventilation and changes in regional ventilation magnitude resulting from adjusted positive end-expiratory pressure, peak inspiratory pressure, inspiration-expiration ratio, surfactant instillation, and prone or supine positioning were identified.

CONCLUSIONS

Provided that EIT hardware and software are further developed to guarantee stable and undisturbed measurements in the ICU and that practical handling is improved, this non-invasive method may become a useful bedside monitoring tool of regional lung ventilation in critically ill infants.

Gravity effects on regional lung ventilation determined by functional EIT during parabolic flights

Gravity-dependent changes of regional lung function were studied during normogravity, hypergravity, and microgravity induced by parabolic flights. Seven healthy subjects were followed in the right lateral and supine postures during tidal breathing, forced vital capacity, and slow expiratory vital capacity maneuvers. Regional 1) lung ventilation, 2) lung volumes, and 3) lung emptying behavior were studied in a transverse thoracic plane by functional electrical impedance tomography (EIT). The results showed gravity-dependent changes of regional lung ventilation parameters. A significant effect of gravity on regional functional residual capacity with a rapid lung volume redistribution during the gravity transition phases was established. The most homogeneous functional residual capacity distribution was found at microgravity. During vital capacity and forced vital capacity in the right lateral posture, the decrease in lung volume on expiration was larger in the right lung region at all gravity phases. During tidal breathing, the differences in ventilation magnitudes between the right and left lung regions were not significant in either posture or gravity phase. A significant nonlinearity of lung emptying was determined at normogravity and hypergravity. The pattern of lung emptying was homogeneous during microgravity.

Genetic transmission of fibrodysplasia ossificans progressiva. Report of a family

Fibrodysplasia ossificans progressiva is a rare connective-tissue disorder characterized by congenital malformation of the great toes and by progressive heterotopic ossification of the tendons, ligaments, fasciae, and skeletal muscles. We document the genetic transmission of fibrodysplasia ossificans progressiva from a sporadically affected father to each of his three children: two daughters and a son. Previous consideration of a genetic etiology was based on the fact that the disease has been reported in several sets of monozygotic twins, that an increased paternal age has been associated with sporadic occurrences of the disorder, and that there have been several reports of genetic transmission in the remote past. Although an autosomal-dominant genetic transmission has long been suspected, the findings in the family reported on here provide confirmation for such inheritance and a basis for the diagnosis and counseling of patients who have this disease.

Imaging pathologic pulmonary air and fluid accumulation by functional and absolute EIT

The increasing use of EIT in clinical research on severely ill lung patients requires a clarification of the influence of pathologic impedance distributions on the validity of the resulting tomograms. Significant accumulation of low-conducting air (e.g. pneumothorax or emphysema) or well-conducting liquid (e.g. haematothorax or atelectases) may conflict with treating the imaging problem as purely linear. First, we investigated the influence of stepwise inflation and deflation by up to 300 ml of air and 300 ml of Ringer solution into the pleural space of five pigs on the resulting tomograms during ventilation at constant tidal volume. Series of EIT images representing relative impedance changes were generated on the basis of a modified Sheffield back projection algorithm and ventilation distribution was displayed as functional (f-EIT) tomograms. In addition, a modified simultaneous iterative reconstruction technique (SIRT) was applied to quantify the resistivity distribution on an absolute level scaled in Omega m (a-EIT). Second, we applied these two EIT techniques on four intensive care patients with inhomogeneous air and fluid distribution and compared the EIT results to computed tomography (CT) and to a reference set of intrathoracic resistivity data of 20 healthy volunteers calculated by SIRT. The results of the animal model show that f-EIT based on back projection is not disturbed by the artificial pneumo- or haematothorax. Application of SIRT allows reliable discrimination and detection of the location and amplitude of pneumo- or haematothorax. These results were supported by the good agreement between the electrical impedance tomograms and CT scans on patients and by the significant differences of regional resistivity data between patients and healthy volunteers.

Modulation of monocyte activation in patients with rheumatoid arthritis by leukapheresis therapy

One of the hallmarks in rheumatoid arthritis (RA) is the intense activation of the monocyte-macrophage system. In the present investigation, the modulation of blood monocyte activation was studied with regard to the secretion of cytokines and inflammatory mediators, and to the expression of cytokine receptors. Patients with severe active RA underwent repeated leukapheresis procedures that removed all circulating monocytes. Highly enriched monocyte preparations from the first and third leukapheresis were studied. There were striking differences between the two monocyte populations. Cells obtained from the first leukapheresis constitutively released large amounts of prostaglandin E2 (PGE2), neopterin, interleukin 1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha). In particular, IL-1 beta and neopterin production were further enhanced by stimulation with either interferon-gamma (IFN-gamma) or TNF-alpha without a synergistic effect. In contrast, cells derived from the third leukapheresis procedure showed a close to normal activation status with only low levels of cytokine and mediator production as well as a reduced response to cytokine stimulation. The number of the receptors for IFN-gamma and TNF-alpha was not changed between first and third leukapheresis. However, TNF-binding capacity was only detectable upon acid treatment of freshly isolated monocytes. A further upregulation was noted upon 24 h in vitro culture, suggesting occupation of membrane receptors and receptor down-regulation by endogenously produced TNF-alpha. Northern blot analysis of cytokine gene expression was in good correlation with the amount of mediators determined on the protein level. These data indicate that cells of the monocyte-macrophage system are already highly activated in the peripheral blood in RA patients with active disease. These cells can be efficiently removed by repeated leukapheresis and are replenished by monocytes that have, with respect to cytokine and mediator production, a considerably lower activation status.

