Reduction In Fatigue Research Articles

The Influence of Branched-Chain Amino Acid Supplementation on Fatigue and Tryptophan Metabolism After Acute and Chronic Exercise in Older Adults: Protocol for a Pilot Randomized Controlled Trial.

Fatigue is a strong predictor of negative health outcomes in older adults. Kynurenine, a metabolite of tryptophan, is strongly associated with fatigue. Reductions in fatigue are observed with exercise; however, exercise training does not completely alleviate symptoms. Branched-chain amino acids (BCAAs) have been shown to have advantageous effects on exercise performance and compete with kynurenine for transport into the central nervous system. Thus, the combination of BCAA and exercise may exert synergized effects of mental and physical fatigue. Therefore, we hypothesize that BCAA added to exercise will shift kynurenine metabolism toward enhanced synthesis of kynurenic acid, thereby reducing fatigue. This randomized, double-blind, placebo-controlled trial aims to compare the effects of acute (approximately 45 min) and chronic (8 wk) exercise with and without BCAA supplementation on mental and physical fatigue and assess whether the hypothesized outcomes are modulated by changes in kynurenine metabolism in 30 older adults (n=15, 50% per group). Older adults (aged 60-80 y) who do not exercise >2 days per week and self-report fatigue (≥3 on a scale of 1-10) will be recruited. Participants will be randomized to either the exercise+BCAA group or exercise+placebo group. Participants will engage in high-volume, moderate-intensity, whole-body exercise training (aerobic and resistance exercise; either in-person or web-based sessions) 3 times per week for 8 weeks. In addition, participants will consume daily either 100 mg/kg body weight of BCAA (2:1:1 leucine:isoleucine:valine) or placebo (maltodextrin) throughout the 8-week intervention. BCAA and placebo powders will be identical in color and dissolved in 400 mL of water and 2.5 g of a calorie-free water flavor enhancer. Muscle biopsies will be collected before and after the intervention after a 12-hour fast to examine changes in the biomarkers of tryptophan metabolism and inflammation. Our primary outcomes include changes in mental and physical fatigue and metabolism after the 8-week exercise training between the 2 groups. Mental and physical fatigue will be measured before and after the intervention. Mental fatigue will be subjectively assessed through the completion of validated questionnaires. Physical fatigue will be measured by isometric handgrip, 1-repetition maximum, chair rise, 400-meter walk, and cardiopulmonary exercise tests. The study was funded in March 2022, with an anticipated projected data collection period lasting from January 2023 through December 2023. The discovery that kynurenine concentrations are associated with fatigue and are responsive to BCAA supplementation during exercise training could have important implications for the development of future interventions, both lifestyle and pharmacologic, to treat fatigue in older adults. ClinicalTrials.gov NCT05484661; https://www.clinicaltrials.gov/study/NCT05484661. DERR1-10.2196/52199.

Effect of Burosumab on Muscle Function and Strength, and Rates of ATP Synthesis in Skeletal Muscle in Adults With XLH.

In clinical trials, burosumab ameliorates symptoms of pain, fatigue, and stiffness and improves performance on certain muscle function studies in patients with X-linked hypophosphatemia (XLH). This work aimed to determine if burosumab increases adenosine triphosphate (ATP) synthesis in skeletal muscle of treatment-naive adults with XLH, and if so, whether that correlates with improved muscle function. Ten untreated, symptomatic adults with XLH had ATP synthesis rates measured in the right calf using the 31P magnetic resonance spectroscopy saturation transfer technique. Baseline muscle function tests and symptoms of pain, fatigue, stiffness, and lower-extremity joint pain were quantified. All participants were treated with burosumab, 1 mg/kg every 4 weeks for 12 weeks. ATP synthesis rates and muscle function tests were repeated 2 weeks ("peak") and 4 weeks ("trough") after the third dose of burosumab. All symptoms improved with treatment. Performance on the 6-Minute Walk Test (6MWT) and Sit to Stand (STS) tests also improved. Muscle strength and ATP synthesis rates did not change over the 3 months of the study. When individuals whose performances on the 6MWT and STS test were at or better than the median outcome for those tests were compared to those whose outcomes were below the median, no difference was observed in the rate of change in ATP synthesis. Intracellular muscle concentrations of phosphate were normal. The improvement in the 6MWT and STS test without changes in muscle strength or ATP synthesis rates suggests that reductions in pain, fatigue, and stiffness may partly explain the improved performance. Intracellular phosphate in skeletal muscle is insulated from hypophosphatemia in XLH.

