Abstract: Introduction: Currently, there has been an increasing concern about the provision of palliative care in non-oncological patients in both professional literature and clinical practice. However, there is not much scientific information on how to provide neurological and palliative care together. The main objective of the project is to create and to verify a concept of neuro-palliative and rehabilitative care for patients with selected neurological diseases in an advanced stage of the disease and also to evaluate bio-psychosocial and spiritual needs of these patients and their caregivers related to the quality of life using created standardized tools. Methodology: Triangulation of research methods (qualitative and quantitative) will be used. A concept of care and assessment tools will be developed by analyzing interviews and focus groups. Qualitative data will be analyzed using grounded theory. The concept of care will be tested in the context of the intervention study. Using quantitative analysis, we will assess the effect of an intervention provided on the saturation of needs, quality of life, and quality of care. A research sample will be made up of the patients with selected neurological diseases (Parkinson´s syndrome, motor neuron disease, multiple sclerosis, Huntington’s disease), together with patients´ family members. Based on the results, educational materials and a certified course for health care professionals will be created. Findings: Based on qualitative data analysis, we will propose the concept of integrated care model combining neurological, rehabilitative and specialist palliative care for patients with selected neurological diseases in different settings of care and services. Patients´ needs related to quality of life will be described by newly created and validated measuring tools before the start of intervention (application of neuro-palliative and palliative approach) and then in the time interval. Conclusion: Based on the results, educational materials and a certified course for doctors and health care professionals will be created.
Abstract: In the last few years, resting-state functional MRI (rs-fMRI) was widely used to investigate the architecture of brain networks by investigating the Blood Oxygenation Level Dependent response. This technique represented an interesting, robust and reliable approach to compare pathologic and healthy subjects in order to investigate neurodegenerative diseases evolution. On the other hand, the elaboration of rs-fMRI data resulted to be very prone to noise due to confounding factors especially the head motion. Head motion has long been known to be a source of artefacts in task-based functional MRI studies, but it has become a particularly challenging problem in recent studies using rs-fMRI. The aim of this work was to evaluate in MS patients a well-known motion correction algorithm from the FMRIB's Software Library - MCFLIRT - that could be applied to minimize the head motion distortions, allowing to correctly interpret rs-fMRI results.
Abstract: Retinoblastoma is a rare type of childhood genetic cancer that affects children worldwide. The diagnosis is often missed due to lack of education and difficulty in presentation of the tumor. Frequently, the tumor on the retina is noticed by photography when the red-eye flash, commonly seen in normal eyes, is not produced. Instead, a yellow or white colored patch is seen or the child has a noticeable strabismus. Early detection can be life-saving though often results in removal of the affected eye. Remaining functioning in the healthy eye when the child is young has resulted in super-vision and high or above-average intelligence. Technological advancement of cameras has helped in early detection. Brain imaging has also made possible early detection of neurological diseases and, together with the monitoring of cortisol levels and yawning frequency, promises to be the next new early diagnostic tool for the detection of neurological diseases where cortisol insufficiency is particularly salient, such as multiple sclerosis and Cushing’s disease.
Abstract: Cortisol is important to our immune system, regulates our stress response, and is a factor in maintaining brain temperature. Saliva cortisol is a practical and useful non-invasive measurement that signifies the presence of the important hormone. Electrical activity in the jaw muscles typically rises when the muscles are moved during yawning and the electrical level is found to be correlated with the cortisol level. In two studies using identical paradigms, a total of 108 healthy subjects were exposed to yawning-provoking stimuli so that their cortisol levels and electrical nerve impulses from their jaw muscles was recorded. Electrical activity is highly correlated with cortisol levels in healthy people. The Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, health details were collected and exclusion criteria applied for voluntary recruitment: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. Significant differences were found between the saliva cortisol samples for the yawners as compared with the non-yawners between rest and post-stimuli. Significant evidence supports the Thompson Cortisol Hypothesis that suggests rises in cortisol levels are associated with yawning. Ethics approval granted and professional code of conduct, confidentiality, and safety issues are approved therein.
