[CLINICAL AND PSYCHOLOGICAL CORRELATIONS IN FIBROMYALGIA PATIENTS]

The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.

Ramadan fasting in patients with adrenal insufficiency

AIM

The risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations.

METHODS

It is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan.

RESULTS

There were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14-79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications.

CONCLUSION

In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

[IRON-DEFICIENCY ANEMIA AS A FACTOR OF DEVELOPMENT OF ASTHENIA SYNDROME]

The aim of this research was to determine the frequency and degree of severity of asthenic syndrome (AS) and estimation of physical health of women with iron-deficiency anemia (IDA) and without it. 30 women were inspected with the set diagnosis of IDA and 20 nearly were healthy. All participants were assessed according objective status. AS was determined by the scale of estimation of asthenia - Scale Asthenic Conditions (SAC) of LD Malkova, the scale of subjective evaluation of asthenia (MFI-20). Level of somatic health was appraised by methodology of LG Apanasenko. As a result of research it was found that in 100% of women with IDA , which more often occurs with expressed hypoxic syndrome, that aggravates a process of AS. The severity of AS directly depends on the degree of IDA. The presence of IDA contributes to decreased physical activity of patients because of progressive weakness and fatigue. The level of physical health is rated as "low" due to low reserve capacity of the cardiorespiratory system and power qualities. In the control group, incidence of AS is significantly lower (40-55%) and the degree of severity in most cases is weak and moderate. The obtained data allow to make the conclusion that the medicines for correction of AS must be necessarily included in therapy of IDA.

[Influence of cytoflavin on symptoms of asthenia, emotional disorders and autonomic regulation in patients with organic asthenic disorder]

The present observational study addressed effects of cytoflavine on symptoms of asthenia and emotional and autonomic regulation in patients with organic emotional-labile (asthenic) disorder (F06.6). Fifty one females and 49 males (mean age 36.8±11.0 years) were included into the study during their in-patient treatment in Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department. All patients received standard antidepressant and vascular therapy, were consulted by psychologists or psychotherapists, visited physiotherapeutic procedures, massage and medical physical training. In addition, 50 patients received cytoflavin two tablets twice per day. At the psychiatric re-assessment before discharge both cytoflavin and control groups showed similar significant reduction of asthenia symptoms. At the same time, patients with cognitive deficits showed significantly larger improvement of cognitive functions after cytoflavin treatment in comparison with cognitively deficient patients after only standard therapy. Improvement of depressive symptoms was significantly larger in cytoflavin group in comparison with controls as well. These data are consistent with previous studies which showed cytoflavin to be effective as a treatment for patients with cognitive deficits and organic depression.

[Methodic approaches to evaluation of visual performance in professional computer users]

Occupation-related and physiologic studies in workers using personal computers revealed variable degrees of changed visual performance in accordance with work conditions class and integral parameter of work intensity. Findings are that the performance change is caused by lower accomodation volume and decrease in temporary characteristics of clear vision stability. Correlation was established between work conditions class and percentage of the performance decrease during the working shift in videodisplay users.

[Effect of Dingguier umbilical paste on rats with functional dyspepsia and mice with splenic asthenia]

OBJECTIVE

To observe the effect of Dingguier umbilical paste on rats with functional dyspepsia and mice with splenic asthenia, and investigate the related mechanism.

METHOD

Functional dyspepsia models of rats were made by irregular food intake plus diluted hydrochloric acid. Successional treatments were offered for 14 days. The rats weights, contents of serum NO, AChE and MC were measured. The rats with splenic asthenia were made by rhubarb feed, and observed the affection of gastric emptying.

RESULT

Compared with those in the model control group, the weight of rats in all dosages Dingguier umbilical paste groups increased obviously (P < 0.05), pepsin activity of rats in the dosage (1.34 g x kg(-1)) Dingguier umbilical paste groups was significantly higher and the contents of NO and quantities of MC in the dosage (2.67 g x kg(-1)) Dingguier umbilical paste groups decreased clearly (P < 0.05), and the contents of serum AChE in all dosages Dingguier umbilical paste groups rose apparently. The weight of mice with splenic asthenia increased obviously, accelerated gastric emptying, and improved the symptom.

CONCLUSION

Dingguier umbilical paste has significant improvement of indigestion. The related mechanism may be to reduce the content of serum NO and the quantity of MC and enhance the content of serum AChE.

[Asthenic disorders and cognitive dysfunction in patients with tension headache]

The article is devoted to the study of cognitive dysfunction in patients suffering from tension headaches. Patients had attention and memory dysfunction, higher levels of anxiety, asthenia and subclinical symptoms of depression. The high efficacy of cerebrolysin in the restoration of cognitive dysfunction confirmed by the data of clinical, psychological and neuropsychological studies was shown.

