FRIEND JAMES (US)
OROSCO JEREMY (US)
CHALASANI SREEKANTH (US)
MAGARAM URI (US)
SALK INST BIOLOGICAL STUDIES (US)
US20150025422A1 | 2015-01-22 | |||
US20090108710A1 | 2009-04-30 | |||
US20080045882A1 | 2008-02-21 | |||
US20190022387A1 | 2019-01-24 |
CLAIMS What is claimed is: 1. A system, comprising: a stimulation apparatus; and a stimulation controller, comprising: at least one data processor; and at least one memory storing instructions which, when executed by the at least one data processor, cause operations comprising: predicting a cellular response to an application of ultrasound stimulation; determining, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient; and administering, to the patient, the ultrasound stimulation treatment by at least causing the stimulation apparatus to operate in accordance with the one or more parameters. 2. The system of claim 1, wherein the stimulation apparatus includes a transducer element formed from a crystal piezoelectric material. 3. The system of claim 2, wherein the crystal piezoelectric material comprises one or more of lithium niobate, lithium tantalate, quartz, and lithium tetraborate. 4. The system of any one of claims 2 to 3, wherein a diffuser is disposed on a first surface of the transducer element to reduce an intensity difference in an ultrasound stimulus generated by the transducer element. 5. The system of claim 4, wherein the diffuser comprises one or more wells machined in a substrate to form a plurality of pillars having varying height. 6. The system of claim 5, wherein the plurality of pillars are submillimeter in height. 7. The system of any one of claims 4 to 6, wherein an epoxy backing is disposed on a second surface of the transducer element. 8. The system of any one of claims 2 to 7, wherein the stimulation apparatus includes a connector configured to provide an electrical connection between the transducer element and a power source. 9. The system of claim 8, wherein the connector comprises a micro-miniature coaxial (MMCX) connector with rotary coaxial connections. 10. The system of any one of claims 8 to 9, wherein the stimulation apparatus further includes a bracket and a mounting plate configured to house the connector and the transducer element. 11. The system of claim 10, wherein the bracket and the mounting plate further house one or more magnets for securing the stimulation apparatus to a treatment area on the patient. 12. The system of any one of claims 1 to 11, wherein the stimulation apparatus is configured to deliver an acoustic pressure in response to a sinusoidal power input. 13. The system of claim 12, wherein a magnitude of the acoustic pressure relative to a dimension of the stimulation apparatus is at least 1 MPa acoustic pressure per gram of the stimulation apparatus. 14. The system of any one of claims 12 to 13, wherein the acoustic pressure is in a range between 0.4 MPa to 0.6 MPa when the sinusoidal power input is in a range of 0.5 watts to 2 watts. 15. The system of any one of claims 1 to 14, wherein the ultrasound stimulation treatment includes the stimulation apparatus delivering an ultrasonic stimulus to induce, in the patient, a cellular membrane deflection that causes a change in transmembrane voltage in multiple cell types. 16. The system of claim 15, wherein the one or more parameters include a magnitude and/or a duration of the ultrasonic stimulus for achieving a desired magnitude of cellular membrane deflection and/or transmembrane voltage changes in the patient. 17. The system of any one of claims 15 to 16, wherein the one or more parameters include an amplitude, a frequency, and/or a peak pressure of the ultrasonic stimulus for achieving a desired magnitude of cellular membrane deflection and/or transmembrane voltage changes in the patient. 18. The system of any one of claims 1 to 17, wherein the one or more parameters are determined by applying a deflection model modelling the cellular response to the application of ultrasound stimulation. 19. The system of claim 18, wherein the deflection model is generated based observations of cellular membrane deflection made using high-speed digital holographic microscopy (DHM) imaging. 20. The system of any one of claims 18 to 19, wherein the deflection model further models a change in transmembrane voltage based on a change in a capacitance of cellular membrane that corresponds to a change in an area of cellular membrane associated with the cellular membrane deflection. 21. A computer-implemented method, comprising: predicting a cellular response to an application of ultrasound stimulation; determining, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient; and administering, to the patient, the ultrasound stimulation treatment by at least causing a stimulation apparatus to operate in accordance with the one or more parameters. 22. The method of claim 1, wherein the stimulation apparatus includes a transducer element formed from a crystal piezoelectric material. 23. The method of claim 2, wherein the crystal piezoelectric material comprises one or more of lithium niobate, lithium tantalate, quartz, and lithium tetraborate. 24. The method of any one of claims 22 to 23, wherein a diffuser is disposed on a first surface of the transducer element to reduce an intensity difference in an ultrasound stimulus generated by the transducer element. 25. The method of claim 24, wherein the diffuser comprises one or more wells machined in a substrate to form a plurality of pillars having varying height. 26. The method of claim 25, wherein the plurality of pillars are submillimeter in height. 27. The method of any one of claims 24 to 26, wherein an epoxy backing is disposed on a second surface of the transducer element. 28. The method of any one of claims 22 to 27, wherein the stimulation apparatus includes a connector configured to provide an electrical connection between the transducer element and a power source. 29. The method of claim 28, wherein the connector comprises a micro-miniature coaxial (MMCX) connector with rotary coaxial connections. 30. The method of any one of claims 28 to 29, wherein the stimulation apparatus further includes a bracket and a mounting plate configured to house the connector and the transducer element. 31. The method of claim 30, wherein the bracket and the mounting plate further house one or more magnets for securing the stimulation apparatus to a treatment area on the patient. 32. The method of any one of claims 21 to 31, wherein the stimulation apparatus is configured to deliver an acoustic pressure in response to a sinusoidal power input. 33. The method of claim 32, wherein a magnitude of the acoustic pressure relative to a dimension of the stimulation apparatus is at least 1 MPa acoustic pressure per gram of the stimulation apparatus. 34. The method of any one of claims 32 to 33, wherein the acoustic pressure is in a range between 0.4 MPa to 0.6 MPa when the sinusoidal power input is in a range of 0.5 watts to 2 watts. 35. The method of any one of claims 21 to 34, wherein the ultrasound stimulation treatment includes the stimulation apparatus delivering an ultrasonic stimulus to induce, in the patient, a cellular membrane deflection that causes a change in transmembrane voltage in multiple cell types. 36. The method of claim 35, wherein the one or more parameters include a magnitude and/or a duration of the ultrasonic stimulus for achieving a desired magnitude of cellular membrane deflection and/or transmembrane voltage changes in the patient. 37. The method of any one of claims 35 to 36, wherein the one or more parameters include an amplitude, a frequency, and/or a peak pressure of the ultrasonic stimulus for achieving a desired magnitude of cellular membrane deflection and/or transmembrane voltage changes in the patient. 38. The method of any one of claims 21 to 37, wherein the one or more parameters are determined by applying a deflection model modeling the cellular response to the application of ultrasound stimulation. 39. The method of claim 38, wherein the deflection model is generated based observations of cellular membrane deflection made using high-speed digital holographic microscopy (DHM) imaging. 40. The method of any one of claims 38 to 29, wherein the deflection model further models a change in transmembrane voltage based on a change in a capacitance of cellular membrane that corresponds to a change in an area of cellular membrane associated with the cellular membrane deflection. 