51 Trajectories and Predictors of Cognitive Change Following COVID-19

Objective:Acute cognitive complications following COVID-19 infection have been appreciated in a subset of patients since the early months of the global pandemic. Emerging data reveal that some patients go on to experience cognitive improvement, whereas others may experience further cognitive decline. We aimed to assess trajectories and predictors of cognitive change in a sample of post-COVID-19 patients.Participants and Methods:This prospective cohort study assessed longitudinal cognitive change in adults receiving care for COVID-19 in the Johns Hopkins Post-Acute COVID-19 Team (JH PACT) clinic. Participants self-administered the Digital Automated Neurobehavioral Assessment (DANA) battery of seven cognitive tests and a performance-based measure of cognitive fatigue on up to six occasions over six weeks. Improvement or decline between the first and last assessment was defined as change of >1 standard deviation of the baseline mean of each outcome. Potential predictors of change included demographic features (age, sex, race/ethnicity, education), COVID-19 illness characteristics (hospitalization or ICU stay, months since symptom onset), and comorbid disease burden. Analyses included measures of central tendency, independent samples t-tests, and chi-square tests of independence.Results:Of the 36 enrolled participants, 29 (81%) completed at least one DANA assessment (M = 4.7 assessments, SD = 1.8). Those completing at least three assessments (n = 24, 66.7%) were included in the present analyses (71% female; 58% white; M age = 54 years, SD = 10.9; M education = 14.6 years, SD = 2.4; M months since COVID-19 symptom onset at recruitment = 9.8, SD = 4.7; M comorbidities = 2.8, SD = 2.0). Fatigue was the most frequently improved outcome measure, with 41.7% of participants scoring >1 standard deviation above the baseline mean fatigue score at their final assessment. Among cognitive outcomes, the greatest frequency of improvement was observed on tests assessing rapid spatial processing (37.5%), processing speed (33.3%), and memory (33.3%). There were no consistent predictors of improvement, but several subtest-specific findings emerged. Specifically, (a) more comorbidities were positively associated with rate of fatigue reduction (p = .04), (b) longer duration since COVID-19 illness was positively associated with rates of memory improvement (p = .02), (c) older age, male sex, and more comorbidities were positively associated with rate of improvement in reaction time (ps < .05), and (d) more assessments completed was positively associated with rates of improvements in working memory (ps < .05). Response inhibition (12.5%), simple reaction times (16.7%), and working memory (16.7%) showed the lowest rates of improvement over time. Declines in cognition were infrequent, with 4.2 - 8.3% (n = 1 to 2) declining on measures of procedural reaction time, spatial processing, inhibitory control, or working memory.Conclusions:At an average of >9 months following acute COVID-19 illness, we observed longitudinal improvements in cognitive fatigue as well as processing speed, memory, and spatial reasoning. Consistent predictors of recovery were not identified, although age, sex, comorbid conditions, and time since illness predicted rates of improvement in select domains. Further analyses with a larger sample size and more stringent analyses are needed to confirm and extend these findings.

The Effectiveness of Non Pharmachological Therapy on Fatigue Level in Patients With Congestive Heart Failure (CHF)