[Asthenic syndrome in patients with burnout syndrome]

The authors present the results of a survey of 103 patients aged 25 to 45 years with burnout syndrom. The results showed that most patients with the syndrome of burnout have clinical manifestations of asthenia, varying degrees of severity. According to psychological and psychophysiological examination in this group of patients were found attention and memory dysfunction. This study evaluated the efficacy of memoplant in the treatment of this pathology. The high efficiency of memoplant (improvement in 69.7% of cases) was detected, confirmed by the data of the clinical, psychological and neuropsychological research.

[Labor physiology role in workers of different type labor activity workability and health. Progress and prospects]

There are presented the data of workers overstrain and fatigue conditions mechanisms based on physiological, psychological and ergonomic aspects of work processes in different types of activities (mental, visual-strained, physical). 15-year historical analysis, current state and prospects of labor physiology methods development are shown. Complex physiological and ergonomic investigations have allowed developing the measures of work ability raise and diseases prevention for workers various professions. Obtained results provided the basis of development of regulatory documents in area of human organism strain physiological norms, consequences of psycho-emotional stress and overstrain prevention taking into account working conditions class.

[Possibilities of antioxidant therapy for asthenia and cognitive deficit in elderly patients with chronic brain ischemia]

AIM

To evaluate the effect of the antioxidant mexidol on the oxidant-antioxidant potential of low-density lipoprotein (LDL), asthenic and anxious symptoms, and cognitive function of neurodynamic type in elderly patients with chronic brain ischemia (CBI).

SUBJECTS AND METHODS

Thirty women (mean age 66.7 years) with grade 1-2 dyscirculatory encephalopathy (DE) were examined. Trends for asthenic, anxious, and cognitive symptoms of neurodynamic type were estimated using the standard tests (MFI-20, Hamilton Anxiety Rating Scale, Schulte Tables, Wechsler test) on days 1, 15, and 60 of mexidol treatment (for 60 days). LDLs were isolated from blood by heparin precipitation. The baseline level of lipid peroxidation products was determined and the concentrations of fat-soluble antioxidants (a-tocopherol, retinol, beta-carotene, and xanthins) were examined in the isolated LDLs on days 1 and 5 of the study.

RESULTS

A 60-day mexidol therapy cycle statistically significantly caused a reduction in asthenic and anxious symptoms in elderly patients with CBI and induced positive changes in the symptoms of cognitive neurodynamics. Assessing the specific features of the pharmacodynamics of the antioxidant mexidol used in the elderly patients for 15 days revealed a statistically significant positive effect on the oxidative potential of LDLs as a decreased predisposition to their antioxidative processes in vivo. The drug's effect in elevating the levels of a-tocopherol and beta-carotene was altered insignificantly (without statistically significant changes), which reflects the pharmacodynamic features of the drug in the elderly patients.

CONCLUSION

The 60-day cycle of therapy with the antioxidant mexidol has a positive impact on asthenic and neurotic symptoms in the elderly patients with CBI. Mexidol is well tolerated and safe when used long.

[Effect of electroacupuncture on differentiation and proliferation of hippocampal nerve stem cells in splenic asthenia pedo-rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on the differentiation and proliferation of nerve stem cells in the hippocampal dentate gyrus (DG) in splenic asthenia pedo-rats so as to study its central mechanism.

METHODS

A total of 72 SD male rats were randomly assigned to normal control group (n=24), model group (n=24) and EA group (n=24) which were further divided into 7 d, 14 d, 28 d and 49 d time-points (n=6). Splenic asthenia model was established by intraperitoneal injection of reserpine and gavage of Dahuang (Radix et Rhizoma Rhei) fluid. EA was applied to bilateral "Zusanli" (ST 36) and "Sanyinjiao" (SP 6) for 20 min, once daily for 7, 14, 28 and 49 days respectively. Brdu, Nestin, glial fibrillary acidic protein (GFAP), and neuron-specific enolase (NSE) expression in the DG of hippocampus were detected by immunohistochemistry double staining.

RESULTS

Compared with the normal control group, the numbers of Brdu, Brdu/GFAP, Brdu/NSE Immunoreactive (IR) positive cells in the DG of hippocampus on day 7 and 14, and that of Brdu/Nestin IR-positive cells on day 7 were decreased considerably in the model group (P < 0.05). Compared to the model group, the numbers of hippocampal Brdu IR-positive cells at the 4 time-points, Brdu/Nestin and Brdu/GFAP on day 7, 14 and 49, and Brdu/NSE on day 7, 14 and 28 were increased significantly in the EA group (P < 0.05). No significant differences were found between the model and control groups in the numbers of hippocampal Brdu and Brdu/NSE IR-positive cells on day 28 and 49, in the number of Brdu/Nestin IR-positive cells on day 14 and 49, in the number of Brdu/GFAP IR-positive cells on day 28; and between the EA and model groups in the numbers of Brdu/Nestin and Brdu/GFAP IR-positive cells on day 28, and in the number of Brdu/NSE IR-positive cells on day 49 (P > 0.05).

