Fatigue Status Research Articles

Muscle fatigue detection and treatment system driven by internet of things

BackgroundInternet of things is fast becoming the norm in everyday life, and integrating the Internet into medical treatment, which is increasing day by day, is of high utility to both clinical doctors and patients. While there are a number of different health-related problems encountered in daily life, muscle fatigue is a common problem encountered by many.MethodsTo facilitate muscle fatigue detection, a pulse width modulation (PWM) and ESP8266-based fatigue detection and recovery system is introduced in this paper to help alleviate muscle fatigue. The ESP8266 is employed as the main controller and communicator, and PWM technology is employed to achieve adaptive muscle recovery. Muscle fatigue can be detected by surface electromyography signals and monitored in real-time via a wireless network.ResultsWith the help of the proposed system, human muscle fatigue status can be monitored in real-time, and the recovery vibration motor status can be optimized according to muscle activity state.DiscussionEnvironmental factors had little effect on the response time and accuracy of the system, and the response time was stable between 1 and 2 s. As indicated by the consistent change of digital value, muscle fatigue was clearly diminished using this system.ConclusionsExperiments show that environmental factors have little effect on the response time and accuracy of the system. The response time is stably between 1 and 2 s, and, as indicated by the consistent change of digital value, our systems clearly diminishes muscle fatigue. Additionally, the experimental results show that the proposed system requires minimal power and is both sensitive and stable.

Changes in Performance and Morning-Measured Responses in Sport Rock Climbers.

The aim of this study was to determine changes in climbers’ hormonal, cardiovascular, neuromuscular, sleep and fatigue status, and their relationship with performance and workloads during a sport rock climbing camp. Mean difficulty of individual leading climbing routes (mean Difficulty) was calculated for six male, intermediate level sport rock climbers participating in a 2-week camp in Orpierre. Additionally, each morning climbers were tested for: cortisol (d-Cortisol) and testosterone (d-Testosterone) concentrations, testosterone/cortisol ratio (T/C), heart rate and heart rate variability in supine (d-L-HR, d-L-SD1, d-L-SD2) and standing positions (d-S-HR, d-S-SD1, d-S-SD2), difference in S-HR and L-HR (HR-S-L), maximal voluntary hand grip strength (MVC), sleep duration (Sleep) and the self-perception of fatigue (M-Fatigue). Only M-Fatigue and d-Testosterone did not change significantly during the camp. Changes in other variables were large and significant, especially in the second week of the camp when the mean Difficulty was > 70%. The greatest changes were noted on the last day, when T/C, HR-S-L, and Sleep decreased and d-Cortisol, d-L-HR, and d-SD1 increased. The monitoring of the uncoupling of neuromuscular, hormonal, and cardiovascular markers can be instrumental in determining the level of athletes’ morning fatigue and readiness during a climbing camp. An increase in d-Cortisol and a decrease in T/C and HR-S-L are relevant indicators of overreaching in sport climbers.

Estimating Driving Fatigue at a Plateau Area with Frequent and Rapid Altitude Change.

Due to the influence of altitude change on a driver’s heart rate, it is difficult to estimate driving fatigue using heart rate variability (HRV) at a road segment with frequent and rapid altitude change. Accordingly, a novel method of driving fatigue estimation for driving at plateau area with frequent altitude changes is proposed to provide active safety monitoring in real time. A naturalistic driving experiment at Qinghai-Tibet highway was conducted to collect drivers’ electrocardiogram data and eye movement data. The results of the eye movement-based method were selected to enhance the HRV-based driving fatigue degree estimation method. A correction factor was proposed to correct the HRV-based method at the plateau area so that the estimation can be made via common portable devices. The correction factors for both upslope and downslope segments were estimated using the field experiment data. The results on the estimation of revised driving fatigue degree can describe the driver’s fatigue status accurately for all the road segments at the plateau area with altitudes from 3540 to 4767 m. The results can provide theoretical references for the design of the devices of active safety prevention.