41. A non-transitory computer readable medium storing instructions, which when executed by at least one data processor, result in operations comprising: predicting a cellular response to an application of ultrasound stimulation; determining, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient; and administering, to the patient, the ultrasound stimulation treatment by at least causing a stimulation apparatus to operate in accordance with the one or more parameters. 42. An apparatus, comprising: means for predicting a cellular response to an application of ultrasound stimulation; means for determining, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient; and means for administering, to the patient, the ultrasound stimulation treatment by at least causing a stimulation apparatus to operate in accordance with the one or more parameters. 43. The apparatus of claim 42, wherein the apparatus is further configured to perform the method of any one of claims 21 to 40. 44. A stimulation apparatus, comprising: a transducer element formed from a crystal piezoelectric material; a diffuser disposed on a first surface of the transducer element to reduce an intensity difference in an ultrasound stimulus generated by the transducer element; an epoxy backing disposed on a second surface of the transducer element; a connector configured to provide an electrical connection between the transducer element and a power source; and a bracket and a mounting plate configured to house the connector and the transducer element. 45. The stimulation apparatus of claim 44, wherein the stimulation apparatus is coupled with a stimulation controller configured to predict a cellular response to an application of ultrasound stimulation, determine, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient, and administer, to the patient, the ultrasound stimulation treatment by at least causing the stimulation apparatus to operate in accordance with the one or more parameters. |
[0088] The design of the Schroder diffuser is based on quadratic-residue sequences defined by s n = n 2 , where n 2 where is the least non-negative remainder mod N, with N always an odd prime. One of the properties of this number sequence relevant to the design of an optimum diffuser is that both the Fourier transform of the exponential sequence r n = exp(i2 πS n / N) and by extension the scattered wave produced by it have a constant magnitude expressed by Equation (1) below in which
[0089] This may then be used to define the wells’ depths, d(x n , y n ) corresponding to the number sequence. In one dimension, the depth of the nth well is given by Equation (2). where a> r is the design frequency, N is a prime number, and c is the speed of sound in the medium. Extending the concept of a diffuser defined per the above numerical sequence to two dimensions involves replacing n 2 in the above formula with n 2 + m 2 , where m represents the number of wells in the second dimension. A representative image of a diffuser fabricated using a 2D sequence is shown as the diffuser 600 in FIG. 6.
[0090] While a ID diffuser creates a uniform 2D pressure field, a 2D diffuser with varying well depths creates a uniform 3D pressure field. Ultrasound neuromodulation typically relies on frequencies in the 1-10 megahertz range and this requires submillimeter well depths as defined by Equation (2). Although structures based on the quadratic-residue sequence have been achieved at the macroscale in two dimensions and at the microscale in one dimension, it has not been achieved in 2D structures on the micron to submillimeter scale due to the lack of established fabrication techniques for these dimensions. Conventional photolithography is good for creating patterns that have the same depth or, at most, a few different depths. It becomes challenging when features of varying depths are desired because multiple photolithography and etching steps are required. Alternate approaches, including 3D or two-photon printing methods, are unable to produce acoustically low-loss structures with sufficient dimensional accuracy at these scales. In some example embodiments, these limitations are overcome by using an excimer laser to machine submillimeter pillars of varying heights in a substrate material (e.g., glass) in two dimensions. Significant phase correlation (normalized autocorrelation >0.73) with the machined geometry is apparent from a time-domain laser Doppler vibrometry scan shown in FIG. 6. The transducer element 204 in the example shown in FIG. 6 may be driven at its resonance frequency with a sinusoidal input power range of 0.5-2 watts and a peak pressure output of 0.6 MPa as measured with a fiber optic hydrophone.
[0091] The benefit of using the diffuser 600 was considered using finite element analysis. The domain was chosen to mimic an experimental setup used for identifying ultrasound-sensitive ion channels in an in vitro setup. This includes an inverted fluorescence microscope with a custom perfusion chamber to house a coverslip and transducer. The simulation domain is illustrated in FIG. 7. Due to computational constraints, the simulation was modelled in two dimensions with 17 wells instead of the full 25-well system. The transducer element 204 and the diffuser 600 assembly were fixed at the bottom of the domain. A custom perfusion chamber that contains a slot for a coverslip was mounted over the ultrasound source. The transducer element 204 was coupled to the coverslip through water and there was a layer of media above the coverslip. The walls were defined to be rigid boundaries with an acoustic impedance Z i = ∞ such that the normal derivative of the total acoustic pressure . The diffuser 600 in the experimental setup includes of 17 elements, the heights of which were calculated from Equation (2). The coverslip serves as a solid boundary and allows the evaluation of the acoustic field in the closed domain below and the open domain above it, corresponding to the different boundary conditions assigned to the model.
[0092] The time variation of the pressure field with and without the diffuser 600 was evaluated. Several points in the fluid domain were chosen and the time evolution of the pressure field for the two cases was compared. A 2D autocorrelation was calculated in order to determine if there were any locations within the domain with coherence (echoes) or localized increases or decreases (constructive and destructive interference) in ultrasound intensity spatial and temporal patterns that form over the duration of the stimulus are represented by a 2D autocorrelation in FIG. 7. It is evident that there is both spatial and temporal periodicity with the transducer alone (see, e.g., FIG. 7(a)) that is greatly reduced when the diffuser is introduced (see, e.g., FIG. 7(b)). Videos of the sample autocorrelation in the domain over the stimulus duration show that there is greater autocorrelation over the duration of the stimulus without the diffuser 600. This indicates that the ultrasound field with the diffuser 600 is temporally aperiodic.
[0093] For the purpose of quantifying any changes to the diffraction at 7 megahertz through the inclusion of the diffuser, an isofrequency contour plot of the simulated data is provided in FIG. 8(a) without the diffuser 600 and in FIG. 8(b) with the diffuser 600. Without the diffuser 600, wave vectors are only present in the vicinity of k x = 0, along the direction of propagation of the pressure wave in the medium: the Y axis. The angular spread is 20 on either side of the direction of propagation without the diffuser. Particularly, the majority of the wave can be seen to be propagating along the Y axis, with significant sidelobes immediately to the left and right and much smaller sidelobes slightly farther away. Including the diffuser 600 produces wave vectors beyond the main direction of propagation (see, e.g., FIG. 8(b)), with significant components oriented along directions from the Y axis (along k x ) to the X axis (along k y ) The previously significant sidelobes remain significant, but are augmented by wave propagation beyond 45 in the XY plane. This indicates strong diffraction from the face of the transducer when including the diffuser. The rootmean-square (RMS) pressure was calculated to determine the temporal and spatial distribution of pressure 10 pm above the coverslip, as shown in FIG. 8(c). The inclusion of the diffuser 600 results in an even root-mean-square (RMS) pressure distribution along the coverslip, whereas the control case shows a fivefold variation of pressure across the coverslip face.
