External training load and performance recovery after small-sided games in soccer: Insights for return-to-play management.

The return-to-play process' characteristics can vary by injury and sport type but are typically composed of phases of different durations, training targets, and intensities that gradually increase the physiological and mechanical load. In team sports, contact drills are a necessary part of the last phases of this process, and they should be planned using the optimal mechanical load. The present study investigated the external load and kinetic recovery in U19 soccer players performing 6vs6 and 3vs3 small-sided games. A global positioning system (GPS) measured external load metrics. The rate of perceived exertion (RPE) was registered at the end. Total quality of recovery (TQR) was collected at the beginning of the training session and after 24 h. Moreover, before and after the small-sided games (SSGs) and at 24 h, delayed-onset muscle soreness (DOMS) of the legs, sprinting time, and vertical jump height (CMJ) were collected. 6vs6 presented higher values in total distance low-, moderate-, high, and very-high-speed distance, and maximum speed (p < 0.05). However, 3vs3 showed higher number of sprints, acceleration, and deceleration at different intensities. Furthermore, no difference was shown in RPE. The effect of fatigue on sprint seems greater for 6vs6, showing an impairment persistent at 24 h (p < 0.05). Moreover, CMJ height was impaired after 6vs6 and at 24 h (p < 0.05) but did not change after 3vs3 (p > 0.05). DOMS values after SSGs and at 24 h were higher than baseline for both conditions (p < 0.05), while TQR decreased at 24 h in both conditions (p < 0.05). Based on our results, it seems that 6vs6, leading to a greater high-speed running distance, might cause a training load that needs more time to recover. This point may be crucial in a return-to-play process, especially when hamstring muscles are involved.

Phase transformation behavior and mechanical properties of HyFlex EDM nickel-titanium endodontic rotary instrument: Evaluation at body temperature.

Background/purpose: Temperature-dependent phase compositional changes influence the mechanical properties of heat-treated nickel-titanium (NiTi) rotary instruments. This study evaluated the phase composition, bending properties, and cyclic fatigue resistance of HyFlex EDM NiTi rotary instruments against differently heat-treated and non-heat-treated NiTi instruments at body temperature (BT). Materials and methods: HyFlex EDM OneFile (EDM) instruments, heat-treated HyFlex CM (CM) and Twisted File (TF) instruments, and non-heat-treated K3 instruments (size #25/.08) were subjected to differential scanning calorimetry, and the martensitic, R-phase, and reverse transformation starting and finishing temperatures were determined. A cantilever bending test and a cyclic fatigue test were conducted at BT (37 °C ± 1.0 °C), and the bending load and number of cycles to failure (NCF) were recorded. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). Results: TF and K3 had reverse transformation finishing temperatures lower than BT, while those for EDM and CM were higher than BT. The bending loads at a 0.5 mm deflection were in the order of EDM < TF < CM < K3 (P < 0.05), and those at a 2.0 mm deflection were EDM < CM and TF < K3 (P < 0.05). EDM had the highest NCF among the four instruments (P < 0.05). Conclusion: The EDM instrument had a reverse transformation finishing temperature higher than BT indicating its martensite/R-phase composition at BT. The EDM instrument had superior flexibility and greater resistance to cyclic fatigue than the CM, TF, and K3 instruments at BT.

Pregnant Women's Knowledge, Attitudes, and Associated Factors Toward Physical Exercise During Pregnancy in Al-Ahsa City, KSA.