Electrical impedance tomography in monitoring experimental lung injury

OBJECTIVE

To apply electrical impedance tomography (EIT) and the new evaluation approach (the functional EIT) in monitoring the development of artificial lung injury.

DESIGN

Acute experimental trial.

SETTING

Operating room for animal experimental studies at a university hospital.

SUBJECTS

Five pigs (41.3 +/- 4.1 kg, mean body weight +/- SD).

INTERVENTIONS

The animals were anaesthetised and mechanically ventilated. Sixteen electrodes were attached on the thoracic circumference and used for electrical current injection and surface voltage measurement. Oleic acid was applied sequentially (total dose 0.05 ml/kg body weight) into the left pulmonary artery to produce selective unilateral lung injury.

MEASUREMENTS AND RESULTS

The presence of lung injury was documented by significant changes of PaCO2 (40.1 mmHg vs control 37.1 mmHg), PaO2 (112.3 mmHg vs 187.5 mmHg), pH (7.35 vs 7.42), mean pulmonary arterial pressure (29.2 mmHg vs 20.8 mmHg) and chest radiography. EIT detected 1) a regional decrease in mean impedance variation over the affected left lung (-41.4% vs control) and an increase over the intact right lung (+ 20.4% vs control) indicating reduced ventilation of the affected, and a compensatory augmented ventilation of the unaffected lung and 2) a pronounced fall in local baseline electrical impedance over the injured lung (-20.6% vs control) with a moderate fall over the intact lung (-10.0% vs control) indicating the development of lung oedema in the injured lung with a probable atelectasis formation in the contralateral one.

CONCLUSION

The development of the local impairment of pulmonary ventilation and the formation of lung oedema could be followed by EIT in an experimental model of lung injury. This technique may become a useful tool for monitoring local pulmonary ventilation in intensive care patients suffering from pulmonary disorders associated with regionally reduced ventilation, fluid accumulation and/or cell membrane changes.

Continuous-flow NMR culture system for mammalian cells

A continuous-flow NMR culture system for mammalian cells has been developed on which 31P-NMR experiments under complete and strictly physiologic conditions have been performed. Observations on the response of the cellular metabolism to stresses such as starvation, low temperature and changes in environmental pH monitored by 31P-NMR are reported. The response of the intracellular pH relative to the external pH of the growth medium is studied. We find that under the experimental conditions used there exists a delta pH varying between less than 0.2 and more than 0.6 pH units. These results are compatible with those obtained using other techniques.

Heavy metal hazards of Asian traditional remedies

In recent years there has been an increase in the use of traditional Asian medicines. It is estimated that 30% of the US population is currently using some form of homeopathic or alternative therapy at a total cost of over $13 billion annually. Herbal medications are claimed and widely believed to be beneficial; however, there have been reports of acute and chronic intoxications resulting from their use. This study characterizes a random sampling of Asian medicines as to the content of arsenic, mercury, and lead. Traditional herbal remedies were purchased in the USA, Vietnam, and China. The Asian remedies evaluated contained levels of arsenic, lead, and mercury that ranged from toxic (49%) to those exceeding public health guidelines for prevention of illness (74%) when consumed according to the directions given in or on the package. Heavy metals contained in Asian remedies may cause illness of unknown origin and result in the consumption of health care resources that are attributable to other causes. The public health hazards of traditional herbal Asian remedies should be identified and disclosed.

Spontaneous cortical activity is transiently poised close to criticality

Brain activity displays a large repertoire of dynamics across the sleep-wake cycle and even during anesthesia. It was suggested that criticality could serve as a unifying principle underlying the diversity of dynamics. This view has been supported by the observation of spontaneous bursts of cortical activity with scale-invariant sizes and durations, known as neuronal avalanches, in recordings of mesoscopic cortical signals. However, the existence of neuronal avalanches in spiking activity has been equivocal with studies reporting both its presence and absence. Here, we show that signs of criticality in spiking activity can change between synchronized and desynchronized cortical states. We analyzed the spontaneous activity in the primary visual cortex of the anesthetized cat and the awake monkey, and found that neuronal avalanches and thermodynamic indicators of criticality strongly depend on collective synchrony among neurons, LFP fluctuations, and behavioral state. We found that synchronized states are associated to criticality, large dynamical repertoire and prolonged epochs of eye closure, while desynchronized states are associated to sub-criticality, reduced dynamical repertoire, and eyes open conditions. Our results show that criticality in cortical dynamics is not stationary, but fluctuates during anesthesia and between different vigilance states.