[0094] The testing setup to verify the effects of the diffuser 600 in vitro includes an upright optical imaging setup including an immersion objective, a custom perfusion chamber, and the diffuser assembly including the transducer element 204 coupled with the diffuser 600. The diffuser assembly and the testing setup are shown in FIG. 9(a). In this particular setup, the transducer element 204 may be formed from lithium niobate due to its relatively high coupling coefficient and zero hysteresis, which implies no heating from the piezoelectric material itself. Human embryonic kidney (HEK293) cells expressing GCaMP6f were transfected with hsTRPAl.
Fluorescence changes were analyzed across four cases, with and without the channel, without the diffuser 600 (e.g., the transducer element 204 alone), and with the diffuser 600. Representative GCaMP6f images of HEK293 cells transfected with hsTRPAl are shown in FIG. 9(b) and heat maps of fluorescence intensity with respect to time are presented in FIG. 9(c), with a clear increase in both the magnitude and number of cells being activated with the presence of the diffuser 600. Cells expressing hsTRPA1 and controls were tested at two different pressure amplitudes, 0.32 and 0.65 MPa, with the ambient pressure as the reference (zero) pressure. There was a consistent increase influorescence intensity with an increase in acoustic pressure for both the control and the hsTRPA1 condition, whether or not the diffuser 600 was present. As shown in FIG.9(d), including the diffuser 600, increased the meanfluorescence amplitude by at least a factor of two for cells that had been infected with hsTRPA1 (p < 0.0001). The application of ultrasound was also shown to have an effect on mouse primary cortical neurons. Neurons were infected with adeno-associated viral (AAV) vectors to express hsTRPA1 and a genetically encoded calcium indicator, GCaMP6f, or a control with only the calcium indicator. Ultrasound in this case triggered an increase in calcium uptake in both cases, with the hsTRPA1 neurons showing a greater number of activated cells in comparison to the control. [0095] The uniform nature of the ultrasoundfield created by the diffuser 600 was also verified ex vivo in a mouse skull while keeping as much of the mouse skull intact during preparation as possible. Pressure measurements were taken at two different locations as indicated in FIG. 10 along the anterior–posterior axis, at the ventral surface of the pons and the ventral surface of the anterior olfactory bulb. With the diffuser 600, the pressure at both these locations was uniform, with minimal deviation between them and a uniform increase with input power to the transducer element 204. However, the transducer element 204 alone produced diverging values of pressure at these positions, so much so that the pressure at the pons (triangle) exceeded the pressure at the anterior olfactory bulb (circle) by a factor of 3 at an input power of 3 watts, yet fell below the hydrophone's minimum measurement value, 0.2 MPa, at the anterior olfactory bulb when using less than 1.25 watts of power. By contrast, when the transducer element 204 is coupled with the diffuser 600, minimal deviation in pressure values are observed at these locations, with pressure values ranging from 0.25 to 0.5 MPa at the ventral surface of both the pons and the anterior olfactory bulb. These brain regions were chosen not for their function, but because they were remote and would therefore be expected to exhibit standing-wave behavior with large variations in the acoustic pressure. Collectively, these results demonstrate that the diffuser 600 is capable of delivering uniform ultrasoundfields in vivo in comparison to the transducer element 204 alone, thus enabling sonogenetic studies across large brain regions. [0096] As noted, existing non- and minimally invasive techniques to stimulate brain regions, such as transcranial magnetic stimulation and transcranial direct current stimulation, offer poor spatial resolution. This is a problem for precisely targeting brain regions that have specific functions. Ultrasound-based stimulation enables targeting brain regions with submillimeter-scale accuracy. This precision can be achieved in different ways, either by using an array to focus ultrasound to a specific region or by using sonogenetics to engineer cells to locally be more sensitive to mechanical stimuli. The development of sonogenetics that started with the TRP4 channel has expanded to include a library of proteins that are sensitive to ultrasound stimuli at different ultrasound stimulation parameters. Examples include MSC, TREK, Piezo, and other TRP channels, all of which have been shown to be sensitive to ultrasound in vitro. [0097] Nevertheless, as noted, a limitation with focused ultrasound is the alteration in the position and shape of the focal zone due to spatial variations in acoustic impedance. Sonogenetics is an attractive option because of the potential of having a toolkit of specific proteins that can be engineered to be sensitive to ultrasound stimuli at different frequencies or pressures. Current ultrasound transducers and how ultrasound interacts with the skull cavity are important limitations in translating sonogenetics into clinical practice. Standing waves in the skull cavity produce nodes and antinodes, each separated by one-half of the acoustic wavelength and responsible for pressure minima and maxima, respectively. This may lead to hemorrhage and heating in tissue as reported in past studies. One could attempt to overcome this issue by using broadband white noise to produce a spatiotemporally random acousticfield, but ultrasonic transducers are unable to provide such noise at pressures sufficient to elicit cellular responses. Considering the mechanical index for the ultrasound used with various examples of the stimulation apparatus 120 disclosed herein, which at below 0.15 is well below the U.S. Federal Drug Administration's clinical safety threshold index of 1.9 without microbubbles, cavitation and adverse heating effects are unlikely. [0098] In some example embodiments, the transducer element 204 of the stimulation apparatus 120 may be coupled with the diffuser 600. In some cases, the diffuser 600 may be a microscale Schröder diffuser designed via computational analysis and fabricated with an excimer laser. The diffuser 600 may be configured to eliminate the spatiotemporally heterogeneous distribution of ultrasound by placing it upon the transducer element 204. The transducer element 204 alone was shown to produce standing waves in the absence of the diffuser 600. With the diffuser 600 in place, autocorrelation of the ultrasoundfield quantifies the elimination of the standing waves and consequent suppression of antinodes associated with potential tissue damage. The predictions of the simulation were verified in vitro using HEK293 cells and neurons that were transfected with a sonogenetic candidate, hsTRPA1. [0099] Schröder's original diffuser design was to be used for diffusion of reflected sound in the farfield of the source, not the nearfield. The essential distinction here is that near the transducer element 204 (e.g., in the nearfield), the acousticfield will exhibit a different distribution than acoustic fields in the farfield away from the transducer element 204. In this case, the boundary between the near field and farfield from the transducer element 204 may be defined as ^^ = ^^ 2 ^^ −1 , where ^^ is the lateral size of the transducer element 204 and λ is the wavelength. Accordingly, the farfield of the transducer element 204 may begin 120 millimeters away from the transducer element 204. This is a far greater distance than the opposite side of the mouse skull, and so the entire system is in the nearfield of the transducer element 204. Existing efforts modify Schröder's diffuser design for optimal performance in the nearfield have been unsuccessful due to fabrication difficulties and modest improvements over the farfield design. Contrastingly, the results associated with various examples of the stimulation apparatus 120 disclosed show that mounting the diffuser 600 with a Schröder based design on the transducer element 204 itself (e.g., as close to the source as is physically possible) is capable of yielding effective results. [0100] It should be appreciated that development of sonogenetics in larger animal models—such as primates—will require ultrasound transducers that are capable of delivering an acousticfield that is spatially and temporally