Small nerve fiber quantification in the diagnosis of diabetic sensorimotor polyneuropathy: Comparing corneal confocal microscopy with intraepidermal nerve fiber density

OBJECTIVE Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard. RESEARCH DESIGN AND METHODS Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy. RESULTS Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14). CONCLUSIONS This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN.

The inferior whorl for detecting diabetic peripheral neuropathy using corneal confocal microscopy

PURPOSE: In vivo corneal confocal microscopy (CCM) is increasingly used as a surrogate endpoint in studies of diabetic polyneuropathy (DPN). However, it is not clear whether imaging the central cornea provides optimal diagnostic utility for DPN. Therefore, we compared nerve morphology in the central cornea and the inferior whorl, a more distal and densely innervated area located inferior and nasal to the central cornea. METHODS: A total of 53 subjects with type 1/type 2 diabetes and 15 age-matched control subjects underwent detailed assessment of neuropathic symptoms (NPS), deficits (neuropathy disability score [NDS]), quantitative sensory testing (vibration perception threshold [VPT], cold and warm threshold [CT/WT], and cold- and heat-induced pain [CIP/HIP]), and electrophysiology (sural and peroneal nerve conduction velocity [SSNCV/PMNCV], and sural and peroneal nerve amplitude [SSNA/PMNA]) to diagnose patients with (DPN+) and without (DPN-) neuropathy. Corneal nerve fiber density (CNFD) and length (CNFL) in the central cornea, and inferior whorl length (IWL) were quantified. RESULTS: Comparing control subjects to DPN- and DPN+ patients, there was a significant increase in NDS (0 vs. 2.6 ± 2.3 vs. 3.3 ± 2.7, P < 0.01), VPT (V; 5.4 ± 3.0 vs. 10.6 ± 10.3 vs. 17.7 ± 11.8, P < 0.01), WT (°C; 37.7 ± 3.5 vs. 39.1 ± 5.1 vs. 41.7 ± 4.7, P < 0.05), and a significant decrease in SSNCV (m/s; 50.2 ± 5.4 vs. 48.4 ± 5.0 vs. 39.5 ± 10.6, P < 0.05), CNFD (fibers/mm2; 37.8 ± 4.9 vs. 29.7 ± 7.7 vs. 27.1 ± 9.9, P < 0.01), CNFL (mm/mm2; 27.5 ± 3.6 vs. 24.4 ± 7.8 vs. 20.7 ± 7.1, P < 0.01), and IWL (mm/mm2; 35.1 ± 6.5 vs. 26.2 ± 10.5 vs. 23.6 ± 11.4, P < 0.05). For the diagnosis of DPN, CNFD, CNFL, and IWL achieved an area under the curve (AUC) of 0.75, 0.74, and 0.70, respectively, and a combination of IWL-CNFD achieved an AUC of 0.76. CONCLUSIONS: The parameters of CNFD, CNFL, and IWL have a comparable ability to diagnose patients with DPN. However, IWL detects an abnormality even in patients without DPN. Combining IWL with CNFD may improve the diagnostic performance of CCM.

Assessment of conjunctival goblet cell density using laser scanning confocal microscopy versus impression cytology

Purpose To determine the association between conjunctival goblet cell density (GCD) assessed using in vivo laser scanning confocal microscopy and conjunctival impression cytology in a healthy population. Methods Ninety (90) healthy participants undertook a validated 5-item dry eye questionnaire, non-invasive tear film break-up time measurement, ocular surface fluorescein staining and phenol red thread test. These tests where undertaken to diagnose and exclude participants with dry eye. The nasal bulbar conjunctiva was imaged using laser scanning confocal microscopy (LSCM). Conjunctival impression cytology (CIC) was performed in the same region a few minutes later. Conjunctival goblet cell density was calculated as cells/mm2. Results There was a strong positive correlation of conjunctival GCD between LSCM and CIC (ρ = 0.66). Conjunctival goblet cell density was 475 ± 41 cells/mm2 and 466 ± 51 cells/mm2 measured by LSCM and CIC, respectively. Conclusions The strong association between in vivo and in vitro cellular analysis for measuring conjunctival GCD suggests that the more invasive CIC can be replaced by the less invasive LSCM in research and clinical practice.

Multiple excitation nano-spot generation and confocal detection for far-field microscopy

An imaging technique is developed for the controlled generation of multiple excitation nano-spots for far-field microscopy. The system point spread function (PSF) is obtained by interfering two counter-propagating extended depth-of-focus PSF (DoF-PSF), resulting in highly localized multiple excitation spots along the optical axis. The technique permits (1) simultaneous excitation of multiple planes in the specimen; (2) control of the number of spots by confocal detection; and (3) overcoming the point-by-point based excitation. Fluorescence detection from the excitation spots can be efficiently achieved by Z-scanning the detector/pinhole assembly. The technique complements most of the bioimaging techniques and may find potential application in high resolution fluorescence microscopy and nanoscale imaging.

