[The use of the concentrate of nucleus containing cells of umbilical cord blood for treatment of asthenic disorders (schizoasthenia) in patients with schizophrenia with negative symptoms]. / Primenenie kontsentrata iadrosoderzhashchikh kletok pupovinnoi krovi u bol'nykh s astenicheskimi rasstroistvami (shizoasteniia) v ramkakh shizofrenii, protekaiushchei s preobladaniem negativnykh rasstroistv.

AIM: To assess the safety and efficacy of umbilical cord blood (UCB) cells in the treatment of schizoasthenia and comorbid negative disorders. MATERIAL AND METHODS: The study was conducted in men (n=15) with remission of schizophrenia with a predominance of asthenic disorders (ICD-10 items F20.6 and F21.5). Patients received intravenous infusions of UCB cells at the average dose of 250 mln viable cells per infusion (4 injections at 2 week intervals). The efficacy and safety were assessed using the Positive and Negative Symptoms of Schizophrenia (PANSS), the General Clinical Impression Scale (CGI), Asthenia Scale MFI-20 3, the MATRIX Consensus Cognitive Battery (MCCB), the Clinical evaluation of adverse events (side effects). RESULTS AND CONCLUSION: The infusions of UCB cells have a positive effect on asthenic disorders, increase the level of general activity and minimize cognitive impairments. The authors assume that UCB cells potentiate the activity of typical and atypical antipsychotics.

[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.

El monóxido de carbono y la neurología. Réplica / Carbon monoxide and neurology. Reply

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Intervenciones con actividad física supervisada en el manejo de la fatiga relacionada con el cáncer: una revisión sistemática / Supervised physical activity interventions in the management of cancer-related fatigue: a systematic review

Introducción: La fatiga relacionada con el cáncer es el síntoma más prevalente y devastador para pacientes con cáncer; la actividad física ha sido propuesta como una intervención segura y eficaz en su control. Objetivo: Determinar la efectividad de las intervenciones de actividad física supervisada en el manejo de la fatiga relacionada con el cáncer (FRC). Metodología: Revisión sistemática de ensayos clínicos controlados aleatorizados. Pacientes adultos diagnosticados con cualquier tipo de cáncer, sin restricción a una etapa particular de diagnóstico o tratamiento. Intervenciones de actividad física (entrenamiento aeróbico y de resistencia) supervisadas por profesionales de la salud. FRC fue analizada como medida de resultado primario, mientras que las medidas secundarias fueron la depresión, la comparación entre intervenciones supervisadas y no supervisadas, el bienestar físico y funcional. El riesgo de sesgo y la calidad metodológica de los estudios fueron evaluados usando la escala de PEDro. Resultados: Catorce (n=14) estudios con bajo riesgo de sesgo (puntuación media de la escala de PEDro= 6,5±1) fueron incluidos (n=1638). La actividad física supervisada mejoró significativamente la FRC; resultados similares se encontraron para el análisis del entrenamiento de resistencia supervisado. Además, dentro del análisis de subgrupos, la actividad física supervisada fue más efectivo que el cuidado convencional en el manejo de la FRC en las pacientes con cáncer de mama. Conclusión: Las intervenciones con actividad física supervisada proporcionan una disminución global de FRC. Estos hallazgos sugieren que el ejercicio aeróbico y el entrenamiento de resistencia deben ser incluidos en los programas de rehabilitación oncológica (AU)

Background: Cancer-related fatigue is the most common and distressing symptom among cancer survivors; physical activity has been proposed as a safe and effective intervention to control it. Objective: This study aimed to determine the effectiveness of supervised physical activity interventions for the management of cancer-related fatigue (CRF). Metodology: Systematic review of randomized controlled trials. Adults (>20 years old) diagnosed with any type of cancer regardless of treatment or diagnosis stage. Physical activity interventions (aerobic and resistance training) supervised by health professionals. CRF was the primary outcome measure, whilst secondary outcomes included depression, the comparison between supervised and non-supervised interventions, physical and functional wellbeing. Risk of bias and methodological quality were evaluated using the PEDro scale. Results: Fourteen studies (n=14) were included (n=1638) with low risk of bias (PEDro mean score=6,5±1). Supervised physical activity significantly improved CRF; similar results were found for resistance training. Further, supervised physical activity was more effective than conventional care for improving CRF among breast cancer. Conclusion: Supervised physical activity interventions provide an overall reduction on CRF. These findings suggest that guidelines of aerobic and resistance training should be included in oncologic rehabilitation programs (AU)

Heritable equine regional dermal asthenia.