incoherent, a notable feature of various examples of the stimulation apparatus 120 disclosed herein. This ensures that the pressure in different regions of the target organ (e.g., brain, pancreas, and/or the like) is uniform over the stimulus duration, thus eliminating the aberrations in the acousticfield due to the skull cavity. Functionalization of specific brain regions using ultrasound-sensitive proteins can offer submillimeter spatial precision. Localization of sonogenetic proteins in combination with an acousticfield provided by a diffuser assembly will also ensure that the observed neuromodulatory effects are solely due to ultrasound activation of targeted regions of tissue and not due to the confounding effects of reflection or interference from the geometry of the skull. [0101] As noted, the actual sonogenetic and ultrasonic-to-chemical action mechanisms associated with ultrasonic cellular stimulation have eluded in vitro and in vivo analysis, yet such an understanding may be fundamental to a precise prescription, application, and control of ultrasonic cellular stimulation in a clinical setting. In some example embodiments, transmission high-speed digital holographic microscopy (DHM), which measures transparent media based on quantifying phase disparities induced by the measured sample, may be used to analyze the ultrasound induced cell membrane dynamics. For example, transmission high-speed digital holographic microscopy (DHM) may operate by comparing phase differences induced in the coherent light transmitted through the sample with reference light traversing an unobstructed path. Digital holographic microscopy has several advantages in comparison to conventional microscopic techniques. Numerical processing of the wavefront transmitted through the sample permits simultaneous computation of intensity and phase distribution. The holographic measurements also make it possible to focus on different object planes without relative movement between the stage and the lens and enables numerical lens aberration correction. The unique digital holographic microscopy system disclosed herein operates at high frame rates (40,000 frames per second) and includes the custom-built perfusion chamber with a built-in ultrasound transducer shown in FIG. 11(a). A heated stage keeps the media at a constant temperature over the duration of the recording. The system reconstructs phase images of cells that are then analyzed to determine the baseline profile (prior to ultrasound), during exposure to ultrasound, and afterward. This enables an accurate visualization of the maximum displacement of the membrane from the mean position under the influence of ultrasound. [0102] The measurements of apical cellular membrane deflection due to ultrasound includes a 25-millisecond baseline recording, followed by a 50-millisecond ultrasound stimulus, and a 25-millisecond post-stimulus dwell (see, e.g., FIG.11(b)), leading to a median deflection of 214 nanometers for human embryonic kidney (HEK293) cells and 159 nanometers for neurons, with a range of 100 to 550 nanometers m across the two tested cell types (see, e.g., FIG.11(c)). Sample reconstructed phase images of HEK293 cells, neurons, and neuronal clusters are shown in FIGS. 1(d) through (f). The baseline deflection for these samples, including a 95% confidence interval, had a range of ± 20 nanometers, inclusive of both random thermal fluctuations across the cell membrane and potential noise introduced to the system due to the imaging arrangement (see, e.g., FIGS.11(g) through (i)). Sample displacement baseline membrane profiles are illustrated in FIGS.11(g) through (h) for HEK293 cells and neurons, and FIG. 11(i) represents the deflection profile for a cluster of neurons. The cluster was imaged to confirm deflection in a group of neurons and help provide insight into the in vivo mechanisms of activation. Results from the neuronal cluster show that the magnitude of deflection remains roughly the same for a group of cells as for a single neuron. The larger deflection at the edges of the cluster is due to the neurons at the edges being less constrained in comparison to the ones in the center. [0103] In addition to membrane deflection during the generation of action potentials, the converse phenomenon of membrane deflection leading to the generation of action potentials may be explored using various examples of the digital holographic microscopy (DHM) system described herein. In particular, compared to other imaging techniques, examples of the digital holographic microscopy (DHM) system disclosed herein provides unparalleled spatiotemporal capabilities. Overall, the experimental setup confirmed that ultrasound stimulation induces cell membrane deflection for cells adherent to a coverslip. These results are further applied to generate a deflection model 115 which, as shown in FIG. 1, may be deployed as a part of the stimulation controller 110 to control the operations of the stimulation apparatus 120. [0104] Based upon the results from the experiments, with cells cultured on a surface and surrounded by media, the membrane is assumed to be fixed at the periphery. A similar case occurs in vivo, where the extracellular matrix holds individual cells in place and provides anchoring locations for sections of the membrane. Cellular anchoring is important because it imposes a characteristic distance over which the range of permissible deflection wavemodes may occur. Its deflection is restricted in the analysis to a single direction, perpendicular to the plane of the membrane and parallel to the direction of propagation of sound. In some cases, the deflection model 115 may ignore the restoring effects of the actin cytoskeleton, which is difficult to estimate and likely plays an important role in restoring the membrane to its original equilibrium position. [0105] The stimulus provided to the cells is in the form of a sinusoidal burst, which is a short-term continuously oscillating ultrasound signal of constant amplitude and frequency. In a burst, a sinusoidal electrical signal is typically applied across the piezoelectric material used in a transducer (e.g., the transducer element 204 of the stimulation apparatus 120), which transforms this signal into a sinusoidally varying pressure field in the fluid medium at the frequency of excitation. Instead of modeling the ultrasound as a step increase in hydrostatic pressure from zero to a fixed positive value at t = 0, the deflection model 115 may model ultrasound as a burst signal oscillating at the ultrasound frequency. An analytical solution for the slower time scale of the membrane mechanics may then be found in response to this harmonic ultrasound excitation. This solution is then used in the deflection model 115 to produce the solution for the deflection of the fixed membrane, resolving the discrepancy between the timescales of ultrasonic stimulation (≈0.1 μs) and the experimentally verified membrane deflection occurring on the order of milliseconds. This hybrid approach was chosen because a numerical simulation of the entire phenomena from ultrasound to membrane deflection would be extremely difficult due to the vastly different spatiotemporal scales, even with state-of-the-art computational resources. Finally, the corresponding hydrostatic pressure is discarded here, because it is orders of magnitude lower than the ultrasonic radiation pressure.
[0106] The damped wave equation describing the deflection, u, of the membrane in response to ultrasonic pressure, P us , is written as wherein p and T) are the dynamic viscosity and density of the surrounding fluid, both assumed to be the same as water as used in prior studies, y is the surface tension between the membrane and media; and d. is the characteristic length of the membrane between anchor points. Equation (3) was solved by the method of eigenfunction expansion. FIG. 11 provides results representative of the analysis, with a 1 MPa pressure supplied to the membrane using a 7 megahertz transducer in the form of a sine wave over a period of 5 milliseconds. The mechanical index for the parameters listed in this experimental setup is 0.37, well below the oft-cited mechanical index threshold for cavitation onset of 0.7 in bubble-perfused tissue. Since no bubbles were used in this setup, the U.S. Federal Drug Administration’s mandated clinical safety threshold index of 1.9 without introduced microbubbles is more appropriate. These data suggest that we are unlikely to cause cavitation and cell viability remains unaffected.