Introduction This research study aims to explore the understanding and perspective of pregnant women in Al-Ahsa regarding physical exercise during their pregnancy. Presently, there exists a deficiency in knowledge concerning the advantages of exercise for the well-being of both the expectant mother and the developing fetus within this area. The study endeavors to enlighten and empower pregnant women about the appropriate types and levels of exercise suitable for their individual physical activity during pregnancy, with the ultimate aim of attaining noteworthy health benefits. The proposed solution entails offering comprehensive education and guidance on the advantages and techniques of exercising during pregnancy. Methodology This is a cross-sectional study carried out in the city of Al-Al-Ahsa, located in Saudi Arabia. The data was collected through an online questionnaire. Subsequently, the collected data underwent a series of essential steps, including coding, thorough checking, and entry into an Excel spreadsheet. The final stage involved analyzing the data using the widely used statistical software SPSS. Results In this research conducted in Al-Ahsa City, the findings were based on a sample of 306 Saudi nationals. Several of the participants were aged over 45 (33.7%), married (81.4%), and had completed their college education (79.7%). In terms of their beliefs, the participants had an average score of 3.51 out of 7. Their level of awareness scored 5.13 out of 8, while their knowledge level scored 3.52 out of 5. A significant number of participants (68.3%) agreed on the importance of exercise during pregnancy, and a considerable percentage (72.9%) believed that any pregnant woman could exercise without seeking healthcare advice. When it came to accessing information about antenatal exercise, digital platforms, especially social media, were the primary source for the participants (63.4%). The most commonly practiced exercise type was walking (77.1%), and the main barriers reported were fatigue (64.4%) and time constraints (34.3%). Age was found to have a notable association with beliefs, awareness, and knowledge scores, while marital status and functional status showed marginal, insignificant associations. Conclusion This research underscores the significance of fostering optimistic beliefs, improving awareness, and addressing knowledge deficiencies through focused educational interventions. It emphasizes the crucial roles that healthcare professionals and digital platforms assume in spreading reliable information and assisting expectant mothers in making well-informed choices regarding their exercise routines. It is essential for future studies to investigate the efficacy of customized interventions and encompass diverse populations, thus deepening our comprehension of antenatal exercise behaviors and the factors that influence them.

Effects of sleep disturbance, cancer-related fatigue, and psychological distress on breast cancer patients' quality of life: a prospective longitudinal observational study.

More attention has gone to researching the cancer-related fatigue (CRF)-sleep disturbance (SD)-psychological distress (PD) symptom cluster in breast cancer patients during the chemotherapy period, but the change trend and heterogeneous development track in the whole treatment stage remain unclear, and it is also unclear whether the appearance of and changes in one symptom cause changes in other symptoms and quality of life (QoL). This study, using breast cancer patients' data collected through a validated questionnaire, examined the relationships between SD, CRF, PD, and QoL using latent growth modeling analyses. CRF developmental trajectories showed an upward trend over five surveys (slope = 0.649, P < 0.001); PD showed a significant weakening trend (slope = - 0.583, P < 0.001); SD showed an increasing trend (slope = 0.345, P < 0.001), and QoL showed a statistically significant weakening trend (slope = - 0.373, P < 0.001). The initial CRF (coefficient = - 0.233, P < 0.01), PD (coefficient = - 0.296, P < 0.01), and SD (coefficient = - 0.388, P < 0.001) levels had a statistically significant negative effect on initial QoL level. The linear development rate of PD was statistically significant and negatively affected that of QoL (coefficient = - 0.305, P < 0.05), whereas the quadratic development rate of SD negatively affected that of QoL (coefficient = - 0.391, P < 0.05). Medical staff should identify the change characteristics of different variables based on SD, CRF, PD, and QoL change trajectories, and advance the intervention time, as changes in variables affect other variables' subsequent changes.

A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops.

BACKGROUND: Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. OBJECTIVE: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. METHODS: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. RESULTS: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. CONCLUSIONS: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities.

Spiritual well-being, faith, meaning in life, peace, and purpose in life for cancer-related fatigue: systematic review with meta-analysis and meta-regressions.

BACKGROUND: Cancer-related fatigue is associated with spiritual distress. Spiritual well-being, characterized by the presence of factors such as meaning in life or purpose in life, seems to play an important role in the management of symptoms of cancer. Currently, the number of studies evaluating the association between cancer-related fatigue and spiritual well-being is increasing and no systematic review has been conducted. AIM: To summarize the association between cancer-related fatigue and spiritual well-being, faith, meaning in life, peace, and purpose in life. DESIGN: A systematic review with meta-analysis. DATA SOURCES: The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to 9 October 2023. We considered studies evaluating the cross-sectional or longitudinal association between cancer-related fatigue and the spiritual factors above mentioned. The Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies tool assessed the methodological quality of cross-sectional and longitudinal studies, respectively. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system rated the certainty of evidence. Meta-analyses, meta-regressions, subgroup meta-analyses, and sensitivity analyses were conducted. RESULTS: A total of 13 studies were included and no longitudinal findings were found. One meta-analysis showed that cancer-related fatigue may be negatively correlated with spiritual well-being (r = - 0.37 (95%CI - 0.44 to - 0.28) p < 0.01). In addition, another meta-analysis found the correlation between cancer-related fatigue and faith was not statistically significant (r = - 0.25 (95%CI - 0.66 to 0.28) p = 0.36). CONCLUSIONS: Cancer-related fatigue may be correlated with spiritual well-being. However, the certainty of evidence was very low across the meta-analyzed outcomes. IMPLICATIONS FOR CANCER SURVIVORS: A negative correlation was observed between spiritual well-being and cancer-related fatigue.