CONCLUSION

EA of ST 36 and SP 6 can effectively suppress splenic asthenia syndrome-induced decrease of the numbers of Brdu, Brdu/GFAP, Brdu/Nestin and Brdu/NSE IR-positive cells in the DG of hippocampus at the early stage in the splenic asthenia rats, which may contribute to its effect in improving splenic asthenia symptoms in clinic by promoting the proliferation and differentiation of some nerve stem cells in the hippocampus.

[Characteristics of the EEG spatial organization of the brain neocortex biopotentials in various clinical neurotic depression]

In 20 patients with various clinical variants of neurotic depression, regional organization of the brain bioelectric activity was studied with the aid of cross-correlation, factorial and coherent analyses. Clinical picture of neurotic depression was reflected within the frame of regional organization of the EEG. Regional organization EEG is modified depending on the degree of neurotic depression manifestation and concomitant syndromes of alarm and asthenia. In depressive syndrome without concomitant asthenic and disturbing, the maximum changes are registered in the right fronto-temporal range--left post-temporal areas. In depression and the alarm, depression cross-correlation and coherent communications in fronto-temporal areas of both hemispheres were recorded. In depressive and disturbing syndromes with the asthenic manifestations, depression cross-correlation and coherent communications in fronto-temporal areas of both hemispheres were observed.

[Effect of electroacupuncture on cellular structure of hippocampus in splenic asthenia pedo-rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on hippocampal structure in splenic asthenia pedo-rats.

METHODS

A total of 15 SD male rats were randomly assigned to normal control group (n=5), model group (n=5) and EA group (n=5). Splenic asthenic syndrome model was established by intragastric administration of rhubarb and intraperitoneal injection of Reserpine for 14 d. EA (1 mA, 3 Hz/iS Hz) was applied to bilateral "Zusanli" (ST 36) and "Sanyinjiao" (SP 6) for 20 mm, once a day for 14 days. The cellular structure of hippocampus was observed by light microscope and transmission electron microscope.

RESULTS

Optical microscopic observation showed that in normal control group, the cellular nucleus was distinct, and the granular cell layer well-arranged and tight. In model group, the intracellular space was widened, and the granular cell layer was out of order in the arrangement. In EA group, the celluldr nucleus and the granular cell layer were nearly normal. Results of the electronic microscope showed that cells in model group had a karyopyknosis with irregular appearance and clear incisure, and some of them presented dissolving and necrotic phenomena; and those in EA group were milder in injury, had nearly-normal nucleus with visible nucleoli and relatively-intact nuclear membrane. Regarding the cellular plasma, in comparison with rich normal organelles of control group, the mitochondria in model group were swelling, with vague, dissolved and broken cristae, while in EA group, majority of the organelles were well-kept, and slightly dissolved mitochondrial cristae found. In regard to the synaptic structure, in comparison with control group, synaptic apomorphosis and swelling mitochondria were found in model group While in EA group, milder swelling and hydropic degeneration were seen. Different from the distinct pre- and post-synaptic membrane and synaptic vesicles of control group, while those in EA group were nearly-normal.

CONCLUSION

electroacupunture can effectively relieve splenasthenic syndrome induced pathohistological changes of neurons of the hippocampus in the rat.

[Clinical characteristics of tertian malaria in the population of Kyrgyzstan under repeated outbreak of the disease]

In the period of an epidemic outbreak, tertian malaria is registered at a high rate among children, which has a characteristic sign of local transmission via malaria mosquitoes. The case histories of 66 patients with tertian malaria, including 27 children aged 10 months to 15 years, treated at the infection unit of Tashkumyr town hospital in July to August 2006, were the subject of this investigation. In childhood malaria, the specific feature of feverish paroxysm is daily fever with evident symptoms of intoxication and signs of neurotoxicosis.

Euchronism, allochronism, and dyschronism: is internal desynchronization of human circadian rhythms a sign of illness?