Abstract: Multiple Sclerosis (MS) is a disease which affects the
central nervous system and causes balance problem. In clinical, this
disorder is usually evaluated using static posturography. Some linear
or nonlinear measures, extracted from the posturographic data (i.e.
center of pressure, COP) recorded during a balance test, has been
used to analyze postural control of MS patients. In this study, the
trend (TREND) and the sample entropy (SampEn), two nonlinear
parameters were chosen to investigate their relationships with the
expanded disability status scale (EDSS) score. 40 volunteers with
different EDSS scores participated in our experiments with eyes open
(EO) and closed (EC). TREND and 2 types of SampEn (SampEn1
and SampEn2) were calculated for each combined COP’s position
signal. The results have shown that TREND had a weak negative
correlation to EDSS while SampEn2 had a strong positive correlation
to EDSS. Compared to TREND and SampEn1, SampEn2 showed a
better significant correlation to EDSS and an ability to discriminate
the MS patients in the EC case. In addition, the outcome of the study
suggests that the multi-dimensional nonlinear analysis could provide
some information about the impact of disability progression in MS on
dynamics of the COP data.
Abstract: In this paper, we present an application of Riemannian
geometry for processing non-Euclidean image data. We consider the
image as residing in a Riemannian manifold, for developing a new
method to brain edge detection and brain extraction. Automating this
process is a challenge due to the high diversity in appearance brain
tissue, among different patients and sequences. The main contribution, in this paper, is the use of an edge-based
anisotropic diffusion tensor for the segmentation task by integrating
both image edge geometry and Riemannian manifold (geodesic,
metric tensor) to regularize the convergence contour and extract
complex anatomical structures. We check the accuracy of the
segmentation results on simulated brain MRI scans of single
T1-weighted, T2-weighted and Proton Density sequences. We
validate our approach using two different databases: BrainWeb
database, and MRI Multiple sclerosis Database (MRI MS DB). We
have compared, qualitatively and quantitatively, our approach with
the well-known brain extraction algorithms. We show that using
a Riemannian manifolds to medical image analysis improves the
efficient results to brain extraction, in real time, outperforming the
results of the standard techniques.
Abstract: Cortisol is essential to the regulation of the immune
system and pathological yawning is a symptom of multiple sclerosis
(MS). Electromyography activity (EMG) in the jaw muscles typically
rises when the muscles are moved – extended or flexed; and yawning
has been shown to be highly correlated with cortisol levels in healthy
people as shown in the Thompson Cortisol Hypothesis. It is likely
that these elevated cortisol levels are also seen in people with MS.
The possible link between EMG in the jaw muscles and rises in saliva
cortisol levels during yawning were investigated in a randomized
controlled trial of 60 volunteers aged 18-69 years who were exposed
to conditions that were designed to elicit the yawning response.
Saliva samples were collected at the start and after yawning, or at the
end of the presentation of yawning-provoking stimuli, in the absence
of a yawn, and EMG data was additionally collected during rest and
yawning phases. Hospital Anxiety and Depression Scale, Yawning
Susceptibility Scale, General Health Questionnaire, demographic,
and health details were collected and the following exclusion criteria
were adopted: chronic fatigue, diabetes, fibromyalgia, heart
condition, high blood pressure, hormone replacement therapy,
multiple sclerosis, and stroke. Significant differences were found
between the saliva cortisol samples for the yawners, t (23) = -4.263, p
= 0.000, as compared with the non-yawners between rest and poststimuli,
which was non-significant. There were also significant
differences between yawners and non-yawners for the EMG
potentials with the yawners having higher rest and post-yawning
potentials. Significant evidence was found to support the Thompson
Cortisol Hypothesis suggesting that rises in cortisol levels are
associated with the yawning response. Further research is underway
to explore the use of cortisol as a potential diagnostic tool as an assist
to the early diagnosis of symptoms related to neurological disorders.
