Implications of neuronal cell loss in chronic liver disease

Contexte: L'encéphalopathie hépatique (EH) est une complication majeure de la maladie hépatique chronique (MHC) caractérisée par des symptômes débilitants, notamment des troubles cognitifs, psychiatriques et moteurs. Il est cru que l’EH, définie comme étant un syndrome métabolique, disparaît après une transplantation hépatique (TH). Cependant, des complications neurologiques persistantes ont été signalées chez jusqu'à 47 % des receveurs de TH. Plusieurs études rétrospectives ont démontré une association entre des antécédents d'épisodes d'EH pré-TH et une mauvaise condition neurologique après la TH. D’autre part, l’alcool est un facteur étiologique fréquent à l’origine de la MHC. Cependant, une consommation excessive d’alcool a également un impact sur le cerveau. À ce jour, l’impact des épisodes d’EH ainsi que de l’alcool sur le développement de l’EH et l’intégrité cérébrale reste indéfini. Par conséquent, nos objectifs étaient 1) d’évaluer l'impact de plusieurs épisodes d’EH (induits par l'ammoniac) et 2) d'évaluer l'effet d'une consommation constante d'alcool sur le déclin neurologique, l'intégrité et les lésions cérébrales chez les rats atteints de MHC induite par la ligature des voies biliaires (LVB). Méthodes: Pour le premier objectif, des rats LVB ont reçu une injection (s.c.) d'acétate d'ammonium (LVB-Ammoniac), précipitant un épisode sévère d'EH réversible (perte du réflexe de redressement) tous les 4 jours à partir de la semaine 3 post-chirurgie LVB ( total ; 4 épisodes). Des rats SHAM ont également reçu une injection d'ammoniaque et des rats témoins BDL/SHAM ont reçu une injection de solution saline. La coordination motrice (rotarod) et la mémoire à court et à long-terme (test de reconnaissance d'objets nouveaux) ont été évaluées une semaine après la dernière injection. Pour évaluer l'intégrité neuronale, une analyse d’immunobuvardage de type Western et d’immunofluorescence a été réalisée dans le cortex frontal, le cervelet et l'hippocampe. Pour le deuxième objectif, des rats LVB ont reçu de l'alcool (LVB-Alcool) deux fois par jour (51 % v/v, dose de 3 g/kg, par gavage) pendant 4 semaines. Les rats SHAM ont également reçu de l'alcool et les rats LVB/SHAM servant de contrôles ont reçu une solution saline. La coordination motrice (rotarod) et le comportement anxieux (champ ouvert et labyrinthe surélevé) ont été évalués une semaine après la dernière administration d'alcool. Des analyses d’immunobuvardage de type Western et d’immunofluorescence ont été effectuées pour étudier l'intégrité neuronale du cortex frontal et du cervelet. Résultats: Chez les LVB-Ammoniac, des niveaux protéiques plus élevés d’un marqueur astrocytaire (GFAP) et apoptotique (caspase-3 et Bax/Bcl2) ont été trouvés dans l'hippocampe, alors que les niveaux de marqueurs neuronaux (NeuN et SMI311) ont été réduits par rapport à tous les autres groupes expérimentaux. Les rats LVB-Ammoniac ont présenté des niveaux accrus de stress oxydatif plasmatique par rapport aux rats SHAM/BDL respectifs. Une diminution des niveaux de capacité antioxydante totale (CAT) et une augmentation des protéines modifiées par le 4-HNE ont été observées dans l'hippocampe (et non dans le cortex frontal ou le cervelet) du groupe LVB-Ammoniac par rapport aux rats SHAM/BDL respectifs. Les résultats d'immunofluorescence ont révélé la colocalisation du marqueur apoptotique (caspase-3 clivée) avec un marqueur neuronal (NeuN) dans la région CA1 de l'hippocampe des rats LVB-Ammoniac. Chez les rats LVB-alcool, il a été démontré une altération de la coordination motrice aux semaines 2, 3, 4 et 5 ainsi qu'une augmentation du comportement anxieux par rapport aux rats SHAM respectifs. Chez les rats BDL-alcool, il a été démontré une diminution des marqueurs neuronaux (NeuN et SMI311), une augmentation de l'activité enzymatique apoptotique (caspase-3 clivée), une augmentation des marqueurs de nécroptose (pRIP3 et pMLKL), une diminution de la CAT et une augmentation des protéines modifiées par 4-HNE dans le cervelet par rapport à tous les groupes. Les résultats d'immunofluorescence ont révélé la colocalisation du marqueur apoptotique (caspase-3 clivée) et du marqueur de nécroptose (pMLKL) dans les neurones de la couche granulaire du cervelet de rats LVB-alcool. Conclusion: De multiples épisodes d'EH sévère ont entraîné une perte de cellules neuronales dans l'hippocampe des rats LVB et qui est associée à une augmentation du stress oxydatif, à l'apoptose et à une diminution des cellules neuronales. Des niveaux élevés du marqueur astrocytaire (GFAP) dans l'hippocampe insinuent une gliose, pouvant être le résultat d'une perte neuronale. De plus, l'administration d'alcool aggrave les troubles de la