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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:133-144. [PMID: 37424273 PMCID: PMC10811972 DOI: 10.1177/17474930231189135] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:7-18. [PMID: 37837346 PMCID: PMC10798034 DOI: 10.1177/15459683231209170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Byrne H, Josev EK, Knight SJ, Scheinberg A, Rowe K, Lubitz L, Seal ML. Hypothalamus volumes in adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): impact of self-reported fatigue and illness duration. Brain Struct Funct 2023; 228:1741-1754. [PMID: 37537279 PMCID: PMC10471696 DOI: 10.1007/s00429-023-02682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex illness of unknown aetiology. Emerging theories suggest ME/CFS may reflect a progressive, aberrant state of homeostasis caused by disturbances within the hypothalamus, yet few studies have investigated this using magnetic resonance imaging in adolescents with ME/CFS. We conducted a volumetric analysis to investigate whether whole and regional hypothalamus volumes in adolescents with ME/CFS differed compared to healthy controls, and whether these volumes were associated with fatigue severity and illness duration. 48 adolescents (25 ME/CFS, 23 controls) were recruited. Lateralised whole and regional hypothalamus volumes, including the anterior-superior, superior tubular, posterior, anterior-inferior and inferior tubular subregions, were calculated from T1-weighted images. When controlling for age, sex and intracranial volume, Bayesian linear regression models revealed no evidence for differences in hypothalamus volumes between groups. However, in the ME/CFS group, a weak linear relationship between increased right anterior-superior volumes and fatigue severity was identified, which was absent in controls. In addition, Bayesian quantile regression revealed a likely-positive association between illness duration and right superior tubular volumes in the ME/CFS group. While these findings suggest overall comparability in regional and whole hypothalamus volumes between adolescents with ME/CFS and controls, preliminary evidence was identified to suggest greater fatigue severity and longer illness duration were associated with greater right anterior-superior and superior-tubular volumes, respectively. These regions contain the anterior and superior divisions of the paraventricular nucleus, involved in the neuroendocrine response to stress, suggesting involvement in ME/CFS pathophysiology. However, replication in a larger, longitudinal cohort is required.
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Affiliation(s)
- Hollie Byrne
- Developmental Imaging, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia.
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia.
- Department of Paediatrics, The University of Melbourne, Melbourne, 3052, Australia.
| | - Elisha K Josev
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, 3052, Australia
| | - Sarah J Knight
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, 3052, Australia
| | - Adam Scheinberg
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, 3052, Australia
| | - Katherine Rowe
- Department of General Medicine, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Lionel Lubitz
- Department of General Medicine, Royal Children's Hospital, Melbourne, 3052, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, 3052, Australia
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Sherif ZA, Gomez CR, Connors TJ, Henrich TJ, Reeves WB. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 2023; 12:e86002. [PMID: 36947108 PMCID: PMC10032659 DOI: 10.7554/elife.86002] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, and cognitive dysfunction that last for months and impact everyday functioning, is referred to as Long COVID under the general category of post-acute sequelae of SARS-CoV-2 infection (PASC). PASC is highly heterogenous and may be associated with multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular syndromes, neuropsychiatric disorders, pulmonary damage, renal failure, stroke, and vascular endothelial dysregulation. A better understanding of the pathophysiologic mechanisms underlying PASC is essential to guide prevention and treatment. This review addresses potential mechanisms and hypotheses that connect SARS-CoV-2 infection to long-term health consequences. Comparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed. Aligning symptoms with other chronic syndromes and identifying potentially regulated common underlining pathways may be necessary for understanding the true nature of PASC. The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein-Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage specific patients.
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Affiliation(s)
- Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of MedicineWashington, District of ColumbiaUnited States
| | - Christian R Gomez
- Division of Lung Diseases, National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI)BethesdaUnited States
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's HospitalNew YorkUnited States
| | - Timothy J Henrich
- Division of Experimental Medicine, University of CaliforniaSan FranciscoUnited States
| | - William Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of TexasSan AntonioUnited States
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Thyroid Profile in the First Three Months after Starting Treatment in Children with Newly Diagnosed Cancer. Cancers (Basel) 2023; 15:cancers15051500. [PMID: 36900289 PMCID: PMC10000403 DOI: 10.3390/cancers15051500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Thyroid hormone anomalies during childhood might affect neurological development, school performance and quality of life, as well as daily energy, growth, body mass index and bone development. Thyroid dysfunction (hypo- or hyperthyroidism) may occur during childhood cancer treatment, although its prevalence is unknown. The thyroid profile may also change as a form of adaptation during illness, which is called euthyroid sick syndrome (ESS). In children with central hypothyroidism, a decline in FT4 of >20% has been shown to be clinically relevant. We aimed to quantify the percentage, severity and risk factors of a changing thyroid profile in the first three months of childhood cancer treatment. METHODS In 284 children with newly diagnosed cancer, a prospective evaluation of the thyroid profile was performed at diagnosis and three months after starting treatment. RESULTS Subclinical hypothyroidism was found in 8.2% and 2.9% of children and subclinical hyperthyroidism in 3.6% and in 0.7% of children at diagnosis and after three months, respectively. ESS was present in 1.5% of children after three months. In 28% of children, FT4 concentration decreased by ≥20%. CONCLUSIONS Children with cancer are at low risk of developing hypo- or hyperthyroidism in the first three months after starting treatment but may develop a significant decline in FT4 concentrations. Future studies are needed to investigate the clinical consequences thereof.
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Zhang HT, Xiong H, Xiao HW, Zhang ZH, Huang CL, Huang MZ. Serum metabolomics reveals the effects of accompanying treatment on fatigue in patients with multiple myeloma. Support Care Cancer 2022; 31:43. [PMID: 36525141 DOI: 10.1007/s00520-022-07526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The renewal and iteration of chemotherapy drugs have resulted in more frequent long-term remissions for patients with multiple myeloma (MM). MM has transformed into a chronic illness for many patients, but the cancer-related fatigue (CRF) of many MM convalescent patients experience is frequently overlooked. We investigated whether the accompanying treatment of family members would affect MM patients' CRF and explore their serum metabolomics, so as to provide clinicians with new ideas for identifying and treating CRF of MM patients. METHODS This was a single-center study, and a total of 30 MM patients were included in the study. Patients were divided into two groups based on whether they have close family members accompanying them through the whole hospitalization treatment. These patients received regular chemotherapy by hematology specialists, and long-term follow-up was done by general practitioners. Patients' CRF assessment for several factors used the Chinese version of the Brief Fatigue Inventory (BFI-C). Face-to-face questionnaires were administered at a time jointly determined by the patient and the investigator. All questionnaires were conducted by a general practitioner. The LC-MS-based metabolomics analysis determined whether the patients' serum metabolites were related to their fatigue severity. A correlation analysis investigated the relationship between serum metabolites and clinical laboratory indicators. RESULTS The fatigue severity of MM patients whose family members participated in the treatment process (group A) was significantly lower than patients whose family members did not participate in the treatment process (group B). There was a statistically significant difference (fatigue severity composite score: t = - 2.729, p = 0.011; fatigue interference composite score: t = - 3.595, p = 0.001). There were no differences between the two groups of patients' gender, age, regarding clinical staging, tumor burden, blood routine, biochemical, or coagulation indexes. There were 11 metabolites, including guanidine acetic acid (GAA), 1-(Methylthio)-1-hexanethiol, isoeucyl-asparagine, L-agaritine, tryptophyl-tyrosine, and betaine, which significantly distinguished the two groups of MM patients. GAA had the strongest correlation with patient fatigue, and the difference was statistically significant (fatigue severity composite score: r = 0.505, p = 0.0044; fatigue interference composite score: r = 0.576, p = 0.0009). The results showed that GAA negatively correlated with albumin (r = - 0.4151, p = 0.0226) and GGT (r = - 0.3766, p = 0.0402). Meanwhile, GAA positively correlated with PT (r = 0.385, p = 0.0473), and the difference was statistically significant. CONCLUSION The study is the first to report that family presence throughout the whole hospitalization may alleviate CRF in MM patients. Moreover, the study evaluated serum metabolites linked to CRF in MM patients and found that CRF has a significant positive correlation with GAA. GAA may be a more sensitive biomarker than liver enzymes, PT, and serum albumin in predicting patient fatigue. While our sample may not represent all MM patients, it proposes a new entry point to help clinicians better identify and treat CRF in MM patients.