Bournemouth University Research & Ethics approval granted:
JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality,
and safety issues have been addressed and approved in the Ethics
submission. Trials identification number: ISRCTN61942768.
http://www.controlled-trials.com/isrctn/
Abstract: Cortisol is essential to the regulation of the immune
system and yawning is a pathological symptom of multiple sclerosis
(MS). Electromyography activity (EMG) in the jaw muscles typically
rises when the muscles are moved and with yawning is highly
correlated with cortisol levels in healthy people. Saliva samples from
59 participants were collected at the start and after yawning, or at the
end of the presentation of yawning-provoking stimuli, in the absence
of a yawn, together with EMG data and questionnaire data: Hospital
Anxiety and Depression Scale, Yawning Susceptibility Scale,
General Health Questionnaire, demographic, health details. Exclusion
criteria: chronic fatigue, diabetes, fibromyalgia, heart condition, high
blood pressure, hormone replacement therapy, multiple sclerosis,
stroke. Significant differences were found between the saliva cortisol
samples for the yawners, t (23) = -4.263, p = 0.000, as compared with
the non-yawners between rest and post-stimuli, which was nonsignificant.
Significant evidence was found to support the Thompson
Cortisol Hypothesis suggesting that rises in cortisol levels are
associated with yawning. Further research is exploring the use of
cortisol as an early diagnostic tool for MS. Ethics approval granted
and professional code of conduct, confidentiality, and safety issues
are approved therein.
Abstract: Paced Auditory Serial Addition Test (PASAT) has
been used as a common research tool for different neurological
disorders like Multiple Sclerosis. Recently, technology let
researchers to introduce a new versions of the visual test, the paced
visual serial addition test (PVSAT). In this paper, the computerized
version of these two tests is introduced. Beside the number of true
responses are interpreted, the reaction time of subjects are calculated
by the software. We hypothesize that paying attention to the reaction
time may be valuable. For this purpose, sixty eight female normal
subjects and fifty eight male normal subjects are enrolled in the
study. We investigate the similarity between the PASAT3 and
PVSAT3 in number of true responses and the new criterion (the
average reaction time of each subject). The similarity between two
tests were rejected (p-value = 0.000) which means that these two test
differ. The effect of sex in the tests were not approved since the pvalues
of different between PASAT3 and PVSAT3 in both sex is the
same (p-value = 0.000) which means that male and female subjects
performed the tests at no different level of performance. The new
criterion shows a negative correlation with the age which offers aged
normal subjects may have the same number of true responses as the
young subjects but they have latent responses. This will give prove
for the importance of reaction time.
Abstract: Acute disseminated encephalomyelitis (ADEM) has
been reported to develop after a hymenoptera sting, but its
pathogenesis is not known in detail. Myelin basic protein (MBP)-
specific T cells have been detected in the blood of patients with
ADEM, and a proportion of these patients develop multiple sclerosis
(MS). In an attempt to understand the mechanisms underlying
ADEM, molecular mimicry between hymenoptera venom peptides
and the human immunodominant MBP peptide was scrutinized,
based on the sequence and structural similarities, whether it was the
root of the disease. The results suggest that the three wasp venom
peptides have low sequence homology with the human
immunodominant MBP residues 85-99. Structural similarity analysis
among the three venom peptides and the MS-related HLA-DR2b
(DRA, DRB1*1501)-associated immunodominant MHC
binding/TCR contact residues 88-93, VVHFFK showed that
hyaluronidase residues 7-12, phospholipase A1 residues 98-103, and
antigen 5 residues 109-114 showed a high degree of similarity
83.3%, 100%, and 83.3% respectively. In conclusion, some wasp
venom peptides, particularly phospholipase A1, may potentially act
as the molecular motifs of the human 3HLA-DR2b-associated
immunodominant MBP88-93, and possibly present a mechanism for
induction of wasp sting-associated ADEM.
Abstract: In Multiple Sclerosis, pathological changes in the
brain results in deviations in signal intensity on Magnetic Resonance
Images (MRI). Quantitative analysis of these changes and their
correlation with clinical finding provides important information for
diagnosis. This constitutes the objective of our work. A new approach
is developed. After the enhancement of images contrast and the brain
extraction by mathematical morphology algorithm, we proceed to the
brain segmentation. Our approach is based on building statistical
model from data itself, for normal brain MRI and including clustering
tissue type. Then we detect signal abnormalities (MS lesions) as a
rejection class containing voxels that are not explained by the built
model. We validate the method on MR images of Multiple Sclerosis
patients by comparing its results with those of human expert
segmentation.