coordination chez les rats LVB et qui ont été associés à une augmentation du stress oxydatif, à une diminution des marqueurs neuronaux (NeuN et SMI311) avec l’apoptose et la nécroptose dans le cervelet des rats LVB-alcool. Globalement, de multiples épisodes d’EH sévère ainsi qu'une consommation constante d'alcool, via le stress oxydatif, déclenchent une perte/lésion neuronale qui entraînera par conséquent une mauvaise condition neurologique après la TH.Background: Hepatic encephalopathy (HE) is a major complication of chronic liver disease (CLD) characterized by debilitating symptoms, including cognitive, psychiatric, and motor disturbances. HE, defined as a metabolic syndrome, is believed to resolve following liver transplantation (LT). However, persisting neurological complications have been reported in up to 47% of LT recipients. Several retrospective studies have demonstrated an association between a history of HE episodes pre-LT and poor neurological outcome following LT. Furthermore, alcohol is a common etiological factor which causes CLD. However, excessive alcohol consumption also impacts the brain. To date, the impact of HE episodes as well as of alcohol on the development of HE and brain integrity remains undefined. Therefore, our aims were to 1) evaluate the impact of multiple episodes (induced by ammonia) and 2) evaluate the effect of constant alcohol consumption on neurological decline, brain integrity and injury in rats with CLD induced via bile-duct ligation (BDL). Methods: In the first aim, BDL rats were injected (s.c.) with ammonium acetate (BDLAmmonia), precipitating a reversible overt episode of HE (loss of righting reflex) every 4 days from week 3 post-BDL surgery (total; 4 episodes). SHAM rats were also injected with ammonia and BDL/SHAM rats were injected with saline as controls. To assess the neuronal integrity, western blot and immunofluorescence analysis were performed for frontal cortex, cerebellum, and hippocampus. Motor coordination (rotarod) and short- and long-memory (novel object recognition test) were assessed one week following last injection. In the second aim, BDL rats were administered alcohol (BDL-Alcohol) twice a day (51% v/v, dose of 3g/kg, via gavage) for 4 weeks. SHAM rats also received alcohol and BDL/SHAM rats received saline as controls. Motor coordination (rotarod) and anxiety-like behavior (open field and elevated plus maze) were assessed one week following last alcohol administration. Western blot and immunofluorescence analyses were performed to investigate neuronal integrity in frontal cortex and cerebellum. Results: In BDL-Ammonia, higher protein levels of astrocytic marker (GFAP) and apoptotic markers (caspase-3 and Bax/Bcl2) were found in the hippocampus, whereas neuronal markers (NeuN and SMI311) levels were reduced compared to all other experimental groups. BDLAmmonia rats showed increased levels of plasma oxidative stress compared to respective SHAM/BDL rats. Decreased levels of total antioxidant capacity (TAC) and increased 4-HNE modified proteins were found in the hippocampus (not in frontal cortex or cerebellum) of the BDL-Ammonia group compared to respective SHAM/BDL rats. Immunofluorescence results revealed the colocalization of apoptotic marker (cleaved caspase-3) with neuronal marker (NeuN) in the CA1 region of the hippocampus of BDL-Ammonia rats. BDL-Alcohol rats demonstrated impaired motor coordination at weeks 2, 3, 4, and 5 as well as an increase in anxiety-like behavior compared to respective SHAM rats. BDL-Alcohol rats showed a decrease in neuronal markers (NeuN and SMI311), an increase in apoptotic enzyme activity (cleaved caspase-3), an increase in necroptosis markers (pRIP3 and pMLKL), a decrease in TAC and an increase in 4-HNE modified proteins in the cerebellum compared to all groups. Immunofluorescence results revealed the colocalization of apoptotic marker (cleaved caspase3) and necroptosis marker (pMLKL) in granular layer neurons of the cerebellum of BDLAlcohol rats. Conclusion: Multiple episodes of overt HE led to neuronal cell loss in the hippocampus of BDL rats which was associated with increased oxidative stress, apoptosis and decreased neuronal count. Elevated levels of astrocytic marker (GFAP) in the hippocampus insinuate gliosis, possibly a result of neuronal loss. Moreover, alcohol administration worsens coordination impairments in BDL rats which were associated with increased oxidative stress, decreased neuronal markers (NeuN and SMI311) with apoptosis and necroptosis in the cerebellum of BDL-Alcohol rats. Overall, both multiple episodes of overt HE as well as continuous alcohol consumption, via oxidative stress, triggers neuronal loss/injury which consequently will lead to poor neurological outcome post-LT