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Affiliation(s)
- Hui-Tao Zhang
- Stem Cell Laboratory, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.,Department of General Practice, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Hao Xiong
- Stem Cell Laboratory, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Hong-Wen Xiao
- Department of Hematology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Zhi-Hong Zhang
- Department of General Practice, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Chun-Lan Huang
- Stem Cell Laboratory, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
| | - Mei-Zhou Huang
- Stem Cell Laboratory, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
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Study on the Antifatigue Effect of Compound Amino Acid Capsules. Cell Microbiol 2022. [DOI: 10.1155/2022/6593811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplementing amino acids was proven to relieve fatigue caused by exercise. This study explored the antifatigue effects of compound amino acid capsules (CAAC) on rats undergoing the forced swimming test (FST). CAAC augmented the endurance of FST in rats and alleviated the damage of skeletal muscle tissue and reduced the content of biochemical indicators in the serum. Furthermore, CAAC prevented skeletal muscle dysfunction in FST rats by modulating inflammation and oxidation reactions. After the treatment with CAAC, apoptosis and apoptosis-related protein and p-p65 were weakened, while the levels of SIRT1 and SIRT1/PGC-1α/Nrf2 pathway-related proteins were enhanced. The antifatigue properties of CAAC were associated with its antioxidant and anti-inflammatory capabilities, which were realized by activating the SIRT1/PGC-1α/Nrf2 pathway.
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8
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An J, Gao W, Liu R, Liu Z. Empirical Study on the Relationship Between Vacation Schedule and Seafarers' Fatigue in Chinese Seafarer Population. Front Psychol 2022; 13:838811. [PMID: 35386897 PMCID: PMC8977519 DOI: 10.3389/fpsyg.2022.838811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Fatigue is an important factor for the safety of ships. In order to alleviate fatigue of the seafarers, the STCW Convention (International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers) has made many regulations on the working time of seafarers. At present, if a crew member takes only one day off at home before returning to work on the ship, the working time on the ship must be re-calculated again. If the time spent at home is not sufficient to allow the crew to recover, the regulations of only stipulating the working time, not stipulating the home vacation time, cannot guarantee the crew's fatigue been well controlled. The aim of present study is to explore the relationship between vacation schedule and fatigue of the seafarers. Methods In present study, a simplified stress scale developed by the Ministry of Labor of Japan has been used as a measurement tool. The method of stratified sampling was adopted. Data collection mainly came from domestic ocean-going seafarers (n = 165). Analysis was conducted using the Cross (chi-square) analysis and hierarchical multiple regression analysis methods. Results We found that there was no difference between crew members of different positions in terms of average vacation time and on-board service time (p > 0.05). The length of last vacation time and this service time for seafarers of different positions showed obvious differences (p < 0.01). The rank has a significant effect on the length of the last vacation (χ2 = 101.560, p = 0.000 < 0.01) and the length of this service time (χ2 = 75.624, p = 0.000 < 0.01). Also, the results showed that there was a significant negative correlation between the duration of vacation and overall fatigue (t = -7.160, p = 0.000 < 0.01), while there was a significant positive correlation between the length of service time on board and overall fatigue (t = 3.474, p = 0.001 < 0.01). Conclusion The results indicated that a reasonable vacation schedule was crucial for the relief of the seafarers' fatigue, and also played a positive role in the state of working on the ship again.
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Affiliation(s)
- Ji An
- Merchant Marine College, Shanghai Maritime University, Shanghai, China
| | - Wenting Gao
- Merchant Marine College, Shanghai Maritime University, Shanghai, China
| | - Runze Liu
- Maritime College, Beibu Gulf University, Guangxi, China
| | - Ziqi Liu
- Merchant Marine College, Shanghai Maritime University, Shanghai, China
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to exert a significant impact on global health care systems, causing devastating mortality and morbidity. As time passes and our understanding of this novel respiratory virus deepens, it is increasingly clear that its effects extend beyond that of the respiratory system. The coronavirus responsible for COVID-19, severe acute respiratory syndrome coronavirus 2, obtains cellular access through the angiotensin-converting enzyme 2 (ACE2) receptor in a process requiring the transmembrane serine protease 2 (TMPRSS2) protein. Both ACE2 and TMPRSS2 are widely expressed in many endocrine glands. This, along with several case reports of thyroid and pituitary disruption in patients with COVID-19, has resulted in significant interest in its impact on the endocrine system. Indeed, as mortality is abated by the increasing availability of effective vaccines, there is increasing focus on the long-term effects on health in COVID-19 survivors. This review summarizes data investigating the effects of COVID-19 on each of the endocrine axes to guide appropriate investigations and optimal management.
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Affiliation(s)
- Sophie A Clarke
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W6 8RF, UK
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10
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Goklemez S, Saligan LN, Pirsl F, Holtzman NG, Ostojic A, Steinberg SM, Hakim FT, Rose JJ, Kang Z, Yu Y, Cao L, Mitchell SA, Im A, Pavletic SZ. Clinical characterization and cytokine profile of fatigue in hematologic malignancy patients with chronic graft-versus-host disease. Bone Marrow Transplant 2021; 56:2934-2939. [PMID: 34433916 PMCID: PMC8639672 DOI: 10.1038/s41409-021-01419-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Limited information is available regarding clinical and biological properties of fatigue in patients with chronic graft-versus-host disease (cGvHD). Patients with moderate-to-severe cGvHD per NIH criteria were enrolled on a cross-sectional study and categorized as "fatigued" if SF-36 vitality score was <40. Clinical and laboratory parameters of fatigued (n = 109) and nonfatigued patients (n = 72) were compared. In univariate analysis, walk velocity, NIH joint-fascia score, human activity profile, and SF-36 physical and mental health self-report scales were correlates of fatigue. No cGvHD biomarkers were associated with fatigue. NIH joint score, Lee sleep and depression questions, and PG-SGA activities and function score jointly predicted fatigue. Though higher rates of depression and insomnia were reported in the fatigued group, antidepressant or sleep aid use did not differ between groups. Survival ratio was not significantly different by fatigue status. Pathophysiology of fatigue in patients with cGvHD is complex and may involve mechanisms unrelated to disease activity. Patients with cGvHD experiencing fatigue had higher rates of untreated depression and insomnia, highlighting the need to focus clinical management of these conditions to improve health-related quality of life.
