Fatigue by the Chalder Questionnaire and post-hemodialysis recovery in a population of predominantly African descent: The PROHEMO.

BACKGROUND/OBJECTIVE: A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. METHODS: A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. RESULTS: Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. CONCLUSION: This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.

Time course of biomechanics during jump landing before and after two different fatigue tasks.

Objective: Muscle fatigue contributes to anterior cruciate ligament (ACL) injuries, with increased knee and hip abduction observed during fatigue. However, there have been no reports revealing the differences between fatigue tasks or the duration of these changes. In this study, we conducted single-leg drop landings before and after hip and knee fatigue tasks to elucidate the changes in lower limb biomechanics over time. Methods: Twenty-two male participants performed single-leg drop landings before, immediately after, and 5, 10, and 15 min after fatigue tasks involving isokinetic hip abduction/adduction (hip fatigue task [HFT]) and knee extension/flexion (knee fatigue task [KFT]). Hip and knee kinematic and kinetic data were collected using a three-dimensional motion analysis device and two force plates. A two-way ANOVA was performed with both the fatigue task (HFT and KFT) and time point (Time 1 to Time 4) as factors, and the main effects and interactions were calculated. Results: The knee adduction angle after the HFT was significantly greater than that after KFT immediately following the fatigue task. The knee flexion moment was significantly lower in the KFT, whereas the knee adduction and internal rotation moments were significantly higher in the HFT immediately after the fatigue task. Conclusion: This study revealed distinct kinematic and kinetic changes specific to each fatigue task, particularly in the frontal plane for hip joint tasks and the sagittal plane for knee joint tasks. These findings could assist in the development of ACL injury prevention programs tailored to the functional improvement and exercise capacity of each joint.

The powerful antioxidant effects of plant fruits, flowers, and leaves help to improve retinal damage and support the relief of visual fatigue.

With the popularization of electronic products, visual fatigue is inevitably frequent. The causes of visual fatigue are varied, but from the perspective of physiological mechanisms, it is mainly closely related to retinal function or structural damage, especially the light source from various mobile devices and office equipments nowadays, which induces oxidative stress damage in the retina and exacerbates the degree of visual fatigue, resulting in the inability to use the eyes for a long period of time, pain in the eyes and periorbital area, blurred vision, dry eyes, tearing, and other discomforts. Food ingredients derived from natural plants have greater application in relieving visual fatigue. Therefore, this paper presents a detailed compilation of six plants that are widely used for their visual fatigue-relieving function, in the hope of providing more raw material choices for the development of products with visual fatigue-relieving functions in the future.

Occupational Fatigue and Its Relationship with Musculoskeletal Disorders and Heat Stress among the Workers of Summer Crops in Southeast Iran in 2021.

Aims: This research aimed to evaluate work fatigue and its relationship with musculoskeletal disorders (MSDs) and heat stress (WBGT) among greenhouse workers in Jiroft County, southeast Iran. Materials and Methods: This cross-sectional study was carried out between September 2021 and February 2022 among 150 workers in summer crop greenhouses. Data were collected by a demographic questionnaire, the Swedish occupational fatigue inventory (SOFI-20), and the Nordic musculoskeletal questionnaire (NMQ), and wet bulb globe temperature (WBGT) was measured as per ISO 7243. The collected data were analyzed by the χ2 test, logistic regression, and multivariable linear regression in the Stata 17.0 software. Results: The results showed a higher total fatigue score among the studied workers (mean = 100.71 out of 200). Among the fatigue dimensions, the three dimensions of lack of energy, physical discomfort, and physical exertion had the highest scores of 27.28, 26.71, and 25.71, respectively. The highest rate of MSD prevalence was in the back (54.7%), neck (50.7%), and shoulders (49.3%). Based on ISO 7243, the mean WBGT was beyond the allowed level for most tasks for greenhouse workers. There was a statistically significant relationship between occupational fatigue with MSDs and WBGT. Conclusion: Given the relatively high score reported for fatigue and its relationship with MSDs and heat stress, it is recommended to conduct further and more applied studies to investigate the approaches to alleviating heat stress and physical ergonomic risk factors in greenhouses in this occupational group.

Determining the Emotional Intelligence and Compassion Fatigue Among Postgraduate Dental Students Using the Emotional Intelligence Scale and the Quality of Life Scale: An Observational Study.

