Patient perspectives of recovery from myalgic encephalomyelitis/chronic fatigue syndrome: An interpretive description study.

AIMS AND OBJECTIVES: Myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS), is characterised by persistent fatigue, postexertional malaise, and cognitive dysfunction. It is a complex, long-term, and debilitating illness without widely effective treatments. This study describes the treatment choices and experiences of ME/CFS patients who have experienced variable levels of recovery. METHOD: Interpretive description study consisting of semi-structured qualitative interviews with 33 people who met the US Centers for Disease Control (2015) diagnostic criteria for ME/CFS and report recovery or symptom improvement. RESULTS: Twenty-six participants endorsed partial recovery, and seven reported full recovery from ME/CFS. Participants reported expending significant time and energy to identify, implement, and adapt therapeutic interventions, often without the guidance of a medical practitioner. They formulated individualised treatment plans reflecting their understanding of their illness and personal resources. Most fully recovered participants attributed their success to mind-body approaches. CONCLUSION: Patients with ME/CFS describe independently constructing and managing treatment plans, due to a lack of health system support. Stigmatised and dismissive responses from clinicians precipitated disengagement from the medical system and prompted use of other forms of treatment.

Integrated 'omics analysis for the gut microbiota response to moxibustion in a rat model of chronic fatigue syndrome.

OBJECTIVE: To observe the efficacy of moxibustion in the treatment of chronic fatigue syndrome (CFS) and explore the effects on gut microbiota and metabolic profiles. METHODS: Forty-eight male Sprague-Dawley rats were randomly assigned to control group (Con), CFS model group (Mod, established by multiple chronic stress for 35 d), MoxA group (CFS model with moxibustion Shenque (CV8) and Guanyuan (CV4), 10 min/d, 28 d) and MoxB group (CFS model with moxibustion Zusanli (ST36), 10 min/d, 28 d). Open-field test (OFT) and Morris-water-maze test (MWMT) were determined for assessment the CFS model and the therapeutic effects of moxibustion.16S rRNA gene sequencing analysis based gut microbiota integrated untargeted liquid chromatograph-mass spectrometer (LC-MS) based fecal metabolomics were executed, as well as Spearman correlation analysis, was utilized to uncover the functional relevance between the potential metabolites and gut microbiota. RESULTS: The results of our behavioral tests showed that moxibustion improved the performance of CFS rats in the OFT and the MWMT. Microbiome profiling analysis revealed that the gut microbiomes of CFS rats were less diverse with altered composition, including increases in pro-inflammatory species (such as Proteobacteria) and decreases in anti-inflammatory species (such as Bacteroides, Lactobacillus, Ruminococcus, and Prevotella). Moxibustion partially normalized these changes in the gut microbiota. Furthermore, CFS was associated with metabolic disorders, which were effectively ameliorated by moxibustion. This was demonstrated by the normalization of 33 microbiota-related metabolites, including mannose (P = 0.001), aspartic acid (P = 0.009), alanine (P = 0.007), serine (P = 0.000), threonine (P = 0.027), methionine (P = 0.023), 5-hydroxytryptamine (P = 0.008), alpha-linolenic acid (P = 0.003), eicosapentaenoic acid (P = 0.006), hypoxanthine (P = 0.000), vitamin B6 (P = 0.000), cholic acid (P = 0.013), and taurocholate (P = 0.002). Correlation analysis showed a significant association between the perturbed fecal microbiota and metabolite levels, with a notable negative relationship between LCA and Bacteroides. CONCLUSIONS: In this study, we demonstrated that moxibustion has an antifatigue-like effect. The results from the 16S rRNA gene sequencing and metabolomics analysis suggest that the therapeutic effects of moxibustion on CFS are related to the regulation of gut microorganisms and their metabolites. The increase in Bacteroides and decrease in LCA may be key targets for the moxibustion treatment of CFS.

Research progress in the treatment of sleep disorder in chronic fatigue syndrome with external therapy of Traditional Chinese Medicine / 国际中医中药杂志

Traditional Chinese Medicine (TCM) external therapy for sleep disorder of chronic fatigue syndrome (CFS) has good anti-fatigue effect and can improve sleep quality of patients. The treatment for sleep disorders of CFS with TCM external treatment mainly adopts acupuncture, moxibustion, massage, TCM bath, transcutaneous acupoint electrical stimulation and auricular point sticking, etc., or alone, or comprehensive application, or combined with oral Chinese materia medica. The appropriate treatment method can be selected according to the patients' condition and compliance, which reflects the unique advantages of TCM syndrome differentiation and treatment and the treatment according to people and time. The existing research still needs to further form a standardized and recognized diagnosis and treatment system, so as to better guide clinical popularization and application.