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Affiliation(s)
- Sencer Goklemez
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | | | - Filip Pirsl
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Noa G. Holtzman
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Alen Ostojic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD,Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Frances T. Hakim
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Jeremy J. Rose
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Zhigang Kang
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Yunkai Yu
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Liang Cao
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Sandra A. Mitchell
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, MD
| | - Annie Im
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | - Steven Z. Pavletic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
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11
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Changes in Humans' Autonomic Nervous System under Dynamic Lighting Environment During A Short Rest. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6697701. [PMID: 34462649 PMCID: PMC8403042 DOI: 10.1155/2021/6697701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
Overloaded work and life stress often result in excessive fatigue and stresses in people, further leading to psychological burden and physiological disease. In this case, good rest is important in busy life. Good rest could result in good quality of life and work efficiency. In order to assist people in getting into deep rest to obtain a restorative state after fatigue, a dynamic lighting system with low-frequency change for assisting users in effective relaxation is proposed in this study. Heart rate variability analysis is used for discussing the change in the autonomic nervous system of the subjects under dynamic lighting environment, and a self-report questionnaire is applied to understand the subjects' psychological feeling. The research results indicate that the subjects significantly showed enhancement in the activities of parasympathetic nervous system within 25 minutes in the dynamic lighting process, in comparison with the steady lighting system. The questionnaire survey results also reveal that the subjects receive higher quality of rest, after the dynamic and low-illuminance lighting stimuli, with good feeling.
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Abstract
A diagnosis of cancer is a major life stressor that can affect the physiological, psychological and physical state of the person concerned. Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness. The aim of this review is to provide background information on cancer-related fatigue. This review discusses cancer-related fatigue (CRF) in terms of the definition, prevalence, risk factors, aetiology, and the measurement scales used. The differences between definitions of symptoms and relevant theories will be explored and discussed to help explain the variety of instruments used in its measurement. The prevalence of fatigue will be assessed by looking critically at the evidence of fatigue and the factors that affect it. Potential treatment and management strategies for CRF will also be discussed. Finally, there will be an overview of the instruments used to measure fatigue. This review also provides important evidence for measuring and managing CRF that can help nurses to understand fatigue among patients with cancer. Assessing CRF should be routinely undertaken in clinical settings to help identify the proper interventions, treatments and management to reduce fatigue among cancer patients.
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Affiliation(s)
- Mohammed Al Maqbali
- Research Assistant, School of Applied Social and Policy Sciences, Ulster University, Magee Campus, Derry-Londonderry
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13
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Clarke SA, Phylactou M, Patel B, Mills EG, Muzi B, Izzi-Engbeaya C, Choudhury S, Khoo B, Meeran K, Comninos AN, Abbara A, Tan T, Dhillo WS. Normal Adrenal and Thyroid Function in Patients Who Survive COVID-19 Infection. J Clin Endocrinol Metab 2021; 106:2208-2220. [PMID: 34008009 PMCID: PMC8194556 DOI: 10.1210/clinem/dgab349] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT The COVID-19 pandemic continues to exert an immense burden on global health services. Moreover, up to 63% of patients experience persistent symptoms, including fatigue, after acute illness. Endocrine systems are vulnerable to the effects of COVID-19 as many glands express the ACE2 receptor, used by the SARS-CoV-2 virion for cellular access. However, the effects of COVID-19 on adrenal and thyroid gland function after acute COVID-19 remain unknown. OBJECTIVE Our objectives were to evaluate adrenal and thyroid gland function in COVID-19 survivors. METHODS A prospective, observational study was undertaken at the Clinical Research Facility, Imperial College NHS Healthcare Trust, including 70 patients ≥18 years of age, at least 3 months after diagnosis of COVID-19. Participants attended a research study visit (8:00-9:30 am), during which a short Synacthen test (250 µg IV bolus) and thyroid function assessments were performed. RESULTS All patients had a peak cortisol ≥450 nmol/L after Synacthen, consistent with adequate adrenal reserve. Basal and peak serum cortisol did not differ according to disease severity or history of dexamethasone treatment during COVID-19. There was no difference in baseline or peak cortisol after Synacthen or in thyroid function tests, or thyroid status, in patients with fatigue (n = 44) compared to those without (n = 26). CONCLUSION Adrenal and thyroid function ≥3 months after presentation with COVID-19 was preserved. While a significant proportion of patients experienced persistent fatigue, their symptoms were not accounted for by alterations in adrenal or thyroid function. These findings have important implications for the clinical care of patients after COVID-19.
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Affiliation(s)
- Sophie A Clarke
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Maria Phylactou
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Bijal Patel
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Edouard G Mills
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Beatrice Muzi
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
| | - Chioma Izzi-Engbeaya
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Sirazum Choudhury
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Faculty of Medical Sciences, Royal Free Campus, University College London, London, NW3 2QG, UK
| | - Karim Meeran
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Alexander N Comninos
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Ali Abbara
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
| | - Waljit S Dhillo
- Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
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14
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Sagaro GG, Di Canio M, Amenta F. Correlation between body mass index and blood pressure in seafarers. Clin Exp Hypertens 2020; 43:189-195. [PMID: 33086896 DOI: 10.1080/10641963.2020.1836193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High blood pressure is a serious medical condition that significantly increases the risk of cardiovascular disease. Although overweight and high blood pressure are frequent consequences for the health of life at sea, there is a paucity of information on the contribution of body mass index (BMI) to high blood pressure (HBP) in seafarers. OBJECTIVE The present study was aimed to examine the relationship between BMI and blood pressure and to analyze further BMI as a risk factor for high blood pressure through a modeling approach. MATERIALS AND METHODS A retrospective analysis was performed on 603 seafarers' medical examination records. The seafarer's blood pressure and BMI were recorded and interpreted according to the WHO criteria. Pearson product-moment correlation was examined to determine the association between BMI and blood pressure. Multinomial logistic regression models were performed to estimate the strength of association between the BMI and the HBP. RESULTS Out of a total of 603 seafarers under study, 44.4% and 55.6% were officers and non-officers, respectively. Mean SBP, DBP, and BMI were significantly higher among non-officers than officers. BMI was positively correlated (p < .01) with both SBP (r = 0.336) and DBP (r = 0.344). About 39% and 16.6% of the study subjects were prehypertension and hypertensive, respectively. The risk of prehypertension and hypertension was higher in individuals who were overweight and obese. CONCLUSIONS Mean blood pressure levels increase parallel to the rise of BMI. Thus, emphasis should be given on a weight management program in relation to the prevention and control of high blood pressure.