Introduction Compassion fatigue (CF) is a problem for professionals who work with traumatized individuals. CF manifests as reliving personal sorrow, nightmares, flashbacks, intrusive thoughts, numbing or avoiding memories of the experience, and elevated physiological arousal. CF makes professionals more likely to make bad choices, such as misplacing treatments or mistreating patients. Emotional intelligence (EI) is essential to comprehending human behavior, performance, and well-being. EI is a crucial component of professional competency in medical education, as postgraduate dental students are also at risk of having CF. They are professionals and have to work with traumatized patients, so the study was conducted to evaluate their CF and EI. This study aimed to evaluate EI and CF among postgraduate dental students at Sharad Pawar Dental College and Hospital, Wardha, India. Materials The observational study was conducted at Sharad Pawar Dental College and Hospital among postgraduate dental students. The data was collected from 80 postgraduate students who responded to the Professional Quality of Life Version 5 and the Emotional Intelligence Scale questionnaires. Result A total of 80 postgraduate dental students responded to the Professional Quality of Life Version 5 and the Emotional Intelligence Scale questionnaires, and all the responses were included in the study. Findings revealed that postgraduate dental students treating patients have high levels of CF and EI. Conclusion This study indicates that there is a high level of CF and EI in postgraduate dental students. As high CF is harmful and can affect physical and mental well-being, proper management should be done through psycho-education and self-care.

Sustained improvements in patient-reported outcomes after long-term sutimlimab in patients with cold agglutinin disease: results from the CADENZA study open-label extension.

Background: Cold agglutinin disease (CAD) is a rare subtype of autoimmune haemolytic anaemia characterised by classical complement pathway-mediated haemolysis, fatigue, and poor quality of life (QoL). Sutimlimab, a C1s inhibitor, rapidly halted haemolysis, and improved patient-reported outcomes (PROs) in patients with CAD in two phase 3 trials (CARDINAL and CADENZA). Here we report PROs from the CADENZA open-label extension (Part B). Methods: The first patient was enrolled in CADENZA (NCT03347422) in March 2018 (Part A) and the last patient completed the study in December 2021 (Part B). All patients who completed the 26-week Part A were eligible to receive biweekly doses of sutimlimab in Part B for up to 1 year after the last patient completed Part A. PROs were assessed throughout Part B, until the last on-treatment visit with available assessment (LV), and after a 9-week washout. Findings: In total, 32/39 patients completed Part B; median Part B treatment duration: 99 weeks. Patients switching from placebo to sutimlimab in Part B experienced rapid improvement in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score and other PROs. Sustained, clinically important improvements in FACIT-Fatigue were observed throughout Part B in patients who switched to sutimlimab and those continuing sutimlimab treatment (combined-group mean [SE] change from baseline at LV: 8.8 [2.1]). Similarly, the combined-group mean [SE] change for 12-Item Short Form Health Survey physical (4.9 [1.7]) and mental (4.0 [1.8]) component scores exceeded clinically important changes from baseline at LV. EuroQol visual analogue scale showed consistent and sustained increases from baseline with sutimlimab treatment. Following a 9-week washout, all PROs approached baseline values. Interpretation: Continued inhibition of the classical complement pathway with sutimlimab results in meaningful long-term improvements in PROs (fatigue and QoL) in patients with CAD. Funding: Sanofi.

The impact of fatigue on people with multiple sclerosis in Morocco.

Background: Multiple sclerosis (MS), fatigue is among the leading clinical symptoms. It is one of the most disabling symptoms for most MS people. Objectives: This research measures the prevalence of fatigue and its impact on the physical, cognitive, and psychosocial abilities of individuals with MS in Morocco. Method: This cross-sectional and descriptive study included 152 participants. Data were collected via an online survey using the snowball method, incorporating sociodemographic characteristics and the Arabic version of the Modified Fatigue Impact Scale. Results: According to the results, 89.4% of respondents experienced pathological fatigue, with an average score of 65.52 (± 18.00). There was a significant relationship between pathological fatigue, age (p = 0.0324), and clinical phenotype (p = 0.041). Fatigue negatively impacted participants' physical, cognitive, and psychological capacities, with average scores of 70.38 (± 8.15), 62.28 (± 10.23), and 73.87 (± 1.86), respectively. Conclusion: The results of our study confirmed a high prevalence of fatigue among people with MS in Morocco. Sustained research in this field remains crucial, as it enables the formulation of strategies aimed at enhancing the quality of life for those impacted by MS. Contribution: This study is the first in Morocco to examine fatigue prevalence in people with MS and its impact on their physical, cognitive, and psychosocial abilities. High fatigue levels hinder the integration of people with MS into professional and student life. The findings emphasize the need for effective symptom and fatigue management.