[0107] As shown in FIG. 12(a), maximum membrane deflection occurs when the ultrasound stimulus is applied, followed by decay due to viscous losses to the host medium. The magnitude of deflection depends on the stimulation frequency and peak pressure, with lower frequencies and higher pressures producing greater membrane deflection. The critical parameters that influence the deflection magnitude are the characteristic membrane anchor length and surface tension, as shown in FIG. 12(b). The deflection predicted by the deflection model 115 for dimensions relevant to the size of a cell are between 100 and 400 nanometers, irrespective of the value of surface tension for an anchor length ranging from 5-20 μm based on the average size of the soma and average diameter of HEK293 cells. When membrane deflection due to a range of surface tension values reported in the literature was modeled, maximum membrane deflection was predicted to occur at the midpoint of the axisymmetric membrane model. This is portrayed in FIG. 12(c), which provides graphical “snapshots” of the ultrasonically-forced membrane overtime. The closed-form displacement solution to Equation (3) provides a link to the fast ultrasonic timescales (on μ s order, or, total response) to phenomena occurring at observable timescales (on ms order, or, observed response), as shown in FIG. 12(d). The character of the membrane “slow time” response -that is, its ability (or lack thereof) to sustain oscillations - is governed by the value of the Ohnesorge number, Oh. The term is defined in this way because the membrane oscillations typically occur slowly (e.g., at a frequency far less than the incident ultrasound).
[0108] The nondimensional parameter Oh characterizes the importance of dissipative viscous forces relative to the combined interaction of conservative inertial and surface tension forces. In other words, Oh characterizes, on average, the extent to which the membrane dissipates or conserves mechanical energy. Typical Oh values for neurons range from ~0.06 to ~0.45 based on values of surface tension, viscosity, and membrane length considered in this work. This implies that inertial and surface tension forces dominate over viscous forces: the slow time membrane response is characteristically oscillatory. This behavior results from the membrane’s tendency toward retaining mechanical energy in the form of sustained oscillations when 0.8. This is explicitly derived in the detailed analysis and suggests that the slow time oscillations of the ultrasonically actuated membrane is implicated in the changes in the membrane capacitance as detailed in the following sections.
[0109] To model the electrical output of a neuron under the influence of ultrasound, a modified version of the original Hodgkin-Huxley equations is first used.
[0110] In this equation, the membrane potential of the neuron, Vm, changes over time with respect to the membrane capacitance, Cm, and the underlying currents, I app , I Na ,I Kd , I M , and is the well-known membrane potential of the cell and, notably, the action potential generation is controlled by the presence of an applied current, I app , while the other currents are based on the membrane morphology and chemistry. The increase of / app beyond a certain threshold produces spiking behaviour typical of neurons. The capacitance, Cm, may also fluctuate due to a morphological change in the membrane. Such a modification is not modeled in the original representation of this equation, but it maybe included. The voltage change as described in Equation (4) includes a time-dependent capacitive currentI app With this included in
Equation (4), it is possible to solve the differential equation for the voltage and gating variables while incorporating the capacitance change due to membrane deflection. Membrane deflection is constrained to a certain extent due to parts of the cell that are adherent to the substrate or the extracellular matrix. This causes an increase in area between the adherent locations and with sufficient deflection, this produces a depolarization across the membrane. The value of the transmembrane voltage is dependent on the magnitude and duration of the applied stimulus. FIG. 13 indicates the change in capacitance due to 6.72 megahertz ultrasound at 0.5 (FIG. 13(a)) and 1 MPa (FIG. 13(b)) with the corresponding area fluctuations that bring about the change in capacitance represented in FIG. 13(c). In order to compute the time dependent area variation, the slow time output of Equation (3) is extracted for use with the axisymmetric area integral. The capacitance of the membrane is then determined by treating it as a dielectric between charged surfaces. This produces a slow time capacitive response, bearing an order of magnitude equivalence to the ion channel relaxation times in the modified Hodgkin-Huxley model.
[0111] The stimulus of 1 MPa results in depolarization as indicated in FIG. 13(d), while the lower pressure does not result in the generation of an action potential over the stimulus duration. Reported values of baseline membrane capacitance have been shown to vary, and longer stimuli will result in the generation of action potentials as a cumulative effect of capacitance change over the duration of the stimulus. FIG. 13(e) represents transmembrane voltage changes for a stimulus of 50 milliseconds. Depolarization takes place in both cases. However, initial spikes are delayed by up to 20 milliseconds in the lower pressure case, indicating the need for increased stimulus durations for lower pressures. The deflection model 115 also shows a lower spike frequency for the 0.5 MPa case in comparison to 1 MPa. The simulation output of the deflection model 115 for the lower pressure and longer stimulus duration case were verified experimentally using voltage clamp electrophysiology (see, e.g., FIG. 13(f)) and shows an initial spike corresponding to the delivery of the ultrasound stimulus, followed by oscillations.