The importance of school in the management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): issues identified by adolescents and their families.

Paediatric Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) is a disabling condition. Schools play a key role in adolescents' experiences with managing ME/CFS. However, little is known about the experiences of adolescents with ME/CFS (and their families) in schools. This paper is an incidental qualitative study, which combines data from two independent ME/CFS studies: study 1 researched ethnic minority adolescents with ME/CFS; study 2 explored Acceptance and Commitment Therapy for adolescents with ME/CFS who had not recovered after one year. Participants included: adolescents with ME/CFS; their families; and medical professionals (ME/CFS specialists and non-specialists). Adolescents, their families, and ME/CFS medical professionals were recruited from a UK specialist paediatric ME/CFS service. Non-ME/CFS medical professionals were recruited from the same region. Semi-structured qualitative interviews and focus groups were undertaken. Participants' views on schools from each study were combined and thematic analysis was used to identify themes. Fifteen adolescents with ME/CFS (11-17 years old), sixteen family members, and ten medical professionals (GPs, school nurses and ME/CFS specialists) were interviewed. Four key themes were found: (1) adolescents identified school was important for aiding ME/CFS recovery, especially educationally and socially; (2) families described varying levels of support from schools and local authorities with help managing ME/CFS - some described significant practical and emotional difficulties to accessing education, whereas others recounted examples of positive supportive strategies, particularly when teachers had previous experience or knowledge of ME/CFS; (3) parents thought three-way communication between schools, healthcare and families could improve support; (4) participants felt schools were an appropriate place for knowledge building and raising awareness of ME/CFS amongst teachers and pupils, to aid improved supportive measures. In conclusion, this paper provides rich data that highlights the importance of education and the realistic fears and hurdles for adolescents with ME/CFS remaining engaged in education and the impact on their future. Some families described positive strategies in school, which were viewed as helpful to manage ME/CFS in the classroom. These strategies could be implemented alongside knowledge building initiatives and improved communication between healthcare and education. There is a need to further investigate useful strategies and determine how teachers can be best supported in implementing them.

Ginger-indirect moxibustion plus acupuncture versus acupuncture alone for chronic fatigue syndrome: a randomized controlled trial.

OBJECTIVE: To assess the efficacy and safety of ginger-indirect moxibustion for chronic fatigue syndrome (CFS). METHODS: In this central randomized, controlled trial, 290 CFS participants were recruited and randomly allocated to group A (ginger-indirect moxibustion plus acupuncture) or group B (acupuncture alone). The study consisted of a treatment period of 8 weeks with a total of 24 treatments (3 sessions per week, every other day), and a follow-up period of 12 weeks. The outcome was measured by Fatigue Severity Scale (FSS), Psychological Health Report (SPHERE), the Self-rating depression scale (SDS) and the Hamilton anxiety scale (HAMA) at baseline, 2, 4, 6, 8, 12 and 20 weeks. RESULTS: With the treatment undergoing, the changes of FSS, SPHERE, SDS and HAMA scores in both groups increased gradually, and the effect maintained at the 12th week. Between groups, significantly higher score changes were seen in group A in FSS after 4 weeks treatment (11.94 9.12, 95%: 0.94, 4.7) and in SPHERE after 2 weeks treatment (3.7 2.27, 95%: 0.56, 2.31). But for SDS and HAMA, the improvement did not differ significantly between groups. No severe adverse events were reported. CONCLUSION: Ginger-indirect moxibustion is a safe and effective intervention to relieve fatigue and accompanying physical symptoms of CFS.

Clinical application and mechanism of moxibustion for chronic fatigue syndrome / 国际中医中药杂志

The treatment rules of point selection and treatment principles for treating chronic fatigue syndrome (CFS) can be divided into three categories: regulating and replenishing, invigorating original yang and regulating zang-fu organs. The mechanism of moxibustion includes improving gut microbiota imbalance, regulating immune cell imbalance and correcting endocrine dysfunction. The moxibustion methods include ginger-partitioned moxibustion, thunder-fire moxibustion, warm acupuncture, and governor moxibustion. Acupuncture points such as Shenque (RN8), Guanyuan (RN4), Qihai (RN6), Zusanli (ST36), Baihui (DU20), Yongquan (KI1) and back-shu points are often selected to exert anti-chronic fatigue effects.