The consumption of large number of drugs in a long period of time makes CHF patients experience anxiety so that it faster to cause fatigue due to physical and psychological problems experienced. In addition, special measures to overcome fatigue conditions in patients with CHF are still rarely done. Without significant treatment efforts, it will cause serious problems for patients for a long time, therefore it is very necessary to study the effectiveness of non-pharmacological therapy for patients with CHF. This study aims to collect and analyze articles related to the effectiveness of non-pharmacological therapy in patients with congestive heart failure. This study is a type of literature review conducted by searching for articles related to effective non-pharmacological therapies to reduce fatigue in heart failure patients. The databases used were Pubmed, Google Scholar, and Pro Quest. Inclusion criteria used for data collection are complete articles, journal publications from 2018 to 2023, in English and Indonesian. The tools and guidelines used utilized the PRISMA method. Non-pharmacological therapies used such as back massage, hypnosis and virtual reality provide effects that will cause relaxation and can stimulate the release of endorphins to reduce the activity of the sympathetic and parasympathetic systems. Six studies (85%) of the total seven studies analyzed showed significant results that non-pharmacological therapies resulted in a significant reduction in fatigue. Each non-pharmacological therapy provided has its own stimulation and effect on the patient which will be effective according to the condition and physical problems experienced by the patient. This systematic review shows that non-pharmacological therapy is an effective therapy in reducing the level of fatigue in patients with congestive heart failure according to the psychological state and physical problems experienced by patients. The results of this study are expected to be the basis for complementary therapy and can be implemented as an independent and innovative intervention in nursing care.

The Effect Of Meridian Acupoint Massage On Fatigue, And Prevention Of Post Partum Depression During The Public Period

Postpartum fatigue is a feeling of tiredness experienced by around 65-80% of mothers after giving birth. Fatigue can trigger post partum depression during the postpartum period. In Indonesia, the incidence of post partum blues is 50% -70%. One of the method is meridian accupoints massage intervention to reduce fatigue and prevent post partum depression. This study aims to analyze the effects of meridian accupoint massage on fatigue and prevention post partum depression in the post partum period.
 A quasi experimental design with pretest posttest nonequivalent control group was utilized. The study group consisted of 28 postpartum women on the 5th day at the Nining Lubuk Pakam Clinic. The instrument used to measure fatigue is th. e Postpartum Fatique Scale, prevention of post partum depression is measured by the Edinburgh Postnatal Depression Scale (EPDS). Data analysis uses independent and dependent t-tests.
 The experimental group demonstrated a significantly larger decrease compared with the control groupin measures of fatique and prevention post partum depressive. There was a significant difference in maternal fatigue and prevention of post partum depression after meridian accupoint massage between the intervention group and the control group with a value of p=0.003; p=0.002. The average reduction in fatigue after meridian accupoint massage was 27.11%, while the reduction in stress as an assessment for preventing post partum depression was 43.41%.
 Meridian Accupoint Massage has been proven to have an influence on reducing fatigue and preventing post partum depression during the postpartum period. For midwives to be able to learn and apply this method to normal postpartum mothers in order to improve the quality of life of postpartum mothers. Meridian accupoint massage intervention can be used as learning material in complementary therapy during the postpartum period.

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx

BackgroundMultimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with ‘traditional’ strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired.MethodsPwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4–6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria.ResultsTwenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73–91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m).ConclusionsProgressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly.Trial registrationGerman Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.

НОВЫЙ ПРИБОР «СИСТЕМА ОЧИСТКИ ДЫХАТЕЛЬНЫХ ПУТЕЙ YANG KUN YK-800» В КИНЕЗИТЕРАПИИ ДЕТЕЙ С ХРОНИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ ЛЕГКИХ

Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) in children are both accompanied by copious amounts of infected sputum. Kinesitherapy (KT) eliminates mucostasis by providing bronchial drainage. KT methods are being constantly improved. The purpose of this research was to determine the effectiveness and safety of the new vest airway clearance system (ACS) chest vibration therapy machine model YK800 by Zhengzhou Yangkun Medical Instrument Co., Ltd. (Zhengzhou, China) in children with CF and PCD. The ACS consists of a compressor and a vest and creates high-frequency oscillation of the chest promoting drainage of problematic parts of the respiratory tract, small- and medium-caliber bronchi. Materials and methods used: in a study based on the National Medical Research Center for Children’s Health (Moscow, Russia) the KT included 5 sessions with the Yangkun YK800 in 15 patients aged 5 to 17 y/o: 8 with CF and 7 with PCD. Objective criteria: measurement of external respiratory function (ERF) and saturation, monitoring of chest excursion, and the 6-minute walk test. Subjective criteria: complaints, well-being, comfort. Results: objective criteria - improved ERF indicators in % (FVC p=0.004; r=0.829; FEV1 p=0.023; r=0.973; FEF25% p=0.018; r=0.840; FEF50% p=0.016; r=0.827; FEF75% p=0.015; r=0.867), especially high-speed indicators (FEF25%, FEF50%, FEF75%) that indicate the cleansing of mucus in the medium and small respiratory tracts; saturation improved (p=0.020; r=0.548); chest excursion increased (p=0.002; r=0.779). According to the 6-minute walk test, there was a significant increase in the distance traveled (p=0.000; r=0.535), 13 (86.6%) patients at the end of the course rated it as easier. Subjective criteria - 80% of patients noted sen-sations of productive coughing, easier expectoration of sputum: improvement in general condi-tion - 15, reduction in fatigue - 12, increased physical activity - 12, easier expectoration of phlegm - 13, reduction in episodes of paroxysmal cough - 13. Comfort in the use of the vest was rated at 4.4 points, noting mild vibration. Conclusion: the Yangkun YK800 vest airway clearance system as part of the KT has shown its effectiveness and safety in children with CF and PCD.

A centrifuge study into the installation response of steel, open-ended, tubular piles, dynamically driven using prolonged impulses

A centrifuge study into the installation response of steel, open-ended, tubular piles, dynamically driven using prolonged impulses

Interdisciplinary rehabilitation for persisting post-concussion symptoms after mTBI: N=15 single case experimental design

BackgroundDespite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant. ObjectivesThis pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs. MethodA single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively. Results16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved. ConclusionsThis pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.

Effects of six-month creatine supplementation on patient- and clinician-reported outcomes, and tissue creatine levels in patients with post-COVID-19 fatigue syndrome.

Dietary creatine has been recently put forward as a possible intervention strategy to reduce post-COVID-19 fatigue syndrome yet no clinical study so far evaluated its efficacy and safety for this perplexing condition. In this parallel-group, randomized placebo-controlled double-blind trial, we analyzed the effects of 6-month creatine supplementation (4 g of creatine monohydrate per day) on various patient- and clinician-reported outcomes, and tissue creatine levels in 12 patients with post-COVID-19 fatigue syndrome. Creatine intake induced a significant increase in tissue creatine levels in vastus medialis muscle and right parietal white matter compared to the baseline values at both 3-month and 6-month follow-ups (p < .05). Two-way analysis of variance with repeated measures revealed a significant difference (treatment vs. time interaction) between interventions in tissue creatine levels (p < .05), with the creatine group was superior to placebo to augment creatine levels at vastus medialis muscle, left frontal white matter, and right parietal white matter. Creatine supplementation induced a significant reduction in general fatigue after 3 months of intake compared to baseline values (p = .04), and significantly improved scores for several post-COVID-19 fatigue syndrome-related symptoms (e.g., ageusia, breathing difficulties, body aches, headache, and difficulties concentrating) at 6-month follow-up (p < .05). Taking creatine for 6 months appears to improve tissue bioenergetics and attenuate clinical features of post-COVID-19 fatigue syndrome; additional studies are warranted to confirm our findings in various post-COVID-19 cohorts.

Comparing two relaxation procedures to ease fatigue in multiple sclerosis: a single-blind randomized controlled trial