Preoperative external beam radiotherapy followed by cytoreductive surgery and intraoperative radiotherapy for locally advanced primary or recurrent renal malignancies

Patients with local persistence or local regional recurrence of cancer after nephrectomy for renal cell cancer are unlikely to respond well to systemic therapy or external irradiation alone. In this analysis, patients with locally recurrent (9) or persistent (2) cancer following nephrectomy (renal cell cancer in 8, transitional cell or squamous cell cancer in 3) usually received 4,500 to 5,040 cGy. preoperative external beam irradiation followed by maximal surgical debulking and intraoperative electron irradiation (1,000 to 2,500 cGy.). Of 8 renal cell cancer patients 6 were alive and 4 were without disease progression at 15 to 50 months (3 of 4 at 29 months or longer). One patient died free of disease at 10.5 months and 3 had metastases (regional in 1 and distant in 3). Of the 3 transitional or squamous cell carcinoma patients 1 died free of disease 28.5 months after initiation of treatment for recurrence and 2 died of disease progression (liver in 1 and local in 1). It appears that select patients with solitary local recurrence or persistence following radical nephrectomy for renal cell cancer may benefit from an aggressive local treatment approach using irradiation (preoperatively and intraoperatively) plus maximal surgical debulking. In patients with locally advanced high grade transitional cell cancer the locally aggressive approach should probably be combined with multi-drug chemotherapy because of increased systemic risks. For both groups (renal cell carcinoma and transitional/squamous cell carcinoma) the most ideal patient for such treatment is one who has not received prior chemotherapy or external irradiation to the site of relapse, since 3 of 5 patients with disease progression after our aggressive approach had received chemotherapy (2) or external beam irradiation (2) elsewhere before referral.

Gravity-dependent phenomena in lung ventilation determined by functional EIT

Gravity exerts an effect on the distribution of intrapulmonary ventilation. A study on the detection of gravity-dependent inhomogeneity of ventilation by a functional EIT technique is presented. The study was performed on five human subjects, whose ventilation distribution was modified by changes in body position. The subjects were studied during spontaneous tidal breathing. The qualitative and quantitative analysis of the functional EIT images revealed that the ventilation is higher in the dependent lung regions when compared with the non-dependent ones. These EIT findings correspond to current knowledge of the physiological behaviour of the lungs as derived from the radioactive-gas methods and raise the possibility of applying the less complicated functional EIT in future studies on ventilation distribution in the lungs. This may be of major interest in the monitoring of intensive care patients with severe pulmonary disorders.

Communication through resonance in spiking neuronal networks

The cortex processes stimuli through a distributed network of specialized brain areas. This processing requires mechanisms that can route neuronal activity across weakly connected cortical regions. Routing models proposed thus far are either limited to propagation of spiking activity across strongly connected networks or require distinct mechanisms that create local oscillations and establish their coherence between distant cortical areas. Here, we propose a novel mechanism which explains how synchronous spiking activity propagates across weakly connected brain areas supported by oscillations. In our model, oscillatory activity unleashes network resonance that amplifies feeble synchronous signals and promotes their propagation along weak connections (“communication through resonance”). The emergence of coherent oscillations is a natural consequence of synchronous activity propagation and therefore the assumption of different mechanisms that create oscillations and provide coherence is not necessary. Moreover, the phase-locking of oscillations is a side effect of communication rather than its requirement. Finally, we show how the state of ongoing activity could affect the communication through resonance and propose that modulations of the ongoing activity state could influence information processing in distributed cortical networks.

The cortex is a highly modular structure with a large number of functionally specialized areas that communicate with each other through long-range cortical connections. It is has been suggested that communication between spiking neuronal networks (SNNs) requires synchronization of spiking activity which is either provided by the flow of neuronal activity across divergent/convergent connections, as suggested by computational models of SNNs, or by local oscillations in the gamma frequency band (30–100 Hz). However, such communication requires unphysiologically dense/strong connectivity, and the mechanisms required to synchronize separated local oscillators remain poorly understood. Here, we present a novel mechanism that alleviates these shortcomings and enables the propagation synchrony across weakly connected SNNs by locally amplifying feeble synchronization through resonance that naturally occurs in oscillating networks of excitatory and inhibitory neurons. We show that oscillatory stimuli at the network resonance frequencies generate a slowly propagating oscillation that is synchronized across the distributed networks. Moreover, communication with such oscillations depends on the dynamical state of the background activity in the SNN. Our results suggest that the emergence of synchronized oscillations can be viewed as a consequence of spiking activity propagation in weakly connected networks that is supported by resonance and modulated by the dynamics of the ongoing activity.