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Journal articleThayyil S, Oliveira V, Lally PJ, et al., 2017,
Hypothermia for encephalopathy in low and middle-income countries (HELIX): study protocol for a randomised controlled trial.
, Trials, Vol: 18, ISSN: 1745-6215BACKGROUND: Therapeutic hypothermia reduces death and disability after moderate or severe neonatal encephalopathy in high-income countries and is used as standard therapy in these settings. However, the safety and efficacy of cooling therapy in low- and middle-income countries (LMICs), where 99% of the disease burden occurs, remains unclear. We will examine whether whole body cooling reduces death or neurodisability at 18-22 months after neonatal encephalopathy, in LMICs. METHODS: We will randomly allocate 408 term or near-term babies (aged ≤ 6 h) with moderate or severe neonatal encephalopathy admitted to public sector neonatal units in LMIC countries (India, Bangladesh or Sri Lanka), to either usual care alone or whole-body cooling with usual care. Babies allocated to the cooling arm will have core body temperature maintained at 33.5 °C using a servo-controlled cooling device for 72 h, followed by re-warming at 0.5 °C per hour. All babies will have detailed infection screening at the time of recruitment and 3 Telsa cerebral magnetic resonance imaging and spectroscopy at 1-2 weeks after birth. Our primary endpoint is death or moderate or severe disability at the age of 18 months. DISCUSSION: Upon completion, HELIX will be the largest cooling trial in neonatal encephalopathy and will provide a definitive answer regarding the safety and efficacy of cooling therapy for neonatal encephalopathy in LMICs. The trial will also provide important data about the influence of co-existent perinatal infection on the efficacy of hypothermic neuroprotection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02387385 . Registered on 27 February 2015.
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Conference paperGhajari M, Hellyer PJ, Sharp DJ, 2017,
Predicting the location of chronic traumatic encephalopathy pathology
, 2017 IRCOBI Conference, Publisher: International Research Council on Biomechanics of Injury (IRCOBI), Pages: 699-700, ISSN: 2235-3151Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to head impacts. Its distinctive neuropathologic feature is deposition of tau proteins in sulcal depths and in perivascular regions. Previous work has investigated pathological and clinical features of CTE, and here the authors report recent work on exploring the link between strain and strain rate distribution within the brain and location of CTE pathology. The authors used a high fidelity finite element (FE) model of traumatic brain injury (TBI) to test the hypothesis that strain and strain rate produced by head impacts are greatest in sulci, where neuropathology is prominently seen in CTE. The authors also analyzed diffusion tensor imaging (DTI) data from a large cohort of TBI patients to provide converging evidence from empirical neuroimaging data for the model’s prediction.
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Conference paperBai W, Oktay O, Sinclair M, et al., 2017,
Semi-supervised learning for network-based cardiac MR image segmentation
, International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), Publisher: Springer Verlag, Pages: 253-260, ISSN: 0302-9743Training a fully convolutional network for pixel-wise (or voxel-wise) image segmentation normally requires a large number of training images with corresponding ground truth label maps. However, it is a challenge to obtain such a large training set in the medical imaging domain, where expert annotations are time-consuming and difficult to obtain. In this paper, we propose a semi-supervised learning approach, in which a segmentation network is trained from both labelled and unlabelled data. The network parameters and the segmentations for the unlabelled data are alternately updated. We evaluate the method for short-axis cardiac MR image segmentation and it has demonstrated a high performance, outperforming a baseline supervised method. The mean Dice overlap metric is 0.92 for the left ventricular cavity, 0.85 for the myocardium and 0.89 for the right ventricular cavity. It also outperforms a state-of-the-art multi-atlas segmentation method by a large margin and the speed is substantially faster.