Physical Function, Pain Severity, and Fatigue in Patients with Relapsed/Refractory Multiple Myeloma: Health-Related Quality of Life Results in Patients Receiving Venetoclax or Placebo in Combination with Bortezomib and Dexamethasone

Physical Function, Pain Severity, and Fatigue in Patients with Relapsed/Refractory Multiple Myeloma: Health-Related Quality of Life Results in Patients Receiving Venetoclax or Placebo in Combination with Bortezomib and Dexamethasone

Combination treatment of astragalus membranaceus, dose-modified chemotherapy, and anti-PD1 checkpoint inhibitor for patients of advanced malignancy with initial cachexia or poor performance status: A single-institute experience

Abstract Background Cancer-related fatigue (CRF), cachexia, or poor performance status, which occurs among patients with advanced malignancy, has always frustrated clinicians and patients and been primarily managed via conservative treatments. The botanically derived drug extracted from Astragalus membranaceus(PG2) has been approved by Taiwan FDA as a standard of choice for CRF management. We show real-world practice about combination treatment of PG2, dose-modified chemotherapy, and anti-PD1 checkpoint inhibitor in patients with advanced malignancy with cachexia, fatigue, or poor performance status here. Methods We conducted a retrospective chart review of patients with advanced malignancy with CRF or cachexia who received a combination treatment mentioned above from Dec. 2016 to Dec. 2018. Results The medical charts of 23 patients with different malignancies who received PG2 during the systemic treatment, including chemotherapy and immunotherapy, were reviewed. The following types of cancers were detected among these patients: digestive system (n = 7), head and neck (n = 7), gynecological (n = 6), and others (n = 3). During recruitment, 22 patients had stage IV cancer. The initial ECOG performance status was 1 (n = 5), 2 (n = 11), > 2 (n = 7). The objective responses were 3 CR (13%), 13 PR (57%), 1 SD (4%), 5 PD (22%), and 1 death with treatment related tumor lysis syndrome of 6 days (4%). The median overall survival (OS) was 20.5 months (95% CI = 14.364, 26.636). The median progression-free survival (PFS) was 11.6 months (95% CI = 2.017, 21.249). Adverse events included anorexia (30%), neutropenia (26%), pneumonia (22%), nephrotoxicity (13%), and nausea and vomiting (13%). The adverse effect for grade 3/4/5 was rare. Conclusions This retrospective study provided real-world data for the management of initially presenting CRF, cachexia, or poor performance status with PG2 injection in 23 advanced cancer patients. The treatment was relatively fair tolerated with impressive results of OS and PFS. Further prospective study of combination therapies including immunotherapy and PG2 injection is warranted for more robust evidence. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Visual Fatigue Assessment Based on Multi-task Learning

Abstract In recent years, with the rapid development of stereoscopic display technology, its applications have become increasingly popular in many fields, and, meanwhile, the number of audiences is also growing. The problem of visual fatigue is becoming more and more prominent. Visual fatigue is mainly caused by vergence‐accommodation conflicts. An evaluation experiment was conducted, and the electroencephalogram (EEG) data of the subjects were collected when they were watching stereoscopic content, and then the stereoscopic fatigue state of the subjects during the viewing process was analyzed. As deep learning is proved to be an effective end-to-end learning method and multi-task learning can alleviate the problem of lacking annotated data, the authors establish a user visual fatigue assessment model based on EEG by using multi-task learning, which can effectively obtain the user’s visual fatigue status, so as to make the comfort designs to avoid the harm caused by user’s visual fatigue.

Pilots’ Fatigue Status Recognition Using Deep Contractive Autoencoder Network

The evaluation of pilots’ fatigue status is of substantial significance in aviation safety, which faces two major issues. They are how to get the fatigue status feature representation and how to identify the fatigue behavior status of pilots via electroencephalogram (EEG) signals. To solve the first issue, we propose a novel fatigue evaluation index via different window functions to compute the power spectrum of relative rhythms from EEG signals. Wavelet packet transform is used to decompose EEG signals from pilots to form four major rhythms, i.e., $\boldsymbol {\delta }$ wave, $\boldsymbol {\theta }$ wave, $\boldsymbol {\alpha }$ wave, and $\boldsymbol {\beta }$ wave, and the combined representation of their power spectrum curve area is the features of pilots’ mental status. To solve the second issue, we propose a new deep contractive autoencoder (AE) network with a softmax (SM) classifier to detect the multistatuses of mental fatigue workload. The recognition results of our model are also compared with that of other models such as the deep AE network with a SM classifier model. The experimental results show that our deep learning model has superior classification performance, and the recognition accuracy of fatigue mental status is up to 91.67%, which shows that the proposed method performs excellently compared with the state-of-the-art methods.