The therapeutic effect of sports on relieving chronic fatigue / O efeito terapêutico dos esportes no alívio da fadiga crônica / El efecto terapéutico de los deportes para aliviar la fatiga crónica

ABSTRACT Introduction Chronic fatigue syndrome (CFS) is a group of long-term fatigue; the rest is difficult to achieve. At the same time, it is accompanied by corresponding physical dysfunction and psychological and mental symptoms. It is very meaningful to find exercise countermeasures to cope with chronic fatigue syndrome actively. Object This article analyzes the current students' CFS to realize the cognition of the disease. At the same time, it analyzes the effect of sports on the treatment of chronic fatigue to help students formulate related sports programs. Method The article conducts a related questionnaire survey and analysis of students and analyzes CFS and exercise status symptoms. Results Generally, students with CFS did not actively participate in sports and had poor physical fitness, especially muscle endurance and cardiopulmonary function. However, students who actively participate in sports training basically do not have CFS. Conclusion CFS students should strengthen physical exercise and improve the CFS situation through exercise. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução a síndrome da fadiga crônica (SFC) é um grupo de fadiga de longa duração; o descanso é difícil de conseguir. Ao mesmo tempo, é acompanhado por disfunção física correspondente e sintomas psicológicos e mentais. É muito significativo encontrar contramedidas de exercícios para lidar ativamente com a síndrome da fadiga crônica. Objetivo este artigo analisa o CFS de alunos atuais para a compreensão da doença. Ao mesmo tempo, analisa o efeito dos esportes no tratamento da fadiga crônica para ajudar os alunos a formular programas esportivos relacionados. Método o artigo conduz uma pesquisa de questionário relacionada e análise de alunos e analisa CFS e sintomas de status de exercício. Resultados Geralmente, os alunos com SFC não participavam ativamente de esportes e apresentavam má aptidão física, principalmente resistência muscular e função cardiopulmonar. Por outro lado, os alunos que participam ativamente do treinamento esportivo basicamente não possuem CFS. Conclusão os alunos do CFS devem fortalecer o exercício físico e melhorar a situação do CFS por meio do exercício. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El síndrome de fatiga crónica (SFC) es un grupo de fatiga a largo plazo; el descanso es difícil de conseguir. Al mismo tiempo, se acompaña de la correspondiente disfunción física y síntomas psicológicos y mentales. Es muy significativo encontrar contramedidas de ejercicio para hacer frente activamente al síndrome de fatiga crónica. Objeto Este artículo analiza el SFC de los estudiantes actuales para comprender la enfermedad. Al mismo tiempo, analiza el efecto del deporte en el tratamiento de la fatiga crónica para ayudar a los estudiantes a formular programas deportivos relacionados. Método El artículo lleva a cabo un cuestionario relacionado y un análisis de los estudiantes y analiza los síntomas del SFC y el estado del ejercicio. Resultados En general, los estudiantes con SFC no participaron activamente en deportes y tenían una mala condición física, especialmente la resistencia muscular y la función cardiopulmonar. Por otro lado, los estudiantes que participan activamente en el entrenamiento deportivo básicamente no tienen SFC. Conclusión Los estudiantes de CFS deben fortalecer el ejercicio físico y mejorar la situación de CFS a través del ejercicio. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Sports medicine treatment based on relieving chronic fatigue and sub-health state / Tratamento da medicina do esporte relacionada ao alivio da fadiga crônica e saúde sub-ótima / Tratamiento de la medicina del deporte relacionada al alivio de la fatiga crónica y salud subóptima

