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Navalón P, Ghosn F, Ferrín M, Almansa B, Moreno-Giménez A, Campos-Berga L, Sahuquillo-Leal R, Diago V, Vento M, García-Blanco A. Temperamental and psychomotor predictors of ADHD symptoms in children born after a threatened preterm labour: a 6-year follow-up study. Eur Child Adolesc Psychiatry 2023; 32:2291-2301. [PMID: 36056973 PMCID: PMC10576661 DOI: 10.1007/s00787-022-02073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022]
Abstract
Children born after threatened preterm labour (TPL), regardless of whether it ends in preterm birth, may represent an undescribed "ADHD cluster". The aim of this cohort study is to identify early temperament and psychomotor manifestations and risk factors of TPL children who present ADHD symptoms. One hundred and seventeen mother-child pairs were followed from TPL diagnosis until the child's 6 years of life. TPL children were divided according to the prematurity status into three groups: full-term TPL (n = 26), late-preterm TPL (n = 53), and very-preterm TPL (n = 38). A non-TPL group (n = 50) served as control. Temperament and psychomotor development at age 6 months and ADHD symptoms at age 6 years were assessed. Perinatal and psychosocial factors were also recorded. All TPL groups showed higher severity of ADHD symptoms compared with non-TPL children (difference in means + 4.19 for the full-term group, + 3.64 for the late-preterm group, and + 4.99 for the very-preterm group, all ps < 0.021). Concretely, very-preterm and late-preterm TPL children showed higher restless/impulsive behaviours, whereas full-term TPL children showed higher emotional lability behaviours. Higher surgency/extraversion and delayed fine motor skills at age 6 months predicted ADHD symptoms at 6 years in TPL children. Male sex, maternal state anxiety symptoms at TPL diagnosis, low parental education, and past maternal experience of traumatic events predicted higher ADHD symptoms in TPL children. Therefore, TPL children may have a higher risk for developing ADHD symptoms, presenting a phenotype that depends on the prematurity status. Moreover, the specific combination of early manifestations and risk factors suggests that TPL children may conform an undescribed group at-risk of ADHD symptoms.
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Affiliation(s)
- Pablo Navalón
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Farah Ghosn
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Maite Ferrín
- Haringey Children and Adolescent Mental Health Service, National Health Service, London, UK
- ReCognition Health, London, UK
| | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Alba Moreno-Giménez
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Laura Campos-Berga
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Rosa Sahuquillo-Leal
- Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Vicente Diago
- Division of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Máximo Vento
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain
- Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Group, La Fe Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain.
- Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain.
- Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain.
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Grau-Del Valle C, Fernández J, Solá E, Montoya-Castilla I, Morillas C, Bañuls C. Association between gut microbiota and psychiatric disorders: a systematic review. Front Psychol 2023; 14:1215674. [PMID: 37599717 PMCID: PMC10435258 DOI: 10.3389/fpsyg.2023.1215674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction In recent years, it has been described that the dysbiosis of the intestinal microbiota plays a transcendental role in several pathologies. In this sense, the importance of the gut microbiota in the gut-brain axis, with a bidirectional communication, has been demonstrated. Furthermore, the gut microbiota has been linked with mood disorders and neuropsychiatric disorders. Methods A systematic review of two databases - PubMed and Scopus - was carried out following PRISMA guidelines. We included original studies in humans with a control group published in the last 11 years, which were assessed by the Critical Appraisal Skills Program (CASP) to confirm their quality. Eighteen articles met all the selection criteria. Results A review of the articles revealed an association between psychiatric disorders and different bacterial phyla. The studies we have reviewed have demonstrated differences between subjects with psychiatric disorders and controls and highlight a clear relationship between depression, stress, autism spectrum disorder (ASD), psychotic episodes, eating disorders, anxiety and brain function and the gut microbiota composition. Conclusion A reduction of fermentative taxa has been observed in different psychiatric disorders, resulting in a decrease in the production of short-chain fatty acids (SCFAs) and an increase in pro-inflammatory taxa, both of which may be consequences of the exacerbation of these pathologies.
