Intravenous mesenchymal stem cell therapy for traumatic brain injury.

OBJECT: Cell therapy has shown preclinical promise in the treatment of many diseases, and its application is being translated to the clinical arena. Intravenous mesenchymal stem cell (MSC) therapy has been shown to improve functional recovery after traumatic brain injury (TBI). Herein, the authors report on their attempts to reproduce such observations, including detailed characterizations of the MSC population, non-bromodeoxyuridine-based cell labeling, macroscopic and microscopic cell tracking, quantification of cells traversing the pulmonary microvasculature, and well-validated measurement of motor and cognitive function recovery. METHODS: Rat MSCs were isolated, expanded in vitro, immunophenotyped, and labeled. Four million MSCs were intravenously infused into Sprague-Dawley rats 24 hours after receiving a moderate, unilateral controlled cortical impact TBI. Infrared macroscopic cell tracking was used to identify cell distribution. Immunohistochemical analysis of brain and lung tissues 48 hours and 2 weeks postinfusion revealed transplanted cells in these locations, and these cells were quantified. Intraarterial blood sampling and flow cytometry were used to quantify the number of transplanted cells reaching the arterial circulation. Motor and cognitive behavioral testing was performed to evaluate functional recovery. RESULTS: At 48 hours post-MSC infusion, the majority of cells were localized to the lungs. Between 1.5 and 3.7% of the infused cells were estimated to traverse the lungs and reach the arterial circulation, 0.295% reached the carotid artery, and a very small percentage reached the cerebral parenchyma (0.0005%) and remained there. Almost no cells were identified in the brain tissue at 2 weeks postinfusion. No motor or cognitive functional improvements in recovery were identified. CONCLUSIONS: The intravenous infusion of MSCs appeared neither to result in significant acute or prolonged cerebral engraftment of cells nor to modify the recovery of motor or cognitive function. Less than 4% of the infused cells were likely to traverse the pulmonary microvasculature and reach the arterial circulation, a phenomenon termed the "pulmonary first-pass effect," which may limit the efficacy of this therapeutic approach. The data in this study contradict the findings of previous reports and highlight the potential shortcomings of acute, single-dose, intravenous MSC therapy for TBI.

Reply to the editor

We appreciate the comments and concerns expressed by Arakawa and colleagues regarding our article, titled “Pulsatile control of rotary blood pumps: Does the modulation waveform matter?”1 Unfortunately, we have to disagree with Arakawa and colleagues. As is obvious from the title of our article, it investigates the effect of different waveforms on the heart–device interaction. In contrast to the authors' claim, this is the first article in the literature that uses basic waveforms (sine, triangle, saw tooth, and rectangular) with different phase shifts to examines their impact on left ventricular unloading. The previous publications2, 3 and 4 just varied the pump speed during systole and diastole, which was first reported by Bearnson and associates5 in 1996, and studied its effect on aortic pressure, coronary flow, and end-diastolic volume. We should mention that dp/dtmax is a load-sensitive parameter of contractility and not representative for the degree of unloading. Moreover, none of the aforementioned reports has studied mechanical unloading and in particular the stroke work of the left ventricle. Our method is unique because we do not just alternate between high and low speed but have accurate control of the waveform because of the direct drive system of Levitronix Technologies LLC (Waltham, Mass) and a custom-developed pump controller. Without referring, Arakawa and associates state “several previous studies have already reported the coronary flow diminishes as the left ventricular assist device support increases.” It should be noted that all the waveforms used in our study have 2000 rpm average value with 1000 rpm amplitude, which is not an excessive speed for the CentriMag rotary pump (Levitronix) to collapse the ventricle and diminish the coronary flow. We agree with Arakawa and coworkers that there is a need for a heart failure model to come to more relevant results with respect to clinical expectations. However, we have explored many existing models, including species and breeds that have a native proneness to cardiomyopathy, but all of them differ from the genetic presentation in humans. We certainly do not believe that the use of microembolization, in which the coronary circulation is impaired by the injection of microspheres, would form a good model from which to draw conclusions about coronary flow change under different loading conditions. A model would be needed in which either an infarct is created to mimic ischemic heart failure or the coronary circulation remains untouched to simulate, for instance, dilated cardiomyopathy. Furthermore, in discussion we clearly mention that “lack of heart failure is a major limitation of our study.” We also believe that unloading is not the only factor of the cardiac functional recovery, and an excessive unloading of the left ventricle might lead to cardiac tissue atrophy. Therefore, in our article we mention that control of the level of cardiac unloading by assist devices has been suggested as a mechanical tool to promote recovery, and more studies are required to find better strategies for the speed modulation of rotary pumps and to achieve an optimal heart load control to enhance myocardial recovery. Finally, there are many publications about pulsing rotary blood pumps and it was impossible to include them all. We preferred to reference some of the earlier basic works such as an original research by Bearnson and coworkers5 and another article published by our group,6 which is more relevant.

Astrocytes from the contused spinal cord inhibit oligodendrocyte differentiation of adult oligodendrocyte precursor cells by increasing the expression of bone morphogenetic proteins.

Promotion of remyelination is an important therapeutic strategy to facilitate functional recovery after traumatic spinal cord injury (SCI). Transplantation of neural stem cells (NSCs) or oligodendrocyte precursor cells (OPCs) has been used to enhance remyelination after SCI. However, the microenvironment in the injured spinal cord is inhibitory for oligodendrocyte (OL) differentiation of NSCs or OPCs. Identifying the signaling pathways that inhibit OL differentiation in the injured spinal cord could lead to new therapeutic strategies to enhance remyelination and functional recovery after SCI. In the present study, we show that reactive astrocytes from the injured rat spinal cord or their conditioned media inhibit OL differentiation of adult OPCs with concurrent promotion of astrocyte differentiation. The expression of bone morphogenetic proteins (BMP) is dramatically increased in the reactive astrocytes and their conditioned media. Importantly, blocking BMP activity by BMP receptor antagonist, noggin, reverse the effects of active astrocytes on OPC differentiation by increasing the differentiation of OL from OPCs while decreasing the generation of astrocytes. These data indicate that the upregulated bone morphogenetic proteins in the reactive astrocytes are major factors to inhibit OL differentiation of OPCs and to promote its astrocyte differentiation. These data suggest that manipulation of BMP signaling in the endogenous or grafted NSCs or OPCs may be a useful therapeutic strategy to increase their OL differentiation and remyelination and enhance functional recovery after SCI.