The authors define a subject as euchronic when the circadian parameters--tau (tau=period), Ø (acrophse or peak time), A (amplitude), and M (MESOR=24 h rhythm-adjusted mean)--of a set of circadian variables are within the confidence limits of appropriate reference values of healthy subjects (HS). We define internal desynchronization as a state in which the circadian tau of a set of rhythms differs from 24 h and when the tau of a given variable differs from that of other variables. Such a state was first observed in singly isolated HS without access to time cues and clues. Herein, data and analyses are presented demonstrating that internal desynchronization appears to be a rather common phenomenon in HS dwelling in their natural environment (i.e., in the presence of usual zeitgebers). This has been documented by longitudinal studies (n approximately=15 days) of the circadian rhythm in sleep-wakefulness, body temperature, right- and left-hand-grip strength, and reaction time involving a total of 246 HS and 134 shift workers (SW), with 45.5% showing good and 54.5% poor SW tolerance. The presence of internal desynchronization observed in SW was associated SW intolerance, with symptoms being sleep alteration/disturbances, sleeping-pill dependence, persisting fatigue (asthenia), mood alteration, and digestive complaints. Internal desynchronization was also documented in groups of HS and tolerant SW, though it was almost the rule among the intolerant SW. The authors introduce two new terms: allochronism to describe the time organization of those SW who evidence internal desynchronization without detectable clinical symptoms, and dyschronism to describe the time organization of those SW who exhibit internal desynchrobization plus the symptoms of SW intolerance or medical illness. The condition of allochronism is not restricted only to SW tolerance, as it was detected in 112 HS without medical complains when exposed to various experimental conditions, including medications and placebos, sojourn in the high Arctic summer, intensive sport training, and task-loaded cognitive performance testing. Dyschronism in SW who are sleep-deprived is associated with persisting fatigue. An unpublished Gallup survey found that 47% of 2478 respondents experienced a state of asthenia during the previous 12 months, with symptoms mimicking those of SW intolerance. In one-third of the cases, the origin of the asthenia was undetermined. Taking into account the high incidence of internal desynchronization found in past investigations and the clinical observation that sleep deprivation is a consequence of many acute and chronic medical conditions (nocturnal pain, nocturnal asthma, etc.), it is suggested that dyschronism may be responsible for the asthenia of unknown origin, at least for some persons. The interindividual (including sex-related) variability in the propensity to exhibit an altered temporal organization, whether it be transient or persistent (i.e., reversible or non-reversible) suggests the involvement of genetic factors. The Dian-Circadian genetic model previously proposed by the authors seems pertinent to conceptualize and explain the various levels and output of internal desynchronization.

Redefining Cancer-Related Asthenia-Fatigue Syndrome

BACKGROUND

Asthenia fatigue syndrome (AFS) is a common symptom perceived by patients with cancer and consists of reported pathologic fatigue, poor endurance, and impaired motor and cognitive function.

OBJECTIVE

The purpose of this study was to examine the relationship between a traditional measure of AFS, visual analogue scale (VAS) fatigue ratings, and a set of more objective functional and physiologic measures (Dietz oncology classification, C-reactive protein, serum albumin, hemoglobin, body mass index [BMI]), Motor Functional Independence Measure (FIM) Score, Cognitive FIM Score. We hypothesized a relationship could suggest the utility of alternative means of assessing and addressing AFS.

METHODS

We retrospectively examined the records of 131 patients admitted to our facility for inpatient rehabilitation because of disability-causing cancer or its treatment.

RESULTS

Of our sample, 94.7% (124 cases) indicated at least mild fatigue and 97.7% (128 cases) showed abnormal serum albumin, C-reactive protein, hemoglobin, or BMI. We used multiple regression analysis to examine the relationship between VAS fatigue ratings and the aforementioned set of functional and physiologic variables. The regression explained a significant proportion of the variability in VAS fatigue ratings (F = 2.25, df = 7,123, p = 0.03, R = 0.34, R(2) = 0.11). However, only Motor FIM Score accounted for a significant independent contribution to the variability in VAS fatigue ratings.

CONCLUSION

The data indicate physiologic and functional variables may provide an alternative, objective, and reliable operational definition of AFS. Specifically, using Motor FIM Score, as a surrogate for VAS fatigue ratings may be used to measure the efficacy of AFS treatment.

[Pathophysiology and treatment of fatigue in multiple sclerosis]

Patients suffering from multiple sclerosis (MS) frequently complain of fatigue (53 to 92 percent depending on studies). Fatigue can be one of the most disabling symptoms of MS and presents as physical or mental fatigue in daily living activities. Besides this permanent feeling of exhaustion, MS patients can suffer from an abnormal tiredness and lack of energy after a given motor or mental task, which defines fatigability. A number of studies explored the origins of fatigue and fatigability by means of subjective and objective tools. The implication of central nervous system dysfunctions has been established in several studies; however the contribution of peripheral nervous system factors and systemic abnormalities associated with inflammatory and immunological parameters was also suggested. The aim of this review is to present the different types of fatigue and fatigability occurring in MS patients, their origins, the investigation tools which allow the quantification of fatigue and fatigability and characterization of their mechanisms. The currently available therapeutic strategies that have been proposed to relieve this disabling symptom are presented.