EEG Information Transfer Changes in Different Daily Fatigue Levels During Drowsy Driving.

A significant issue for traffic safety has been drowsy driving for decades. A number of studies have investigated the effects of acute fatigue on spectral power; and recent research has revealed that drowsy driving is associated with a variety of brain connections in a specific cortico-cortical pathway. In spite of this, it is still unclear how different brain regions are connected in drowsy driving at different levels of daily fatigue. This study identified the brain connectivity-behavior relationship among three different daily fatigue levels (low-, median- and high-fatigue) with the EEG data transfer entropy. According to the results, only low- and medium-fatigue groups demonstrated an inverted U-shaped change in connectivity from high performance to poor behavioral performance. In addition, from low- to high-fatigue groups, connectivity magnitude decreased in the frontal region and increased in the occipital region. These study results suggest that brain connectivity and driving behavior would be affected by different levels of daily fatigue.

Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach.

BACKGROUND: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients' quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. OBJECTIVE: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. METHODS: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. RESULTS: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. CONCLUSIONS: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50157.

The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Recovery from a severe burn injury requires early and aggressive therapy, which is often painful and distressing to the patient. Burn therapists who guide these interventions may be prone to experiencing secondary trauma and compassion fatigue through repeated exposure to difficult situations. At the same time, therapists may gain a sense of purpose and altruism from their work, fostering compassion satisfaction. Despite being well documented in other health professions, compassion fatigue and compassion satisfaction have not been sufficiently explored among burn therapists. This study aimed to quantify and characterize burn therapists' compassion fatigue and satisfaction using the Professional Quality of Life scale and to answer the question of what job-related factors may impact these outcomes. A total of 143 burn therapists participated in this study. Results revealed compassion fatigue subsale scores of burnout and secondary traumatic stress in the low or moderate range and compassion satisfaction scores in the moderate or high ranges for all participants. This study presents new knowledge for the field of burn care in its quantification of professional quality of life in burn therapists. While burn therapists experienced moderate-to-high levels of compassion satisfaction in their work, burnout and stress also approached moderate levels. Years of practice was a significant predictor of compassion. Although the reasons for this are not clear, it may be related to increased competence or confidence in practice and may suggest a need for different support strategies for practitioners at each stage of their burn therapy career.

Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study.

PURPOSE: Physical activity is an important modifiable determinant of health. There has been a historical aversion to movement in people with myasthenia gravis (MG) due to the pathophysiology of the disease, however, research suggests engagement in physical activity is safe and does not exacerbate symptoms. There are currently no studies investigating the qualitative perspectives of people with MG on physical activity. The aim of this study was to explore perceptions of physical activity, barriers, enablers, and participants' experiences of physical activity advice from health professionals. MATERIALS AND METHODS: Semi-structured interviews were used, with verbatim transcripts analysed using content analysis. RESULTS: Ten adults (median age 64.5 years) living in Australia with generalised MG were interviewed. Key findings were identified: (1) Physical activity is perceived to be important for general health and for MG; (2) Medical management and social support are key enablers; (3) Fatigue and pain are potential barriers; and (4) Experiences with healthcare professionals were considered insufficient and failed to provide disease specific advice regarding MG and physical activity. CONCLUSION: People with MG have unique barriers and enablers to physical activity engagement that clinicians should consider when providing physical activity behaviour change support to this population.