ABSTRACT Introduction: Chronic fatigue syndrome (CFS), also known as chronic fatigue and immune dysfunction syndrome, has become a common disease in modern medicine. Objective: The paper analyzes the impact of exercise training on patients' quality of life with chronic fatigue syndrome. Methods: We conducted fatigue investigations on college students and analyzed the exercise ability of college students with chronic fatigue syndrome. We then compared the findings with healthy college students. In the process, we recorded the physiological indicators and satisfaction scores of the two groups of patients. Results: Muscle endurance and cardiopulmonary function-related exercise ability of the college students with chronic fatigue syndrome are significantly different. After completing the same exercise, the scores of personal exertions were higher. Conclusion: Appropriate and regular exercise can achieve ideal results in the treatment of chronic fatigue syndrome. In-depth research, popularization, and application by scholars is highly suggested. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A síndrome da fadiga crônica (SFC), também conhecida como fadiga crônica e síndrome de disfunção imunológica, tem se tornado uma doença comum para a medicina moderna. Objetivo: Este estudo analisa o impacto do treinamento de exercícios na qualidade de vida de pacientes com síndrome de fadiga crônica. Métodos: Conduzimos investigações sobre a fadiga em estudantes universitários e analisamos a habilidade para exercícios de estudantes universitários com síndrome de fadiga crônica. Durante o processo, registramos indicadores fisiológicos e escores de satisfação dos dois grupos de pacientes. Resultados: A resistência muscular e habilidade em praticar exercícios relacionados à função cardiopulmonar dos estudantes universitários com síndrome de fadiga crônica são significativamente diferentes. Após completar o mesmo exercício, os escores de esforço pessoal eram mais altos. Conclusão: Exercícios adequados e regulares podem atingir resultados ideais no tratamento da síndrome de fadiga crônica. Pesquisas aprofundadas, a popularização e a aplicação por parte de pesquisadores são altamente recomendadas. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: La síndrome de la fatiga crónica (SFC), también conocida como fatiga crónica e inmunodeficiencia, se ha tornado una enfermedad común para la medicina moderna. Objetivo: Este estudio analiza el impacto del entrenamiento de ejercicios en la calidad de vida de pacientes con síndrome de fatiga crónica. Métodos: Conducimos investigaciones sobre la fatiga en estudiantes universitarios y analizamos la habilidad para ejercicios de estudiantes universitarios con síndrome de fatiga crónica. Durante el proceso, registramos indicadores fisiológicos y puntajes de satisfacción de los dos grupos de pacientes. Resultados: La resistencia muscular y habilidad en practicar ejercicios relacionados a la función cardiopulmonar de los estudiantes universitarios con síndrome de fatiga crónica son significativamente diferentes. Tras completar el mismo ejercicio, los puntajes de esfuerzo personal eran más altos. Conclusión: Ejercicios adecuados y regulares pueden atingir resultados ideales en el tratamiento de la síndrome de fatiga crónica. Investigaciones profundizadas, la popularización y la aplicación por los investigadores son altamente recomendadas. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Scientific physical training on the clinical recovery of chronic fatigue injury / Treino físico científico para a recuperação de lesões por fadiga crônica / Entrenamiento físico científico para la recuperación de lesiones por fatiga crónica

ABSTRACT Introduction: Chronic fatigue syndrome is also called chronic fatigue and immune dysfunction syndrome. This disease has now become a common disease in modern medicine. Objective: To explore and analyze the effect of exercise therapy on chronic fatigue syndrome. Methods: We selected 70 patients with chronic fatigue syndrome for the experiment. The exercise group performed gradual exercise, and the control group was inactive. Results: Appropriate and regular exercise can achieve ideal results in the treatment of chronic fatigue syndrome. Conclusion: Studying methods to prevent and recover from fatigue syndrome will help in understanding and focusing attention on the topic of fatigue, as well as being aware of the methods of self-prevention of fatigue syndrome. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A síndrome de fadiga crônica é também chamada de fadiga crônica e síndrome de disfunção imune. Esta doença tem se tornado comum na medicina moderna. Objetivo: Explorar e analisar o efeito da terapia por exercício na síndrome de fadiga crônica. Métodos: Selecionamos 70 pacientes com síndrome de fadiga crônica para o experimento. O grupo de exercício praticou exercícios moderados e o grupo de controle permaneceu inativo. Resultados: Exercícios adequados e regulares podem atingir resultados ideais no tratamento da síndrome de fadiga crônica. Conclusão: O estudo de métodos para prevenir e se recuperar da síndrome de fadiga crônica ajuda ao entender e ficar atento ao tema da fadiga, assim como reconhecer os métodos de autoprevenção da síndrome da fadiga. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El síndrome de fatiga crónica se llama también fatiga crónica y síndrome de disfunción inmune. Esta enfermedad se ha vuelto común en la medicina moderna. Objetivo: Explorar y analizar el efecto de la terapia por ejercicio en el síndrome de fatiga crónica. Métodos: Seleccionamos 70 pacientes con síndrome de fatiga crónica para el experimento. El grupo de ejercicios practicó ejercicios moderados y el grupo de control permaneció inactivo. Resultados: Ejercicios adecuados y regulares pueden atingir resultados ideales en el tratamiento del síndrome de fatiga crónica. Conclusión: El estudio de métodos para prevenir y recuperarse del síndrome de fatiga crónica ayuda a entender y estar atento al tema de la fatiga, así como reconocer los métodos de autoprevención del síndrome de fatiga. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

An analysis of 2-day cardiopulmonary exercise testing to assess unexplained fatigue.

Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (2-day CPET protocol) are increasingly used to evaluate post-exertional malaise (PEM) and related disability among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This protocol may extend to other fatiguing illnesses with similar characteristics to ME/CFS; however, 2-day CPET protocol reliability and minimum change required to be considered clinically meaningful (i.e., exceeding the standard error of the measure) are not well characterized. To address this gap, we evaluated the 2-day CPET protocol in Gulf War Illness (GWI) by quantifying repeatability of seven CPET parameters, establishing their thresholds of clinically significant change, and determining whether changes differed between veterans with GWI and controls. Excluding those not attaining peak effort criteria (n = 15), we calculated intraclass correlation coefficients (ICCs), the smallest real difference (SRD%), and repeated measures analysis of variance (RM-ANOVA) at the ventilatory anaerobic threshold (VAT) and peak exercise in 15 veterans with GWI and eight controls. ICC values at peak ranged from moderate to excellent for veterans with GWI (mean [range]; 0.84 [0.65 - 0.92]) and were reduced at the VAT (0.68 [0.37 - 0.78]). Across CPET variables, the SRD% at peak exercise for veterans with GWI (18.8 [8.8 - 28.8]) was generally lower than at the VAT (28.1 [9.5 - 34.8]). RM-ANOVAs did not detect any significant group-by-time interactions (all p > .05). The methods and findings reported here provide a framework for evaluating 2-day CPET reliability, and reinforce the importance of carefully considering measurement error in the population of interest when interpreting findings.

Estudo Controlado das Alterações Hemodinâmicas Centrais de uma Sessão de Exercício Inspiratório com Diferentes Cargas na Insuficiência Cardíaca / Controlled Study of Central Hemodynamic Changes in Inspiratory Exercise with Different Loads in Heart Failure

Resumo Fundamento A fraqueza muscular inspiratória contribui para a intolerância ao exercício e diminuição da qualidade de vida dos pacientes com insuficiência cardíaca. Estudos com treinamento da musculatura inspiratória demonstram melhora da força muscular inspiratória, da capacidade funcional e da qualidade de vida. Porém, pouco se sabe sobre a resposta hemodinâmica central (RHC) durante o exercício inspiratório (EI). Objetivo Avaliar a RHC em uma única sessão de EI com diferentes cargas (placebo, 30 e 60%) na insuficiência cardíaca. Métodos Ensaio clínico randomizado placebo-controlado, em pacientes com insuficiência cardíaca com fração de ejeção reduzida, classe funcional II e III. Vinte pacientes, com idade de 65±11 anos, completaram uma sessão única de exercício inspiratório, em 3 ciclos de 15 minutos, com washout de 1 hora, envolvendo cargas de 30% (C30), 60% (C60) e placebo, utilizando um resistor de carga linear ( PowerBreathe Light ). O estudo hemodinâmico não invasivo foi realizado por bioimpedância cardiotorácica ( Niccomo™CardioScreen® ). Análise estatística foi feita com o Teste t de Student e a correlação de Pearson, considerado significante p≤0,05. Resultados Foi observado aumento da frequência cardíaca (FC) com a C30 (64±15 vs 69±15 bpm; p=0,005) e C60 (67±14 vs 73±14 bpm, p=0,002). No volume sistólico (VS), observou-se diminuição com a C30 (73±26 vs 64±20 ml; p=0,004). O débito cardíaco (DC) apresentou aumento apenas com a C60 (4,6±1,5 vs 5,3±1,7 l/min; p=-0,001). Conclusão Quando utilizada a carga de 60%, em uma sessão única de EI, foram observadas alterações na RHC. A FC e o DC aumentaram, assim como as escalas de Borg e sensação subjetiva de dispneia. Já a carga de 30% promoveu diminuição do VS. (Arq Bras Cardiol. 2020; 114(4):656-663)

Abstract Background Inspiratory muscle weakness contributes to exercise intolerance and decreased quality of life in patients with heart failure. Studies with inspiratory muscle training show improvement in inspiratory muscle strength, functional capacity and quality of life. However, little is known about the central hemodynamic response (CHR) during inspiratory exercise (IE). Objective To evaluate CHR in a single IE session with different loads (placebo, 30% and 60%) in heart failure. Methods Randomized placebo-controlled clinical trial in patients with heart failure with reduced ejection fraction, functional class II and III. Twenty patients aged 65 ± 11 years completed a single session of inspiratory exercise, in 3 cycles of 15 minutes, with a 1-hour washout, involving loads of 30% (C30), 60% (C60) and placebo, using a linear load resistor (PowerBreathe Light). The noninvasive hemodynamic study was performed by cardiothoracic bioimpedance (Niccomo™ CardioScreen®). Statistical analysis was performed with Student's t-test and Pearson's correlation, and P≤0.05 was considered significant. Results An increase in heart rate (HR) was observed with C30 (64 ± 15 vs 69 ± 15 bpm; p = 0.005) and C60 (67 ± 14 vs 73 ± 14 bpm, p = 0.002). A decrease was observed in systolic volume (SV) with C30 (73 ± 26 vs 64 ± 20 ml; p = 0.004). Cardiac output (CO), on its turn, increased only with C60 (4.6 ± 1.5 vs 5.3 ± 1.7 l/min; p = -0.001). Conclusion When using the 60% load, in a single IE session, changes in CHR were observed. HR and CD increased, as did the Borg scales and subjective sensation of dyspnea. The 30% load reduced the SV. (Arq Bras Cardiol. 2020; 114(4):656-663)