BackgroundVarious relaxation procedures have been proposed to reduce fatigue in multiple sclerosis (MS). However, it is unknown, which type of relaxation has the largest effect on fatigue reduction and on autonomic nervous system (ANS) activity.ObjectiveWe aimed to compare two biofeedback-supported relaxation exercises: a deep breathing (DB) exercise and progressive muscle relaxation (PMR), which may ameliorate MS fatigue and alter ANS activity.MethodsWe performed a single-blind randomized clinical trial, introducing MS patients (n = 34) to the DB or PMR exercise. We first tested cardiovagal integrity, reflected by changes in heart rate variability (HRV) in response to DB. Participants then performed a fatigue-inducing vigilance task, followed by the DB or PMR. State fatigue was recorded consecutively at baseline, after the vigilance task, and after the relaxation exercise, along with HRV reflecting ANS activity.ResultsOnly patients assigned to the PMR group experienced a significant drop in fatigue, whereas both relaxation exercises changed ANS activity. MS patients showed the expected autonomic response during the cardiovagal reflex test. The vigilance task elevated short-term feelings of fatigue and significantly reduced HRV parameters of parasympathetic activity. Trait fatigue was negatively correlated with HRV during the second half of the vigilance task.ConclusionPMR alleviates short-term feelings of fatigue in persons with MS. The vigilance task in combination with HRV measurements may be helpful for evaluating relaxation procedures as a treatment of fatigue. Hereby, future studies should ensure longer and more frequent relaxation exercises and focus on patients with weak to moderate fatigue.Trial registrationTrial Registry: DRKS00024358.

Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials

Fatigue is barrier of physical activity participation in adults with chronic conditions. However, physical activity alleviates fatigue symptoms. This systematic review and meta-analysis aimed to (1) synthesise evidence from randomised controlled trials (RCTs) exploring the effects of physical activity interventions on fatigue reduction and (2) evaluate their effectiveness. Medline/CINAHL/EMBASE/Web of Science and Scopus were searched up to June 24th, 2023. Two reviewers independently conducted study screening and selection (RCTs), extracted data and assessed risk of bias (RoB2). Outcome was the standardised mean difference (SMD) with 95% confidence intervals in fatigue between experimental and control groups. 38 articles met the inclusion criteria. Overall, physical activity interventions moderately reduced fatigue (SMD = 0.54, p < 0.0001). Interventions lasting 2–6 weeks demonstrated a larger effect on fatigue reduction (SMD = 0.86, p < 0.00001). Interventions with 18–24 sessions showed a large effect on fatigue reduction (SMD = 0.97, p < 0.00001). Aerobic cycling and combination training interventions had a large to moderate effect (SMD = 0.66, p = 0.0005; SMD = 0.60, p = 0.0010, respectively). No long-term effects were found during follow-up. Physical activity interventions moderately reduced fatigue among adults with chronic conditions. Duration, total sessions, and mode of physical activity were identified as key factors in intervention effectiveness. Further research is needed to explore the impact of physical activity interventions on fatigue.

Potential Mechanism of Fatigue Induction and Its Management by JAK Inhibitors in Inflammatory Rheumatic Diseases.

It is well known that fatigue is a highly disabling symptom commonly observed in inflammatory rheumatic diseases (IRDs). Fatigue is strongly associated with a poor quality of life and seems to be an independent predictor of job loss and disability in patients with different rheumatic diseases. Although the pathogenesis of fatigue remains unclear, indirect data suggest the cooperation of the immune system, the central and autonomic nervous system, and the neuroendocrine system in the induction and sustainment of fatigue in chronic diseases. Fatigue does not correspond with disease activity and its mechanism in IRDs. It is suggested that it may change over time and vary between individuals. Abnormal production of pro-inflammatory cytokines such as interleukin-6 (IL-6), interferons (IFNs), granulocyte-macrophage colony-stimulating factor (GM-CSF), TNF, IL-15, IL-17 play a role in both IRDs and subsequent fatigue development. Some of these cytokines such as IL-6, IFNs, GM-CSF, and common gamma-chain cytokines (IL-15, IL-2, and IL-7) activate the Janus Kinases (JAKs) family of intracellular tyrosine kinases. Therapy blocking JAKs (JAK inhibitors - JAKi) has been recently proven to be an effective approach for IRDs treatment, more efficient in pain reduction than anti-TNF. Therefore, the administration of JAKi to IRDs patients experiencing fatigue may find rational implications as a therapeutic modulator not only of disease inflammatory symptoms but also fatigue with its components like pain and neuropsychiatric features as well. In this review, we demonstrate the latest information on the mechanisms of fatigue in rheumatic diseases and the potential effect of JAKi on fatigue reduction.