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Journal articleDatta G, Colasanti A, Kalk N, et al., 2017,
[(11)C]PBR28 or [(18)F]PBR111 detect white matter inflammatory heterogeneity in multiple sclerosis
, Journal of Nuclear Medicine, Vol: 58, Pages: 1477-1482, ISSN: 1535-5667Objective: To assess microglial activation in lesions and in normal appearing white matter of multiple sclerosis (MS) patients using positron emission tomography (PET). Methods: 34 MS patients (7 with secondary progressive MS (SPMS), 27 with relapsing remitting MS (RRMS)) and 30 healthy volunteers, genetically stratified for translocator protein (TSPO), binding status underwent PET scanning with TSPO radioligands ((11)C-PBR28 or (18)F-PBR111). Regional TSPO availability was measured as a distribution volume ratio (DVR) relative to the caudate (a pseudo-reference region). White matter lesions (WML) were classified as "active" (DVR highest in the lesion), "peripherally active" (peri-lesional DVR highest), "inactive" (DVR highest in surrounding normal appearing white matter, NAWM) or "undifferentiated" (similar DVR across lesion, peri-lesional and NAWM volumes). Results: The mean DVR in NAWM of patients was greater than that of the healthy volunteer white matter for both radioligands. Uptake for individual WML in patients was heterogeneous, but the median WML DVR and NAWM DVR for individual patients were strongly correlated (ρ = 0.94, P = 4x10-11). A higher proportion of lesions were inactive in patients with SPMS (35 %) than RRMS (23 %), but active lesions were found in all patients, including those on highly efficacious treatments. Conclusion: TSPO radioligand uptake was increased in brains of MS patients relative to healthy controls with two TSPO radiotracers. WML showed heterogeneous patterns of uptake. Active lesions were found in patients with both RRMS and SPMS. Their independent prognostic significance needs further investigation.
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Journal articleTan CL, Alavi SA, Baldeweg SE, et al., 2017,
The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance
, JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Vol: 88, Pages: 971-981, ISSN: 0022-3050Pituitary dysfunction is a recognised, but potentially underdiagnosed complication of traumatic brain injury (TBI). Post-traumatic hypopituitarism (PTHP) can have major consequences for patients physically, psychologically, emotionally and socially, leading to reduced quality of life, depression and poor rehabilitation outcome. However, studies on the incidence of PTHP have yielded highly variable findings. The risk factors and pathophysiology of this condition are also not yet fully understood. There is currently no national consensus for the screening and detection of PTHP in patients with TBI, with practice likely varying significantly between centres. In view of this, a guidance development group consisting of expert clinicians involved in the care of patients with TBI, including neurosurgeons, neurologists, neurointensivists and endocrinologists, was convened to formulate national guidance with the aim of facilitating consistency and uniformity in the care of patients with TBI, and ensuring timely detection or exclusion of PTHP where appropriate. This article summarises the current literature on PTHP, and sets out guidance for the screening and management of pituitary dysfunction in adult patients with TBI. It is hoped that future research will lead to more definitive recommendations in the form of guidelines.
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Journal articleSliwinska M, Ribeiro Violante I, Wise R, et al., 2017,
Stimulating Multiple-Demand Cortex Enhances Vocabulary Learning
, Journal of Neuroscience, Vol: 37, Pages: 7606-7618, ISSN: 1529-2401It is well established that domain general networks (DGNs) in the human brain become active when diverse novel skills and behaviors are being learnt. However, their causal role in learning remains to be established. In the present study, we first performed functional magnetic resonance imaging on healthy participants to confirm that DGNs were most active in the initial stages of learning a novel vocabulary, consisting of pronounceable nonwords (pseudowords), each associated with a picture of a real object. We then examined, in healthy participants, whether repetitive transcranial magnetic stimulation of a frontal midline node of the cingulo-opercular DGN affected learning rates during the initial stages of learning. We report that stimulation of this node, but not a control brain region, substantially improved both accuracy and response times during the earliest stage of learning pseudowords-object associations. This stimulation had no effect on the processing of established vocabulary, tested by the accuracy and response times when participants decided whether a real word was accurately paired with a picture of an object. These results provide evidence that non-invasive stimulation to DGN nodes can enhance learning rates, thereby demonstrating their causal role in the learning process. We propose that this causal role makes DGNs candidate targets for experimental therapeutics; for example, in stroke patients with aphasia attempting to reacquire a vocabulary.
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Journal articleGruszka A, Hampshire A, Barker RA, et al., 2017,
Normal aging and Parkinson's disease are associated with the functional decline of distinct frontal-striatal circuits.
, Cortex, Vol: 93, Pages: 178-192Impaired ability to shift attention between stimuli (i.e. shifting attentional 'set') is a well-established part of the dysexecutive syndrome in Parkinson's Disease (PD), nevertheless cognitive and neural bases of this deficit remain unclear. In this study, an fMRI-optimised variant of a classic paradigm for assessing attentional control (Hampshire and Owen 2006) was used to contrast activity in dissociable executive circuits in early-stage PD patients and controls. The results demonstrated that the neural basis of the executive performance impairments in PD is accompanied by hypoactivation within the striatum, anterior cingulate cortex (vACC), and inferior frontal sulcus (IFS) regions. By contrast, in aging it is associated with hypoactivation of the anterior insula/inferior frontal operculum (AI/FO) and the pre-supplementary motor area (preSMA). Between group behavioural differences were also observed; whereas normally aging individuals exhibited routine-problem solving deficits, PD patients demonstrated more global task learning deficits. These findings concur with recent research demonstrating model-based reinforcement learning deficits in PD and provide evidence that the AI/FO and IFS circuits are differentially impacted by PD and normal aging.