Danza terapéutica y ejercicio físico. efecto sobre la fibromialgia / Therapeutic dance and physical exercise. effect on fibromyalgia / Dança terapéutica e exercício físico. efeito sobre a fibromialgia

Resumen Objetivo: Establecer el efecto de la danza terapéutica y del ejercicio físico sobre la sintomatología y el número de puntos dolorosos en mujeres con fibromialgia. Materiales y métodos: Estudio cuasiexperimental que consideró una muestra probabilística aleatorizada. Un total de 37 mujeres con fibromialgia fueron sometidas a programas de danza terapéutica (n=18) y ejercicio físico (n=19). La edad promedio fue 47,4±8,4 años. La duración de la intervención fue de 3 meses con una frecuencia de entrenamiento de 2 sesiones por semana y una duración de 60 minutos por sesión. Todas las participantes suministraron información que permitió determinar el índice de dolor generalizado y la escala de severidad de síntomas. Resultados: La danza terapéutica y el ejercicio físico disminuyeron significativamente el número de puntos dolorosos (12,1±2,8 a 7,3±3,1 para valores pre y post respectivamente (p=0,000)); y los síntomas asociados a la fibromialgia (8,7±2,3 a 5,7±2,6 para valores pre y post respectivamente (p=0,000)). Conclusiones: La danza terapéutica y el ejercicio físico tienen un efecto benéfico equivalente en la disminución del índice de dolor generalizado, la depresión, los síntomas cognitivos y los trastornos del sueño en mujeres con fibromialgia.

Abstract Objective: To establish the effect of therapeutic dance and physical exercise on the symptomatology and number of painful points in women with fibromyalgia. Materials and methods: Quasi-experimental study that considered a randomized probabilistic sample. A total of 37 women with fibromyalgia underwent therapeutic dance (n=18) and physical exercise (n=19) programs. The average age was 47.4 ± 8.4 years. The length of the intervention was 3 months with a training frequency of 2 sessions per week and a duration of 60 minutes per session. All the participants provided information that allowed to determine the general pain index (GPI) and the scale of symptom severity (SSS). Results: Therapeutic dance and physical exercise significantly decreased the number of painful points (from 12.1 ± 2.8 to 7.3 ± 3.1 for pre- and post-values respectively (p = 0.000)) and the symptoms associated with fibromyalgia (8.7 ± 2.3 to 5.7 ± 2.6 for pre- and post-values respectively (p = 0.000)). Conclusions: Therapeutic dance and physical exercise have an equivalent beneficial effect on the reduction of the general pain index, depression, cognitive symptoms and sleep disorders in women with fibromyalgia.

Resumo Objetivo: Estabelecer o efeito da dança terapêutica e o exercício físico sobre a sintomatologia e o número de pontos dolorosos em mulheres com fibromialgia. Materiais e métodos: Estudo quase experimental que considerou uma amostra probabilística aleatória. Um total de 37 mulheres com fibromialgia foram submetidas a programas de dança terapêutica (n=18) e exercício físico (n=19). A idade média foi 47,4±8,4 anos. A duração da intervenção foi de 3 meses com uma frequência de treinamento de 2 sessões por semana e uma duração de 60 minutos por sessão. Todas as participantes subministraram informação que permitiu determinar o índice da dor generalizada e a escada de severidade de sintomas. Resultados: A dança terapêutica e o exercício físico diminuíram significativamente o número de pontos dolorosos (12,1±2,8 a 7,3±3,1 para valores pré e post respectivamente (p=0,000)); e os sintomas associados à fibromialgia (8,7±2,3 a 5,7±2,6 para valores pré e post respectivamente (p=0,000)). Conclusões: A dança terapêutica e o exercício físico tem um efeito benéfico equivalente na diminuição do índice da dor generalizado, a depressão, os sintomas cognitivos e os transtornos do sono em mulheres com fibromialgia.

Risk factors for postoperative fatigue syndrome in outpatients with painless gastroscopy / 中华麻醉学杂志

Objective@#To identify the risk factors for postoperative fatigue syndrome (POFS) in outpatients with painless gastroscopy.@*Methods@#The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview, intraoperative recording, and telephone follow-up.POFS occurrence, score and outcomes were evaluated.The patients were divided into POFS group (groupⅠ) and non-POFS group (groupⅡ) according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors.@*Results@#Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS, and the incidence was 28.0%, the initial fatigue score was (5.2±2.4), and the duration of POFS was 3(9) h. The mean consumption of propofol (according to anesthesia time, mg/min) was an independent risk factor for POFS.@*Conclusion@#The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.

