Stochastic models of synaptic plasticity must confront the corrosive influence of fluctuations in synaptic strength on patterns of synaptic connectivity. To solve this problem, we have proposed that synapses act as filters, integrating plasticity induction signals and expressing changes in synaptic strength only upon reaching filter threshold. Our earlier analytical study calculated the lifetimes of quasi-stable patterns of synaptic connectivity with synaptic filtering. We showed that the plasticity step size in a stochastic model of spike-timing-dependent plasticity (STDP) acts as a temperature-like parameter, exhibiting a critical value below which neuronal structure formation occurs. The filter threshold scales this temperature-like parameter downwards, cooling the dynamics and enhancing stability. A key step in this calculation was a resetting approximation, essentially reducing the dynamics to one-dimensional processes. Here, we revisit our earlier study to examine this resetting approximation, with the aim of understanding in detail why it works so well by comparing it, and a simpler approximation, to the system\'s full dynamics consisting of various embedded two-dimensional processes without resetting. Comparing the full system to the simpler approximation, to our original resetting approximation, and to a one-afferent system, we show that their equilibrium distributions of synaptic strengths and critical plasticity step sizes are all qualitatively similar, and increasingly quantitatively similar as the filter threshold increases. This increasing similarity is due to the decorrelation in changes in synaptic strength between different afferents caused by our STDP model, and the amplification of this decorrelation with larger synaptic filters.

OBJECTIVE: To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity.
METHODS: Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial.
METHODS: Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial.
METHODS: Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning-enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12-48) of treatment. These features were examined for their associations with anatomic and functional outcomes.
METHODS: Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ-retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA).
RESULTS: Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (P < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (P < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ r ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ r ≤ 0.41; SHRM volume: -0.33 ≤ r ≤ -0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all P < 0.01) and greater gains in BCVA (all P < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters.
CONCLUSIONS: Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Parkinson\'s disease (PD) is currently considered progressive neurodegeneration of both the central and peripheral nervous systems. Widespread neuropathological changes lead to a complex clinical presentation with typical motor (hypokinesia, tremor, and rigidity) and various nonmotor symptoms. Orthostatic hypotension is one of the most disabling nonmotor features contributing to increased morbidity and mortality and decreased quality of life (QoL). Our study aimed to disclose the effect of a continuous infusion of levodopa-carbidopa intestinal gel (LCIG) on symptoms of orthostatic hypotension. Nine patients indicated for LCIG and eight matched patients on optimized medical treatment (OMT) were examined with scales for orthostatic symptoms (SCOPA-AUT), nonmotor symptoms and motor fluctuations (MDS-UPDRS), and QoL (PDQ39) at both baseline and after six months. The scores of \"light-headedness after standing\" and \"fainting\" decreased in the LCIG group compared to the OMT group. Treatment with LCIG was associated with a significantly higher decrease in the score of \"light-headedness after standing\". Change in the PDQ39 correlated positively with fluctuation improvement and with change in the scores of both \"light-headedness\" and \"fainting\". LCIG treatment improved symptoms of orthostatic hypotension in patients with PD mainly by a reduction in motor complications. Decreased severity in both motor and nonmotor fluctuations was connected also with improved QoL. Continuous treatment with LCIG should be considered not only in the case of severe motor fluctuation but also in patients with nonmotor fluctuations responsive to dopaminergic treatment.

To evaluate the prevalence during a 10-year follow-up of clinically relevant fluctuations in pain and the course of hip pain in participants with hip complaints suspected to be early stage hip osteoarthritis (OA). To distinguish between participants with relevant fluctuations in pain and those without based on baseline characteristics.
Data were collected at baseline and after 2, 5, 8, and 10 years on 495 participants from the Cohort Hip and Cohort Knee Study (CHECK) with hip pain at baseline. Baseline demographic, anamnestic, and physical-examination characteristics were assessed. The primary outcome was levels of pain in the past week (scored using 0-10 Numeric Rating Scale) at follow-up assessments. Relevant fluctuation was defined as average absolute residuals greater than 1 after fitting a straight line to the participant\'s pain scores over time.
The majority of the participants (76%) had stable or decreasing pain. Relevant fluctuations were found in 37% of the participants. The following baseline variables were positively associated with the presence of relevant fluctuations: higher levels of pain in the past week, use of pain transformation as a coping style, higher number of comorbidities, use of pain medication, and higher levels of high-sensitivity C-reactive protein. No associations were found for baseline radiographic hip OA or clinical hip OA.
During a 10-year follow-up, the majority of participants had stable or decreasing pain levels. In those participants with relevant fluctuation (37%), a limited number of baseline variables were associated with increased odds of having relevant fluctuations in pain.
Pain appears to be an important reason for consulting the general practitioner (GP) for hip osteoarthritis (OA) complaints. We know that hip pain remained quite stable over 10 years. Also is known that there is considerable variety between patients in pain. In this study, we found relevant pain fluctuations in 37% of primary care patients with hip complaints over a period of 10 years. The pain fluctuation was not associated with having osteoarthritis, neither radiographic hip OA (diagnosed based on a X-ray) or clinical hip OA (determined according to the American College of Rheumatology (ACR) criteria) at baseline. More research is needed to discover why some people experience fluctuations in time than others.