[Studying the mechanisms of ladasten action]

The effect of N-(2-adamantyl)-N-(p-bromophenyl)amine (ladasten) on the behavior of MR and MNRA inbred rats with different emotional-stress reaction (ESR) phenotypes was studied in the conventional open-field test. Ladasten (30 mg/kg, i.p.) produced anxiolytic effect in MR rates, while not influencing MNRA animals. At the same time, a model stress induced disorder in the regulation of 3 H-diazepam binding to the benzodiazepine site of GABA(A) receptor in MR (but not in MNRA) rats. Ladasten administered in the anxiolytic dose prevented stress-induced changes in reception at this site.

Adjuvant role of vitamin B analogue (sulbutiamine) with anti-infective treatment in infection associated asthenia

AIMS OF THE STUDY

Asthenic symptoms such as weakness accompany illness. This study investigates whether the centrally acting cholinergic agent, vitamin B analogue (sulbutiamine), is effective and acceptable in relieving these symptoms in infectious disease when combined with specific anti-infective treatment.

METHODOLOGY

In a prospective uncontrolled, non-randomised, commercial, observational study, 1772 patients with an infectious disease and asthenic symptoms, drawn from the practice of 350 randomly selected physicians throughout India, received vitamin B analogue (sulbutiamine) in addition to specific anti-infective treatment for 15 days. The primary outcome variable was complete resolution of asthenic symptoms with treatment.

RESULTS

The number (%, 95% confidence interval) of patients with complete resolution of all asthenic symptoms was 916 (51.7, 49.4-54). In the remaining patients, severe asthenia was reduced but persisted in 11 (0.6, 0-26); and moderate asthenia in 94 (5.3, 0-17.6). The response was greater in patients with acute infection and symptoms more related to cerebral function. Side effects occurred in 10 (0.6%), patients and well being improved significantly.

CONCLUSIONS

Vitamin B analogue (sulbutiamine) may be a useful adjunct to specific anti-infective treatment.

[Correction of asthenovegetative disorders in the postoperative period in pulmonary tuberculosis patients]

58 patients with asthenia were observed during postoperative period after surgery treatment of tuberculosis. All of the patients were divided into two groups: 34 patients taking anti tuberculosis drugs and Stimol, and 24 patients taking only anti tuberculosis drugs. Following method where used to appreciate states of the patients: scales of Symptoms Check List--90, acid-base and gas state of blood, EKG, ECHOKG, KIG, Contactles Spirometry.

RESULTS

Treatment with using of Stimol leads to quicker regress of asthenia to improvement in both cardiovascular and respiratory systems and normalization of gas state of blood. Effect of this medicine can be connected with positive influence on cardiac and respiratory functions of the body due to normalization vegetative prevision and improvement of metabolism in cells of drain and cardiomyocyties.

Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis

OBJECTIVES

To investigate whether the single-item fatigue question of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Fatigue Inventory (MFI) are appropriate instruments to measure fatigue in ankylosing spondylitis (AS); to identify factors that influence fatigue in AS; and to assess how fatigue in all its aspects is associated with quality of life in AS.

METHODS

A total of 812 patients with AS were included. Patients completed questionnaires on disease activity (BASDAI), functional ability (Bath Ankylosing Spondylitis Functional Index [BASFI]), global well-being (Bath Ankylosing Spondylitis Global Score [BAS-G]), overall perceived health (EuroQoL visual analog scale), and quality of life (Ankylosing Spondylitis Quality of Life questionnaire, and Short Form 36 [SF-36]). Patients were dichotomized into a F+ group (fatigue = major symptom) if the BASDAI fatigue score was > 5.0 and a F- group (fatigue = minor symptom) if the fatigue score was < 5.0. Reproducibility was assessed with intraclass correlation coefficients, and responsiveness was calculated according to 3 different methods. Logistic regression analysis was used to determine which factors were associated with fatigue. Multiple regression analysis was used to investigate whether fatigue contributes in explaining quality of life.