Simultaneous Nonlinear Model Predictive Control and State Estimation: Theory and Applications

As computational power increases, online optimization is becoming a ubiquitous approach for solving control and estimation problems in both academia and industry. This widespread popularity of online optimization techniques is largely due to their abilities to solve complex problems in real time and to explicitly accommodate hard constraints. In this dissertation, we discuss an especially popular online optimization control technique called model predictive control (MPC). Specifically, we present a novel output-feedback approach to nonlinear MPC, which combines the problems of state estimation and control into a single min-max optimization. In this way, the control and estimation problems are solved simultaneously providing an output-feedback controller that is robust to worst-case system disturbances and noise. This min-max optimization is subject to the nonlinear system dynamics as well as constraints that come from practical considerations such as actuator limits. Furthermore, we introduce a novel primal-dual interior-point method that can be used to efficiently solve the min-max optimization problem numerically and present several examples showing that the method succeeds even for severely nonlinear and non-convex problems. Unlike other output-feedback nonlinear optimal control approaches that solve the estimation and control problems separately, this combined estimation and control approach facilitates straightforward analysis of the resulting constrained, nonlinear, closed-loop system and yields improved performance over other standard approaches. Under appropriate assumptions that encode controllability and observability of the nonlinear process to be controlled, we show that this approach ensures that the state of the closed-loop system remains bounded. Finally, we investigate the use of this approach in several applications including the coordination of multiple unmanned aerial vehicles for vision-based target tracking of a moving ground vehicle and feedback control of an artificial pancreas system for the treatment of Type 1 Diabetes. We discuss why this novel combined control and estimation approach is especially beneficial for these applications and show promising simulation results for the eventual implementation of this approach in real-life scenarios

Brain-muscle axis during treatment of minimal hepatic encephalopathy with L-ornithine L-aspartate