Subacute neural stem cell therapy for traumatic brain injury.

INTRODUCTION: Traumatic brain injury (TBI) frequently results in devastating and prolonged morbidity. Cellular therapy is a burgeoning field of experimental treatment that has shown promise in the management of many diseases, including TBI. Previous work suggests that certain stem and progenitor cell populations migrate to sites of inflammation and improve functional outcome in rodents after neural injury. Unfortunately, recent study has revealed potential limitations of acute and intravenous stem cell therapy. We studied subacute, direct intracerebral neural stem and progenitor cell (NSC) therapy for TBI. MATERIALS AND METHODS: The NSCs were characterized by flow cytometry and placed (400,000 cells in 50 muL 1x phosphate-buffered saline) into and around the direct injury area, using stereotactic guidance, of female Sprague Dawley rats 1 wk after undergoing a controlled cortical impact injury. Immunohistochemistry was used to identify cells located in the brain at 48 h and 2 wk after administration. Motor function was assessed using the neurological severity score, foot fault, rotarod, and beam balance. Cognitive function was assessed using the Morris water maze learning paradigm. Repeated measures analysis of variance with post-hoc analysis were used to determine significance at P < 0.05. RESULTS: Immunohistochemistry analysis revealed that 1.4-1.9% of infused cells remained in the neural tissue at 48 h and 2 wk post placement. Nearly all cells were located along injection tracks at 48 h. At 2 wk some cell dispersion was apparent. Rotarod motor testing revealed significant increases in maximal speed among NSC-treated rats compared with saline controls at d 4 (36.4 versus 27.1 rpm, P < 0.05) and 5 (35.8 versus 28.9 rpm, P < 0.05). All other motor and cognitive evaluations were not significantly different compared to controls. CONCLUSIONS: Placement of NSCs led to the cells incorporating and remaining in the tissues 2 wk after placement. Motor function tests revealed improvements in the ability to run on a rotating rod; however, other motor and cognitive functions were not significantly improved by NSC therapy. Further examination of a dose response and optimization of placement strategy may improve long-term cell survival and maximize functional recovery.

Significance of social cognitive remediation therapy within a comprehensive treatment concept

Objectives: The final goal in the successful treatment of schizophrenia patients is defined in improved functional recovery. Thus the integration of social cognitive tasks within a comprehensive treatment concept should offer significant advantages in generalization and transfer of therapy effects. Recent therapy outcome research supports these advantages. Empirical modeling identified social cognition as a mediating factor between neurocognition and functional recovery. Regarding this, we first developed the Integrated Psychological Therapy Program (IPT). It consists of 5 subprograms and combines interventions on neurocognition, social cognition, and social competence. As a further development of the cognitive part of IPT we developed the Integrated Neurocognitive Therapy (INT), which focuses on all social and neurocognitive domains defined by MATRICS. Methods: The aim was to investigate whether the application of the complete IPT is superior in comparison to the use of single IPT subprograms. Data were based on 37 independent IPT studies including a total sample of 1692 schizophrenia patients. Additionally, the proximal outcome in cognitive domains as well as in more distal outcome areas was investigated in an international RCT on INT including 169 schizophrenia outpatients. Results: All IPT subprogram variations obtained significant effects in proximal outcome. Each subprogram domain reached the largest effects in the targeted area. With regard to distal outcomes, combinations of subprograms showed a significant reduction of negative symptoms and an improvement in not targeted areas of functioning. This strongly supports vertical generalization effects to other functional domains. Regarding INT, results support efficacy compared to TAU in various cognitive domains, in psychosocial functioning and symptoms after therapy and at 1-year-follow-up. Conclusion: Results support evidence for the efficacy of longer lasting integrated therapy. The success of these treatment concepts is strongly based on successful therapy of social cognitive functions.

Baclofen and gamma-hydroxybutyrate differentially altered behavior, EEG activity and sleep in rats.

OBJECTIVES Animal and human studies have shown that sleep may have an impact on functional recovery after brain damage. Baclofen (Bac) and gamma-hydroxybutyrate (GHB) have been shown to induce physiological sleep in humans, however, their effects in rodents are unclear. The aim of this study is to characterize sleep and electroencelphalogram (EEG) after Bac and GHB administration in rats. We hypothesized that both drugs would induce physiological sleep. METHODS Adult male Sprague-Dawley rats were implanted with EEG/electromyogram (EMG) electrodes for sleep recordings. Bac (10 or 20 mg/kg), GHB (150 or 300 mg/kg) or saline were injected 1 h after light and dark onset to evaluate time of day effect of the drugs. Vigilance states and EEG spectra were quantified. RESULTS Bac and GHB induced a non-physiological state characterized by atypical behavior and an abnormal EEG pattern. After termination of this state, Bac was found to increase the duration of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep (∼90 and 10 min, respectively), reduce sleep fragmentation and affect NREM sleep episode frequency and duration (p<0.05). GHB had no major effect on vigilance states. Bac drastically increased EEG power density in NREM sleep in the frequencies 1.5-6.5 and 9.5-21.5 Hz compared to saline (p<0.05), while GHB enhanced power in the 1-5-Hz frequency band and reduced it in the 7-9-Hz band. Slow-wave activity in NREM sleep was enhanced 1.5-3-fold during the first 1-2 h following termination of the non-physiological state. The magnitude of drug effects was stronger during the dark phase. CONCLUSION While both Bac and GHB induced a non-physiological resting state, only Bac facilitated and consolidated sleep, and promoted EEG delta oscillations thereafter. Hence, Bac can be considered a sleep-promoting drug and its effects on functional recovery after stroke can be evaluated both in humans and rats.

Early reherniation of disk material in eleven dogs with surgically treated thoracolumbar intervertebral disk extrusion.