A data-driven approach to understand factors contributing to exoskeleton use-intention in construction

Work-related musculoskeletal disorders (WMSDs) remain an important heath concern for construction workers. Occupational exoskeletons (EXOs) are a new ergonomic intervention to control WMSD risk, yet their adoption has been low in construction. We explored contributing factors to EXO use-intention, by building a decision tree to predict the intention to try an exoskeleton using responses to an online survey. Variable selection and hyperparameter tuning were used respectively to reduce the number of potential predictors, and for a better prediction performance. Performance was assessed using four common metrics. The importance of variables in the final tree was calculated to understand which variable had a greater influence. The final tree had moderate prediction performance. Important variables identified were associated with opinions on EXO use, demographics, job demands, and perceived potential risks. The key influential variables were EXOs becoming standard equipment and fatigue reduction with EXO use. Practical implications of the findings are discussed.

Fatigue Verification Concept for Details containing Weld Imperfections

AbstractSteel structures subjected to repeated stress variations must be verified against fatigue in accordance with EN 1993‐1‐9 on the basis of a detail catalog. As one major concern, the background of the detail classification in terms of an extensive database does not provide information on the considered quality of welds. Certain weld imperfections are present in every construction. However, the extent of imperfection sizes that can be tolerated to provide sufficient fatigue resistance has not yet been scientifically determined.On an experimental and numerical basis, the presented concept allows the quantitative connection of fatigue classes with sizes of weld imperfections. For the two representative details of the load‐carrying‐cruciform joint and the non‐load‐carrying transverse stiffener, basic fatigue classes without explicit imperfections are calculated first. Furthermore, stress increase factors were determined that indicate the decrease in fatigue strength for weld imperfections of different type and size.A combination model is used to determine the fatigue strength of a detail with multiple weld imperfections. Using a simple formula and reading fatigue classes and reduction factors in tables, the fatigue strength of an imperfect detail can be easily determined.

Rhodiola rosea as an adaptogen to enhance exercise performance: a review of the literature.

Rhodiola rosea (RR) is a plant whose bioactive components may function as adaptogens, thereby increasing resistance to stress and improving overall resilience. Some of these effects may influence exercise performance and adaptations. Based on studies of rodents, potential mechanisms for the ergogenic effects of RR include modulation of energy substrate stores and use, reductions in fatigue and muscle damage and altered antioxidant activity. At least sixteen investigations in humans have explored the potential ergogenicity of RR. These studies indicate acute RR supplementation (∼200 mg RR containing ∼1 % salidroside and ∼3 % rosavin, provided 60 min before exercise) may prolong time-to-exhaustion and improve time trial performance in recreationally active males and females, with limited documented benefits of chronic supplementation. Recent trials providing higher doses (∼1500 to 2400 mg RR/d for 4–30 d) have demonstrated ergogenic effects during sprints on bicycle ergometers and resistance training in trained and untrained adults. The effects of RR on muscle damage, inflammation, energy system modulation, antioxidant activity and perceived exertion are presently equivocal. Collectively, it appears that adequately dosed RR enhances dimensions of exercise performance and related outcomes for select tasks. However, the current literature does not unanimously show that RR is ergogenic. Variability in supplementation dose and duration, concentration of bioactive compounds, participant characteristics, exercise tests and statistical considerations may help explain these disparate findings. Future research should build on the longstanding use of RR and contemporary clinical trials to establish the conditions in which supplementation facilitates exercise performance and adaptations.

Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography: A single-blind, multicenter, randomized controlled trial.

Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients' recovery. This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t = 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26-0.71, P <0.001) and 0.76 (95% CI: 0.57-0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05-0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39-0.95, P = 0.028) in the multivariable models. Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery. ClinicalTrials.gov , No. NCT03075280.

Short- and mid-term outcomes of multisystem inflammatory syndrome in children: a longitudinal prospective single-center cohort study.