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Affiliation(s)
- Getu Gamo Sagaro
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino , Camerino, Italy
| | - Marzio Di Canio
- Research Department, Internationale Radio Medical Center (C.I.R.M.) , Rome, Italy
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino , Camerino, Italy.,Research Department, Internationale Radio Medical Center (C.I.R.M.) , Rome, Italy
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15
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Choudhury A, Routray D, Swain S, Das AK. Prevalence and risk factors of people at-risk of obstructive sleep apnea in a rural community of Odisha, India: a community based cross-sectional study. Sleep Med 2019; 58:42-47. [PMID: 31078079 DOI: 10.1016/j.sleep.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a progressive sleep disordered breathing condition characterized by repeated episodes of upper airway collapse during sleep. Despite being the most common sleep apnea, it often remains undiagnosed and untreated, especially in rural communities. There is a paucity of literature estimating the prevalence of the disease and associated risk factors from the rural population of Odisha. METHODS It is a cross-sectional study that was conducted in a rural community of Odisha, India to find out the prevalence of people living with the risk of OSA. Multi-staged sampling was done. Participants were evaluated using the Berlin questionnaire (BQ) after obtaining informed consent. Data were analyzed using SPSS with the significance level set at 95%. Univariate and multivariate analysis was done to evaluate the risk factors associated with the condition. RESULTS Out of 200 community dwellers surveyed using the BQ, 25% had a high likelihood of OSA. Among these high risk subjects, snoring was reported by 70%, excessive daytime sleepiness by 50%. Out of those who were at risk of OSA, 28% were smokers and 48% reported alcohol use. The associated risk factors were age >35 years (OR = 4.5, 95% CI = 1.4-13.8, p < 0.05), BMI ≥ 25 kg/m2 (aOR = 3.5, 95% CI = 1.2- 10.5, p < 0.05), alcoholism (aOR = 4.5, 95% CI = 1.8-11.1, p = 0.001), and hypertension (aOR = 11.5, 95% CI = 4.7-28, p < 0.001). The prevalence was not affected by the type of diet (vegetarian vs non-vegetarian), use of tobacco or tea consumption. CONCLUSION OSA is highly prevalent in the rural community of Odisha. Independent risk factors associated with such subjects were obesity, regular alcohol consumption, and hypertension. Further prevalence studies are recommended.
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Affiliation(s)
| | - Dipanweeta Routray
- Department of Community Medicine, S.C.B. Medical College, Cuttack, Odisha, India.
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16
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Seth RK, Kimono D, Alhasson F, Sarkar S, Albadrani M, Lasley SK, Horner R, Janulewicz P, Nagarkatti M, Nagarkatti P, Sullivan K, Chatterjee S. Increased butyrate priming in the gut stalls microbiome associated-gastrointestinal inflammation and hepatic metabolic reprogramming in a mouse model of Gulf War Illness. Toxicol Appl Pharmacol 2018; 350:64-77. [PMID: 29751049 PMCID: PMC6121708 DOI: 10.1016/j.taap.2018.05.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/07/2018] [Indexed: 01/07/2023]
Abstract
Most of the associated pathologies in Gulf War Illness (GWI) have been ascribed to chemical and pharmaceutical exposures during the war. Since an increased number of veterans complain of gastrointestinal (GI), neuroinflammatory and metabolic complications as they age and there are limited options for a cure, the present study was focused to assess the role of butyrate, a short chain fatty acid for attenuating GWI-associated GI and metabolic complications. Results in a GWI-mouse model of permethrin and pyridostigmine bromide (PB) exposure showed that oral butyrate restored gut homeostasis and increased GPR109A receptor copies in the small intestine (SI). Claudin-2, a protein shown to be upregulated in conditions of leaky gut was significantly decreased following butyrate administration. Butyrate decreased TLR4 and TLR5 expressions in the liver concomitant to a decrease in TLR4 activation. GW-chemical exposure showed no clinical signs of liver disease but a significant alteration of metabolic markers such as SREBP1c, PPAR-α, and PFK was evident. Liver markers for lipogenesis and carbohydrate metabolism that were significantly upregulated following GW chemical exposure were attenuated by butyrate priming in vivo and in human primary hepatocytes. Further, Glucose transporter Glut-4 that was shown to be elevated following liver complications were significantly decreased in these mice after butyrate administration. Finally, use of TLR4 KO mice completely attenuated the liver metabolic changes suggesting the central role of these receptors in the GWI pathology. In conclusion, we report a butyrate specific mechanistic approach to identify and treat increased metabolic abnormalities in GWI veterans with systemic inflammation, chronic fatigue, GI disturbances, metabolic complications and weight gain.
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Affiliation(s)
- Ratanesh Kumar Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Diana Kimono
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Firas Alhasson
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sutapa Sarkar
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Muayad Albadrani
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Stephen K Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Mitzi Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Prakash Nagarkatti
- Department of Pathology Microbiology and Immunology, USC School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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17
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Kim K, Gu MO, Jung JH, Hahm JR, Kim SK, Kim JH, Woo SH. Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients. Thyroid 2018; 28:236-245. [PMID: 29258382 DOI: 10.1089/thy.2017.0277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The objective of this study was to determine the effect of a home-based exercise program on fatigue, anxiety, quality of life (QoL), and immune function of thyroid cancer patients taking thyroid hormone replacement after thyroidectomy. METHOD This quasi-experimental study with a non-equivalent control group included 43 outpatients taking thyroid hormone replacement after thyroidectomy (22 in the experimental group and 21 in the control group). After education about the home-based exercise program, subjects in the experimental group underwent 12 weeks of aerobic, resistance, and flexibility exercise. A comparative analysis was conducted between the two groups. RESULTS Patients in the experimental group were significantly less fatigued or anxious (p < 0.01). They reported significantly improved QoL (p < 0.05) compared to those in the control group. Natural killer cell activity was significantly higher in the exercise group compared to that in the control group (p < 0.05). CONCLUSION A home-based exercise program is effective in reducing fatigue and anxiety, improving QoL, and increasing immune function in patients taking thyroid hormone replacement after thyroidectomy. Therefore, such a home-based exercise program can be used as an intervention for patients who are taking thyroid hormone replacement after thyroidectomy.
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Affiliation(s)
- Kyunghee Kim
- 1 Department of Otolaryngology, Gyeongsang National University , Jinju, Korea
- 2 Department of Nursing Graduate School, Gyeongsang National University , Jinju, Korea
| | - Mee Ock Gu
- 3 College of Nursing, Gyeongsang National University , Jinju, Korea
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
| | - Jung Hwa Jung
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Jong Ryeal Hahm
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Soo Kyoung Kim
- 4 Institute of Health Sciences, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
| | - Jin Hyun Kim
- 6 Biomedical Research Institute, Gyeongsang National University , Jinju, Korea
| | - Seung Hoon Woo
- 1 Department of Otolaryngology, Gyeongsang National University , Jinju, Korea
- 5 Department of Internal Medicine, Gyeongsang National University , Jinju, Korea
- 7 Beckman Laser Institute, University of California , Irvine, California
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18
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Golabi P, Sayiner M, Bush H, Gerber LH, Younossi ZM. Patient-Reported Outcomes and Fatigue in Patients with Chronic Hepatitis C Infection. Clin Liver Dis 2017; 21:565-578. [PMID: 28689594 DOI: 10.1016/j.cld.2017.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fatigue is a common symptom. Diagnosis is difficult. Fatigue is often a complex symptom. In the recent years, fatigue has gained considerable amount of attention. It has 2 major types, central and peripheral, which may occur together or alone. Although fatigue has many strong relations with depression and sleep disorders, it is a separate entity. For the diagnosis of fatigue, self-reports and patient-reported outcomes are highly valuable tools because these methods can reflect patients' perceptions. Treating the underlying disease with newly developed direct-acting antivirals often improves the perceived fatigue. Healthy lifestyle changes are the cornerstone of the treatment.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Haley Bush
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health system, Claude Moore Health Education and Research Building, 3rd floor, 300 Gallows Road, Falls Church, VA 22042, USA; Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA 22042, USA.