OBJECTIVE To report findings and outcomes of dogs with reherniation of nuclear material within 7 days of hemilaminectomy for acute thoracolumbar (TL) intervertebral disk extrusion. STUDY DESIGN Retrospective case series. ANIMALS Chondrodystrophic dogs (n = 11). METHODS Dogs with acute neurologic decline within 1 week of surgical decompression for TL disk extrusion were identified. Advanced imaging was used to document extradural spinal cord compression at the previous surgery site. Ten dogs had a 2nd decompressive surgery to remove extruded nuclear material. RESULTS All dogs had acute neurologic deterioration (average, 2 neurologic grades) 2-7 days after initial hemilaminectomy. Computed tomography (CT; n = 10) or myelography (n = 1) documented extradural spinal cord compression compatible with extruded disk material at the previous hemilaminectomy site. Dogs that had a 2nd surgical decompression improved neurologically within 24 hours and were paraparetic at discharge. The single dog that did not have decompressive surgery did not regain deep nociception during 185-day follow-up. CONCLUSIONS Early reherniation at the site of previous hemilaminectomy can produce acute deterioration of neurologic function and should be investigated with diagnostic imaging. Repeat decompressive surgery can lead to functional recovery.

Non-canonical actions of Nogo-A and its receptors

Nogo-A is a myelin associated protein and one of the most potent neurite growth inhibitors in the central nervous system. Interference with Nogo-A signaling has thus been investigated as therapeutic target to promote functional recovery in CNS injuries. Still, the finding that Nogo-A presents a fairly ubiquitous expression in many types of neurons in different brain regions, in the eye and even in the inner ear suggests for further functions besides the neurite growth repression. Indeed, a growing number of studies identified a variety of functions including regulation of neuronal stem cells, modulation of microglial activity, inhibition of angiogenesis and interference with memory formation. Aim of the present commentary is to draw attention on these less well-known and sometimes controversial roles of Nogo-A. Furthermore, we are addressing the role of Nogo-A in neuropathological conditions such as ischemic stroke, schizophrenia and neurodegenerative diseases.

Determinants of patients' expectations about total knee arthroplasty outcomes

Knee osteoarthritis (OA) is the most prevalent form of arthritis in the US, affecting approximately 37% of adults. Approximately 300,000 total knee arthroplasty (TKA) procedures take place in the United States each year. Total knee arthroplasty is an elective procedure available to patients as an irreversible treatment after failure of previous medical treatments. Some patients sacrifice quality of life and endure many years of pain before making the decision to undergo total knee replacement. In making their decision, it is therefore imperative for patients to understand the procedure, risks and surgical outcomes to create realistic expectations and increase outcome satisfaction. ^ From 2004-2007, 236 OA patients who underwent TKA participated in the PEAKS (Patient Expectations About Knee Surgery) study, an observational longitudinal cohort study, completed baseline and 6 month follow-up questionnaires after the surgery. We performed a secondary data analysis of the PEAKS study to: (1) determine the specific presurgical patient characteristics associated with patients’ presurgical expectations of time to functional recovery; and (2) determine the association between presurgical expectations of time to functional recovery and postsurgical patient capabilities (6 months after TKA). We utilized the WOMAC to measure knee pain and function, the SF-36 to measure health-related quality of life, and the DASS and MOS-SSS to measure psychosocial quality of life variables. Expectation and capability measures were generated from panel of experts. A list of 10 activities was used for this analysis to measure functional expectations and postoperative functional capabilities. ^ The final cohort consisted of 236 individuals, was predominately White with 154 women and 82 men. The mean age was 65 years. Patients were optimistic about their time to functional recovery. Expectation time of being able to perform the list activities per patient had a median of less than 3 months. Patients who expected to be able to perform the functional activities by 3 months had better knee function, less pain and better overall health-related quality of life. Despite expectation differences, all patients showed significant improvement 6 months after surgery. Participant expectation of time to functional recovery was not an independent predictor of capability to perform functional activities at 6 months. Better presurgical patient characteristics were, however, associated with a higher likelihood of being able to perform all activities at 6 months. ^ This study gave us initial insight on the relationship between presurgical patient characteristics and their expectations of functional recovery after total knee replacement. Future studies clarifying the relationship between patient presurgical characteristics and postsurgical functional capabilities are needed.^

In vivo longitudinal studies of spinal cord injury and vascular endothelial growth factor treatment

Approximately 12,000 new cases of spinal cord injury (SCI) are added each year to the estimated 259,000 Americans living with SCI. The majority of these patients return to society, their lives forever changed by permanent loss of sensory and motor function. While there are no FDA approved drugs for the treatment of SCI or a universally accepted standard therapy, the current though controversial treatment includes the delivery of high dosages of the corticosteroid methyliprednisolone sodium succinate, surgical interventions to stabilize the spinal column, and physical rehabilitation. It is therefore critically important to fully understand the pathology of injury and determine novel courses and rationally-based therapies for SCI. ^ Vascular endothelial growth factor (VEGF) is an attractive target for treating central nervous system (CNS) injury and disease because it has been shown to influence angiogenesis and neuroprotection. Preliminary studies have indicated that increased vasculature may be associated with functional recovery; therefore exogenous delivery of a pro-angiogenic growth factor such as VEGF may improve neurobehavioral outcome. In addition, VEGF may provide protection from secondary injury and result in increased survival and axonal sprouting. ^ In these studies, SCI rats received acute intraspinal injections of VEGF, the antibody to VEGF, or vehicle control. The effect of these various agents was investigated using longitudinalmulti-modal magnetic resonance imaging (MRI), neuro- and sensory behavioral assays, and end point immunohistochemistry. We found that rats that received VEGF after SCI had increased tissue sparing and improved white matter integrity at the earlier time points as shown by advanced magnetic resonance imaging (MRI) techniques. However, these favorable effects of VEGF were not maintained, suggesting that additional treatments with VEGF at multiple time points may be more beneficial, Histological examinations revealed that VEGF treatment may result in increased oligodendrogenesis and therefore may eventually lead to remyelination and improved functional outcome. ^ On the neurobehavioral studies, treatments with VEGF and Anti-VEGF did not significantly affect performance on tests of open-field locomotion, grid walk, inclined plane, or rearing. However, VEGF treatment resulted in significantly increased incidence of chronic neuropathic pain. This phenomenon could possibly be attributed to the fact that VEGF treatment may promote axonal sprouting and also results in tissue sparing, thereby providing a substrate for the growth of new axons. New connections made by these sprouting axons may involve components of pathways involved in the transmission of pain and therefore result in increased pain in those animals. ^