A Huber-loss-driven clustering technique and its application to robust cell detection in confocal microscopy images

We address the problem of detecting cells in biological images. The problem is important in many automated image analysis applications. We identify the problem as one of clustering and formulate it within the framework of robust estimation using loss functions. We show how suitable loss functions may be chosen based on a priori knowledge of the noise distribution. Specifically, in the context of biological images, since the measurement noise is not Gaussian, quadratic loss functions yield suboptimal results. We show that by incorporating the Huber loss function, cells can be detected robustly and accurately. To initialize the algorithm, we also propose a seed selection approach. Simulation results show that Huber loss exhibits better performance compared with some standard loss functions. We also provide experimental results on confocal images of yeast cells. The proposed technique exhibits good detection performance even when the signal-to-noise ratio is low.

Taylor series expansion based multidimensional image reconstruction for confocal and 4pi microscopy

We propose and experimentally demonstrate a three-dimensional (3D) image reconstruction methodology based on Taylor series approximation (TSA) in a Bayesian image reconstruction formulation. TSA incorporates the requirement of analyticity in the image domain, and acts as a finite impulse response filter. This technique is validated on images obtained from widefield, confocal laser scanning fluorescence microscopy and two-photon excited 4pi (2PE-4pi) fluorescence microscopy. Studies on simulated 3D objects, mitochondria-tagged yeast cells (labeled with Mitotracker Orange) and mitochondrial networks (tagged with Green fluorescent protein) show a signal-to-background improvement of 40% and resolution enhancement from 360 to 240 nm. This technique can easily be extended to other imaging modalities (single plane illumination microscopy (SPIM), individual molecule localization SPIM, stimulated emission depletion microscopy and its variants).

MRT Letter: A Unified Accelerated Maximum Likelihood Technique for Widefield, Confocal, and Super-Resolution 4Pi Microscopy

We propose an algorithmic technique for accelerating maximum likelihood (ML) algorithm for image reconstruction in fluorescence microscopy. This is made possible by integrating Biggs-Andrews (BA) method with ML approach. The results on widefield, confocal, and super-resolution 4Pi microscopy reveal substantial improvement in the speed of 3D image reconstruction (the number of iterations has reduced by approximately one-half). Moreover, the quality of reconstruction obtained using accelerated ML closely resembles with nonaccelerated ML method. The proposed technique is a step closer to realize real-time reconstruction in 3D fluorescence microscopy. Microsc. Res. Tech. 78:331-335, 2015. (c) 2015 Wiley Periodicals, Inc.

Dual Confocal Laser-Induced Fluorescence/Moveable Contactless Conductivity Detector For Capillary Electrophoresis Microchip

A new dual simultaneous detector was developed for capillary electrophoresis microchip. Confocal laser-induced fluorescence (LIF) and moveable contactless conductivity detection (MCCD) were combined together for the first time. The two detection systems shared a common detection cell and could respond simultaneously. They were mutually independent and advantageous in analyses of mixtures containing organic and inorganic ions. The confocal LIF had high sensitivity and the MCCD could move along the separation channel and detect in different positions of the channel. The detection conditions of the dual detector were optimized. Rhodamine B was used to evaluate the performance of the dual detector. The limit of detection of the confocal LIF was < 5 nM, and that of the MCCD was 0.1 mu M. The dual detector had highly sensitivity and could offer response easily, rapidly and simultaneously. 

Dual confocal laser-induced fluorescence/moveable contactless

A new dual simultaneous detector was developed for capillary electrophoresis microchip. Confocal laser-induced fluorescence (LIF) and moveable contactless conductivity detection (MCCD) were combined together for the first time. The two detection systems shared a common detection cell and could respond simultaneously. They were mutually independent and advantageous in analyses of mixtures containing organic and inorganic ions. The confocal LIF had high sensitivity and the MCCD could move along the separation channel and detect in different positions of the channel. The detection conditions of the dual detector were optimized. Rhodamine B was used to evaluate the performance of the dual detector. The limit of detection of the confocal LIF was <5 nM, and that of the MCCD was 0.1 μM. The dual detector had highly sensitivity and could offer response easily, rapidly and simultaneously.