The association between intolerance of uncertainty and academic burnout among university students: the role of self-regulatory fatigue and self-compassion.

Introduction: Increased uncertainty is a major feature of the current society that poses significant challenges to university students' mental health and academics. However, current research has not paid sufficient attention to this issue, and no study has explored the underlying mechanisms between intolerance of uncertainty and academic burnout among university students. Methods: This study examined the association between uncertainty intolerance and academic burnout among university students and the role of self-regulatory fatigue and self-compassion in light of the theory of limited resources. Convenience sampling was used to survey 1,022 Chinese university students. Results: The findings demonstrated that intolerance of uncertainty significantly influenced university students' academic burnout with self-regulatory fatigue serving as a key mediator. Additionally, self-compassion can effectively moderate the effects of intolerance of uncertainty on self-regulatory fatigue and academic burnout. Discussion: These results indicated that the depletion of cognitive resources brought about by uncertainty in the current highly uncertain social environment may be one of the key pathways to academic burnout among university students. Furthermore, current research provides insights into how to mitigate the negative effects of uncertainty on university students.

Clinical-epidemiological characterization of patients with long COVID in Mexico.

BACKGROUND: Long COVID is defined as the persistence of COVID-19 symptoms four weeks after having undergone acute infection, according to the most recent CDC definition. It is estimated that there are 65 million people affected by this entity, although other figures speak of 200 million. OBJECTIVE: To characterize the population affected by long COVID in Mexico. MATERIAL AND METHODS: Patients older than 18 years who agreed to answer an online survey and who met the criteria for long COVID were included. RESULTS: Data from 203 subjects were included, with 138 (68.0%) being found to be females, and average age to be 41.8 years; 29.6% had severe disease, and 70.4%, mild to moderate disease; 89.7% had received prior COVID-19 vaccination: 6.9% had received one dose; 31.5%, two doses; and 51.2%, three or more doses. The main risk factors were diabetes, overweight or obesity, and hypertension. The most commonly reported symptom was fatigue, followed by other neuropsychiatric manifestations. CONCLUSION: It is important for the population affected by long COVID to be characterized in order to generate diagnostic and treatment protocols.

ANTECEDENTES: El COVID persistente se define como la persistencia de síntomas de COVID-19 después de cuatro semanas de cursar con un cuadro agudo, según la definición más reciente de los Centers for Disease Control and Prevention. Se estima que existen 65 millones de personas afectadas por esta entidad, aunque algunos reportes indican 200 millones. OBJETIVO: Caracterizar a la población afectada por COVID persistente en México. MATERIAL Y MÉTODOS: Se incluyeron pacientes mayores de 18 años que consintieron responder a una encuesta en línea y que cumplían los criterios de COVID persistente. RESULTADOS: Se incluyeron los datos de 203 sujetos. Se identificó que 138 (68.0 %) contestaron ser del sexo femenino, con una media de edad de 41.8 años; 29.6 % presentó enfermedad grave y 70.4 %, enfermedad leve a moderada; 89.7 % había recibido vacunas previas para COVID-19: 6.9 %, una dosis; 31.5 %, dos dosis; y 51.2 %, tres o más dosis. Los principales factores de riesgo fueron diabetes, sobrepeso u obesidad e hipertensión arterial sistémica. El principal síntoma reportado fue fatiga, seguido de otras manifestaciones neuropsiquiátricas. CONCLUSIÓN: Es importante caracterizar a la población para generar protocolos de diagnóstico y tratamiento.

Human-Robot Collaboration With a Corrective Shared Controlled Robot in a Sanding Task.