Physical activity is perceived positively by people with myasthenia gravis, both due to the general benefits and disease-specific impacts, however unique barriers such as fatigue and pain can make physical activity engagement challenging.Tailored physical activity behaviour change support is recommended to consider these barriers on an individual level.Effective interprofessional collaboration is important in ensuring medical management is optimised to enable greater physical activity participation, and behaviour change techniques involving social supports may warrant consideration.Health professionals should seek to improve their understanding of myasthenia gravis to deliver evidence-based, person-centred approaches to physical activity promotion in this population.

Effects of photobiomodulation therapy on muscle function in individuals with multiple sclerosis.

BACKGROUND: In people with multiple sclerosis (pwMS), muscle fatigue and weakness are common issues that can interfere with daily activities. Photobiomodulation therapy (PBMT), comprising light in a 600-1100 nm bandwidth, is a low-level laser therapy thought to improve muscle performance in non-disease populations, in part, by improving mitochondrial function and thus, might be beneficial in pwMS. Given this potential, we aimed to investigate the effects of PBMT on muscle performance in pwMS, both in the short-term and over an extended period. METHODS: This study consisted of two parts with a randomized double-blind crossover design. In study I, muscle function was assessed in four sessions before and after PBMT in ambulatory pwMS (N = 17, F = 14) as follows: maximal voluntary contraction (MVC) and muscle fatigue of the right tibialis anterior (TA) muscle was compared at baseline and following a two-min submaximal fatiguing contraction. Then, PBMT was administered to the belly of TA muscle at different doses of energy of an active device (40 J, 80 J, 120 J) or placebo. The muscle function assessment was then repeated. OUTCOME VARIABLES: muscle force recovery (%), muscle fatigue (%). Statistical tests included McNemar's exact test, Wilcoxon signed-rank test, and the Friedman test. In study II, a subgroup from study I (N = 12, F = 11) received individualized doses (i.e., best dose-effect observed in study I) of active, or placebo PBMT, which was administered on the TA muscle for two weeks. Muscle function assessments were performed pre- and post-PBMT in four sessions similar to study I. OUTCOME VARIABLES: Baseline strength (N), endurance time (s), and muscle fatigue (%). The Wilcoxon signed-rank test was used for statistical analysis. Values are reported as mean (SD). RESULTS: In study I, participants who received a high dose of PBMT showed significant improvement in force recovery (101.89 % (13.55 %)) compared to the placebo group (96.3 % (18.48 %); p = 0.03). Muscle fatigue did not significantly improve with either active PBMT or placebo. In study II, active PBMT resulted in a significant improvement in muscle strength compared to both the baseline (pre-PBMT = 162.70 N (37.52 N); post-PBMT = 185.56 N (33.95 N); p = 0.01) and the placebo group (active PBMT: mean-change = 22.87 N (23.67 N); placebo: mean-change = -4.12 N (31.95 N); p = 0.02). Endurance time and muscle fatigue did not show significant improvement with either active PBMT or placebo. CONCLUSION: Our findings suggest that an individualized dose of PBMT might improve muscle performance, including force recovery and strength in individuals with mild-moderate MS. Therefore, PBMT might be a novel therapeutic modality, either as a standalone treatment or in combination with other interventions, to improve muscle performance in pwMS.

In-Season Training Load Variation - Heart Rate Recovery, Perceived Recovery Status, and Performance in Elite Male Water Polo Players: A Pilot Study.

BACKGROUND: Increased training and competition demands of the in-season period may disturb athlete fatigue and recovery balance. The aim of this study was to describe the training load distribution applied in a competitive period and the training adaptations and fatigue/recovery status of elite water polo players. HYPOTHESIS: Effective workload management during tapering (TAP) would restore player recovery and enhance performance. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: Training load, perceived recovery, maximal speed in 100- and 200-meter swim, heart rate (HR) during submaximal swimming (HRsubmax) and HR recovery (HRR) were assessed in 7 outfield water polo players a week before starting a normal training microcycle (NM), after NM, and after congested (CON) and TAP training blocks in the lead-up to the Final Eight of the European Champions League. RESULTS: Training load was higher in NM compared with CON and TAP by 28.9 ± 2.6% and 42.8 ± 2.1% (P < 0.01, d = 11.54, and d = 13.45, respectively) and higher in CON than TAP by 19.4 ± 4.2% (P < 0.01, d = 3.78). Perceived recovery was lower in CON compared with NM and TAP (P < 0.01, d = 1.26 and d = 3.11, respectively) but not different between NM and TAP (P = 0.13, d = 0.62). Both 100- and 200-meter swim performance was improved in TAP compared with baseline (P < 0.01, d = 1.34 and d = 1.12, respectively). No differences were detected among other training blocks. HRsubmax and most HRR were similar among the training periods. CONCLUSION: Effective management of training load at TAP can restore recovery and improve swimming performance without affecting HR responses. CLINICAL RELEVANCE: Despite lower workloads, CON training impairs perceived recovery without affecting performance; however, a short-term training load reduction after a CON fixture restores recovery and improves performance.