Cancer-Related Fatigue, Laboratory Markers as Indicators for Nutritional Status among Patients with Colorectal Cancer

Our objective was to determine the relationship between cancer-related fatigue (CRF), laboratory markers, and nutritional status among patients with colorectal cancer (CRC). A cross-sectional design was used. A sample of 80 participants diagnosed with CRC participated and completed the study's surveys including the patient-generated subjective global assessment (PG-SGA), cancer fatigue scale (CFS), laboratory markers sheet, and patient-related factors sheet. Positive relationships were identified between PG-SGA and CRF, physical fatigue, cognitive fatigue, WBC, and calcium level (r = 0.781, 0.820, 0.751, 0.680, and 0.710; P = 0.001 respectively). Negative relationships were found between PG-SGA and sodium, potassium, and hemoglobin levels (r = −0.801, −0.761, and −0.810; P = 0.001 respectively). The regression analysis revealed an R2 = 0.610 (adjusted R2 = 0.590), F (4.58, P < 0.001). Finally, the above-mentioned independent variables accounted for 61.0% of the variance in PG-SGA. Patients with CRC are experiencing nutritional problems during their treatment. Cancer-related fatigue and other laboratory markers are considered indicators for nutritional status. Clinical dietitians and oncology nurses can work together to monitor these parameters and provide clinical treatment when needed.

Anti-Inflammatory Diets and Fatigue.

Accumulating data indicates a link between a pro-inflammatory status and occurrence of chronic disease-related fatigue. The questions are whether the observed inflammatory profile can be (a) improved by anti-inflammatory diets, and (b) if this improvement can in turn be translated into a significant fatigue reduction. The aim of this narrative review was to investigate the effect of anti-inflammatory nutrients, foods, and diets on inflammatory markers and fatigue in various patient populations. Next to observational and epidemiological studies, a total of 21 human trials have been evaluated in this work. Current available research is indicative, rather than evident, regarding the effectiveness of individuals’ use of single nutrients with anti-inflammatory and fatigue-reducing effects. In contrast, clinical studies demonstrate that a balanced diet with whole grains high in fibers, polyphenol-rich vegetables, and omega-3 fatty acid-rich foods might be able to improve disease-related fatigue symptoms. Nonetheless, further research is needed to clarify conflicting results in the literature and substantiate the promising results from human trials on fatigue.

Impact of Melatonin and Branched-Chain Amino Acids Cosupplementation on Quality of Life, Fatigue, and Nutritional Status in Cachectic Heart Failure Patients: A Randomized Controlled Trial.

Background: Cardiac cachexia (CC) adversely affects the lifestyle of heart failure (HF) patients. The current study examined the impact of melatonin cosupplementation and branched-chain amino acids (BCAAs) on quality of life (QoL), fatigue, and nutritional status in cachectic HF patients. Methods: In this trial, 84 CC patients were randomized to melatonin, BCAAs, or coadministration (both) as intervention groups and a control group over 8 weeks. At baseline and postintervention, QoL, fatigue, and nutritional status were assessed. Results: After intervention, improvement in the overall and physical dimensions of QoL and appetite score were found to be statistically significant in the BCAAs (P < .001) and the melatonin+BCAAs (P < .001) groups compared with the placebo group. The emotional dimension score was significantly lower in the BCAAs group compared with the placebo group (P = .001). There was a statistically significant improvement in fatigue severity in all 3 intervention groups compared with the placebo group. The nutrition risk index (NRI) score increased significantly only in the melatonin group (P = .015), and there was no significant difference between the other groups (P = .804). Conclusions: Cosupplementation with BCAAs and melatonin improved QoL, fatigue status, and appetite in cachectic HF patients but did not affect NRI.

Tracking Fatigue and Health State in Multiple Sclerosis Patients Using Connnected Wellness Devices

Multiple Sclerosis requires long-term disease management, but tracking patients through the use of clinical surveys is hindered by high costs and patient burden. In this work, we investigate the feasibility of using data from ubiquitous sensing to predict MS patients' fatigue and health status, as measured by the Fatigue Severity Scale (FSS) and EQ-5D index. We collected data from 198 MS patients who are given connected wellness devices for over 6 months. We examine how accurately can the collected data predict reported FSS and EQ-5D scores per patient using an ensemble of regressors. In predicting for both FSS and EQ-5D, we are able to achieve errors aligning with the instrument' standard measurement error (SEM), as well as strong and significant correlations between predicted and ground truth values. We also show a simple adaptation method that greatly reduces prediction errors through the use of just 1 user-supplied ground truth datapoint. For FSS (SEM 0.7), the universal model predicts weekly scores with MAE 1.00, while an adapted model predicts with MAE 0.58. For EQ-5D (SEM 0.093), the universal model predicts weekly scores with MAE 0.097, while an adapted model predicts with MAE 0.065. Our study represents the first sets of results showing that fatigue and health state of MS patients can be measured using data from connected wellness devices and a small number of background features, with promising prediction performance with errors within the accepted range of error in the widely used clinically-validated questionnaires. Future extensions and potential applications of our results can positively impact MS patient disease management and support clinical research.