OBJECTIVE: Physical and cognitive workloads and performance were studied for a corrective shared control (CSC) human-robot collaborative (HRC) sanding task. BACKGROUND: Manual sanding is physically demanding. Collaborative robots (cobots) can potentially reduce physical stress, but fully autonomous implementation has been particularly challenging due to skill, task variability, and robot limitations. CSC is an HRC method where the robot operates semi-autonomously while the human provides real-time corrections. METHODS: Twenty laboratory participants removed paint using an orbital sander, both manually and with a CSC robot. A fully automated robot was also tested. RESULTS: The CSC robot improved subjective discomfort compared to manual sanding in the upper arm by 29.5%, lower arm by 32%, hand by 36.5%, front of the shoulder by 24%, and back of the shoulder by 17.5%. Muscle fatigue measured using EMG, was observed in the medial deltoid and flexor carpi radialis for the manual condition. The composite cognitive workload on the NASA-TLX increased by 14.3% for manual sanding due to high physical demand and effort, while mental demand was 14% greater for the CSC robot. Digital imaging showed that the CSC robot outperformed the automated condition by 7.16% for uniformity, 4.96% for quantity, and 6.06% in total. CONCLUSIONS: In this example, we found that human skills and techniques were integral to sanding and can be successfully incorporated into HRC systems. Humans performed the task using the CSC robot with less fatigue and discomfort. APPLICATIONS: The results can influence implementation of future HRC systems in manufacturing environments.

The validity and reliability of quadriceps twitch force as a measure of skeletal muscle fatigue while cycling.

The measurement of skeletal muscle fatigue in response to cycling exercise is commonly done in isometric conditions, potentially limiting its ecological validity, and creating challenges in monitoring the time course of muscle fatigue across an exercise bout. This study aimed to determine if muscle fatigue could be reliably assessed by measuring quadriceps twitch force evoked while pedaling, using instrumented pedals. Nine participants completed three laboratory visits: a step incremental test to determine power output at lactate threshold, and on separate occasions, two constant-intensity bouts at a power output 10% above lactate threshold. Femoral nerve electrical stimulation was applied to elicit quadriceps twitch force both while pedaling (dynamic) and at rest (isometric). The test-retest reliability of the dynamic twitch forces and the agreement between the dynamic and isometric twitch forces were evaluated. Dynamic twitch force was found to have excellent reliability in an unfatigued state (intraclass correlation coefficient (ICC) = 0.920 and mean coefficient of variation (CV) = 7.5%), and maintained good reliability at task failure (ICC = 0.846 and mean CV = 11.5%). When comparing dynamic to isometric twitch forces across the task, there was a greater relative decline in the dynamic condition (P = 0.001). However, when data were normalized to the 5 min timepoint when potentiation between conditions was presumed to be more similar, this difference disappeared (P = 0.207). The reliability of this method was shown to be commensurate with the gold standard method utilizing seated isometric dynamometers and offers a new avenue to monitor the kinetics of muscle fatigue during cycling in real time.

Randomized Controlled Trial on the Effects of Home-Based Breathing Exercises on Respiratory Function and Fatigue in COVID-19-Cured Young Patients.

This study investigates the effects of home-based Kakao Healthcare breathing exercises and stretching on respiratory function and fatigue in COVID-19-cured patients. A total of 35 participants performed four movements of home-based breathing exercises and five respiratory muscle stretching exercises four times a week for four weeks. Respiratory function was measured using forced vital capacity(FVC), forced expiratory volume in one second(FEV1), FEV1/FVC ratio, and peak expiratory flow(PEF). Fatigue was assessed using the Fatigue Severity Scale (FSS). Data analysis was performed using independent-sample and paired-sample t-tests in SPSS 24, with the significance level set at p < 0.05. After four weeks of home-based Kakao Healthcare breathing exercises, there were significant increases in respiratory FVC, FEV1, FEV1/FVC, and PEF function values observed in the training group (T.G.) after the exercise intervention (p < 0.05). Such an increase was observed when comparing these values with their corresponding pre-exercise measurements. In contrast, there were no statistically significant differences in respiratory function outcomes before and after exercise in the control group (C.G.) (p > 0.05). The FSS scores were statistically significant within the training group (T.G.) (p > 0.05). The 4-week Kakao Healthcare breathing exercise scheme was found to be capable of improving some respiratory functions in COVID-19-recovered patients, but it showed no significant improvement in fatigue levels.

Tailored Physical Activity Interventions for Long COVID: Current Approaches and Benefits-A Narrative Review.