Robotic assisted and exoskeleton gait training effect in mental health and fatigue of multiple sclerosis patients. A systematic review and a meta-analysis.

PURPOSE: Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue. MATERIALS AND METHODS: We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models. RESULTS: The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS). CONCLUSIONS: Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.

The effect of progressive relaxation exercise on fatigue level of intensive care nurses: A randomised controlled trial.

OBJECTIVE: The aim of this study is to examine the effect of progressive muscle relaxation exercise on the fatigue level of intensive care nurses. METHODS: In this clinical trial, the participants were randomly assigned to the intervention (n = 38) and control (n = 37) groups after obtaining necessary approvals. The nurses in the intervention group applied progressive muscle relaxation every day for 4 weeks, with each session lasting for 15 min. None of the participants in the control group were subjected to any intervention. Data were collected using a questionnaire and the fatigue severity scale (FSS) (the lower the total score, the less the fatigue). The questionnaires were applied at the baseline, and the FSS was applied at the baseline and the end of the first, second, third, and fourth weeks. RESULTS: While the FSS mean scores of the intervention and control groups at baseline were 4.84 ± 1.01 and 5.23 ± 0.96, respectively (p = 0.086), the FSS mean score of the intervention group (3.13 ± 1.58) was significantly lower than the score of the control group (4.12 ± 1.70) at the fourth week (p = 0.011). Also in the 1st, 2nd, and 3rd weeks of the study, the FSS scores of the nurses in intervention group decreased statistically significantly compared to that of the nurses in the control group. CONCLUSIONS: This study indicated that a 4-week progressive muscle relaxation intervention alleviated fatigue in intensive care nurses. CLINICAL TRIAL REGISTRATION NUMBER: NCT05435664 (Clinicaltrials.gov).

The gastrointestinal microbiota in the development of ME/CFS: a critical view and potential perspectives.

Like other infections, a SARS-CoV-2 infection can also trigger Post-Acute Infection Syndromes (PAIS), which often progress into myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS, characterized by post-exercise malaise (PEM), is a severe multisystemic disease for which specific diagnostic markers or therapeutic concepts have not been established. Despite numerous indications of post-infectious neurological, immunological, endocrinal, and metabolic deviations, the exact causes and pathophysiology remain unclear. To date, there is a paucity of data, that changes in the composition and function of the gastrointestinal microbiota have emerged as a potential influencing variable associated with immunological and inflammatory pathways, shifts in ME/CFS. It is postulated that this dysbiosis may lead to intestinal barrier dysfunction, translocation of microbial components with increased oxidative stress, and the development or progression of ME/CFS. In this review, we detailed discuss the findings regarding alterations in the gastrointestinal microbiota and its microbial mediators in ME/CFS. When viewed critically, there is currently no evidence indicating causality between changes in the microbiota and the development of ME/CFS. Most studies describe associations within poorly defined patient populations, often combining various clinical presentations, such as irritable bowel syndrome and fatigue associated with ME/CFS. Nevertheless, drawing on analogies with other gastrointestinal diseases, there is potential to develop strategies aimed at modulating the gut microbiota and/or its metabolites as potential treatments for ME/CFS and other PAIS. These strategies should be further investigated in clinical trials.

Return to Work in Breast Cancer Patients following an Interdisciplinary Rehabilitation Program in a Community-Based Cancer Rehabilitation Center: A Pilot Study.