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Affiliation(s)
- Carmen Grau-Del Valle
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Javier Fernández
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Eva Solá
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | | | - Carlos Morillas
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Celia Bañuls
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
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Liu NH, Liu HQ, Zheng JY, Zhu ML, Wu LH, Pan HF, He XX. Fresh Washed Microbiota Transplantation Alters Gut Microbiota Metabolites to Ameliorate Sleeping Disorder Symptom of Autistic Children. J Microbiol 2023; 61:741-753. [PMID: 37665552 DOI: 10.1007/s12275-023-00069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 09/05/2023]
Abstract
Accumulating studies have raised concerns about gut dysbiosis associating autism spectrum disorder (ASD) and its related symptoms. However, the effect of gut microbiota modification on the Chinese ASD population and its underlying mechanism were still elusive. Herein, we enrolled 24 ASD children to perform the first course of fresh washed microbiota transplantation (WMT), 18 patients decided to participate the second course, 13 of which stayed to participate the third course, and there were 8 patients at the fourth course. Then we evaluated the effects of fresh WMT on these patients and their related symptoms. Our results found that the sleeping disorder symptom was positively interrelated to ASD, fresh WMT significantly alleviated ASD and its sleeping disorder and constipation symptoms. In addition, WMT stably and continuously downregulated Bacteroides/Flavonifractor/Parasutterella while upregulated Prevotella_9 to decrease toxic metabolic production and improve detoxification by regulating glycolysis/myo-inositol/D-glucuronide/D-glucarate degradation, L-1,2-propanediol degradation, fatty acid β-oxidation. Thus, our results suggested that fresh WMT moderated gut microbiome to improve the behavioral and sleeping disorder symptoms of ASD via decrease toxic metabolic production and improve detoxification. Which thus provides a promising gut ecological strategy for ASD children and its related symptoms treatments.
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Affiliation(s)
- Nai-Hua Liu
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Nonglin Down Street 19, Guangzhou, 510080, People's Republic of China
| | - Hong-Qian Liu
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, The First Affiliated Hospital of Guangdong Pharmaceutical University, Nonglin Down Street 19, Guangzhou, 510080, People's Republic of China
| | - Jia-Yi Zheng
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Meng-Lu Zhu
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
| | - Li-Hao Wu
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, The First Affiliated Hospital of Guangdong Pharmaceutical University, Nonglin Down Street 19, Guangzhou, 510080, People's Republic of China
| | - Hua-Feng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China.
| | - Xing-Xiang He
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Nonglin Down Street 19, Guangzhou, 510080, People's Republic of China.
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, The First Affiliated Hospital of Guangdong Pharmaceutical University, Nonglin Down Street 19, Guangzhou, 510080, People's Republic of China.
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Prasad P, Romero R, Chaiworapongsa T, Gomez-Lopez N, Lo A, Galaz J, Taran AB, Jung E, Gotsch F, Than NG, Tarca AL. Further Evidence that an Episode of Premature Labor Is a Pathologic State: Involvement of the Insulin-Like Growth Factor System. Fetal Diagn Ther 2023; 50:236-247. [PMID: 37231893 PMCID: PMC10591834 DOI: 10.1159/000530862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/21/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Approximately 47% of women with an episode of preterm labor deliver at term; however, their infants are at greater risk of being small for gestational age and for neurodevelopmental disorders. In these cases, a pathologic insult may disrupt the homeostatic responses sustaining pregnancy. We tested the hypothesis of an involvement of components of the insulin-like growth factor (IGF) system. METHODS This is a cross-sectional study in which maternal plasma concentrations of pregnancy-associated plasma protease (PAPP)-A, PAPP-A2, insulin-like growth factor-binding protein 1 (IGFBP-1), and IGFBP-4 were determined in the following groups of women: (1) no episodes of preterm labor, term delivery (controls, n = 100); (2) episode of preterm labor, term delivery (n = 50); (3) episode of preterm labor, preterm delivery (n = 100); (4) pregnant women at term not in labor (n = 61); and (5) pregnant women at term in labor (n = 61). Pairwise differences in maternal plasma concentrations of PAPP-A, PAPP-A2, IGFBP-1, and IGFBP-4 among study groups were assessed by fitting linear models on log-transformed data and included adjustment for relevant covariates. Significance of the group coefficient in the linear models was assessed via t-scores, with p < 0.05 deemed a significant result. RESULTS Compared to controls, (1) women with an episode of premature labor, regardless of a preterm or a term delivery, had higher mean plasma concentrations of PAPP-A2 and IGFBP-1 (each p < 0.05); (2) women with an episode of premature labor who delivered at term also had a higher mean concentration of PAPP-A (p < 0.05); and (3) acute histologic chorioamnionitis and spontaneous labor at term were not associated with significant changes in these analytes. CONCLUSION An episode of preterm labor involves the IGF system, supporting the view that the premature activation of parturition is a pathologic state, even in those women who delivered at term.