This narrative review explores the essential role of physical activity in managing long COVID, which is characterized by persistent symptoms such as fatigue, breathlessness, and cognitive impairments following SARS-CoV-2 infection. In this context, "physical activity" includes various exercises, such as aerobic and resistance training, as well as flexibility and balance exercises, thereby encompassing the subset known as "exercise". The methodology involved a comprehensive literature search across PubMed, EBSCO (EDS), and Google Scholar, selecting peer-reviewed articles from December 2019 to June 2024 focusing on long COVID physical activity interventions. The review highlights that tailored exercise programs, adjusted to individual health status and abilities, significantly alleviate symptoms and enhance psychological well-being. Key findings emphasize the importance of personalized exercise prescriptions due to the variability in patient responses and the need for a multidisciplinary approach in developing and monitoring interventions. Despite promising outcomes, the review identifies research gaps, including the need for long-term studies, randomized controlled trials, and deeper mechanistic insights. It suggests that standardized reporting, templates like the Consensus on Exercise Reporting Template (CERT), and integrating digital health tools are essential for optimizing interventions. Overall, the review advocates including personalized physical activity or exercise programs in standard care for long COVID to improve patient outcomes and quality of life.

Post-COVID-19 Condition: How Sociodemographic Factors, Physical Well-Being and Functionality Influence Quality of Life and Mental Health Symptoms.

BACKGROUND: Long COVID-19 syndrome remains a global public health problem, with more than 145 million people affected with multisystemic symptoms. Addressing the requirements of individuals impacted by a syndrome characterised by a complex and variable clinical presentation is of utmost importance. Identifying the variables that can exert influence and understanding their progression is essential for directing treatment strategies aimed at enhancing both independence and quality of life. Therefore, the aim of this study was to analyse the influence of sociodemographic and clinical variables on existence and their relationship with asthenia, anxiety symptoms and low mood. METHODS: An analytical study secondary to an observational cross-sectional descriptive study. RESULTS: Logistic regression showed significant univariate effects on asthenia [sex (p = 0.034); age (p = 0.042); Activities of Daily Living Questionnaire [ADQL (p = 0.002)] [physical functioning (p < 0.001) and general health (p = 0.014)] and multivariate [sex (p = 0.019), adult age (p = 0.01) and physical functioning (p = 0.04)]]; low mood [time of evolution (p = 0.028) and multivariate [time course (p = 0.007), ADLQ (p = 0.011), role physical (p = 0.013) and general health (p = 0.001)]] and anxiety [physical functioning (p = 0.046) and multivariate [physical functioning (p = 0.034), age (p = 0.011), time of evolution (p = 0.001) and ADQL (p = 0.011)]]. CONCLUSIONS: Increased age, gender and longer evolution time seem to favour the prevalence and occurrence of mental health symptoms; greater independence and good physical functioning are protective factors with respect to the occurrence of mental health-related symptoms in patients affected by post-COVID-19 condition.

Exploring sleepiness and stress among London bus drivers: An on-road observational study.

Bus driver sleepiness is commonplace but often goes unreported within the industry. Whilst past research has begun to shed a light on the prevalence, potential causes, and consequences of bus driver sleepiness, this is often done using self-report methods. This is the first study to investigate sleepiness amongst city bus drivers on-road using a live bus route with drivers' regular schedules. A total of 16 participants completed two drives of their regular bus route once during an early morning shift and once during a daytime shift whilst physiological and self-report measures of sleep and stress were taken. Prior to these drives, drivers recorded their sleep in a diary and wore an actigraph to obtain objective sleep measures. Results showed that most drivers did not obtain sufficient sleep prior to early morning shifts, and often did not obtain as much sleep as they would need in order to feel rested before work. Sleepiness and stress were observed in both shifts. During early morning shifts sleepiness was likely a result of working during circadian lows and not obtaining enough sleep prior to the shift. In contrast, sleepiness during the daytime shift was likely a result of completing a highly demanding task in complex traffic which not only contributed to fatigue, but also led to increased levels of stress. As well as demonstrating the prevalence of sleepiness amongst bus drivers, these findings show that the causes of sleepiness can be multifaceted and often come about due to a combination of work and personal factors. In addition, the experience of sleepiness is not the same for all drivers, with individual differences in the experience of sleepiness playing a large role. These differences highlight the need for individualised interventions which should be considered by policymakers alongside the combination of causal factors within a larger systems approach.