Parametric and structural self-adaptation of embedded systems using evolvable hardware

Los sistemas empotrados han sido concebidos tradicionalmente como sistemas de procesamiento específicos que realizan una tarea fija durante toda su vida útil. Para cumplir con requisitos estrictos de coste, tamaño y peso, el equipo de diseño debe optimizar su funcionamiento para condiciones muy específicas. Sin embargo, la demanda de mayor versatilidad, un funcionamiento más inteligente y, en definitiva, una mayor capacidad de procesamiento comenzaron a chocar con estas limitaciones, agravado por la incertidumbre asociada a entornos de operación cada vez más dinámicos donde comenzaban a ser desplegados progresivamente. Esto trajo como resultado una necesidad creciente de que los sistemas pudieran responder por si solos a eventos inesperados en tiempo diseño tales como: cambios en las características de los datos de entrada y el entorno del sistema en general; cambios en la propia plataforma de cómputo, por ejemplo debido a fallos o defectos de fabricación; y cambios en las propias especificaciones funcionales causados por unos objetivos del sistema dinámicos y cambiantes. Como consecuencia, la complejidad del sistema aumenta, pero a cambio se habilita progresivamente una capacidad de adaptación autónoma sin intervención humana a lo largo de la vida útil, permitiendo que tomen sus propias decisiones en tiempo de ejecución. Éstos sistemas se conocen, en general, como sistemas auto-adaptativos y tienen, entre otras características, las de auto-configuración, auto-optimización y auto-reparación. Típicamente, la parte soft de un sistema es mayoritariamente la única utilizada para proporcionar algunas capacidades de adaptación a un sistema. Sin embargo, la proporción rendimiento/potencia en dispositivos software como microprocesadores en muchas ocasiones no es adecuada para sistemas empotrados. En este escenario, el aumento resultante en la complejidad de las aplicaciones está siendo abordado parcialmente mediante un aumento en la complejidad de los dispositivos en forma de multi/many-cores; pero desafortunadamente, esto hace que el consumo de potencia también aumente. Además, la mejora en metodologías de diseño no ha sido acorde como para poder utilizar toda la capacidad de cómputo disponible proporcionada por los núcleos. Por todo ello, no se están satisfaciendo adecuadamente las demandas de cómputo que imponen las nuevas aplicaciones. La solución tradicional para mejorar la proporción rendimiento/potencia ha sido el cambio a unas especificaciones hardware, principalmente usando ASICs. Sin embargo, los costes de un ASIC son altamente prohibitivos excepto en algunos casos de producción en masa y además la naturaleza estática de su estructura complica la solución a las necesidades de adaptación. Los avances en tecnologías de fabricación han hecho que la FPGA, una vez lenta y pequeña, usada como glue logic en sistemas mayores, haya crecido hasta convertirse en un dispositivo de cómputo reconfigurable de gran potencia, con una cantidad enorme de recursos lógicos computacionales y cores hardware empotrados de procesamiento de señal y de propósito general. Sus capacidades de reconfiguración han permitido combinar la flexibilidad propia del software con el rendimiento del procesamiento en hardware, lo que tiene la potencialidad de provocar un cambio de paradigma en arquitectura de computadores, pues el hardware no puede ya ser considerado más como estático. El motivo es que como en el caso de las FPGAs basadas en tecnología SRAM, la reconfiguración parcial dinámica (DPR, Dynamic Partial Reconfiguration) es posible. Esto significa que se puede modificar (reconfigurar) un subconjunto de los recursos computacionales en tiempo de ejecución mientras el resto permanecen activos. Además, este proceso de reconfiguración puede ser ejecutado internamente por el propio dispositivo. El avance tecnológico en dispositivos hardware reconfigurables se encuentra recogido bajo el campo conocido como Computación Reconfigurable (RC, Reconfigurable Computing). Uno de los campos de aplicación más exóticos y menos convencionales que ha posibilitado la computación reconfigurable es el conocido como Hardware Evolutivo (EHW, Evolvable Hardware), en el cual se encuentra enmarcada esta tesis. La idea principal del concepto consiste en convertir hardware que es adaptable a través de reconfiguración en una entidad evolutiva sujeta a las fuerzas de un proceso evolutivo inspirado en el de las especies biológicas naturales, que guía la dirección del cambio. Es una aplicación más del campo de la Computación Evolutiva (EC, Evolutionary Computation), que comprende una serie de algoritmos de optimización global conocidos como Algoritmos Evolutivos (EA, Evolutionary Algorithms), y que son considerados como algoritmos universales de resolución de problemas. En analogía al proceso biológico de la evolución, en el hardware evolutivo el sujeto de la evolución es una población de circuitos que intenta adaptarse a su entorno mediante una adecuación progresiva generación tras generación. Los individuos pasan a ser configuraciones de circuitos en forma de bitstreams caracterizados por descripciones de circuitos reconfigurables. Seleccionando aquellos que se comportan mejor, es decir, que tienen una mejor adecuación (o fitness) después de ser evaluados, y usándolos como padres de la siguiente generación, el algoritmo evolutivo crea una nueva población hija usando operadores genéticos como la mutación y la recombinación. Según se van sucediendo generaciones, se espera que la población en conjunto se aproxime a la solución óptima al problema de encontrar una configuración del circuito adecuada que satisfaga las especificaciones. El estado de la tecnología de reconfiguración después de que la familia de FPGAs XC6200 de Xilinx fuera retirada y reemplazada por las familias Virtex a finales de los 90, supuso un gran obstáculo para el avance en hardware evolutivo; formatos de bitstream cerrados (no conocidos públicamente); dependencia de herramientas del fabricante con soporte limitado de DPR; una velocidad de reconfiguración lenta; y el hecho de que modificaciones aleatorias del bitstream pudieran resultar peligrosas para la integridad del dispositivo, son algunas de estas razones. Sin embargo, una propuesta a principios de los años 2000 permitió mantener la investigación en el campo mientras la tecnología de DPR continuaba madurando, el Circuito Virtual Reconfigurable (VRC, Virtual Reconfigurable Circuit). En esencia, un VRC en una FPGA es una capa virtual que actúa como un circuito reconfigurable de aplicación específica sobre la estructura nativa de la FPGA que reduce la complejidad del proceso reconfiguración y aumenta su velocidad (comparada con la reconfiguración nativa). Es un array de nodos computacionales especificados usando descripciones HDL estándar que define recursos reconfigurables ad-hoc: multiplexores de rutado y un conjunto de elementos de procesamiento configurables, cada uno de los cuales tiene implementadas todas las funciones requeridas, que pueden seleccionarse a través de multiplexores tal y como ocurre en una ALU de un microprocesador. Un registro grande actúa como memoria de configuración, por lo que la reconfiguración del VRC es muy rápida ya que tan sólo implica la escritura de este registro, el cual controla las señales de selección del conjunto de multiplexores. Sin embargo, esta capa virtual provoca: un incremento de área debido a la implementación simultánea de cada función en cada nodo del array más los multiplexores y un aumento del retardo debido a los multiplexores, reduciendo la frecuencia de funcionamiento máxima. La naturaleza del