This pilot study aimed to determine the effects of differential learning in sprint running with and without changes of direction (COD) on physical performance parameters in female basketball players and to determine the feasibility of the training protocol. Nine female basketball players completed 4 weeks of repeated sprint training (RST) with (COD, n = 4) or without (NCOD, n = 5) changes of direction. A battery of sprints (0-10 and 0-25 m), vertical jumps (counter movement jump (CMJ), drop jump, and single-leg CMJs), and COD tests were conducted before and after intervention. NCOD completed two sets of ten sprints of 20 m, whereas COD performed 20 m sprints with a 180 degree turn at 10 m, returning to the starting line. Before each sprint, participants were instructed to provide different fluctuations (i.e., differential learning) in terms of varying the sprint. Both groups had 30 s of passive recovery between two sprints and 3 min between sets. A significant effect of time for the 0-10 m sprint, CMJ, and single leg-CMJ asymmetries were observed. Adding \"erroneous\" fluctuation during RST seems to be a suitable and feasible strategy for coaches to enhance physical performance in young female basketball players. However, further studies including larger samples and controlled designs are recommended to strengthen present findings.

OBJECTIVE: To evaluate the effect of fluctuations in waist circumference (WC), weight, and body mass index (BMI) on the incidence of diabetes in older adults.
METHODS: A prospective cohort of 61,587 older adults (age, 60-96 years) who did not have diabetes at study initiation was examined. Data on weight, BMI, and WC were collected, and participants were followed up until 31 December 2018. The main end point was new-onset diabetes. A Cox regression model was used to estimate the risk of diabetes (hazard ratios [HRs] and confidence intervals [CI]) in these participants.
RESULTS: During a mean follow-up of 3.6 years, being overweight (HR [95% CI] 1.87 [1.62-2.17]), obesity (1.41 [1.26-1.59]), abdominal obesity (1.42 [1.28-1.58]), and obesity plus abdominal obesity at baseline (1.93 [1.66-2.25]) increased the risk of diabetes onset. Compared with older adults who \"maintained normal WC\", those who \"remained abdominally obese\" (HR = 1.66), \"became abdominally obese\" (HR = 1.58), or \"achieved normal WC\" (HR = 1.36) were at a higher risk of diabetes onset, as well as those with an increase in WC > 3 cm or > 5% compared with the baseline level. Weight gain or loss > 6 kg or weight gain > 5%, increase or decrease in BMI > 2 kg/m2, or an increase in BMI > 10% were associated with a higher diabetes risk. The diabetes risk was reduced by 19% in overweight older adults who exercised daily.
CONCLUSIONS: For older adults, WC, BMI, and healthy weight maintenance reduce the diabetes risk. The findings may provide evidence for developing guidelines of proper weight and WC control for older adults.

BACKGROUND: Parkinson\'s disease (PD) patients in chronic levodopa treatment may experience motor and non-motor fluctuations, which may affect their quality of life. Safinamide is a new monoamine oxidase B inhibitor, also exerting a non-dopaminergic effect, recently approved as add-on therapy in fluctuating PD patients.
METHODS: We performed a longitudinal prospective study in a cohort of 20 fluctuating PD patients, to test whether safinamide 50 mg may improve non-motor, cognitive, and behavioral symptoms over a 6-month treatment period. At each timepoint, clinical features were assessed by means of validated PD-specific scales. Neuropsychological assessment was performed by exploring all five cognitive domains.
RESULTS: Compared to baseline, significant improvement was found in PD patients at 6-month follow-up in items investigating interest (p = 0.02), motivation (p = 0.02), and urinary disturbances (p = 0.03). Moreover, neuropsychiatric assessment showed a significant decrease in fatigue and apathy scores (p = 0.02 and p = 0.01, respectively). Motor assessment revealed a significant reduction in the total wake-up time spent in OFF state (p = 0.01). Follow-up neuropsychological evaluation did not reveal any change compared to baseline.
CONCLUSIONS: Our data reveal that, along with motor fluctuation improvement, treatment with safinamide 50 mg may significantly decrease non-motor symptom burden in PD patients. Interestingly, non-dopaminergic mechanisms, such as glutamatergic overdrive, have been demonstrated to play a role in many pathways underlying these symptoms. Thus, we hypothesize that the neurotransmitter receptor-binding profile of safinamide may explain our findings.