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19
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Psychometric Evaluation of the Patient-Reported Outcomes Measurement Information System Fatigue-Short Form Across Diverse Populations. Nurs Res 2017; 65:279-89. [PMID: 27362514 DOI: 10.1097/nnr.0000000000000162] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The need for reliable, valid tools to measure patient-reported outcomes (PROs) is critical both for research and for evaluating treatment effects in practice. The Patient-Reported Outcomes Measurement Information System Fatigue-Short Form v1.0-Fatigue 7a (PROMIS F-SF) has had limited psychometric evaluation in various populations. OBJECTIVES The aim of the study is to examine psychometric properties of PROMIS F-SF item responses across various populations. METHODS Data from five studies with common data elements were used in this secondary analysis. Samples from patients with fibromyalgia, sickle cell disease, cardiometabolic risk, pregnancy, and healthy controls were used. Reliability was estimated using Cronbach's alpha. Dimensionality was evaluated with confirmatory factor analysis. Concurrent validity was evaluated by examining Pearson's correlations between scores from the PROMIS F-SF, the Multidimensional Fatigue Symptom Inventory-Short Form, and the Brief Fatigue Inventory. Discriminant validity was evaluated by examining Pearson's correlations between scores on the PROMIS F-SF and measures of stress and depressive symptoms. Known groups validity was assessed by comparing PROMIS F-SF scores in the clinical samples to healthy controls. RESULTS Reliability of PROMIS F-SF scores was adequate across samples, ranging from .72 in the pregnancy sample to .88 in healthy controls. Unidimensionality was supported in each sample. Concurrent validity was strong; across the groups, correlations with scores on the Multidimensional Fatigue Symptom Inventory-Short Form and Brief Fatigue Inventory ranged from .60 to .85. Correlations of the PROMIS F-SF with measures of stress and depressive mood were moderate to strong, ranging from .37 to .64. PROMIS F-SF scores were significantly higher in clinical samples compared to healthy controls. DISCUSSION Reliability and validity of the PROMIS F-SF were acceptable. The PROMIS F-SF is a suitable measure of fatigue across the four diverse clinical populations included in the analysis.
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20
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Vergaelen E, Claes S, Kempke S, Swillen A. High prevalence of fatigue in adults with a 22q11.2 deletion syndrome. Am J Med Genet A 2017; 173:858-867. [PMID: 28190295 DOI: 10.1002/ajmg.a.38094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/20/2016] [Indexed: 01/23/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is a microdeletion syndrome with high phenotypic variability, including somatic disorders like congenital heart disease and psychiatric disorders such as schizophrenia, anxiety disorders, and mood disorders. Clinical observations suggest that many patients with 22q11.2DS suffer from severe fatigue. However, to the best of our knowledge, no previous study has investigated the potential association between 22q11.2DS and fatigue. Twenty-nine patients (mean age 26.8, 18-38 y) with 22q11.2DS completed the multidimensional fatigue inventory (MFI) measuring severity of fatigue. The results of the study group were compared with published population norms. In addition, cross-sectional associations between fatigue, depression (Beck Depression Inventory-BDI), and a quality of life questionnaire (WHO) in patients with 22q11.2 DS were examined. Subscales and total MFI scores were significantly higher in adults with 22q11.2DS. Approximately 80% of the study group had a total MFI score above the mean of the norms. A significant correlation between depressive symptoms and fatigue was found. Fatigue was also significantly associated with quality of life scores, specifically the general score, psychological health, and environment. This is the first report of high levels of fatigue in adults with the 22q11.2DS. Fatigue is a frequent complaint in this age group and should get the necessary attention given its association with quality of life and depression severity. Taking into account the multisystem nature of the 22q11.2DS, we recommend a systematic clinical examination to exclude underlying somatic or psychiatric causes of fatigue. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Elfi Vergaelen
- Center for Human Genetics, University Hospital Leuven, Leuven, Belgium.,University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Stephan Claes
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Stefan Kempke
- Faculty of Psychology and Educational Sciences and GRASP, KU Leuven, Leuven, Belgium
| | - Ann Swillen
- Center for Human Genetics, University Hospital Leuven, Leuven, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium
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Barat P, Meiffred MC, Brossaud J, Fuchs D, Corcuff JB, Thibault H, Capuron L. Inflammatory, endocrine and metabolic correlates of fatigue in obese children. Psychoneuroendocrinology 2016; 74:158-163. [PMID: 27627133 DOI: 10.1016/j.psyneuen.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
Alterations in endocrine functions and low-grade systemic inflammation represent fundamental characteristics of obesity. These biological systems have been repeatedly linked to fatigue symptoms. The aim of the study was to assess the relationship between fatigue dimensions and metabolic/inflammatory markers in a sample of non-diabetic obese children. The possibility that inflammation-induced alterations in tryptophan metabolism relates to specific dimensions of fatigue was also investigated in a subsample of patients. The study was conducted in 41 obese children, median aged 12 [9-15] years, recruited in a pediatric tertiary center. Three dimensions of fatigue (e.g., general fatigue, sleep/rest, cognitive fatigue) were assessed using the Pediatric Quality of Life Inventory Multidimentional Fatigue Scale. In addition, a principal component analysis was performed to identify fatigue dimensions that were specific to the population under study. This analysis extracted five relevant dimensions corresponding respectively to concentration, energy, self-perceived cognitive efficiency, sleep/rest and motivation/anhedonia. Blood samples were collected for the measurement of inflammatory and metabolic markers, including high sensitivity C-reactive protein (hs-CRP), insulin, uricemia and glycaemia. Tryptophan, kynurenine and neopterin levels were also determined in a subsample of 17 patients. In the whole population under study, cognitive fatigue and reduced motivation/anhedonia were associated with BMI, independently of sex and age. The dimension of reduced motivation/anhedonia was associated with insulin resistance and inflammatory biomarkers. The association with insulin resistance persisted when the extent of fat mass (BMI-SDS) was taken into account. No association was found between tryptophan metabolism and specific dimensions of fatigue, but kynurenine and the kynurenine/tryptophan ratio correlated with insulin and HOMA-IR. These data indicate that insulin resistance in non diabetic obese children is associated with both cognitive fatigue and reduced motivation/anhedonia and with alterations in tryptophan metabolism. Further investigations are needed to determine whether inflammation-induced alterations in tryptophan metabolism is directly or indirectly implicated in insulin resistance and related fatigue.