hardware evolutivo, capaz de optimizar su propio comportamiento computacional, le convierten en un buen candidato para avanzar en la investigación sobre sistemas auto-adaptativos. Combinar un sustrato de cómputo auto-reconfigurable capaz de ser modificado dinámicamente en tiempo de ejecución con un algoritmo empotrado que proporcione una dirección de cambio, puede ayudar a satisfacer los requisitos de adaptación autónoma de sistemas empotrados basados en FPGA. La propuesta principal de esta tesis está por tanto dirigida a contribuir a la auto-adaptación del hardware de procesamiento de sistemas empotrados basados en FPGA mediante hardware evolutivo. Esto se ha abordado considerando que el comportamiento computacional de un sistema puede ser modificado cambiando cualquiera de sus dos partes constitutivas: una estructura hard subyacente y un conjunto de parámetros soft. De esta distinción, se derivan dos lineas de trabajo. Por un lado, auto-adaptación paramétrica, y por otro auto-adaptación estructural. El objetivo perseguido en el caso de la auto-adaptación paramétrica es la implementación de técnicas de optimización evolutiva complejas en sistemas empotrados con recursos limitados para la adaptación paramétrica online de circuitos de procesamiento de señal. La aplicación seleccionada como prueba de concepto es la optimización para tipos muy específicos de imágenes de los coeficientes de los filtros de transformadas wavelet discretas (DWT, DiscreteWavelet Transform), orientada a la compresión de imágenes. Por tanto, el objetivo requerido de la evolución es una compresión adaptativa y más eficiente comparada con los procedimientos estándar. El principal reto radica en reducir la necesidad de recursos de supercomputación para el proceso de optimización propuesto en trabajos previos, de modo que se adecúe para la ejecución en sistemas empotrados. En cuanto a la auto-adaptación estructural, el objetivo de la tesis es la implementación de circuitos auto-adaptativos en sistemas evolutivos basados en FPGA mediante un uso eficiente de sus capacidades de reconfiguración nativas. En este caso, la prueba de concepto es la evolución de tareas de procesamiento de imagen tales como el filtrado de tipos desconocidos y cambiantes de ruido y la detección de bordes en la imagen. En general, el objetivo es la evolución en tiempo de ejecución de tareas de procesamiento de imagen desconocidas en tiempo de diseño (dentro de un cierto grado de complejidad). En este caso, el objetivo de la propuesta es la incorporación de DPR en EHW para evolucionar la arquitectura de un array sistólico adaptable mediante reconfiguración cuya capacidad de evolución no había sido estudiada previamente. Para conseguir los dos objetivos mencionados, esta tesis propone originalmente una plataforma evolutiva que integra un motor de adaptación (AE, Adaptation Engine), un motor de reconfiguración (RE, Reconfiguration Engine) y un motor computacional (CE, Computing Engine) adaptable. El el caso de adaptación paramétrica, la plataforma propuesta está caracterizada por: • un CE caracterizado por un núcleo de procesamiento hardware de DWT adaptable mediante registros reconfigurables que contienen los coeficientes de los filtros wavelet • un algoritmo evolutivo como AE que busca filtros wavelet candidatos a través de un proceso de optimización paramétrica desarrollado específicamente para sistemas caracterizados por recursos de procesamiento limitados • un nuevo operador de mutación simplificado para el algoritmo evolutivo utilizado, que junto con un mecanismo de evaluación rápida de filtros wavelet candidatos derivado de la literatura actual, asegura la viabilidad de la búsqueda evolutiva asociada a la adaptación de wavelets. En el caso de adaptación estructural, la plataforma propuesta toma la forma de: • un CE basado en una plantilla de array sistólico reconfigurable de 2 dimensiones compuesto de nodos de procesamiento reconfigurables • un algoritmo evolutivo como AE que busca configuraciones candidatas del array usando un conjunto de funcionalidades de procesamiento para los nodos disponible en una biblioteca accesible en tiempo de ejecución • un RE hardware que explota la capacidad de reconfiguración nativa de las FPGAs haciendo un uso eficiente de los recursos reconfigurables del dispositivo para cambiar el comportamiento del CE en tiempo de ejecución • una biblioteca de elementos de procesamiento reconfigurables caracterizada por bitstreams parciales independientes de la posición, usados como el conjunto de configuraciones disponibles para los nodos de procesamiento del array Las contribuciones principales de esta tesis se pueden resumir en la siguiente lista: • Una plataforma evolutiva basada en FPGA para la auto-adaptación paramétrica y estructural de sistemas empotrados compuesta por un motor computacional (CE), un motor de adaptación (AE) evolutivo y un motor de reconfiguración (RE). Esta plataforma se ha desarrollado y particularizado para los casos de auto-adaptación paramétrica y estructural. • En cuanto a la auto-adaptación paramétrica, las contribuciones principales son: – Un motor computacional adaptable mediante registros que permite la adaptación paramétrica de los coeficientes de una implementación hardware adaptativa de un núcleo de DWT. – Un motor de adaptación basado en un algoritmo evolutivo desarrollado específicamente para optimización numérica, aplicada a los coeficientes de filtros wavelet en sistemas empotrados con recursos limitados. – Un núcleo IP de DWT auto-adaptativo en tiempo de ejecución para sistemas empotrados que permite la optimización online del rendimiento de la transformada para compresión de imágenes en entornos específicos de despliegue, caracterizados por tipos diferentes de señal de entrada. – Un modelo software y una implementación hardware de una herramienta para la construcción evolutiva automática de transformadas wavelet específicas. • Por último, en cuanto a la auto-adaptación estructural, las contribuciones principales son: – Un motor computacional adaptable mediante reconfiguración nativa de FPGAs caracterizado por una plantilla de array sistólico en dos dimensiones de nodos de procesamiento reconfigurables. Es posible mapear diferentes tareas de cómputo en el array usando una biblioteca de elementos sencillos de procesamiento reconfigurables. – Definición de una biblioteca de elementos de procesamiento apropiada para la síntesis autónoma en tiempo de ejecución de diferentes tareas de procesamiento de imagen. – Incorporación eficiente de la reconfiguración parcial dinámica (DPR) en sistemas de hardware evolutivo, superando los principales inconvenientes de propuestas previas como los circuitos reconfigurables virtuales (VRCs). En este trabajo también se comparan originalmente los detalles de implementación de ambas propuestas. – Una plataforma tolerante a fallos, auto-curativa, que permite la recuperación funcional online en entornos peligrosos. La plataforma ha sido caracterizada desde una perspectiva de tolerancia a fallos: se proponen modelos de fallo a nivel de CLB y de elemento de procesamiento, y usando el motor de reconfiguración, se hace un análisis sistemático de fallos para un fallo en cada elemento de procesamiento y para dos fallos acumulados. – Una plataforma con calidad de filtrado dinámica que permite la adaptación online a tipos de ruido diferentes y diferentes comportamientos computacionales teniendo en cuenta los recursos de procesamiento disponibles. Por un lado, se evolucionan filtros con comportamientos no destructivos, que permiten esquemas de filtrado en cascada escalables; y por otro, también se evolucionan filtros escalables teniendo en cuenta requisitos computacionales