[0112] The deflection model 115 may represent how ultrasound results in membrane deflection and eventually leads to transmembrane voltage changes. At the outset, real-time membrane deflection due to ultrasound maybe demonstrated using high-speed digital holographic microscopy (DHM) imaging. The Hodgkin-Huxley equations, which are a set of phenomenological equations describing action potential generation in a squid axon and are one of the most important neuronal models, are leveraged. However, observations of mechanical deflection accompanying action potentials show that the underlying assumptions of the Hodgkin– Huxley model may need to be revisited, as there are mechanical phenomena involved. In the context of ultrasound neuromodulation, the deflection model 115 disclosed herein presents insights into the generation of action potentials due to mechanical deflections and is theoretically supported by other models. The deflection due to the applied ultrasound stimulus results in a net area change of the membrane between the two pin locations that represent an adherent cell. The area changes take place elastically while maintaining constant volume. This results in a change in capacitance that, when incorporated in the Hodgkin–Huxley model, results in transmembrane voltage changes. Capacitance of the membrane can be modeled using an expression for a parallel plate capacitor, and an increase in area results in a proportional increase in capacitance. [0113] The deflection model 115 does not take into account restoring effects of the actin cytoskeleton, whose influence will lower the membrane de-flection and cause the inner leaflet to deflect less than the outer leaflet. However, this cannot account for the ≈100 nm deflection observed in experiments, and only plays a minor role in bringing about capacitance changes according to previous studies. The deflection model 115 and the use of high-speed digital holographic microscopy (DHM) imaging present opportunities for exploring the influence of ultrasound on native neurons and HEK293 cells. A combination of fluorescence imaging with digital holographic microscopy can be used to image focal adhesions and cells that have been engineered to express membrane proteins that are sensitive to ultrasound stimuli, in other words using sonogenetics. At a cellular level, there are two proposed models for the activation of a mechanically-gated ion channel: the force from lipid model and the force from filament model. The force from lipid model proposes that changes in membrane tension or local membrane curvature result in opening or closing of channels. In the force from filament model, the stimulus is transferred to tethers that connect the membrane to the cytoskeleton. Conformational changes in the tethers result in opening or closing of the channel. In reality, both models play a part in opening and closing a given channel. [0114] Although it is difficult to estimate the relative contribution of these mechanisms, it is possible to estimate the deflection of the cell membrane as highlighted in the preceding sections. This is of particular significance given the membrane bound proteins such as TRPA1, MsCL, Piezo, and their interaction with the action network. Disruption of the actin cytoskeleton has been shown to reduce mechanosensitive activity of such ion channels and it is possibly due to decreased separation between the leaflets of the bilayer when the action network is disrupted. In addition to quantifying the deflection due to mechanosensitive proteins, there is potential to quantify the forces on the cell due to ultrasound using Förster resonance energy transfer force sensors. [0115] In some example embodiments, the deflection model 115 also predicts the generation of action potentials from capacitive changes that occur when the adherent cell is exposed to ultrasound. Charge across the membrane is maintained by a gradient in ion concentration across the cell membrane, with Na+ ions on the outside and Cl− ions on the inside, resulting in a net negative resting potential. As the membrane deflects, it is partially constrained by the adherent regions, resulting in an increase in area of the membrane between the adherent locations. An increase in the area of the membrane directly increases its capacitance. [0116] Transmembrane voltage changes are demonstrated for a pressure of 0.5 MPa and a pressure of 1 MPa. The observation is that voltage changes only take place for the higher pressure case for lower stimulus durations, thus defining a pressure threshold dependent upon the duration of stimulus. The influence of longer stimulus durations on the generation of action potentials is also investigated for different values of baseline capacitance. As verified by a current clamp electrophysiology study in the whole cell configuration, increased stimulus durations even at lower pressures result in action potential generation, though with lower spike rates. [0117] One of the limitations with performing single cell current clamp electrophysiology while using ultrasound at amplitudes sufficient to drive a physiological response is the loss of a seal between the membrane and the patch pipette due to the membrane’s deflection. There are, however, reports of current clamp electrophysiology results with ultrasound using microbubbles and at much higher frequencies or with devices. In each of these three cases, there is reason to believe that while the stimulation techniques or device may work for in vitro work, they will not be suitable for in vivo work. One potential way to overcome this issue would be to perform electrophysiological recordings for cells encased in matrigel that would limit the movement of the recording pipette with respect to the membrane. [0118] In some example embodiments, identifying the mechanisms underlying ultrasound neuromodulation offers valuable insight into the underlying effects of ultrasound on cell membranes, as well as insight into how these effects translate to transmembrane voltage changes. The predictions of the deflection model 115 were confirmed using a novel, high-speed imaging technique. Leveraging this real time visualization and quantification of membrane deflection, the deflection model 115 may enable a prediction of the depolarization due to the imposed ultrasound stimulus.
[0119] In some example embodiments, the deflection model 115 may be configured to the model membrane deflection and transmembrane voltage changes induced by ultrasound stimulus applied, for example, by the stimulation apparatus 120. As the pressure wave propagated through the fluid and contacted the adherent cell, the region of the cell membrane between adhesion zones deflected. This deflection led to a change in area of the membrane and causes a capacitance change. The two-dimensional model assumed that the membrane had a known value of surface tension.
The membrane was surrounded by a fluid, assumed to have the properties of water in this case. The vertical displacement of the membrane was approximated to be equal to the displacement of the fluid just above the membrane. The start was with a simplified version of the Navier-Stokes equation where p and rj are the density and viscosity of water, respectively. The expression VP is the pressure gradient and v is the velocity. In Equation (5), the convective acceleration is v • Vv = 0 as the flow is unidirectional in z and the fluid is assumed to be incompressible. The membrane was symmetric in x and y, allowing the viscous term to be simplified as θ x v z = θ y v z . What was left were
[0120] The net pressure gradient in this case is a function of the time dependent pressure in the fluid due to ultrasound and the surface tension of the membrane, which resists deformation where u is the displacement in z and P US is the pressure due to an ultrasound source, typically acting in the form of a sinusoidal pulse, P US = P 0 sin(wt), where to = 2π f. By contrast, other models at this point chose to represent the ultrasound as a step change in the pressure, from a static, zero relative pressure to a static positive value at time t = 0 well below the pressure amplitudes used in experimental studies, typically 1 kPa to 1 MPa. Such representations may be numerically attractive but difficult to reconcile with the harmonic oscillatory pressure delivered by the transducer. In the absence of an analytical solution for the ultrasound propagating through the medium and membrane, one would be forced to numerically represent the megahertz-order sinusoidal signal with sufficiently small spatiotemporal step sizes to satisfy the Nyquist criterion, and do so for at least several hundred milliseconds to determine the response of the cell membrane to the ultrasound pressure oscillation, producing very large models with many millions to billions of temporal steps for a single solution. Consequently, past studies were understandably forced to make spurious approximations to avoid impossibly prohibitive computation times.
[0121] Substituting this into Equation (6) produced a partial differential equation for the displacement of the membrane driven by ultrasound
[0122] The boundary conditions are the clamped conditions at the ends of the membrane and the initial displacement condition
[0123] If hydrostatic pressure is included, the initial condition for membrane displacement may be found by solving The general solution to partial differential Equation (8) was obtained with the method of eigenfunction expansion, as outlined further on. This was achieved using an orthogonal eigenbasis where X n = (n π/ d ) 2 corresponds to the nth wavemode for a membrane with diameter d.
Expanding u gives [0124] Accordingly, the even modes vanish and n = 2 k + 1 may be written, and 0 where Z is an integer set. Substituting this expression into Equation (6), one has where c 1 = 2n/ p and c 0 = 2πr /pd, are written in terms of the density of the surrounding fluid, p; the viscosity of the surrounding fluid, η the surface tension along the fluid-membrane interface, y; and the membrane diameter, d. By multiplying both sides by integrating over x from 0 to d, and then leveraging the orthogonality of sines, it was found that the time-dependent component for the nth eigenmode satisfied the second-order ordinary differential equation where
[0125] The means for obtaining a solution to equations of the form Equation (13) is known.
The homogeneous solution and its coefficients are given by where the coefficients n are
[0126] The inhomogeneous solution is where [0127] The total waveform solution was then numerically implemented by taking a finite- term approximation of Equation (11).
[0128] The change in area, A, of the membrane then be calculated once the time-dependent membrane deflection is obtained
[0129] By extension, this allowed to determine the change in membrane ca-pacitance, C, due to the area change where it was regarded that the membrane was a dielectric between two charged surfaces. In this case, L is the thickness of the bilayer and has values between 4 and 9 nanometers, and the relative permittivity, e, has a value of 2.