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Journal articleHuntley JD, Hampshire A, Bor D, et al., 2017,
The importance of sustained attention in early Alzheimer's disease.
, Int J Geriatr Psychiatry, Vol: 32, Pages: 860-867INTRODUCTION: There is conflicting evidence regarding impairment of sustained attention in early Alzheimer's disease (AD). We examine whether sustained attention is impaired and predicts deficits in other cognitive domains in early AD. METHODS: Fifty-one patients with early AD (MMSE > 18) and 15 healthy elderly controls were recruited. The sustained attention to response task (SART) was used to assess sustained attention. A subset of 25 patients also performed tasks assessing general cognitive function (ADAS-Cog), episodic memory (Logical memory scale, Paired Associates Learning), executive function (verbal fluency, grammatical reasoning) and working memory (digit and spatial span). RESULTS: AD patients were significantly impaired on the SART compared to healthy controls (total error β = 19.75, p = 0.027). SART errors significantly correlated with MMSE score (Spearman's rho = -0.338, p = 0.015) and significantly predicted deficits in ADAS-Cog (β = 0.14, p = 0.004). DISCUSSIONS: Patients with early AD have significant deficits in sustained attention, as measured using the SART. This may impair performance on general cognitive testing, and therefore should be taken into account during clinical assessment, and everyday management of individuals with early AD. Copyright © 2016 John Wiley & Sons, Ltd.
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Journal articleGoverdovsky V, von Rosenberg W, Nakamura T, et al., 2017,
Hearables: multimodal physiological in-ear sensing
, Scientific Reports, Vol: 7, ISSN: 2045-2322Future health systems require the means to assess and track the neural and physiological function of a user over long periods of time, and in the community. Human body responses are manifested through multiple, interacting modalities – the mechanical, electrical and chemical; yet, current physiological monitors (e.g. actigraphy, heart rate) largely lack in cross-modal ability, are inconvenient and/or stigmatizing. We address these challenges through an inconspicuous earpiece, which benefits from the relatively stable position of the ear canal with respect to vital organs. Equipped with miniature multimodal sensors, it robustly measures the brain, cardiac and respiratory functions. Comprehensive experiments validate each modality within the proposed earpiece, while its potential in wearable health monitoring is illustrated through case studies spanning these three functions. We further demonstrate how combining data from multiple sensors within such an integrated wearable device improves both the accuracy of measurements and the ability to deal with artifacts in real-world scenarios.
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Journal articleMetzler-Baddeley C, Foley S, de Santis S, et al., 2017,
Dynamics of white matter plasticity underlying working memory training: multimodal evidence from diffusion MRI and relaxometry
, Journal of Cognitive Neuroscience, Vol: 29, Pages: 1509-1520, ISSN: 0898-929XAdaptive working memory (WM) training may lead to cognitive benefits that are associated with white matter plasticity in parietofrontal networks, but the underlying mechanisms remain poorly understood. We investigated white matter microstructural changes after adaptive WM training relative to a nonadaptive comparison group. Microstructural changes were studied in the superior longitudinal fasciculus, the main parietofrontal connection, and the cingulum bundle as a comparison pathway. MRI-based metrics were the myelin water fraction and longitudinal relaxation rate R1 from multicomponent relaxometry (captured with the mcDESPOT approach) as proxy metrics of myelin, the restricted volume fraction from the composite hindered and restricted model of diffusion as an estimate of axon morphology, and fractional anisotropy and radial diffusivity from diffusion tensor imaging. PCA was used for dimensionality reduction. Adaptive training was associated with benefits in a “WM capacity” component and increases in a microstructural component (increases in R1, restricted volume fraction, fractional anisotropy, and reduced radial diffusivity) that predominantly loaded on changes in the right dorsolateral superior longitudinal fasciculus and the left parahippocampal cingulum. In contrast, nonadaptive comparison activities were associated with the opposite pattern of reductions in WM capacity and microstructure. No group differences were observed for the myelin water fraction metric suggesting that R1 was a more sensitive “myelin” index. These results demonstrate task complexity and location-specific white matter microstructural changes that are consistent with tissue alterations underlying myelination in response to training.
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