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Affiliation(s)
- Pascal Barat
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France; Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France.
| | - Marie-Claire Meiffred
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Julie Brossaud
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University Center for Chemistry and Biomedicine, A-6020 Innsbruck, Austria
| | - Jean-Benoit Corcuff
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Helene Thibault
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Lucile Capuron
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; INRA, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France
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Stephan KE, Manjaly ZM, Mathys CD, Weber LAE, Paliwal S, Gard T, Tittgemeyer M, Fleming SM, Haker H, Seth AK, Petzschner FH. Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression. Front Hum Neurosci 2016; 10:550. [PMID: 27895566 PMCID: PMC5108808 DOI: 10.3389/fnhum.2016.00550] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023] Open
Abstract
This paper outlines a hierarchical Bayesian framework for interoception, homeostatic/allostatic control, and meta-cognition that connects fatigue and depression to the experience of chronic dyshomeostasis. Specifically, viewing interoception as the inversion of a generative model of viscerosensory inputs allows for a formal definition of dyshomeostasis (as chronically enhanced surprise about bodily signals, or, equivalently, low evidence for the brain's model of bodily states) and allostasis (as a change in prior beliefs or predictions which define setpoints for homeostatic reflex arcs). Critically, we propose that the performance of interoceptive-allostatic circuitry is monitored by a metacognitive layer that updates beliefs about the brain's capacity to successfully regulate bodily states (allostatic self-efficacy). In this framework, fatigue and depression can be understood as sequential responses to the interoceptive experience of dyshomeostasis and the ensuing metacognitive diagnosis of low allostatic self-efficacy. While fatigue might represent an early response with adaptive value (cf. sickness behavior), the experience of chronic dyshomeostasis may trigger a generalized belief of low self-efficacy and lack of control (cf. learned helplessness), resulting in depression. This perspective implies alternative pathophysiological mechanisms that are reflected by differential abnormalities in the effective connectivity of circuits for interoception and allostasis. We discuss suitably extended models of effective connectivity that could distinguish these connectivity patterns in individual patients and may help inform differential diagnosis of fatigue and depression in the future.
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Affiliation(s)
- Klaas E Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Wellcome Trust Centre for Neuroimaging, University College LondonLondon, UK; Max Planck Institute for Metabolism ResearchCologne, Germany
| | - Zina M Manjaly
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Department of Neurology, Schulthess ClinicZurich, Switzerland
| | - Christoph D Mathys
- Wellcome Trust Centre for Neuroimaging, University College London London, UK
| | - Lilian A E Weber
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Saee Paliwal
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Tim Gard
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH ZurichZurich, Switzerland; Center for Complementary and Integrative Medicine, University Hospital ZurichZurich, Switzerland
| | | | - Stephen M Fleming
- Wellcome Trust Centre for Neuroimaging, University College London London, UK
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Anil K Seth
- Sackler Centre for Consciousness Science, School of Engineering and Informatics, University of Sussex Brighton, UK
| | - Frederike H Petzschner
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland
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Determinants of seafarers' fatigue: a systematic review and quality assessment. Int Arch Occup Environ Health 2016; 90:13-37. [PMID: 27804037 DOI: 10.1007/s00420-016-1174-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/12/2016] [Indexed: 10/24/2022]
Abstract
PURPOSE Fatigue jeopardizes seafarer's health and safety. Thus, knowledge on determinants of fatigue is of great importance to facilitate its prevention. However, a systematic analysis and quality assessment of all empirical evidence specifically for fatigue are still lacking. The aim of the present article was therefore to systematically detect, analyze and assess the quality of this evidence. METHODS Systematic searches in ten databases were performed. Searches considered articles published in scholarly journals from 1980 to April 15, 2016. Nineteen out of 98 eligible studies were included in the review. The main reason for exclusion was fatigue not being the outcome variable. RESULTS Most evidence was available for work time-related factors suggesting that working nights was most fatiguing, that fatigue levels were higher toward the end of watch or shift, and that the 6-h on-6-h off watch system was the most fatiguing. Specific work demands and particularly the psychosocial work environment have received little attention, but preliminary evidence suggests that stress may be an important factor. A majority of 12 studies were evaluated as potentially having a high risk of bias. CONCLUSIONS Realistic countermeasures ought to be established, e.g., in terms of shared or split night shifts. As internal as well as external validity of many study findings was limited, the range of factors investigated was insufficient and few studies investigated more complex interactions between different factors, knowledge derived from studies of high methodological quality investigating different factors, including psychosocial work environments, are needed to support future preventive programs.
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Chen T, Yao L, Ke D, Cao W, Zuo G, Zhou L, Jiang J, Yamahara J, Li Y, Wang J. Treatment with Rhodiola crenulata root extract ameliorates insulin resistance in fructose-fed rats by modulating sarcolemmal and intracellular fatty acid translocase/CD36 redistribution in skeletal muscle. Altern Ther Health Med 2016; 16:209. [PMID: 27405506 PMCID: PMC4942897 DOI: 10.1186/s12906-016-1176-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 06/29/2016] [Indexed: 12/29/2022]
Abstract
Background Rhodiola species have been used for asthenia, depression, fatigue, poor work performance and cardiovascular diseases, all of which may be associated with insulin resistance. To disclose the underlying mechanisms of action, the effect of Rhodiola crenulata root (RCR) on insulin resistance was investigated. Methods Male Sprague-Dawley rats were treated with liquid fructose in their drinking water over 18 weeks. The extract of RCR was co-administered (once daily by oral gavage) during the last 5 weeks. The indexes of lipid and glucose homeostasis were determined enzymatically and/or by ELISA. Gene expression was analyzed by Real-time PCR, Western blot and/or confocal immunofluorescence. Results RCR extract (50 mg/kg) suppressed fructose-induced hyperinsulinemia and the increases in the homeostasis model assessment of insulin resistance index and the adipose tissue insulin resistance index in rats. Additionally, this treatment had a trend to restore the ratios of glucose to insulin and non-esterified fatty acids (NEFA) to insulin. Mechanistically, RCR suppressed fructose-induced acceleration of the clearance of plasma NEFA during oral glucose tolerance test (OGTT), and decreased triglyceride content and Oil Red O staining area in the gastrocnemius. Furthermore, RCR restored fructose-induced sarcolemmal overexpression and intracellular less distribution of fatty acid translocase/CD36 that contributes to etiology of insulin resistance by facilitating fatty acid uptake. Conclusion These results suggest that RCR ameliorates insulin resistance in fructose-fed rats by modulating sarcolemmal and intracellular CD36 redistribution in the skeletal muscle. Our findings may provide a better understanding of the traditional use of Rhodila species.