Despite curative treatment and discharge from acute hospital settings, breast cancer patients often have cancer- and treatment-related morbidity which impairs them from returning to work. Hence, the role of community-based return to work rehabilitation programs is important to help these patients transition back to work. This was a retrospective cohort study involving patients with breast cancer conducted at a community-based cancer rehabilitation center. Patients were involved in an interdisciplinary vocational rehabilitation program involving physiatrists, occupational therapists, physiotherapists and social workers. We recruited 63 patients for this study cohort, with 46 (73.0%) patients ≤ 60 years old. After undergoing the rehabilitation program, there were 37 (58.7%) participants who successfully returned to work. These participants returned to work at either within 6 months (27.0%), 12 months (29.7%) or 24 months (43.2%) after enrollment into the program, with a majority enrolling in white collar jobs. Multivariate regression analysis revealed that significant negative factors for return to work were advanced stage of cancer (p = 0.004), along with clinically significant fatigue, measured on the Brief Fatigue Inventory (p < 0.001). However, perceived work ability (p = 0.020) was found to be a positive factor.

A Novel Experimental Approach for the Measurement of Vibration-Induced Changes in the Rheological Properties of Ex Vivo Ovine Brain Tissue.

Increased incidence of traumatic brain injury (TBI) imposes a growing need to understand the pathology of brain trauma. A correlation between the incidence of multiple brain traumas and rates of behavioural and cognitive deficiencies has been identified amongst people that experienced multiple TBI events. Mechanically, repetitive TBIs may affect brain tissue in a similar way to cyclic loading. Hence, the potential susceptibility of brain tissue to mechanical fatigue is of interest. Although temporal changes in ovine brain tissue viscoelasticity and biological fatigue of other tissues such as tendons and arteries have been investigated, no methodology currently exists to cyclically load ex vivo brain tissue. A novel rheology-based approach found a consistent, initial stiffening response of the brain tissue before a notable softening when subjected to a subsequential cyclic rotational shear. History dependence of the mechanical properties of brain tissue indicates susceptibility to mechanical fatigue. Results from this investigation increase understanding of the fatigue properties of brain tissue and could be used to strengthen therapy and prevention of TBI, or computational models of repetitive head injuries.

Recognition of Human Lower Limb Motion and Muscle Fatigue Status Using a Wearable FES-sEMG System.

Functional electrical stimulation (FES) devices are widely employed for clinical treatment, rehabilitation, and sports training. However, existing FES devices are inadequate in terms of wearability and cannot recognize a user's intention to move or muscle fatigue. These issues impede the user's ability to incorporate FES devices into their daily life. In response to these issues, this paper introduces a novel wearable FES system based on customized textile electrodes. The system is driven by surface electromyography (sEMG) movement intention. A parallel structured deep learning model based on a wearable FES device is used, which enables the identification of both the type of motion and muscle fatigue status without being affected by electrical stimulation. Five subjects took part in an experiment to test the proposed system, and the results showed that our method achieved a high level of accuracy for lower limb motion recognition and muscle fatigue status detection. The preliminary results presented here prove the effectiveness of the novel wearable FES system in terms of recognizing lower limb motions and muscle fatigue status.

Impaired Hand Grip Strength Correlates with Greater Disability and Symptom Severity in Post-COVID Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Background: Post-COVID syndrome (PCS) encompasses a diverse array of symptoms persisting beyond 3 months after acute SARS-CoV-2 infection, with mental as well as physical fatigue being the most frequent manifestations. Methods: In 144 female patients with PCS, hand grip strength (HGS) parameters were assessed as an objective measure of muscle fatigue, with 78 meeting the Canadian Consensus Criteria for postinfectious myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The severity of disability and key symptoms was evaluated using self-reported questionnaires. Results: Patients with ME/CFS exhibited heightened overall symptom severity, including lower physical function (p < 0.001), a greater degree of disability (p < 0.001), more severe fatigue (p < 0.001), postexertional malaise (p < 0.001), and autonomic dysfunction (p = 0.004) compared to other patients with PCS. While HGS was impaired similarly in all patients with PCS and exhibited a significant correlation with physical function across the entire patient group, HGS of patients with ME/CFS uniquely demonstrated associations with key symptoms. Conclusions: Thus, impaired HGS serves as an objective marker of physical function in patients with PCS. Only in patients meeting ME/CFS criteria is impaired HGS also associated with the severity of hallmark symptoms. This suggests a common mechanism for muscle fatigue and other symptoms in the ME/CFS subtype, distinct from that in other types of PCS.