de filtrado cambiantes dinámicamente. Este documento está organizado en cuatro partes y nueve capítulos. La primera parte contiene el capítulo 1, una introducción y motivación sobre este trabajo de tesis. A continuación, el marco de referencia en el que se enmarca esta tesis se analiza en la segunda parte: el capítulo 2 contiene una introducción a los conceptos de auto-adaptación y computación autonómica (autonomic computing) como un campo de investigación más general que el muy específico de este trabajo; el capítulo 3 introduce la computación evolutiva como la técnica para dirigir la adaptación; el capítulo 4 analiza las plataformas de computación reconfigurables como la tecnología para albergar hardware auto-adaptativo; y finalmente, el capítulo 5 define, clasifica y hace un sondeo del campo del hardware evolutivo. Seguidamente, la tercera parte de este trabajo contiene la propuesta, desarrollo y resultados obtenidos: mientras que el capítulo 6 contiene una declaración de los objetivos de la tesis y la descripción de la propuesta en su conjunto, los capítulos 7 y 8 abordan la auto-adaptación paramétrica y estructural, respectivamente. Finalmente, el capítulo 9 de la parte 4 concluye el trabajo y describe caminos de investigación futuros. ABSTRACT Embedded systems have traditionally been conceived to be specific-purpose computers with one, fixed computational task for their whole lifetime. Stringent requirements in terms of cost, size and weight forced designers to highly optimise their operation for very specific conditions. However, demands for versatility, more intelligent behaviour and, in summary, an increased computing capability began to clash with these limitations, intensified by the uncertainty associated to the more dynamic operating environments where they were progressively being deployed. This brought as a result an increasing need for systems to respond by themselves to unexpected events at design time, such as: changes in input data characteristics and system environment in general; changes in the computing platform itself, e.g., due to faults and fabrication defects; and changes in functional specifications caused by dynamically changing system objectives. As a consequence, systems complexity is increasing, but in turn, autonomous lifetime adaptation without human intervention is being progressively enabled, allowing them to take their own decisions at run-time. This type of systems is known, in general, as selfadaptive, and are able, among others, of self-configuration, self-optimisation and self-repair. Traditionally, the soft part of a system has mostly been so far the only place to provide systems with some degree of adaptation capabilities. However, the performance to power ratios of software driven devices like microprocessors are not adequate for embedded systems in many situations. In this scenario, the resulting rise in applications complexity is being partly addressed by rising devices complexity in the form of multi and many core devices; but sadly, this keeps on increasing power consumption. Besides, design methodologies have not been improved accordingly to completely leverage the available computational power from all these cores. Altogether, these factors make that the computing demands new applications pose are not being wholly satisfied. The traditional solution to improve performance to power ratios has been the switch to hardware driven specifications, mainly using ASICs. However, their costs are highly prohibitive except for some mass production cases and besidesthe static nature of its structure complicates the solution to the adaptation needs. The advancements in fabrication technologies have made that the once slow, small FPGA used as glue logic in bigger systems, had grown to be a very powerful, reconfigurable computing device with a vast amount of computational logic resources and embedded, hardened signal and general purpose processing cores. Its reconfiguration capabilities have enabled software-like flexibility to be combined with hardware-like computing performance, which has the potential to cause a paradigm shift in computer architecture since hardware cannot be considered as static anymore. This is so, since, as is the case with SRAMbased FPGAs, Dynamic Partial Reconfiguration (DPR) is possible. This means that subsets of the FPGA computational resources can now be changed (reconfigured) at run-time while the rest remains active. Besides, this reconfiguration process can be triggered internally by the device itself. This technological boost in reconfigurable hardware devices is actually covered under the field known as Reconfigurable Computing. One of the most exotic fields of application that Reconfigurable Computing has enabled is the known as Evolvable Hardware (EHW), in which this dissertation is framed. The main idea behind the concept is turning hardware that is adaptable through reconfiguration into an evolvable entity subject to the forces of an evolutionary process, inspired by that of natural, biological species, that guides the direction of change. It is yet another application of the field of Evolutionary Computation (EC), which comprises a set of global optimisation algorithms known as Evolutionary Algorithms (EAs), considered as universal problem solvers. In analogy to the biological process of evolution, in EHW the subject of evolution is a population of circuits that tries to get adapted to its surrounding environment by progressively getting better fitted to it generation after generation. Individuals become circuit configurations representing bitstreams that feature reconfigurable circuit descriptions. By selecting those that behave better, i.e., with a higher fitness value after being evaluated, and using them as parents of the following generation, the EA creates a new offspring population by using so called genetic operators like mutation and recombination. As generations succeed one another, the whole population is expected to approach to the optimum solution to the problem of finding an adequate circuit configuration that fulfils system objectives. The state of reconfiguration technology after Xilinx XC6200 FPGA family was discontinued and replaced by Virtex families in the late 90s, was a major obstacle for advancements in EHW; closed (non publicly known) bitstream formats; dependence on manufacturer tools with highly limiting support of DPR; slow speed of reconfiguration; and random bitstream modifications being potentially hazardous for device integrity, are some of these reasons. However, a proposal in the first 2000s allowed to keep investigating in this field while DPR technology kept maturing, the Virtual Reconfigurable Circuit (VRC). In essence, a VRC in an FPGA is a virtual layer acting as an application specific reconfigurable circuit on top of an FPGA fabric that reduces the complexity of the reconfiguration process and increases its speed (compared to native reconfiguration). It is an array of computational nodes specified using standard HDL descriptions that define ad-hoc reconfigurable resources; routing multiplexers and a set of configurable processing elements, each one containing all the required functions, which are selectable through functionality multiplexers as in microprocessor ALUs. A large register acts as configuration memory, so VRC reconfiguration is very fast given it only involves writing this register, which drives the selection signals of the set of multiplexers. However, large overheads are introduced by this virtual layer; an area overhead due to the simultaneous implementation of every function in every node of the array plus the multiplexers, and a delay overhead due to the multiplexers, which