RESULTS

Fifty-three percent of the patients were assigned to the F+ group. They scored significantly worse compared with the F- group with respect to each dimension of the MFI and to all other questionnaires studied (all P < 0.001). The BASDAI fatigue question, as well as each separate dimension of the MFI, showed moderate to good reproducibility (0.57-0.75) and responsiveness (0.23-0.96). Fatigue was, in the opinion of the patients, highly associated with pain (70% of patients) and stiffness (54% of patients). Logistic regression analysis showed that scores on BASDAI, BASFI, BAS-G, and mental health status (SF-36) were independently associated with fatigue (R(2) = 0.52). Multiple regression analysis showed that scores on the BASDAI fatigue question were significantly associated with quality of life. With the 5 MFI dimensions as explanatory variables, different aspects of fatigue were associated with different domains of quality of life.

CONCLUSIONS

Fatigue as a major symptom of AS can effectively be measured with either a single-item question on the intensity of fatigue or with the MFI. The MFI, however, provides more insight into specific dimensions of fatigue. Fatigue appears to be associated with the level of disease activity, functional ability, global well-being, and mental health status. In addition, fatigue negatively influences different aspects of quality of life.

Cachexia and asthenia in cancer patients

Over the past 10 years, there have been major advances in the understanding of cancer cachexia and asthenia. These common complications of cancer are now thought to be the consequences of complex interactions between host, tumour, and psychosocial factors. Cachexia and asthenia commonly coexist, but they can occur independently of each other. Recently identified tumour-derived factors cause lipolysis and protein catabolism. Cytokines produced by the host in response to tumour presence cause metabolic abnormalities, which result in decreased protein and lipid synthesis, increased lipolysis, and anorexia. Many other factors contribute to asthenia, such as anaemia, autonomic failure, and muscular abnormalities. Future research should clarify optimum management. The way forward seems to lie in a multidimensional approach with combined therapy to manage both cancer cachexia and asthenia.

Mixed cryoglobulinemia in hepatitis C patients. GERMIVIC

Cryoglobulins are immunoglobulins that persist in the serum, precipitate with cold temperature and resolubilize when rewarmed. Types II and III are mixed cryoglobulins (MC), composed of different immunoglobulins, with a monoclonal component in type II and only polyclonal immunoglobulins in type III. Mixed cryoglobulins are associated with connective-tissue disease, malignant hematological disorder (type B lymphoproliferation) or obvious infectious process. Mixed cryoglobulinemia syndrome is characterized by the clinical triad of purpura, arthralgia and asthenia associated with type II or type III MC. The disorder is the consequence of an immune-complex-type vasculitis as supported by clinical features, analysis of the cryoglobulins, the usually depressed level of complement during the active phase of the disease, and the deposition of immunoglobulins and complement in the lesions. Such cryoglobulinemia vasculitis may involve numerous organs, particularly the peripheral nervous system and the kidneys. MC is frequently associated with clinical and biological evidence of liver disease. There has been some controversy about which comes first, MC or chronic liver disease, but it seems fairly clear that MC is often a manifestation of underlying chronic active or persistent hepatitis. In MC patients, the hepatotropic antigen(s) capable of triggering production of antibodies which can later form immune complexes has been sought for many years. In the last ten years, numerous studies have demonstrated that infection with hepatitis C virus is involved in the pathogenesis of most mixed cryoglobulinemia. This review analyzes the main published data on hepatitis C virus-mixed cryoglobulinemia, the role of liver alterations, the predictive factors associated with MC production in HCV patients and its symptomatic nature or not, and the different types of vasculitis associated with HCV chronic infection.

[The main clinico-neurological syndromes of prolonged hypokinesia]

Based on analysis of the nature and course of disorders in 81 volunteers as the sequel to strict horizontal (0 degree) or head-down (-4 degrees to -6 degrees) bed rest (hypokinesia) from seven days up to six months, neurological phenomenology of the following clinical syndromes was described: "acute" hemodynamics deviations, physical and thermal discomfort, astheno-neurotic developments, autonomous vascular dysfunction and trophic disturbances, neuromuscular disorders, statokinetic disorders, algesia, and degraded ability to do physical performance tests. Each of the above syndromes became perceptible at certain phases of bed rest, progressed as the time of hypokinesia grew and sharply aggravated early in the readaptation period on regaining the vertical posture and peaked during physical testing. Despite of the variety of physical exercises and supportive medicaments used during six months of bed rest, recovery of the health disorders took no less than two months of extensive therapeutic/rehabilitative treatment.

[Muscle, fatigue, sports and infection]

PURPOSE

Skeletal muscle can be considered as motors which convert chemical energy into mechanical energy. We can evaluate the intracellular pH and energy state of phosphate-containing metabolites in skeletal muscle of patients complaining fatigue or asthenia, using phosphorus MRS.