Abstract Background: Minimal Hepatic Encephalopathy (MHE) is a fluctuant cognitive deficit, and a common complication of cirrhosis, with significant health and socioeconomic consequences. Oral L-Ornithine L-Aspartate (LOLA) has been proposed to treat MHE but mechanism and efficacy are unknown. This study hypothesises LOLA treatment will correlate with improvements in: 1) Cognitive function (primary endpoints) 2) Relation to Brain-muscle axis (secondary endpoints) Design and methods: This double-blinded placebo-controlled trial included 34 patients (LOLA n=14, placebo n=20) over 12 weeks. All underwent psychometric testing (PHES, CogstateTM, Stroop, Short Form-36). Secondary endpoints included brain volume, white matter microstructure, brain function (proton MR spectroscopy/ functional MRI); muscle power (handgrip strength, 6-minute-walk-test); anthropometry (upper limb skinfold); muscle metabolome (lateral vastus muscle biopsy LC-MS analysis). Results: Significantly more patients receiving LOLA reported improved energy levels, specifically in Vitality (SF36 subdomain). No differences in PHES, Cogstate and Stroop test performance occured. Change-in-biceps skinfold thickness demonstrated significant gain with LOLA compared to placebo, without differences in power. LC-MS experiments were not discriminatory. Whole Brain differences in FA and RD suggested reduced brain oedema (subcortical volume reduction and global white matter changes). No significant group differences in fMRI task/ resting activation were seen. Spectroscopy of ACC showed significantly higher unresolved glutamine-glutamate (Glx) complex levels with LOLA, also correlating with increased PPI use, and may represent LOLA-driven increased Krebs-cycling or a function of altered gut microbiome. Conclusion: No cognitive benefits were demonstrated. Improved quality of life measures maybe a nutritional consequence also relating to increased biceps skinfold thickness with LOLA. Effects on brain oedema are postulated. Future studies need higher powering to allow subanalysis by aetiology, and smaller voxels at basal ganglia are recommended. Attempts to replicate rising ACC Glx with LOLA and regions of interest identified on fMRI subanalysis may be fruitful.Open Acces

Multi-Robot Relative Pose Estimation in SE(2) with Observability Analysis: A Comparison of Extended Kalman Filtering and Robust Pose Graph Optimization

In this study, we address multi-robot localization issues, with a specific focus on cooperative localization and observability analysis of relative pose estimation. Cooperative localization involves enhancing each robot's information through a communication network and message passing. If odometry data from a target robot can be transmitted to the ego robot, observability of their relative pose estimation can be achieved through range-only or bearing-only measurements, provided both robots have non-zero linear velocities. In cases where odometry data from a target robot are not directly transmitted but estimated by the ego robot, both range and bearing measurements are necessary to ensure observability of relative pose estimation. For ROS/Gazebo simulations, we explore four sensing and communication structures. We compare extended Kalman filtering (EKF) and pose graph optimization (PGO) estimation using different robust loss functions (filtering and smoothing with varying batch sizes of sliding windows) in terms of estimation accuracy. In hardware experiments, two Turtlebot3 equipped with UWB modules are used for real-world inter-robot relative pose estimation, applying both EKF and PGO and comparing their performance.Comment: 20 pages, 21 figure

Navigation and guidance requirements for commercial VTOL operations

The NASA Langley Research Center (LaRC) has undertaken a research program to develop the navigation, guidance, control, and flight management technology base needed by Government and industry in establishing systems design concepts and operating procedures for VTOL short-haul transportation systems in the 1980s time period. The VALT (VTOL Automatic Landing Technology) Program encompasses the investigation of operating systems and piloting techniques associated with VTOL operations under all-weather conditions from downtown vertiports; the definition of terminal air traffic and airspace requirements; and the development of avionics including navigation, guidance, controls, and displays for automated takeoff, cruise, and landing operations. The program includes requirements analyses, design studies, systems development, ground simulation, and flight validation efforts

Data-Driven Development of a Roadside Safety Marketing Campaign for Tree Removal – Phase I

Since the 1970s, tree crashes have been one of the most common and deadly fixed-object fatal crash types, resulting in more than 3,000 fatal crashes and 3,500 fatalities each year. While fatal tree crashes could be prevented by removing trees adjacent to the roadway, an extensive national tree removal project would be unnecessary, cost-prohibitive, and would experience significant political resistance. The Midwest Pooled Fund Program jointly funded a research study to develop marketing methods and approaches which would focus on tree removal, replacement, or relocation in the most critical areas. Researchers conducted an extensive background investigation into tree crashes, other available studies that reviewed and analyzed tree crash data, and various state DOT and local safety-related marketing campaigns. Researchers also investigated state and local recommendations for clear zone requirements adjacent to various road classes, and issued a survey to state DOTs to obtain local perspectives of marketing and advertising plans. Finally, researchers collected over 400,000 tree and utility pole crashes from 12 different states over a five-year period to analyze the crash data and tabulate results. Draft marketing and advertising plans were developed to demonstrate the type of safety advertising techniques and messages which could be used to inform and influence the public regarding the danger of roadside trees and the importance of tree removal