Mental Fatigue in Sport-From Impaired Performance to Increased Injury Risk.

The literature describing the effects of mental fatigue (MF) has grown tremendously. This is accompanied by identification of a host of performance-determining parameters affected by MF. MF results from prolonged cognitive effort and predominantly affects physical, technical, tactical, and perceptual-cognitive dimensions of sport, while physiological parameters (eg, heart rate, lactate) and physical aspects of maximal and supramaximal efforts are predominantly unaffected. The aim of this paper was to provide an overview of the parameters described in the literature as influenced by MF. By identifying the different parameters, we not only see how they affect the performance of athletes but also raise concerns about the potentially increased injury risk due to MF. Preliminary evidence suggests that subsequent disturbances in balance, motor skills, and decision-making processes could potentially increase the vulnerability to injury. An abundance of lab-based studies looked into the effects of MF on performance; however, many questions remain about the mechanisms of origin and neurophysiological causes of MF, and only small steps have been taken to translate this knowledge into practice. Thus, there is a need for more research into the underlying mechanisms of MF and the role of the brain, as well as more applied research with a high ecological validity that also takes into account the potential increased risk of injury due to MF.

Nonpelvic comorbid symptoms of 45 patients with pain of pelvic venous origin, before and after treatment.

OBJECTIVE: To report the prevalence and severity of nonpelvic symptoms for patients with venous-origin chronic pelvic pain (VO-CPP) and to describe outcomes after pelvic vein stenting and embolization. METHODS: We retrospectively reviewed outcomes of 45 women with VO-CPP who underwent treatment with iliac vein stenting and/or embolization. Patients completed symptom-severity questionnaires before and after treatment that assessed for pelvic pain, and multiple other symptoms, including brain fog, anxiety, depression, musculoskeletal pain, fatigue, migraines and more. RESULTS: Patient age ranged from 18 to 65 years. The prevalence of common symptoms was as follows: migraines, 69%; brain fog, 76%; anxiety attacks, 58%; excess sweating, 64%; hip pain, 73%; diarrhea, 62%; constipation, 76%; and abdominal bloating, 82%. After treatment, most symptom scores improved by more than 50%; exceptions were excessive sweating (41% improvement) and bloating (47% improvement). Prevalence of individual symptoms that bundle into POTS ranged from 29% to 76%, where symptom improvement ranged from 23% to 59% after treatment. Overlapping individual symptoms characteristic of fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) were present in 64% to 82% of patients and all improved by 49% to 63% after treatment. CONCLUSIONS: Pelvic venous flow abnormality is linked causally to a spectrum of interrelated symptoms, of which many can be bundled into named syndromes of unknown cause. With catheter- based treatment of pelvic venous pooling, nonpelvic symptom and syndrome scores improved.

The effects of fatigue on the relationship between ankle angle at initial contact and the knee and hip joints in landing: Assessing the risk of ACL injury.

BACKGROUND: Anterior cruciate ligament (ACL) injuries may correlate with lower limb angles and biomechanical factors in both dominant and non-dominant legs at initial contact (IC) post-landing. This study aims to investigate the correlation between ankle angles in three axes at IC and knee and hip joint angles during post-spike landings in professional volleyball players, both pre- and post-fatigue induction. RESEARCH QUESTION: To what extent does fatigue influence lower limb joint angles, and what is the relationship between ankle joint angles and hip and knee angles at IC during the landing phase following a volleyball spike? METHODS: Under conditions involving the peripheral fatiguing protocol, the lower limb joint angles at IC following post-spike landings were measured in 28 professional male volleyball players aged between 19 and 28 years, who executed the Bosco fatigue protocol both before and after inducing fatigue. A paired t-test was utilized to compare the joint angles pre- and post-fatigue in both dominant and non-dominant legs. Furthermore, Pearson's correlation test was conducted to explore the relationship between ankle angles at IC and the corresponding knee and hip joint angles. RESULTS: The findings of the study revealed that fatigue significantly increased hip external rotation and decreased knee joint flexion and external rotation in both the dominant and non-dominant legs (p < 0.05). Additionally, correlation analysis demonstrated that the ankle joint's positioning in the frontal and horizontal planes was significantly associated with hip flexion and external rotation at the IC, as well as with knee flexion and rotation (0.40 < r < 0.80). CONCLUSION: Fatigue increased hip external rotation and ankle internal rotation, weakening the correlation between these joints while strengthening the ankle-knee relationship, indicating a reduced hip control in jumps. This suggests a heightened ACL injury risk in the dominant leg due to the weakened ankle-hip connection, contrasting with the non-dominant leg.