[0130] The above value of capacitance change was coupled with the modified Hodgkin-
Huxley neuronal model, where the capacitive current is defined as This model contained a voltage-gated sodium current and delayed-rectifier potassium current to generate actions, a slow non-inactivating potassium current to recapitulate the spike-frequency adaptation behaviour seen in thalamocortical cells, and a leakage current.
[0131] Equation (21) defines the voltage-gated Na + current where is the maximal conductance and E Na = 50mV is the Nemst potential of the Na + channels. The parameter sets the spike threshold where the gating variables m and h vary with time according to
where is the maximal conductance of the delayed-rectifier K + channels and is the Nemst potential of the K + channels, and with n evolving over time as
[0132] A slow non-inactivating Recurrent may be defined as where iiss tthhee mmaaxxiimmaall ccoonndduuccttaannccee aanndd ms is the decay time constant for adaptation of the slow non inactivation K+ channels. The parameter p is such that
[0133] The leakage current is where iiss tthhee mmaaxxiimmaall ccoonductance and nductance and is the Nemst potential of the non-voltage-dependent, nonspecific ion channels. The following initial conditions were set for the gating terms
[0134] Equations (21)- (26) were solved with initial conditions (28) to obtain the transmembrane voltage change of a neuron when subjected to ultrasound stimuli. A better understanding of the membrane wave propagation can be obtained by considering the decay transience of the constituent wavemodes within the context of the solution to Equation (14). Each wavemode will have a solution of the form where is the homogeneous solution and is the inhomogeneous solution for the forced wavemode propagation initialized from zero initial conditions? The general form of the former can be used to characterize the decay transience where the coefficients a are determined by the initial conditions and r + n are the eigenvalues of the left side of Equation (11) (the roots of the characteristic equation) as
[0135] Then the discriminant determines the character of the wavemode
[0136] The physical conditions for degeneracy required an exacting degree of marginality rarely (if ever) encountered in real systems, so that this solution type may be safely ignored (degeneracy corresponds to algebraic growth at small times that was mediated by exponential decay at longer times).
[0137] Rewriting the conditions (32) in terms of physical parameters, it was found that where is the Ohnesorge number characterizing the balance between the dissipative viscous effects and the conservative effects resulting from interaction between inertia and surface tension. There exists a condition for oscillation of the unforced membrane and this condition is When Oh < no oscillatory unforced wavemodes are permitted and the unforced membrane will not oscillate. When the condition is satisfied, it was observed that oscillation can be attributed exclusively to wavemodes with the “smallest” mode numbers, and that these will always include the fundamental mode.
[0138] FIG. 14 depicts a flowchart illustrating an example of a process 1400 for ultrasound based cellular stimulation, in accordance with some example embodiments. Referring to FIGS. 1- 14, the process 1400 may be performed by the ultrasound-based cellular stimulation system 100, for example, by the stimulation controller 110 and the stimulation apparatus 120.
[0139] At 1402, the stimulation controller 110 may predict a cellular response to application of ultrasound stimulation. In some example embodiments, the stimulation controller 110 may apply the deflection model 115 to predict a cellular membrane deflection and the corresponding transmembrane voltage changes induced by the application of an ultrasonic stimulus. As noted, the deflection model 115 may be formulated based on observations made using high-speed digital holographic microscopy (DHM) imaging of cellular membrane deflection (e.g., displacement of cellular membrane) under the influence of various ultrasonic stimulus. For instance, FIG. 11 shows that the measurements of apical cellular membrane deflection due to ultrasound includes a 25-millisecond baseline recording, followed by a 50-millisecond ultrasound stimulus, and a 25-millisecond post-stimulus dwell (see, e.g., FIG. 11(b)), leading to a median deflection of 214 nanometers for human embryonic kidney (HEK293) cells and 159 nanometers for neurons, with a range of 100 to 550 nanometers m across the two tested cell types (see, e.g., FIG. 11(c)). In accordance with the resulting deflection model 115, when subjected to an ultrasonic stimulus in the form of a sinusoidal burst (e.g., a short-term continuously oscillating ultrasound signal of constant amplitude and frequency), maximum membrane deflection is achieved when the ultrasound stimulus is first applied, followed by decay due to viscous losses to the host medium. Moreover, in accordance with the deflection model 115, the magnitude of cellular membrane deflection depends on the stimulation frequency and peak pressure, with lower frequencies and higher pressures producing greater membrane deflection. In some cases, the deflection model 115 applied to predict cellular responses for a patient may be generated using at least some patient-specific data. Alternatively and/or additionally, the deflection model 115 may be generated using at least some non-patient specific data collected from other patients and/or experimental cohorts. [0140] At 1404, the stimulation controller 110 may determine, based at least on the predicted cellular response, one or more parameters of an ultrasound stimulation treatment for a patient. For instance, in some example embodiments, the predicted cellular response may include a magnitude of cellular membrane deflection and/or transmembrane voltage changes induced by the application of an ultrasonic stimulus. Accordingly, the stimulation controller 110 may therefore determine one or more parameters of an ultrasound stimulation treatment for achieving a desired or suitable magnitude of cellular membrane deflection and/or transmembrane voltage changes for a particular patient. For example, the stimulation controller 110 may determine a magnitude and/or a duration of the ultrasonic stimulus for achieving the desired magnitude of cellular membrane deflection and/or transmembrane voltage changes for the patient. In some cases, the stimulation controller 110 may determine, based at least on the cellular responses predicted by the application of the deflection model 115, one or more of an amplitude, a frequency, and/or a pressure (e.g., peak pressure) of the ultrasonic stimulus to achieved the desired magnitude of cellular membrane deflection and/or transmembrane voltage changes for the patient. [0141] At 1406, the stimulation controller 110 may administer, to the patient, the ultrasound stimulation treatment by at least causing the stimulation apparatus 120 to operate in accordance with the one or more parameters. In some example embodiments, the stimulation controller 110 may operate, based at least on the one or more parameters determined in operation 1404, the stimulation apparatus 120 to administer the ultrasound stimulation treatment to the patient. As noted, the stimulation apparatus 120 may include the transducer element 204 formed from a single crystal piezoelectric material (e.g., lithium niobate and the like) having a certain fundamental frequency (e.g., such as approximately 7 megahertz) coupled with a minimal backing epoxy 206. As such, the transducer element 204 of the stimulation apparatus 120 may be driven at high powers without significant heating, thus avoiding tissue damage in the patient. In particular, the stimulation apparatus 120 may be driven at a high power to deliver high magnitudes of acoustic pressure relative to its dimensions (e.g., size, weight, and/or the like) and without significant heating. For example, the magnitude of the acoustic pressure relative to the dimension of the stimulation apparatus 120 may be at least 1 MPa acoustic pressure per gram of the stimulation apparatus 120. In some cases, the stimulation apparatus 120 may include the diffuser 600, which may be disposed on the surface of the transducer element 204 to maximize the uniformity of the ultrasound field created by the stimulation apparatus 120. The diffuser 600 may provide near lossless reduction in the presence of extremely high and low ultrasound intensity, and thus eliminates adverse effects such as heating and tissue damage. Various examples of the stimulation apparatus 120 disclosed herein are also lightweight, portable, and easily secured (e.g., via the magnets 212) to a treatment location of the patient to provide non-invasive or minimally invasive ultrasound based cellular stimulation. In the case of a sonogenetic treatment, for example, the ultrasound