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Affiliation(s)
- Priya Prasad
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Tinnakorn Chaiworapongsa
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Anderson Lo
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jose Galaz
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Andreea B. Taran
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - Eunjung Jung
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Francesca Gotsch
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nandor Gabor Than
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Maternity Private Clinic of Obstetrics and Gynecology, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Adi L. Tarca
- Pregnancy Research Branch**, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, USA
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Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review. Pediatr Res 2022; 92:1225-1239. [PMID: 35681094 DOI: 10.1038/s41390-022-02135-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/27/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022]
Abstract
The objective of this study was to synthesize the body of knowledge on the association between ACS exposure for risk of preterm birth and brain development in infants ultimately born late preterm and term. Three databases and eight conference proceedings were systematically searched (1972-2021). Selection criteria included ACS administration for risk of preterm delivery, cohort of late preterm and term infants, and assessment of brain development. Data on study characteristics, ACS administration, and neurological outcomes were extracted and qualitatively synthesized according to themes. Neurological outcomes of the included studies (n = 27) were grouped into four themes. The most common adverse outcomes were reduced neonatal head circumference, structural cortical differences on MRI, increased prevalence of psychiatric problems, and increased risk of neurodevelopmental delays in ACS-exposed late preterm and term infants. Our scoping review demonstrated that ACS exposure for risk of preterm delivery may have important neurological implications in infants ultimately born late preterm and term. Given that the existing research is at serious risk for bias, further research that accounts for confounders such as preterm labor, maternal stress, and the number of ACS courses is needed to better establish the long-term neurological effects of ACS on late preterm and term infants. IMPACT: Due to the difficulty in predicting preterm birth, approximately 40% of fetuses exposed to antenatal corticosteroids (ACS) are born at term (≥37 weeks' gestation). This scoping review summarizes the knowledge on the association between ACS exposure for risk of preterm birth and brain development in late preterm and term infants. The majority of studies reported that ACS exposure was associated with adverse brain development outcomes across various domains, such as reduced neonatal head circumference, cortical differences on MRI, and increased prevalence of psychiatric problems and neurodevelopmental delays in late preterm and term infants.
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Salhi I, Qbadou M, Gouraguine S, Mansouri K, Lytridis C, Kaburlasos V. Towards Robot-Assisted Therapy for Children With Autism—The Ontological Knowledge Models and Reinforcement Learning-Based Algorithms. Front Robot AI 2022; 9:713964. [PMID: 35462779 PMCID: PMC9020227 DOI: 10.3389/frobt.2022.713964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Robots are more and more present in our lives, particularly in the health sector. In therapeutic centers, some therapists are beginning to explore various tools like video games, Internet exchanges, and robot-assisted therapy. These tools will be at the disposal of these professionals as additional resources that can support them to assist their patients intuitively and remotely. The humanoid robot can capture young children’s attention and then attract the attention of researchers. It can be considered as a play partner and can directly interact with children or without a third party’s presence. It can equally perform repetitive tasks that humans cannot achieve in the same way. Moreover, humanoid robots can assist a therapist by allowing him to teleoperated and interact from a distance. In this context, our research focuses on robot-assisted therapy and introduces a humanoid social robot in a pediatric hospital care unit. That will be performed by analyzing many aspects of the child’s behavior, such as verbal interactions, gestures and facial expressions, etc. Consequently, the robot can reproduce consistent experiences and actions for children with communication capacity restrictions. This work is done by applying a novel approach based on deep learning and reinforcement learning algorithms supported by an ontological knowledge base that contains relevant information and knowledge about patients, screening tests, and therapies. In this study, we realized a humanoid robot that will assist a therapist by equipping the robot NAO: 1) to detect whether a child is autistic or not using a convolutional neural network, 2) to recommend a set of therapies based on a selection algorithm using a correspondence matrix between screening test and therapies, and 2) to assist and monitor autistic children by executing tasks that require those therapies.
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Affiliation(s)
- Intissar Salhi
- SSDIA, ENSET, Department of Mathematics & Computer Science, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Mohammed Qbadou
- SSDIA, ENSET, Department of Mathematics & Computer Science, Hassan II University of Casablanca, Mohammedia, Morocco
- *Correspondence: Mohammed Qbadou,
| | - Soukaina Gouraguine
- SSDIA, ENSET, Department of Mathematics & Computer Science, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Khalifa Mansouri
- SSDIA, ENSET, Department of Mathematics & Computer Science, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Chris Lytridis
- HUman-MAchines INteraction (HUMAIN) Lab, Department of Computer Science, International Hellenic University (IHU), Kavala, Greece
| | - Vassilis Kaburlasos
- HUman-MAchines INteraction (HUMAIN) Lab, Department of Computer Science, International Hellenic University (IHU), Kavala, Greece
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