Multisensory mental imagery of fatigue in patients with multiple Sclerosis. Preliminary evidence from a fMRI study.

Fatigue, defined as a subjective lack of physical and/or mental energy, is a clinical symptom highly characterizing multiple sclerosis (MS). The present study utilized a novel approach to the study of fatigue, examining first person-mental imagery of the symptom. Eighteen right-handed patients with MS (14F, 4 M, mean age 45.8 ± 8.15 years) were evaluated and were compared to nineteen healthy controls (10F, 9 M, mean age 43.15 ± 8.34 years) Patients were all in relapsing remitting form and no patient had presented relapses in the 6 months prior to inclusion in the study. We evaluated their behavioral performance and fMRI activations. We used an fMRI paradigm used to trigger first person-mental imagery of fatigue, through short sentences describing the principal manifestations of fatigue. Participants were asked to imagine the corresponding sensations (Sensory Imagery, SI). As a control, they had to imagine the visual scenes (Visual Imagery, VI) described in short phrases. They made a vividness rating by pressing the corresponding button. Behaviorally, we found that patients' mean scores at the Multidimensional Fatigue Symptom Inventory for the general scale, physical scale, and mental scale were significantly higher than healthy controls (p = 0.05, p = 0.002, p = 0.006 respectively), but not for the emotional scale and for vigor scale (p = 0.207, n.s., p = 0.06, n.s.). In the imagery fMRI task, patients were significantly slower (mean reaction times and standard deviation: 2.24 s ± 0.33) than controls (mean reaction times and standard deviation: 1.918 s ± 0.455) for the SI task (Z=-2.058, p = 0.040), while no significant difference was found for the VI task. Regarding brain mapping, our main result is a group by task interaction. The SI task (vs. VI task) in healthy controls (relative to patients) increased activation in the left inferior parietal lobule. These preliminary results indicate that fatigue is related to dysfunctions in higher-order aspects of motor control, given the role of the posterior parietal lobe in motor planning and multisensory integration.

Short-term intermittent hypoxia exposure for dyspnea and fatigue in post-acute sequelae of COVID-19: a randomized controlled study.

BACKGROUND: Post-acute sequelae of COVID-19 (PASC) is incurring a huge health and economic burden worldwide. There is currently no effective treatment or recommended drug for PASC. METHODS: This prospective randomized controlled study was conducted in a hospital in China. The effect of intermittent hypoxia exposure (IHE; five-minute hypoxia alternating with five-minute normal air, repeated five times) on dyspnea and fatigue was investigated in patients meeting the NICE definition of PASC. Patients were computationally randomized to receive normoxia exposure (NE) and routine therapy or IHE and routine therapy. Six-minute walk distance (6MWD) and spirometry were tested before and after the interventions; the Borg Dyspnea Scale (Borg) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to assess dyspnea; and the Fatigue Assessment Scale (FAS) and the Chalder Fatigue Scale-11 (CFQ-11) were used to assess fatigue. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300070565). FINDINGS: Ninety-five participants (33 males and 62 females) were recruited between March 1, 2023 and December 30, 2023. Forty-seven patients in the IHE group received 10.0 (9.0, 15.0) days of IHE, and 48 patients in NE group received 10.0 (8.0, 12.0) days of NE. 6MWD, forced vital capacity (FVC), FVC %pred, forced expiratory volume in 1 s (FEV1), FEV1 %pred, tidal volume (VT), and dyspnea and fatigue scales markedly improved after IHE (p < 0.05), and improvements were greater than in the NE group (all p < 0.05). Furthermore, participants in IHE group had better subjective improvements in dyspnea and fatigue than those in the NE group (p < 0.05). Compared with <10 days of IHE, ≥10 days of IHE had a greater impact on 6MWD, FVC, FEV1, FEV1 %pred, VT, FAS, and CFQ-11. No severe adverse events were reported. INTERPRETATION: IHE improved spirometry and 6MWD and relieved dyspnea and fatigue in PASC patients. Larger prospective studies are now needed to verify these findings.