based stimulation delivered by the stimulation apparatus 120 may be applied to an area that have been pretreated (e.g., injected) with genetically engineered cells to be more responsive to the ultrasound stimulus. [0142] FIG.15 depicts a block diagram illustrating an example of a computing system 1500 consistent with implementations of the current subject matter. Referring to FIGS.1-15, the computing system 1500 may implement the stimulation controller 110 and/or any components therein. [0143] As shown in FIG.15, the computing system 1500 can include a processor 1510, a memory 1520, a storage device 1530, and input/output device 1540. The processor 1510, the memory 1520, the storage device 1530, and the input/output device 1540 can be interconnected via a system bus 550. The processor 1510 is capable of processing instructions for execution within the computing system 1500. Such executed instructions can implement one or more components of, for example, the stimulation controller 110. In some implementations of the current subject matter, the processor 1510 can be a single-threaded processor. Alternately, the processor 1510 can be a multi-threaded processor. The processor 1510 is capable of processing instructions stored in the memory 1520 and/or on the storage device 1530 to display graphical information for a user interface provided via the input/output device 1540. [0144] The memory 1520 is a computer readable medium such as volatile or non-volatile that stores information within the computing system 1500. The memory 1520 can store data structures representing configuration object databases, for example. The storage device 1530 is capable of providing persistent storage for the computing system 1500. The storage device 1530 can be a floppy disk device, a hard disk device, an optical disk device, or a tape device, or other suitable persistent storage means. The input/output device 1540 provides input/output operations for the computing system 1500. In some implementations of the current subject matter, the input/output device 1540 includes a keyboard and/or pointing device. In various implementations, the input/output device 1540 includes a display unit for displaying graphical user interfaces. [0145] According to some implementations of the current subject matter, the input/output device 1540 can provide input/output operations for a network device. For example, the input/output device 1540 can include Ethernet ports or other networking ports to communicate with one or more wired and/or wireless networks (e.g., a local area network (LAN), a wide area network (WAN), the Internet). [0146] In some implementations of the current subject matter, the computing system 1500 can be used to execute various interactive computer software applications that can be used for organization, analysis and/or storage of data in various (e.g., tabular) format (e.g., Microsoft Excel®, and/or any other type of software). Alternatively, the computing system 1500 can be used to execute any type of software applications. These applications can be used to perform various functionalities, e.g., planning functionalities (e.g., generating, managing, editing of spreadsheet documents, word processing documents, and/or any other objects, etc.), computing functionalities, communications functionalities, etc. The applications can include various add-in functionalities or can be standalone computing products and/or functionalities. Upon activation within the applications, the functionalities can be used to generate the user interface provided via the input/output device 1540. The user interface can be generated and presented to a user by the computing system 1500 (e.g., on a computer screen monitor, etc.). [0147] One or more aspects or features of the subject matter described herein can be realized in digital electronic circuitry, integrated circuitry, specially designed application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs) computer hardware, firmware, software, and/or combinations thereof. These various aspects or features can include implementation in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which can be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device, and at least one output device. The programmable system or computing system may include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. [0148] These computer programs, which can also be referred to as programs, software, software applications, applications, components, or code, include machine instructions for a programmable processor, and can be implemented in a high-level procedural and/or object- oriented programming language, and/or in assembly/machine language. As used herein, the term “machine-readable medium” refers to any computer program product, apparatus and/or device, such as for example magnetic discs, optical disks, memory, and Programmable Logic Devices (PLDs), used to provide machine instructions and/or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine-readable signal. The term “machine-readable signal” refers to any signal used to provide machine instructions and/or data to a programmable processor. The machine-readable medium can store such machine instructions non-transitorily, such as for example as would a non-transient solid- state memory or a magnetic hard drive or any equivalent storage medium. The machine-readable medium can alternatively or additionally store such machine instructions in a transient manner, such as for example, as would a processor cache or other random access memory associated with one or more physical processor cores. [0149] To provide for interaction with a user, one or more aspects or features of the subject matter described herein can be implemented on a computer having a display device, such as for example a cathode ray tube (CRT) or a liquid crystal display (LCD) or a light emitting diode (LED) monitor for displaying information to the user and a keyboard and a pointing device, such as for example a mouse or a trackball, by which the user may provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well. For example, feedback provided to the user can be any form of sensory feedback, such as for example visual feedback, auditory feedback, or tactile feedback; and input from the user may be received in any form, including acoustic, speech, or tactile input. Other possible input devices include touch screens or other touch-sensitive devices such as single or multi-point resistive or capacitive track pads, voice recognition hardware and software, optical scanners, optical pointers, digital image capture devices and associated interpretation software, and the like. [0150] In the descriptions above and in the claims, phrases such as “at least one of” or “one or more of” may occur followed by a conjunctive list of elements or features. The term “and/or” may also occur in a list of two or more elements or features. Unless otherwise implicitly or explicitly contradicted by the context in which it used, such a phrase is intended to mean any of the listed elements or features individually or any of the recited elements or features in combination with any of the other recited elements or features. For example, the phrases “at least one of A and B;” “one or more of A and B;” and “A and/or B” are each intended to mean “A alone, B alone, or A and B together.” A similar interpretation is also intended for lists including three or more items. For example, the phrases “at least one of A, B, and C;” “one or more of A, B, and C;” and “A, B, and/or C” are each intended to mean “A alone, B alone, C alone, A and B together, A and C together, B and C together, or A and B and C together.” Use of the term “based on,” above and in the claims is intended to mean, “based at least in part on,” such that an unrecited feature or element is also permissible. [0151] The subject matter described herein can be embodied in systems, apparatus, methods, and/or articles depending on the desired configuration. The implementations set forth in the foregoing description do not represent all implementations consistent with the subject matter described herein. Instead, they are merely some examples consistent with aspects related to the described subject matter. Although a few variations have been described in detail above, other modifications or additions are possible. In particular, further features and/or variations can be provided in addition to those set forth herein. For example, the implementations described above can be directed to various combinations and subcombinations of the disclosed features and/or combinations and subcombinations of several further features disclosed above. In addition, the logic flows depicted in the accompanying figures and/or described herein do not necessarily require the particular order shown, or sequential order, to achieve desirable results. Other implementations may be within the scope of the following claims.