MAIN POINTS

Acute infectious disease and extreme endurance exercise may induce a loss of oxidative capacity of muscle tissue. Muscle fatigue is not due only to an insufficient supply of ATP to the energy consuming mechanisms. Phosphorus MRS show a muscle production of toxic metabolites such as lactates, protons and ammonia. These metabolic features induced excessive intracellular acidosis of skeletal muscle and systemic hyperammonia, responsible of fatigue and asthenia.

PERSPECTIVES

Reversal of the excessive acidosis and improvement of the capacity for oxidative ATP synthesis might help to relieve the symptoms of exhaustion/fatigue in these patients.

[Role of autonomic nervous system in pathogenesis and clinical manifestation of arterial hypertension in Icenko-Cushing disease]

AIM

To study the role of autonomic nervous system (ANS) in pathogenesis and clinical symptoms of arterial hypertension (AH) in Icenko-Cushing disease (ICD).

MATERIALS AND METHODS

Clinical and paraclinical parameters (vegetative reflexes, special tables, 10 words memory and Spilberg's tests, ECG, electroencephalography, computed tomography, MR-tomography, hormonal status) were studied in 48 ICD patients before and after treatment (adenomectomy, irradiation of the hypophysis, adrenalectomy, parlodel, chlotidin chemotherapy).

RESULTS

94.5% of patients with active ICD had blood hypertension and vegetovascular asthenia. There was a trend to cerebrovascular impairment. In spite of biochemical and clinical ICD remission lipothemia persisted in many patients.

CONCLUSION

Pathogenesis of blood hypertension in ICD is related to hypersecretion of ACTH and corticosteroids but further progress of the disease depends on phenotypic features of autonomic nervous system and developing defects of CNS.

[Changes in brain memory functions as affected by a constant magnetic field]

Effects of CMF on memory processes in adult volunteers (non-sleep us hypnotic condition) has been studied at laboratory and clinical conditions. The results point out that CMF changes the interhemispheric relations and result in memory malfunction. The malfunction of memory activity in volunteers after action of CMF was influenced by two factors: magnetic field position under different brain areas and functional status of volunteers: awake or hypnotic.

On the intercorrelation of some frequency and amplitude parameters of the human EEG and its functional significance. Communication II: neurodynamic imbalance in endogenous asthenic-like disorders

In 67 borderline psychiatric patients suffering from schizotypal/slowly developing schizophrenic disorders and 18 patients suffering from cyclothymia, the factor structure of the period (interval-amplitude) parameters of the EEG proved to be similar to that obtained in normal subjects during mental activity and reported in part I (Lazarev, Int. J. Psychophysiol., 28 (1998) 77-98). However, 51 patients with schizotypal disorders with a predominance of asthenic-like symptomatology, characterized by mild thought disorders with difficulty in focusing attention, were distinguished from normal subjects, cyclothymic patients and other patients of schizotypy without well-defined asthenic symptoms by significantly increased values of EEG Factor II which was positively related to the index-presence in epoch, frequency and regularity of low-amplitude beta-waves, and reduced values of an EEG Factor III which was positively correlated with mean alpha-period and theta-index. According to normative data (part I; Lazarev, Int. J. Psychophysiol., 28 (1998) 77-98), this probably reflects a neurodynamic imbalance between an excess of 'cortical excitation' (Factor II) and a deficit of 'active selective inhibition' (Factor III). This imbalance appears to be opposite to the changes in values of these factors found in normal subjects during focusing attention and motor automation, when compared with relaxed wakefulness. The functional properties of Factors II and III ascribed on the basis of psychological testing suggest that such an imbalance could reflect a predominance of successively organised associative mental processes over the selective inhibition of irrelevant associations. This could cause difficulties in voluntary attention, mental automation and in the performance of simultaneous mental operations. In most cases, there was no difference in Factor I which was positively related to the index, amplitude and regularity of alpha-activity and wave amplitudes in other bands, and negatively related to the indices and mean periods of delta- and theta-waves, the factor presumed to depict 'general activation'.

Preliminary results of a study assessing asthenia and related psychological and biological phenomena in patients with advanced cancer

Asthenia is a very common symptom of patients with advanced cancer, but its investigation is hindered by a lack of suitable validated measuring instruments. The goal of the present study was to construct and validate a questionnaire for the study of asthenia in cancer patients, as well as to establish correlations with other symptoms and physiological and biochemical parameters. A group of 31 patients with advanced cancer and a control group of 30 healthy volunteers were examined. The proposed questionnaire, based on visual analogue scales, questions with categorical answers and on the hospital anxiety and depression scale was validated by comparing results of the patient and control groups, by the test/retest method and by comparison with the evaluation of an observer. Correlation with various physiological and biochemical parameters was performed. The questionnaire distinguished well among the patients and control groups. VAS of asthenia proved quite stable over a period of 5 days. Correlations of asthenia with lack of appetite, the hospital anxiety and depression scale, weight, heart rate and serum cortisol levels could be established. No significant correlation between asthenia and various serum markers of inflammation and cytokines, including C-reactive protein, tumour necrosis factor, interleukin-1, and interleukin-2 receptors, could be found. The proposed questionnaire for evaluation of asthenia could be validated in a patient sample of limited size and a simplified questionnaire based on visual analogue scales is being developed for further investigations.