Risk factors for postoperative fatigue syndrome in out-patients with painless colonoscopy / 中华麻醉学杂志

Objective To identify the risk factors for postoperative fatigue syndrome (POFS) in out-patients with painless colonoscopy.Methods The out-patients received painless colonoscopy from October 2016 to February 2017 in Northern Jiangsu People's Hospital were selected.The possible factors related to POFS,such as general situation,present history and past history,intraoperative conditions,postoperative diagnosis,were summarized by reviewing the relevant literature.The questionnaires were completed by preoperative interview,filling in questionnaires by doctors during operation,interview before leaving the hospital,and follow-up phone calls.POFS occurrence and initial fatigue scale and duration were evaluated.The patients were divided into POFS group (group Ⅰ) and non-POFS group (group Ⅱ) according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors.Results Four hundred and forty-one patients were enrolled in this study,129 cases developed POFS,and the incidence was 29.2％.Using dezocine and higher percentage of change in heart rate were the risk factors for POFS,and male and appropriately prolonging the waiting time on the day of examination were the protective factors for POFS.Conclusion Using dezocine and higher percentage of change in heart rate are the risk factors for POFS,and male and appropriately prolonging the waiting time on the day of examination are the protective factors for POFS in outpatients with painless colonoscopy.

Risk factors for postoperative fatigue syndrome in outpatients with painless gastroscopy / 中华麻醉学杂志

Objective To identify the risk factors for postoperative fatigue syndrome(POFS)in outpatients with painless gastroscopy.Methods The outpatients received painless gastroscopy from October 2016 to February 2017 in our hospital were included in this study.The possible factors related to POFS were summarized by reviewing the relevant literature.The questionnaires were completed by the methods such as preoperative interview,intraoperative recording,and telephone follow-up.POFS occurrence,score and outcomes were evaluated.The patients were divided into POFS group(groupⅠ)and non-POFS group(groupⅡ)according to whether POFS occurred.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors.Results Two hundred and forty-six patients completed this study.Sixty-nine cases developed POFS,and the incidence was 28.0％,the initial fatigue score was(5.2±2.4),and the duration of POFS was 3(9)h.The mean con-sumption of propofol(according to anesthesia time,mg/min)was an independent risk factor for POFS.Conclusion The mean consumption of propofol is an independent risk factor for POFS in outpatients with painless gastroscopy.

Symptoms of chronic fatigue syndrome/myalgic encephalopathy are not determined by activity pacing when measured by the chronic pain coping inventory.

OBJECTIVES: Chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) is a chronic illness which can cause significant fatigue, pain and disability. Activity pacing is frequently advocated as a beneficial coping strategy, however, it is unclear whether pacing is significantly associated with symptoms in people with CFS/ME. The first aim of this study was therefore to explore the cross-sectional associations between pacing and levels of pain, disability and fatigue. The second aim was to explore whether changes in activity pacing following participation in a symptom management programme were related to changes in clinical outcomes. DESIGN: Cross-sectional study exploring the relationships between pacing, pain, disability and fatigue (n=114) and pre-post treatment longitudinal study of a cohort of patients participating in a symptom management programme (n=35). SETTING: Out-patient physiotherapy CFS/ME service. PARTICIPANTS: One-hundred and fourteen adult patients with CFS/ME. MAIN OUTCOME MEASURES: Pacing was assessed using the chronic pain coping inventory. Pain was measured using a Numeric Pain Rating Scale, fatigue with the Chalder Fatigue Scale and disability with the Fibromyalgia Impact Questionnaire. RESULTS: No significant associations were observed between activity pacing and levels of pain, disability or fatigue. Likewise, changes in pacing were not significantly associated with changes in pain, disability or fatigue following treatment. CONCLUSIONS: Activity pacing does not appear to be a significant determinant of pain, fatigue or disability in people with CFS/ME when measured with the chronic pain coping index. Consequently, the utility and measurement of pacing require further investigation.

Clinical observation of abdominal acupuncture for subhealth insomnia / 针灸推拿医学（英文版）

Objective:To assess the clinical efficacy of abdominal acupuncture for subhealth insomnia.Methods:Eighty-two cases of subhealth insomnia were randomly divided into an observation group (41 cases) and a control group (41 cases).The control group was treated with conventional acupuncture.The observation group was treated with Bo's abdominal acupuncture on the basis of conventional acupuncture.Six treatments constituted one treatment course.The measuring scale of traditional Chinese medicine syndrome for subhealth state (MSSSHS) and Pittsburgh sleep quality index (PSQI) scores were compared between the two groups after two courses,to estimate the efficacy of abdominal acupuncture for subhealth insomnia.Results:One case dropped out from the observation group,while 2 cases dropped out from the control group.The MSSSHS score and PSQI score both declined after the treatment in the two groups (all P＜0.05).The MSSSHS and PSQI scores in the observation group were significantly lower than those in the control group (both P＜0.05).Conclusion:The abdominal acupuncture is effective for subhealth insomnia,and it can enhance the effect of conventional acupuncture.