Effect of an annular pupil filter on differential confocal microscopy

Combining differential confocal microscopy and an annular pupil filter, we obtained the normalized axial intensity distribution curve of an optical system. We used the sharp slopes of the axial response curve of the optical system to measure the surface profile of a reflection grating. Experimental results prove that this method can extend the axial dynamic range and improve the transverse resolution of three-dimensional profilometry by sacrificing axial resolution. (C) 2000 Optical Society of America.

Adesão dos cimentos Epiphany SE e iRoot SP: Resistência à tração e mapeamento dentinário por microscopia digital

O objetivo deste estudo foi avaliar o efeito da microestrutura dentinária na adesão de cimentos endodônticos modernos através: do desenvolvimento de uma metodologia para caracterizar microestruturalmente a dentina; da avaliação da resistência de união (através de ensaios de tração) dos cimentos endodônticos Epiphany SE, iRoot SP e AH Plus; da correlação dos dados obtidos da caracterização da microestrutura dentinária e dos ensaios de tração. Trinta terceiros molares inclusos, recém extraídos, foram embutidos em resina epóxi e seccionados 0,5mm abaixo da junção esmalte-dentina. Doze amostras foram eliminadas durante à preparação metalográfica devido à exposição da câmara pulpar. De cada dente, uma área de análise (AA) com 3,25 mm de diâmetro foi mapeada utilizando técnicas de microscopia ótica digital para: captura de ~400 imagens formando um mosaico; análise digital de imagens, obtendo os resultados de quantidade de túbulos (QT) e de fração de área de túbulos (FAT) do mosaico; conversão da imagem do mosaico em um mapa colorido em que as cores estão diretamente relacionadas à densidade de área tubular. As dezoito amostras restantes foram divididas em 3 grupos (N=6), de acordo com o cimento utilizado, para confecção dos corpos de prova para os ensaios de tração. Os valores de da resistência de união (RU) obtidos foram analisados estatisticamente com teste não-pareado t com correção de Welch e pelo teste F para comparar variâncias Os dados de FAT e de QT foram submetidos ao teste de D'Agostino & Pearson revelando-se não normais (P>0,05), o que indica grande variabilidade da amostragem. O cimento Epiphany SE apresentou uma resistência de união significativamente menor que o cimento AH Plus (P <0,05). Os corpos de prova do iRoot SP falharam prematuramente e não foram analisados. A aplicação do teste r de Spearman não demonstrou correlação significativa entre FAT e RU (P>0,05). O MEV de pressão variável foi utilizado para avaliar qualitativamente a superfície de fratura após os ensaios de tração. A análise revelou um padrão de fratura mista para o AH Plus e o Epiphany SE, além de diferenças no tamanho e na forma das partículas desses cimentos, o que pode influenciar no comportamento mecânico. Dentro da amostragem realizada, não se encontrou correlação significativa entre microestrutura dentinária e a resistência de união.

Emprego de microscopia de fluorescência para a quantificação microbiana em amostras salinas da indústria do petróleo

Os micro-organismos constituem um grande problema em termos econômicos para a indústria petrolífera. Estes são responsáveis pela produção de substâncias corrosivas e a formação de biofilmes, que causam deterioração dos materiais metálicos. Os principais grupos microbianos presentes em amostras ambientais da indústria do petróleo são as bactérias anaeróbias heterotróficas totais (BANHT) e as bactérias redutoras de sulfato (BRS). Atualmente, a quantificação desses grupos microbianos é realizada através da técnica do Número Mais Provável (NMP) que estima o resultado em aproximadamente 28 dias. Neste trabalho foi otimizada uma metodologia para a microscopia de fluorescência de amostras salinas provenientes de tanques de armazenamento de água/óleo. As condições testadas foram o tipo de óleo de imersão, o tipo de diluente, o volume do corante, o volume da amostra corada e a concentração do fixador (glutaraldeído) numa tentativa de correlacionar com resultados de quantificação de BANHT e BRS através da técnica convencional do NMP. Nesse caso, as células totais foram quantificadas por microscopia de fluorescência utilizando o corante fluorescente laranja de acridina (AO). Verificou-se que houve uma correlação entre os resultados da quantificação de células totais por microscopia de fluorescência e os resultados de BANHT pela técnica do NMP, devido a pouca variação de valores expressos em ambas as quantificações. Entretanto, não foi possível correlacionar os resultados da quantificação de células totais com os resultados de BRS por NMP devido à grande variação dos valores de quantificação de BRS. Na microscopia de fluorescência, foi possível, quantificar os micro-organismos em aproximadamente 30 minutos e através das fotografias, verificou-se ainda que as amostras apresentaram-se nítidas e os micro-organismos com uma boa fluorescência