Hereditary equine regional dermal asthenia is a form of Ehlers-Danlos syndrome, and has an autosomal recessive mode of inheritance. Affected horses are typically born normal and develop lesions within the first 2 years of life. The most common symptoms of the disease include stretchy, loose skin that feels doughy or mushy. More severely affected horses experience spontaneous skin sloughing and extensive lacerations, hematomas, and seromas from minor trauma. Affected horses have a higher than expected incidence of corneal ulcers. DNA testing can normal, establish carrier and affected status. Palliative therapy is available, but no curative treatment exists.

[Postviral asthenia and fatigue syndrome in a therapist's practice].

Asthenia serves as a symptom of many both organic and mental diseases. 16-64% of patients with this diagnosis visit a polyclinic therapist. Asthenia is an obligate symptom of a number of mental illnesses, including stress-related neurotic disorders, and somatoform disorders (panic attacks, generalized anxiety disorders, somatoform autonomic disorders, adjustment disorders), as well as nonpsychotic petit mal depressions. Patients with these disorders generally see therapists or general practitioners, rather than psychiatrists. The paper reflects the classification, differential diagnosis, and treatment of asthenia. A clinical case is described; its therapy is warranted.

[The use of phototherapy and photochromotherapy in the combined treatment of the patients presenting with astheno-depressive syndrome and neurotic disorders].

The objective of the present clinical and psychopathological study was to estimate the influence of high-intensity white and yellow phototherapy on the clinical condition of 41 and 18 patients respectively presenting with astheno-depressive syndrome. The control group was comprised of 42 patients who were treated by standard pharmacotherapy. Clinical observations of the patients were supplemented by the evaluation of their conditions and characteristics using the Symptom Checklist-90 questionnaire, the Bekhterev Depression Inventory, and the Beck Depression Inventory. The patients of the three groups were surveyed before and within 20 days after the initiation of the treatment. It was shown that white light phototherapy considerably reduced the severity of asthenia and depression. Yellow light phototherapy proved more efficacious in the patients with asthenia and somatovegetative dysfunctions.

[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.

Sunitinib in metastatic renal cell carcinoma: recommendations for management of noncardiovascular toxicities.

The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.

Lenalidomide treatment for patients with multiple myeloma: diagnosis and management of most frequent adverse events.

The introduction of novel antimyeloma therapies, including thalidomide, lenalidomide, and bortezomib, has expanded treatment options for patients with this disease. These compounds have altered the natural history of multiple myeloma, resulting in substantial improvements in patient outcomes. However, like with any other drug, their use is associated with a specific toxicity profile. The major adverse events (AEs) associated with lenalidomide include: hematological toxicities (myelosuppression), mainly neutropenia, venous thromboembolism, gastrointestinal disturbance, skin toxicity, atrial fibrillation, asthenia, and decreased peripheral blood stem cell yield during stem cell collection when lenalidomide is used after a long period of time. These AEs are predictable, consistent, and manageable with patient monitoring, supportive care, and dose adjustment. In this article, using three clinical cases as examples, we discuss the diagnoses and management of the most frequent AEs associated with lenalidomide treatment in patients with multiple myeloma.

The office evaluation of weakness.

The office evaluation of weakness can be a daunting task. Many different disorders affecting many different parts of the nervous system can manifest with "weakness," and several nonneurologic conditions may present with complaints of weakness. It is the job of the neurologist to determine whether a patient has neurologic weakness or suffers simply from fatigue. The physician then must properly localize the pathophysiologic site of weakness. The author focuses on neuromuscular causes of weakness affecting muscle, the neuromuscular junction, peripheral nerve, or the anterior horn cell. General historical and examination clues to localization will be discussed. A localization-based evaluation will be outlined, with more specific recommendations regarding the evaluation of a few specific disorders offered. Localization-specific laboratory, electrodiagnostic, imaging, and pathologic investigations will be presented.

Exercise as an intervention for frailty.

By 2015, nearly 15% of the US population will be older than 65 years. In 2030, there will be more than 70 million older Americans. This increase in the elderly population has prompted interest in recent years toward the study of frail older adults. This article reviews the literature investigating the utility of aerobic and resistance exercise training as an intervention for frailty in older adults. In addition, areas of future research are addressed, including concerns related to the dissemination of exercise interventions on a widespread scale. Guidelines for an "exercise prescription" for frail older adults are briefly outlined.