[The characteristics of perception under emotionally stressed goal-directed activity]

The taste and visual analysers were studied during the tests period in students. The effect of emotions on the sensory sphere was shown to be determined by their sign and their sthenic or asthenic character. Both positive and negative emotions seem to be able to develop in asthenic or sthenic ways.

In vitro polymorphonuclear neutrophil function in surgical patients does not correlate with anergy but with "activating" processes such as sepsis or trauma

We studied 199 preoperative patients admitted for esophagogastric, gastric, colonic, or rectal resections, 132 patients with severe blunt trauma, 180 surgical intensive care unit patients with major sepsis, and 95 laboratory controls in order to clarify the role of polymorphonuclear neutrophil (PMN) adherence and chemotaxis to outcome. Patients were also stratified by the delayed-type hypersensitivity response to five ubiquitous antigens. PMN adherence and PMN chemotaxis were not different in preoperative reactive or anergic patients and were equal to the control values, whereas both reactive patients and anergic patients showed altered PMN function after trauma or sepsis. There was no difference in PMN adherence or chemotaxis between patients who died and those who lived. Multiple logistic regression analysis showed that patient age, delayed-type hypersensitivity, and admission serum albumin level, not PMN adherence or chemotaxis, were significantly related to septic mortality. We concluded that altered circulating PMN adherence and chemotaxis is seen in all patients after an "activation" event such as trauma or sepsis. This is a nonspecific immune alteration not related to specific immune events such as delayed-type hypersensitivity; it does not correlate with patient outcome and should not be used as a predictive variable.

Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer

Sixty-four consecutive patients with advanced breast cancer were included in a study designed to determine the prevalence of asthenia and its association with other clinical features. The Asthenia Score (AS, the average of four tests designed by our group to assess asthenia) was 59 +/- 9 for patients versus 88 +/- 7 for a group of 68 normal controls (p less than 0.001). Twenty-six patients (41%) scored below the tenth percentile of normal controls and were considered asthenics. AS was correlated with depression and the general severity index of the SCL-90 R test. No association was found between AS and nutritional status, lean body mass, tumor mass, anemia, or type of treatment. We conclude that asthenia is a frequent symptom in patients with advanced breast cancer, which, in our series, showed independent correlations only with psychological distress.

[The importance of individualized physical training in the rehabilitation of patients with arterial hypotension]

Essential hypotension patients whose 2-year program of rehabilitation included continuous physical training according to individual multifactorial programs or relevant training combined with drug therapy showed more favourable clinical response. Threshold muscular load and everyday motor activity rose more significantly when compared to those in patients who received chemotherapy alone.

[The preoperative mental state]

In four studies psychological and psychophysiological correlations to anesthesiologically important factors were investigated. The most important preoperative emotions are anxiety, depression and asthenia. These emotions are part of the preoperative stress response. It was investigated which factors are correlated to these emotions and how these emotions correlate to physiological parameters, important in anesthesia. Sex, age, the quality of former experience of anesthesia and suffering of a chronic disease influence the degree of preoperative emotional stress. Cancer or the suspect of cancer increase preoperative anxiety. The preoperative psychological state correlates to blood pressure, heart rate and P-cortisol as well as to complications in anesthesia. There are two psychophysiological risk groups: Patients in a bad psychological state and patients in a good psychological state. Patients in the mean group have the best prognosis. Differences depending on the emotions anxiety depression and asthenia are described and discussed.

Association of mitral-valve prolapse with low body-weight and low blood pressure

Subjects with mitral-valve prolapse (MVP) have been observed to have an asthenic body build. To determine whether body-weight differed between individuals with inherited MVP and normal subjects, 177 relatives of 45 patients with MVP were studied, 35 female and 19 male relatives had MVP, and 51 female and 72 male relatives did not. There was no difference in mean height between relatives with and without MVP, but those with MVP weighed significantly less. Blood pressure was also significantly lower in relatives with MVP than in normal relatives. It is suggested that the lower blood pressure and the possible beneficial effects of lower weight on other cardiovascular risk factors may provide a selective advantage to carriers of the MVP gene, explaining its high prevalence in the general population. These findings may provide the first example of a common inherited condition which is systematically associated with changes in body-weight and blood pressure.