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The Intervention Effects of Acupuncture on Fatigue Induced by Exhaustive Physical Exercises: A Metabolomics Investigation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:508302. [PMID: 26442121 PMCID: PMC4579316 DOI: 10.1155/2015/508302] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 01/03/2023]
Abstract
In this study, the antifatigue effects of acupuncture had been investigated at the metabolic level on the young male athletes with exhaustive physical exercises. After a series of exhaustive physical exercises and a short-term rest, the athletes either were treated with needling acupuncture on selected acupoints (TA group) or enjoyed an extended rest (TR group). NMR-based metabolomics analysis was then applied to depict the metabolic profiles of urine samples, which were collected from the athletes at three time points including the time before exercises, the time before and after the treatment of acupuncture, or taking the extended rest. The results from multivariate statistical analysis indicated that the recoveries of disturbed metabolites in the athletes treated with acupuncture were significantly faster than in those only taking rest. After the treatment with acupuncture, the levels of distinguished metabolites, 2-hydroxybutyrate, 3-hydroxyisovalerate, lactate, pyruvate, citrate, dimethylglycine, choline, glycine, hippurate, and hypoxanthine were recovered at an accelerated speed in the TA group in comparison with the TR group. The above-mentioned results indicated that the acupuncture treatment ameliorated fatigue by backregulating the perturbed energy metabolism, choline metabolism, and attenuating the ROS-induced stress at an accelerated speed, which demonstrated that acupuncture could serve as an alternative fatigue-relieving approach.
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Segerstedt J, Lundqvist R, Eliasson M. Patients with type 1 diabetes in Sweden experience more fatigue than the general population. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2015; 2:105-109. [PMID: 29204373 PMCID: PMC5685038 DOI: 10.1016/j.jcte.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/26/2022]
Abstract
Aims Type 2 diabetes has been linked to fatigue, but results on type 1 diabetes are ambiguous. Our aim was to determine if type 1 diabetes is associated with fatigue and whether the fatigue is due to complications or to the disease itself. Methods The Multidimensional Fatigue Inventory (MFI-20), was submitted to all 435 adult patients with type 1 diabetes in the National Diabetes Register at the Sunderby Hospital clinic and to a control group of 2500 persons. The participation rate was 62% in both groups. Results Type 1 diabetes was associated with greater fatigue, with a 1.4-point difference (0.9–1.9, 95% CI) in general fatigue on a scale of 4–20. Type 1 diabetes was an independent predictor of fatigue, as were cardiovascular and cerebrovascular disease. Women with long diabetes duration but without complications experienced more fatigue than women in the general population (difference in general fatigue = 2.5, p = 0.021), whereas men showed no significant difference. Conclusions Type 1 diabetes is associated with greater fatigue, partly ascribed to vascular disease. Type 1 diabetes of long duration might be associated with fatigue regardless of classical complications, but further research is needed to confirm results.
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Affiliation(s)
- Johan Segerstedt
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
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Seland M, Holte H, Bjøro T, Schreiner T, Bollerslev J, Loge JH, Fosså SD, Kiserud CE. Chronic fatigue is prevalent and associated with hormonal dysfunction in long-term non-Hodgkin lymphoma survivors treated with radiotherapy to the head and neck region. Leuk Lymphoma 2015; 56:3306-14. [DOI: 10.3109/10428194.2015.1036258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Gamper EM, Wintner LM, Rodrigues M, Buxbaum S, Nilica B, Singer S, Giesinger JM, Holzner B, Virgolini I. Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme. Eur J Nucl Med Mol Imaging 2015; 42:1179-88. [PMID: 25771905 PMCID: PMC4480943 DOI: 10.1007/s00259-015-3022-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) in differentiated thyroid cancer (DTC) research has so far received little attention and available results are conflicting. We studied the HRQOL of radioiodine-naive DTC patients in comparison with the general population (GP), investigated the course of HRQOL up to 30 months after radioiodine remnant ablation (RAA) and sought to identify patient characteristics associated with HRQOL. METHODS We analysed data from routine HRQOL monitoring at a nuclear medicine department. Between 2005 and 2013, a total of 439 thyroid cancer patients (all histologies) completed the EORTC Quality of Life Questionnaire Core-30 (QLQ-C30) at least once during their treatment at the department. We compared patients' baseline HRQOL scores before RAA with scores from age-matched and sex-matched controls from the Austrian GP. We then determined the course of HRQOL over the 30 months after RAA and assessed the impact of the following clinical variables on HRQOL: method of thyroid-stimulating hormone (TSH) stimulation, histology (papillary vs. follicular) and disease stage. RESULTS A total of 284 patients (mean age 48.3 years, SD 15.0 years; 71.6% women; 80.7% papillary type) with a baseline HRQOL assessment before RAA were available. We found clinically meaningful differences in the detriment in patients on almost all domains. These were largest for fatigue (23 points) and role functioning (25 points). Data from 241 patients (mean age 48.6 years, SD 15.9 years; 68.9% women; 76.3% papillary type) were included in the longitudinal analysis. Investigating the course of HRQOL, a significant improvement over time was found for role and emotional functioning, fatigue, pain, and dyspnoea. A range of HRQOL scores were improved in patients with exogenous TSH stimulation, but some scores both in patients with exogenous TSH stimulation and in those followed for 30 months, especially fatigue and role functioning, did not reach levels in the GP sample. CONCLUSION Our results show that the favourable prognosis of DTC does not directly translate into good HRQOL in these patients. Persistent restrictions in regaining their normal daily life in terms of work and leisure highlight the importance of more detailed investigation of DTC patients' wellbeing, support needs, and disease experience.
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Affiliation(s)
- Eva-Maria Gamper
- Department for Nuclear Medicine, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria,
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Abstract
There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.
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Evaluation of objective and perceived mental fatigability in older adults with vascular risk. J Psychosom Res 2014; 76:458-64. [PMID: 24840140 PMCID: PMC4033905 DOI: 10.1016/j.jpsychores.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Mental fatigability refers to the failure to sustain participation in tasks requiring mental effort. Older adults with vascular risk are at particular risk for experiencing mental fatigability. The present study (1) tested a new way of measuring objective mental fatigability by examining its association with perceived mental fatigability; and (2) identified associated psychological, physiological, and situational predictors. METHODS A cross-sectional study was conducted with 49 community-dwelling participants aged 75+ years with vascular risk. A 20-minute fatigability-manipulation task was used to induce mental fatigability and develop objective and perceived mental fatigability measures. Objective fatigability was calculated by the change of reaction time over the course of the task. Perceived fatigability was calculated by the change of fatigue self-reported before and after the task. A set of potential psychological, physiological, and situational predictors were measured. RESULTS There was a significant increase in reaction time and self-reported fatigue to the fatigability manipulation task, indicating occurrence of objective and perceived mental fatigability. Reaction time and self-reported fatigue were moderately, but significantly correlated. Higher levels of executive control and having a history of more frequently engaging in mental activities were associated with lower objective mental fatigability. None of the examined factors were associated with perceived mental fatigability. CONCLUSION Objective and perceived mental fatigability were sensitive to our fatigability-manipulation task. While these two measures were correlated, they were not associated with the same factors. These findings need to be validated in studies with a more heterogeneous sample and a greater variety of fatigability-manipulation tasks.