[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.

An epidemiological study of the perception of asthenia by oncologists in cancer patients: POA study.

INTRODUCTION: Despite the high prevalence of asthenia in cancer patients, around 50-75%, and its impact on quality of life, it continues to be a difficult symptom to assess and manage. This study defines the extent of perception and diagnosis of asthenia associated with cancer among Spanish oncologists. METHODS: A descriptive, observational study conducted in Spain based on a five-part structured questionnaire available to participants through a private website. RESULTS: The 100 oncologists surveyed, most in the public healthcare setting, diagnose asthenia in 58-70% of cases. They consider old age (56.5%) and advanced-stage disease (94.2%) as factors associated with the occurrence of asthenia, which is also common in, particularly, tumours, such as pancreatic cancer (30.4%), and some therapies, notably chemotherapy alone (67%) or combined with radiotherapy (96%). Despite its adequate detection, physicians rarely ask their patients about asthenia, use instruments for its evaluation or assess its impact on quality of life. Likewise, only 40% of all patients are treated, although therapeutic intervention, a multidisciplinary approach combining drug and non-drug treatments and managing a variety of causative factors, can be considered adequate. Finally, 91.5% of those surveyed do not have action guidelines for asthenia in their hospitals. CONCLUSIONS: Even when asthenia is widely diagnosed in cancer patients in Spain, there is a laxity in its assessment and treatment. Increased awareness among healthcare professionals of its impact and relevance is therefore required, as well as adequate protocols for its systematic detection and management within the routine assessment and treatment of cancer patients.

An epidemiological study of the perception of asthenia by oncologists in cancer patients: POA study

INTRODUCTION: Despite the high prevalence of asthenia in cancer patients, around 50-75%, and its impact on quality of life, it continues to be a difficult symptom to assess and manage. This study defines the extent of perception and diagnosis of asthenia associated with cancer among Spanish oncologists. METHODS: A descriptive, observational study conducted in Spain based on a five-part structured questionnaire available to participants through a private website. RESULTS: The 100 oncologists surveyed, most in the public healthcare setting, diagnose asthenia in 58-70% of cases. They consider old age (56.5%) and advanced-stage disease (94.2%) as factors associated with the occurrence of asthenia, which is also common in, particularly, tumours, such as pancreatic cancer (30.4%), and some therapies, notably chemotherapy alone (67%) or combined with radiotherapy (96%). Despite its adequate detection, physicians rarely ask their patients about asthenia, use instruments for its evaluation or assess its impact on quality of life. Likewise, only 40% of all patients are treated, although therapeutic intervention, a multidisciplinary approach combining drug and non-drug treatments and managing a variety of causative factors, can be considered adequate. Finally, 91.5% of those surveyed do not have action guidelines for asthenia in their hospitals. CONCLUSIONS: Even when asthenia is widely diagnosed in cancer patients in Spain, there is a laxity in its assessment and treatment. Increased awareness among healthcare professionals of its impact and relevance is therefore required, as well as adequate protocols for its systematic detection and management within the routine assessment and treatment of cancer patients (AU)

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[Management of cancer-related fatigue]. / Prise en charge de l'asthénie associée au cancer.

INTRODUCTION: Cancer-related fatigue is very common but its management remains frustrating. We thus sought to review current knowledge in this field: epidemiologic data, pathophysiological mechanisms, assessment, and treatment. METHODS: We queried the Medline database for all articles on this topic published between 1997 and 2007 and analyzed the articles published in English and French, as well as some of the essential earlier work. RESULTS: Approximately 60 to 96% of patients treated for cancer report fatigue. The prevalence of fatigue that persists after the disease is considered to be in remission is substantial. Fatigue is a multidimensional problem with biological, psychological, social, and personal aspects. Physical causes must be systematically considered (comorbidities, anemia, and endocrine disorders), but most cases remain unresolved. Many may be attributed to deconditioning. There is not now any pharmacological therapy that treats this symptom effectively. Some psychostimulants are being tested, but the initial results of the studies are contradictory. Exercise is the intervention for which there is the most evidence of effectiveness. CONCLUSION: Cancer-related fatigue is a very common symptom for which no specific cause can usually be identified. In this situation, rest may be more harmful than exercise.