We calculate the transverse velocity fluctuations correlation function of a linear and homogeneous viscoelastic liquid by using a generalized Langevin equation (GLE) approach. We consider a long-ranged (power-law) viscoelastic memory and a noise with a long-range (power-law) auto-correlation. We first evaluate the transverse velocity fluctuations correlation function for conventional time derivatives C ^ N F ( k → , t ) and then introduce time fractional derivatives in their equations of motion and calculate the corresponding fractional correlation function. We find that the magnitude of the fractional correlation C ^ F ( k → , t ) is always lower than the non-fractional one and decays more rapidly. The relationship between the fractional loss modulus G F ″ ( ω ) and C ^ F ( k → , t ) is also calculated analytically. The difference between the values of G ″ ( ω ) for two specific viscoelastic fluids is quantified. Our model calculation shows that the fractional effects on this measurable quantity may be three times as large as compared with its non-fractional value. The fact that the dynamic shear modulus is related to the light scattering spectrum suggests that the measurement of this property might be used as a suitable test to assess the effects of temporal fractional derivatives on a measurable property. Finally, we summarize the main results of our approach and emphasize that the eventual validity of our model calculations can only come from experimentation.

Variations in alertness and attention are common in Lewy body diseases (LBD) and among the core features of dementia with Lewy bodies (DLB). Dopamine transporter SPECT is an accurate biomarker of nigrostriatal degeneration (NSD) in LBD.
The present study investigated performance on a computerized alertness test as a potential measure of attention in patients with NSD compared to patients without NSD.
Thirty-six patients with cognitive impairment plus at least one core feature of DLB referred for [123I]FP-CIT SPECT imaging were prospectively recruited. Performance in a computerized test of intrinsic alertness was compared between patients with and those without NSD as assessed by [123I]FP-CIT SPECT.
Reaction times to auditory stimuli (adjusted for age, sex, and education) were significantly longer in patients with NSD compared to those with a normal [123I]FP-CIT SPECT scan (p < 0.05). Statistical analyses revealed no significant differences comparing reaction times to visual stimuli or dispersion of reaction times between groups. Exploratory analysis in a subgroup of patients with available [18F]FDG PET revealed that longer reaction times were associated with decreased glucose metabolism in the prefrontal cortex (statistical parametric mapping, adjusted for age and sex; p < 0.005, cluster extent > 50 voxels).
Computerized assessment of auditory reaction times is able to detect alertness deficits in patients with NSD and might help to measure alertness deficits in patients with LBD and NSD. Future studies in larger samples are needed to evaluate the diagnostic utility of computerized alertness assessment for the differential diagnosis of LBD.

Safinamide is a monoamine-oxidase-B inhibitor with peculiar features. At the dose of 100 mg/day, safinamide stimulates dopaminergic transmission and reduces glutamatergic transmission. Here, we investigated the effects of safinamide 100 mg on executive functions at the end of levodopa dose in fluctuating Parkinson\'s disease (PD) patients. Thirty-two fluctuating PD patients were submitted at baseline (V1) to the UPDRS-III, the Frontal Assessment Battery (FAB) and the Stroop-Word-Color-Test (SWCT) at the end of levodopa dose. Safinamide was then added to the original therapy. After 12 weeks of treatment, patients underwent the final visit (V2), including the UPDRS-III, the FAB and the SWCT with the same daily time schedule as V1. Treatment with safinamide was associated with significant increases of the total FAB score, SWCT-interference time score and UPDRS-III score. Within FAB subdomains, add-on with safinamide significantly increased motor programming and increased mental flexibility and inhibitory control scores. The results of this exploratory study show that add-on with safinamide improves executive functions at the end of levodopa dose in fluctuating PD patients. In particular, attention and inhibition of cognitive interference were significantly ameliorated by add-on with safinamide, suggesting increased modulatory performances of prefrontal cortical pathways. If confirmed by future research on larger cohorts and under controlled conditions, the present results may represent the basis for a novel indication for the use of safinamide in fluctuating PD patients.