Pacing, Conventional Physical Activity and Active Video Games to Increase Physical Activity for Adults with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious illness of biological origin characterized by profound physical and cognitive exhaustion and postexertion malaise. Pacing is a common strategy used to manage available energy and complete activities of daily living; yet little research has investigated this as a strategy to increase physical activity levels. Typically, people living with ME/CFS are faced by unique barriers to physical activity participation and are less physically active than healthy peers. As such they are at increased risk of physical inactivity-related health consequences. Active video games may be a feasible and acceptable avenue to deliver physical activity intervention by overcoming many of the reported barriers to participation. OBJECTIVE: The primary objective of this pilot study is to determine the feasibility and acceptability of active video games to increase physical activity levels of people with ME/CFS. The secondary aims are to explore the preliminary effectiveness of pacing and active video gaming to pacing alone and pacing plus conventional physical activity to increase the physical activity levels of adults with ME/CFS and explore the relationship between physical activity and cumulative inflammatory load (allostatic load). METHODS: This study will use a mixed method design, with a 3-arm pilot randomized controlled trial, exit interviews, and collection of feasibility and process data. A total of 30 adults with ME/CFS will be randomized to receive either (1) pacing, (2) pacing and conventional physical activity, or (3) pacing and active video gaming. The intervention duration will be 6 months, and participants will be followed up for 6 months postintervention completion. The intervention will be conducted in the participant's home, and activity intensity will be determined by continuously monitored heart rate and ratings of perceived exertion. Feasibility and acceptability and process data will be collected during and at the end of the intervention. Health-related outcomes (eg, physical activity, blood samples, quality of life, and functioning) will be collected at baseline, end of intervention, and 6 months after intervention completion. RESULTS: This protocol was developed after 6 months of extensive stakeholder and community consultation. Enrollment began in January 2017; as of publication, 12 participants were enrolled. Baseline testing is scheduled to commence in mid-2017. CONCLUSIONS: This pilot study will provide essential feasibility and acceptability data which will guide the use of active video games for people with ME/CFS to increase their physical activity levels. Physical activity promotion in this clinical population has been poorly and under-researched, and any exploration of alternative physical activity options for this population is much needed. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry: ACTRN12616000285459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370224 (Archived by WebCite at http://www.webcitation.org/6qgOLhWWf).

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review.

BACKGROUND: The pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of D-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of D-lactic acidosis (D-la). METHODS: D-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high D-lactate levels. Fifty-nine D-la episodes were included in the qualitative synthesis comparing D-la symptoms with ME/CFS diagnostic criteria. A narrative review of D-la mechanisms and relevance for ME/CFS was provided. RESULTS: The majority of neurological disturbances reported in D-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported D-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS. LIMITATIONS: Interpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for D-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined. CONCLUSIONS: Shared symptomatology and underlying microbiota-gut-brain interactions raise the possibility of a continuum of acute (D-la) versus chronic (ME/CFS) presentations related to D-lactate absorption. Measurement of D-lactate in ME/CFS is needed to effectively evaluate whether subclinical D-lactate levels affect neurological symptoms in this clinical population.

Healthy Settings in Hospital - How to Prevent Burnout Syndrome in Nurses: Literature Review.

Healthy settings involve a holistic and multidisciplinary method that integrates actions towards risk factors. In hospital settings, a high level of stress can lead to depression, anxiety, decreased job satisfaction and lower loyalty to the organization. Burnout syndrome can be defined as physical, psychological and emotional exhaustion, depersonalization, and low sense of personal accomplishment. The aim of this literature review was to make systematic literature analysis to provide scientific evidence for the consequences of constant exposure to high levels of stress and for the methods to be used to prevent burnout syndrome among health care workers. The Medline database was searched to identify relevant studies and articles published during the last 15 years. The key words used in this survey were burnout syndrome, prevention, nurses, and healthy settings. The 6 eligible studies were included in literature review. Evidence showed nurses to be exposed to stress and to have symptoms of burnout syndrome. As a result of burnout syndrome, chronic fatigue and reduced working capacity occur, thus raising the risk of adverse events. In conclusion, the occurrence of burnout syndrome is a major problem for hospitals and healthcare system. Action plan for hospital burnout syndrome prevention would greatly reduce the incidence and improve the quality of health care.