Linda Loterh
Autonomic Dysfunction in CFS - Could the Liver be implicated?
Institute of Neuroscience, Newcastle University
30th June – 29th August 2014
I was fortunate enough to embark on a summer studentship from 30th June to 29th August
2014 at the Institute of Neuroscience in Newcastle. I was based in Academic Psychiatry,
working with Dr Stuart Watson and Dr Andreas Finkelmeyer. The project I was involved in
was looking at autonomic nervous system dysfunction in Chronic Fatigue Syndrome (CFS)
patients, and assessing whether the liver could be implicated. Our hypothesis was that
altered sequestration of blood into the liver could be a potential cause of some CFS
symptoms, such as hypotension and fatigue.
The first few weeks involved reading papers on the topic in order to
gain a better understanding of what literature was already out there.
Once our supervisor was convinced we had a thorough understanding
of the topic, we began collecting our data by analysing functional MRI
(fMRI) scans of the livers. This involved manually tracing the outline of
the liver slices from fMRI scans, which would then be put together to
obtain an approximation of the liver volume. This process took over
6 weeks, and we took some necessary steps to ensure our results
were reliable.
An example of a liver tracing in the
axial plane.
Firstly, the liver scans were randomised and anonymised so that my colleague and I were
blinded to avoid bias. Secondly, we both obtained independent tracings of the first 10
patients, and the outcomes were analysed for correlation to ensure that we were tracing
correctly and consistently. Once this was complete, the list of scans were divided, and we
completed our own separate lists in order to be fast and efficient.
Throughout the placement, there were numerous talks and symposiums where students
and researches presented their work, and we were strongly encouraged to attend.
Additionally, due to various projects running concurrently, I was able to assist with other
projects, including a clinical study which involved cognitive testing of depressed patients. It
was great being able to sample the different areas of research, and was also a nice break
from tracing livers, which became monotonous after a couple of weeks. Once we had
finished collecting our data, we were able to analyse our results. This was a great
opportunity to learn statistical tests and how to use them practically, as well as the ability to
interpret the results.
In the last week, my colleague and I worked together to create a poster showcasing our
research at the UK CFS/ME Research Collaborative Conference (CMRC). This was a
challenging but worthwhile process, and one that allowed us to think deeply about what our
research meant, what we had found out and what could be concluded from our summers
work. This was also the most enjoyable aspect because it was great to see our hard work
pay off, and working in a team with other established researchers to create the poster was
an eye-opening experience.
Presenting the poster at the UK CMRC conference was
another great experience, and allowed me to find out
more about the various aetiological processes that
contribute to CFS, as well as the effect it has on the
patient, and how we as clinicians can help. Additionally,
the opportunity to network with researchers and present
our findings was invaluable and unforgettable. Our poster
raised lots of interesting questions that allowed us to
Myself and my colleague at the CMRC
conference.
critically evaluate our work and synthesise new ideas and
conclusions, helping us to move forward with our
research.
Looking forward to the future, my colleague and I plan to write up the project report
throughout the academic year, and hope to get it published. In summary, I have gained a lot
from my summer in research, including a better understanding of research and research
methodology. Furthermore, I have been able to develop my team working skills, strategic
thinking and organisation and time management skills, which I can use in other aspects of
Medicine. Following my experience, I would now like to pursue a career in Academic
Medicine and I believe this is a great step towards that.
With thanks to: Institute of Neuroscience, MRC, Inspire and Association of Physicians.