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Poulsen TR, Burr H, Hansen HL, Jepsen JR. Health of Danish seafarers and fishermen 1970-2010: What have register-based studies found? Scand J Public Health 2014; 42:534-45. [DOI: 10.1177/1403494814534538] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background:This study aimed to review Danish register-studies on seafarers’ and fishermen’s health and safety. Methods: Register-based or register-linked studies from 1970 until 2012 were identified and reviewed. Four categories of studies were included: mortality, hospitalization, specific diagnoses and conditions and accidents. Standardized risks estimates were typically calculated by comparison with the total Danish working population. Results: Elevated rates were found in all four categories. For mortality male seafarers had excess rates of accidents, cirrhosis of the liver, cancer, and suicides, and fishermen of accidents and cardiovascular disorders. Female seafarers in male-dominated occupations also had increased mortality rates. Elevated hospitalization rates for male seafarers were particularly prominent for endocrine/nutritional conditions, cervical discopathy, gastrointestinal and cardiovascular diseases, cancers, hearing impairment, and injuries, and for female seafarers cancers, circulatory and genitourinary diseases and injuries. Fishermen had increased hospitalization rates for cardiovascular diseases, bronchitis, emphysema, lung cancer, gonarthrosis, thoracolumbar discopathy, rotator cuff syndrome, carpal tunnel syndrome, injuries and hearing impairment. Specific diagnoses and conditions: There was an elevated risk of tuberculosis, hepatitis B and certain cancers for male seafarers, and of obesity and occupational accidents for both fishermen and seafarers. Conclusions: In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen’s and seafarers’ health will remain essential for implementing appropriate preventive measures.
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Affiliation(s)
| | - Hermann Burr
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Germany
| | | | - Jørgen Riis Jepsen
- Centre of Maritime Health and Society, University of Southern Denmark, Denmark
- Department of Occupational Medicine, Hospital of South-western Jutland, Denmark
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Husson O, Nieuwlaat WA, Oranje WA, Haak HR, van de Poll-Franse LV, Mols F. Fatigue among short- and long-term thyroid cancer survivors: results from the population-based PROFILES registry. Thyroid 2013; 23:1247-55. [PMID: 23578315 PMCID: PMC3783928 DOI: 10.1089/thy.2013.0015] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The aims of this study were (i) to obtain insight into the prevalence of fatigue among short- and long-term thyroid cancer (TC) survivors, by comparing a sample of TC survivors with an age- and sex-matched normative population, and (ii) to investigate which demographic, clinical, and TC-specific health-related quality of life (HRQoL) characteristics were associated with fatigue. METHODS All patients found to have TC between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a cross-sectional survey on fatigue (Fatigue Assessment Scale), TC-specific HRQoL (THYCA-QoL), and psychological distress (Hospital Anxiety and Depression Scale). The fatigue scores were compared with those of an age- and sex-matched normative population (n=530). Multiple logistic regression analyses were conducted to investigate the independent associations between clinical and demographic characteristics, TC-specific HRQoL, and psychological distress with fatigue. RESULTS Eighty-six percent (n=306) responded. TC survivors were more often classified as fatigued or very fatigued (short-term <5 years: 43%; long-term 5-10 years: 44%; long-term 10-15 years: 47%; long-term >15 years: 39%) compared to the normative population (25%; p<0.001). Anxiety (odds ratio (OR) 1.15, 95% confidence interval [CI] 1.03-1.28) and depression (OR 1.43 [CI 1.22-1.68]) were associated with fatigue, as was also the case for TC-specific neuromuscular (OR 1.03 [CI 1.01-1.06]), concentration (OR 1.03 [CI 1.01-1.06]), and psychological TC-specific HRQoL (OR 1.06 [CI 1.02-1.10]). CONCLUSION Short- and long-term TC survivors report higher levels of fatigue than an age- and sex-matched normative population do. Both TC-specific HRQoL and psychological distress were associated with fatigue.
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Affiliation(s)
- Olga Husson
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | | | - Wilma A. Oranje
- Department of Endocrinology, TweeSteden Hospital, Tilburg, The Netherlands
| | - Harm R. Haak
- Department of Endocrinology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Lonneke V. van de Poll-Franse
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - Floortje Mols
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands
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Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age. Int Psychogeriatr 2013; 25:275-85. [PMID: 23083533 PMCID: PMC3552486 DOI: 10.1017/s1041610212001718] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The present study examined the prospective relationships between subjective fatigue, cognitive function, and everyday functioning. METHODS A cohort study with secondary data analysis was conducted using data from 2,781 community-dwelling older adults without dementia who were enrolled to participate in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized intervention trial. Measures included demographic and health information at baseline, and annual assessments of subjective fatigue, cognitive function (i.e. speed of processing, memory, and reasoning), and everyday functioning (i.e. everyday speed and everyday problem-solving) over five years. RESULTS Four distinct classes of subjective fatigue were identified using growth mixture modeling: one group complaining fatigue "some of the time" at baseline but "most of the time" at five-year follow-up (increased fatigue), one complaining fatigue "a good bit of the time" constantly over time (persistent fatigue), one complaining fatigue "most of the time" at baseline but "some of the time" at five-year follow-up (decreased fatigue), and the fourth complaining fatigue "some of the time" constantly over time (persistent energy). All domains of cognitive function and everyday functioning declined significantly over five years; and the decline rates, but not the baseline levels, differed by the latent class of subjective fatigue. Except for the decreased fatigue class, there were different degrees of significant associations between the decline rates of subjective fatigue and all domains of cognitive function and everyday functioning in other classes of subjective fatigue. CONCLUSION Future interventions should address subjective fatigue when managing cognitive and functional abilities in community-dwelling older adults.
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Cutovic M, Konstantinovic L, Stankovic Z, Vesovic-Potic V. Structured exercise program improves functional capacity and delays relapse in euthyroid patients with Graves' disease. Disabil Rehabil 2012; 34:1511-8. [PMID: 22394073 DOI: 10.3109/09638288.2012.660599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate short- and long-term effects of structured exercise program in euthyroid patients with Graves' disease. METHODS The study employed a retrospective case-control design. The exercise group (n = 62) underwent 3 weeks of structured exercise program consisting of daily walking, strengthening, and stretching exercises while the control group (n = 62) participated in leisure activities. Thyroid profile, aerobic capacity, and perceived fatigue were evaluated on in-patient admission and discharge. Time to discontinuation of anti-thyroid medication after discharge and time to relapse of symptoms were determined. RESULTS The exercise group increased estimated peak oxygen consumption (significant group-by-time ANOVA interaction, P < 0.001), decreased serum thyroxin (P = 0.038), increased serum thyrotropin (P = 0.071), and reported less fatigue (Fisher's exact test, p < 0.001) from admission to discharge. The anti-thyroid medication was withdrawn within 6 months of discharge in significantly greater proportion of subjects in the exercise than control group (84% vs. 18%). Conversely, the rate of relapse within 12 months of medication withdrawal was smaller in the exercise (29%) than control group (72%). CONCLUSIONS The results suggest that structured exercise program may normalize thyroid profile, improve aerobic capacity, and reduce fatigue on the short-term basis as well as reduce the need for anti-thyroid medication on the long-term basis.
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Affiliation(s)
- Milisav Cutovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Gerber LH. Fatigue: A Challenge for PM&R. PM R 2010; 2:324-6. [DOI: 10.1016/j.pmrj.2010.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
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