also reduces maximum frequency of operation. The very nature of Evolvable Hardware, able to optimise its own computational behaviour, makes it a good candidate to advance research in self-adaptive systems. Combining a selfreconfigurable computing substrate able to be dynamically changed at run-time with an embedded algorithm that provides a direction for change, can help fulfilling requirements for autonomous lifetime adaptation of FPGA-based embedded systems. The main proposal of this thesis is hence directed to contribute to autonomous self-adaptation of the underlying computational hardware of FPGA-based embedded systems by means of Evolvable Hardware. This is tackled by considering that the computational behaviour of a system can be modified by changing any of its two constituent parts: an underlying hard structure and a set of soft parameters. Two main lines of work derive from this distinction. On one side, parametric self-adaptation and, on the other side, structural self-adaptation. The goal pursued in the case of parametric self-adaptation is the implementation of complex evolutionary optimisation techniques in resource constrained embedded systems for online parameter adaptation of signal processing circuits. The application selected as proof of concept is the optimisation of Discrete Wavelet Transforms (DWT) filters coefficients for very specific types of images, oriented to image compression. Hence, adaptive and improved compression efficiency, as compared to standard techniques, is the required goal of evolution. The main quest lies in reducing the supercomputing resources reported in previous works for the optimisation process in order to make it suitable for embedded systems. Regarding structural self-adaptation, the thesis goal is the implementation of self-adaptive circuits in FPGA-based evolvable systems through an efficient use of native reconfiguration capabilities. In this case, evolution of image processing tasks such as filtering of unknown and changing types of noise and edge detection are the selected proofs of concept. In general, evolving unknown image processing behaviours (within a certain complexity range) at design time is the required goal. In this case, the mission of the proposal is the incorporation of DPR in EHW to evolve a systolic array architecture adaptable through reconfiguration whose evolvability had not been previously checked. In order to achieve the two stated goals, this thesis originally proposes an evolvable platform that integrates an Adaptation Engine (AE), a Reconfiguration Engine (RE) and an adaptable Computing Engine (CE). In the case of parametric adaptation, the proposed platform is characterised by: • a CE featuring a DWT hardware processing core adaptable through reconfigurable registers that holds wavelet filters coefficients • an evolutionary algorithm as AE that searches for candidate wavelet filters through a parametric optimisation process specifically developed for systems featured by scarce computing resources • a new, simplified mutation operator for the selected EA, that together with a fast evaluation mechanism of candidate wavelet filters derived from existing literature, assures the feasibility of the evolutionary search involved in wavelets adaptation In the case of structural adaptation, the platform proposal takes the form of: • a CE based on a reconfigurable 2D systolic array template composed of reconfigurable processing nodes • an evolutionary algorithm as AE that searches for candidate configurations of the array using a set of computational functionalities for the nodes available in a run time accessible library • a hardware RE that exploits native DPR capabilities of FPGAs and makes an efficient use of the available reconfigurable resources of the device to change the behaviour of the CE at run time • a library of reconfigurable processing elements featured by position-independent partial bitstreams used as the set of available configurations for the processing nodes of the array Main contributions of this thesis can be summarised in the following list. • An FPGA-based evolvable platform for parametric and structural self-adaptation of embedded systems composed of a Computing Engine, an evolutionary Adaptation Engine and a Reconfiguration Engine. This platform is further developed and tailored for both parametric and structural self-adaptation. • Regarding parametric self-adaptation, main contributions are: – A CE adaptable through reconfigurable registers that enables parametric adaptation of the coefficients of an adaptive hardware implementation of a DWT core. – An AE based on an Evolutionary Algorithm specifically developed for numerical optimisation applied to wavelet filter coefficients in resource constrained embedded systems. – A run-time self-adaptive DWT IP core for embedded systems that allows for online optimisation of transform performance for image compression for specific deployment environments characterised by different types of input signals. – A software model and hardware implementation of a tool for the automatic, evolutionary construction of custom wavelet transforms. • Lastly, regarding structural self-adaptation, main contributions are: – A CE adaptable through native FPGA fabric reconfiguration featured by a two dimensional systolic array template of reconfigurable processing nodes. Different processing behaviours can be automatically mapped in the array by using a library of simple reconfigurable processing elements. – Definition of a library of such processing elements suited for autonomous runtime synthesis of different image processing tasks. – Efficient incorporation of DPR in EHW systems, overcoming main drawbacks from the previous approach of virtual reconfigurable circuits. Implementation details for both approaches are also originally compared in this work. – A fault tolerant, self-healing platform that enables online functional recovery in hazardous environments. The platform has been characterised from a fault tolerance perspective: fault models at FPGA CLB level and processing elements level are proposed, and using the RE, a systematic fault analysis for one fault in every processing element and for two accumulated faults is done. – A dynamic filtering quality platform that permits on-line adaptation to different types of noise and different computing behaviours considering the available computing resources. On one side, non-destructive filters are evolved, enabling scalable cascaded filtering schemes; and on the other, size-scalable filters are also evolved considering dynamically changing computational filtering requirements. This dissertation is organized in four parts and nine chapters. First part contains chapter 1, the introduction to and motivation of this PhD work. Following, the reference framework in which this dissertation is framed is analysed in the second part: chapter 2 features an introduction to the notions of self-adaptation and autonomic computing as a more general research field to the very specific one of this work; chapter 3 introduces evolutionary computation as the technique to drive adaptation; chapter 4 analyses platforms for reconfigurable computing as the technology to hold self-adaptive hardware; and finally chapter 5 defines, classifies and surveys the field of Evolvable Hardware. Third part of the work follows, which contains the proposal, development and results obtained: while chapter 6 contains an statement of the thesis goals and the description of the proposal as a whole, chapters 7 and 8 address parametric and structural self-adaptation, respectively. Finally, chapter 9 in part 4 concludes the work and describes future research paths.