Multisystem inflammatory syndrome in children (MIS-c) emerged during the coronavirus disease 2019 pandemic and is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the extensively studied clinical manifestation of acute condition, the short- and long-term effects of MIS-c on children's health are unknown. This was a prospective longitudinal cohort study. Children aged <18 years who met the Centers for Disease Prevention and Control (CDC) diagnostic criteria and who were admitted to the Children's Clinical University Hospital of Latvia (CCUH) between July 1, 2020, and April 15, 2022, were enrolled in the study. An outpatient follow-up program was initiated in July 2020. All children were evaluated at 2 weeks, 2 months (1-3 months), and 6 months (5-7 months) after discharge. The face-to-face interviews comprised four domains as follows: symptom assessment, physical examination, laboratory testing, and cardiological investigation [including electrocardiogram (ECG) and echocardiography (echo)]. Overall, 21 patients with MIS-c were enrolled. The median age of the study group was 6 years. At the 2-week follow-up, almost half of the patients (N = 10, 47.6%) reported exercise intolerance with provoked tiredness. Laboratory tests showed a considerable increase in blood cell count, with a near doubling of leukocyte and neutrophil counts and a tripling of thrombocyte levels. However, a decline in the levels of inflammatory and organ-specific markers was observed. Cardiological investigation showed significant improvement with gradual resolution of the acute-phase pathological findings. Within 2 months, improvement in exercise capacity was observed with 5-fold and 2-fold reductions in physical intolerance (N = 2, 9.5%) and physical activity-induced fatigue (N = 5, 23.8%), respectively. Normalization of all blood cell lines was observed, and cardiological investigation showed no persistent changes. At the 6-month visit, further improvement in the children's exercise capacity was observed, and both laboratory and cardiological investigation showed no pathological changes. Most persistent symptoms were reported within the first 2 weeks after the acute phase, with decreased physical activity tolerance and activity-induced fatigue as the main features. A positive trend was observed at each follow-up visit as the spectrum of the children's complaints decreased. Furthermore, rapid normalization of laboratory markers and cardiac abnormalities was observed.

Course of Duration and Trigger Factors of Vertigo Attacks in Patients with Benign Recurrent Vertigo, Menière’s Disease, or Vestibular Migraine

Introduction: Benign recurrent vertigo (BRV), Menière’s disease (MD), and vestibular migraine (VM) show many similarities with regard to the course of vertigo attacks and clinical features. In this paper, we elaborate on the decreasing frequency of vertigo attacks observed in a previous study from our group by exploring changes in the duration and trigger factors of vertigo attacks in patients with BRV, MD, or VM. Methods: For this 3-year prospective cohort study in our tertiary referral center we recruited patients with a confirmed diagnosis of BRV, MD, or VM by a neurologist and otorhinolaryngologist in our center in 2015–2016. A study-specific questionnaire was used to assess the usual duration of vertigo attacks and their potential triggers every 6 months. Main outcome measures were changes in duration and trigger factors of vertigo attacks in the subgroups of patients with persisting attacks, which were analyzed using repeated measures logistic regression models. Results: 121 patients were included (BRV: n = 44; MD: n = 43; VM: n = 34) of whom 117 completed the 3-year follow-up period and 57 (48.7%) kept reporting vertigo attacks at one more follow-up measurements. None of the diagnosis groups showed statistically significant shortening of attack duration at the subsequent annual follow-up measurements compared to baseline. At baseline, stress and fatigue being reported as triggers for attacks differed significantly between the three groups (stress: BRV 40.9%, MD 62.8%, VM 76.5%, p = 0.005; fatigue: BRV 31.0%, MD 48.8%, VM 68.8%, p = 0.003). In the VM group, a consistent reduction of stress and fatigue as triggers was observed up until the 24- and the 30-month follow-up measurements, respectively, with odds ratios (ORs) ranging from 0.15 to 0.33 (all p < 0.05). In the MD group, a consistent reduction of head movements as trigger was observed from the 24-month measurement onward (ORs ranging from 0.07 to 0.11, all p < 0.05). Conclusion: Our study showed no reduction in vertigo attack duration over time in patients with BRV, MD, and VM who remain to have vertigo attacks. In VM and MD patients with persisting vertigo attacks stress, fatigue and head movements became less predominant triggers for vertigo attacks.

Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases

ObjectiveTo identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the...