Axonal regeneration and lack of astrocytic gliosis in EphA4-deficient mice

Spinal cord injury usually results in permanent paralysis because of lack of regrowth of damaged neurons. Here we demonstrate that adult mice lacking EphA4 (-/-), a molecule essential for correct guidance of spinal cord axons during development, exhibit axonal regeneration and functional recovery after spinal cord hemisection. Anterograde and retrograde tracing showed that axons from multiple pathways, including corticospinal and rubrospinal tracts, crossed the lesion site. EphA4 -/- mice recovered stride length, the ability to walk on and climb a grid, and the ability to grasp with the affected hindpaw within 1-3 months of injury. EphA4 expression was upregulated on astrocytes at the lesion site in wild-type mice, whereas astrocytic gliosis and the glial scar were greatly reduced in lesioned EphA4-/- spinal cords. EphA4 -/- astrocytes failed to respond to the inflammatory cytokines, interferon-gamma or leukemia inhibitory factor, in vitro. Neurons grown on wild-type astrocytes extended shorter neurites than on EphA4 -/- astrocytes, but longer neurites when the astrocyte EphA4 was blocked by monomeric EphrinA5-Fc. Thus, EphA4 regulates two important features of spinal cord injury, axonal inhibition, and astrocytic gliosis.

Clinical decision-making and myocardial viability: current perspectives

Not all myocardium involved in a myocardial infarction is dead or irreversibly damaged. The balance between the amount of scar and live tissue, and the nature of the live tissue, determine the likelihood that contractile function will improve after revascularisation. This improvement (which defines viability) may be predicted with about 80% accuracy using several techniques. This review examines the determinants of functional recovery and how they may be integrated in making decisions regarding revascularisation. (Intern Med J 2005; 35: 118–125)

Novel renoprotective actions of erythropoietin: New uses for an old hormone

Erythropoietin (EPO) has been used widely for the treatment of anaemia associated with chronic kidney disease and cancer chemotherapy for nearly 20 years. More recently, EPO has been found to interact with its receptor (EPO-R) expressed in a large variety of non-haematopoietic tissues to induce a range of cytoprotective cellular responses, including mitogenesis, angiogenesis, inhibition of apoptosis and promotion of vascular repair through mobilization of endothelial progenitor cells from the bone marrow. Administration of EPO or its analogue, darbepoetin, promotes impressive renoprotection in experimental ischaemic and toxic acute renal failure, as evidenced by suppressed tubular epithelial apoptosis, enhanced tubular epithelial proliferation and hastened functional recovery. This effect is still apparent when administration is delayed up to 6 h after the onset of injury and can be dissociated from its haematological effects. Based on these highly encouraging results, at least one large randomized controlled trial of EPO therapy in ischaemic acute renal failure is currently underway. Preliminary experimental and clinical evidence also indicates that EPO may be renoprotective in chronic kidney disease. The purpose of the present article is to review the renoprotective benefits of different protocols of EPO therapy in the settings of acute and chronic kidney failure and the potential mechanisms underpinning these renoprotective actions. Gaining further insight into the pleiotropic actions of EPO will hopefully eventuate in much-needed, novel therapeutic strategies for patients with kidney disease.

Delayed administration of darbepoetin or erythropoietin protects against ischemic acute renal injury and failure

Administration of human recombinant erythropoietin ( EPO) at time of acute ischemic renal injury ( IRI) inhibits apoptosis, enhances tubular epithelial regeneration, and promotes renal functional recovery. The present study aimed to determine whether darbepoetin-alfa ( DPO) exhibits comparable renoprotection to that afforded by EPO, whether pro or antiapoptotic Bcl-2 proteins are involved, and whether delayed administration of EPO or DPO 6 h following IRI ameliorates renal dysfunction. The model of IRI involved bilateral renal artery occlusion for 45 min in rats ( N = 4 per group), followed by reperfusion for 1-7 days. Controls were sham-operated. Rats were treated at time of ischemia or sham operation ( T0), or post-treated ( 6 h after the onset of reperfusion, T6) with EPO ( 5000 IU/kg), DPO ( 25 mu g/kg), or appropriate vehicle by intraperitoneal injection. Renal function, structure, and immunohistochemistry for Bcl-2, Bcl-XL, and Bax were analyzed. DPO or EPO at T0 significantly abrogated renal dysfunction in IRI animals ( serum creatinine for IRI 0.17 +/- 0.05mmol/l vs DPO-IRI 0.08 +/- 0.03mmol/l vs EPO-IRI 0.04 +/- 0.01mmol/l, P = 0.01). Delayed administration of DPO or EPO ( T6) also significantly abrogated subsequent renal dysfunction ( serum creatinine for IRI 0.17 +/- 0.05mmol/l vs DPO-IRI 0.06 +/- 0.01mmol/l vs EPO-IRI 0.03 +/- 0.03mmol/l, P = 0.01). There was also significantly decreased tissue injury ( apoptosis, P < 0.05), decreased proapoptotic Bax, and increased regenerative capacity, especially in the outer stripe of the outer medulla, with DPO or EPO at T0 or T6. These results reaffirm the potential clinical application of DPO and EPO as novel renoprotective agents for patients at risk of ischemic acute renal failure or after having sustained an ischemic renal insult.