OS7.5 Healthcare utilization, medication use, and productivity loss in glioma patients with depressive symptoms and their family caregivers

Abstract BACKGROUND Gliomas are associated with great societal burden through both direct (health and social care) and indirect (e.g., productivity loss) costs, but socioeconomic reports are scarce. We describe costs in a sample of glioma patients at high risk for depression and their family caregivers, and explore relationships between costs and treatable symptoms (depression; fatigue; cognitive complaints). MATERIAL AND METHODS Data from a nationwide randomised trial comparing internet-based therapy for depressive symptoms with waitlist controls were used. Healthcare utilization, medication use, and productivity loss based on the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TIC-P) were described and costs in the past 4 weeks were calculated. Caregivers reported on their own costs and wellbeing We used generalized linear regression models to predict costs using multiple observations per participant and robust standard errors. We included depressive symptoms (CES-D), fatigue (CIS), cognitive complaints (MOS), tumour grade (low-/high-grade), and disease status (stable/progression/active treatment). RESULTS Data from 91 glioma patients and 46 caregivers were used with multiple assessments from baseline through 12 months follow-up. Baseline data showed that over a 4 week period, 64.8% of patients (M=€394.99, sd=856.83) and 41.3% of caregivers (M=€131.11, sd=392.89) had used healthcare services. Medication was used by 90.1% of patients (M=€100.83, sd=191.07) and 43.5% of caregivers (M=€13.19, sd=21.03). Productivity loss resulted in M=€1231.19, sd=2185.35 for patients and M=€310.92, sd=841.36 for caregivers. In total, mean direct and indirect costs were €1632.22 (sd=2314.25) for patients and €447.85 (sd=1002.94) for caregivers. In patients, more depressive symptoms and cognitive complaints were associated with increased healthcare use costs; higher tumour grade and active disease were linked with higher medication costs (all p&lt;.05). Active treatment was related to higher overall costs (p&lt;.05). In caregivers, increased caregiver fatigue was associated with higher productivity loss and overall costs; more caregiver cognitive complaints were associated with higher total costs; higher tumour grade was associated with higher healthcare use and total costs; and patient active treatment was linked with higher healthcare use costs (all p&lt;.05). CONCLUSION Direct and indirect costs are substantial in glioma patients and caregivers. This indicates that the true cost of brain tumours is a burden shared between patients, caregivers, the healthcare system, and society more widely. Tentative links between costs and symptoms of depression, fatigue, and cognitive complaints indicate that adequate support may lead to cost reductions. Multivariable regression models are currently being prepared.

The importance of physical function in patients with multiple myeloma for improving quality of life.

To investigate the relationship between physical function and quality of life in multiple myeloma patients. In this retrospective cross-sectional study, data from patients with multiple myeloma (N = 63), who were referred to the department of Rehabilitation Medicine from October 2017 to May 2018, were reviewed. Patients were excluded based on the following criteria: acute illness, unstable medical conditions, impaired cognition or communication, refusal, or inability to perform the assessment. Physical function was evaluated with the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-MY20 were used for the evaluation of quality of life. To evaluate fatigue and psychotic status, the Fatigue Severity Scale and Beck Depression Inventory were used. Patients were divided into two groups ("good-function group" and "poor-function group"), based on previously studied normative values of the Mini-BESTest. Clinical data was reviewed to interrogate the contributing factors of physical function. Positive correlations were observed between Mini-BESTest scores and all domains of the QLQ-C30. The Mini-BESTest score was lower in patients with lower serum hemoglobin (r = 0.396, p = 0.001) and albumin levels (r = 0.440, p < 0.001), severe disease-related symptoms (r = - 0.39, p = 0.02), and depression (r = - 0.538, p < 0.001). Further, the poor-function group showed lower hemoglobin (p = 0.024) and albumin levels (p = 0.004). In patients with multiple myeloma, physical function had a significant relationship with quality of life. Low hemoglobin and albumin levels, severe disease- or treatment-related symptoms, and depression were related to decreased physical function, and thus consequentially exert an effect on quality of life in multiple myeloma patients.

Mediating effect of trait coping style on nurses' occupational stress and fatigue

Objective To investigate the fatigue status and influencing factors of nurses, and to evaluate whether trait coping styles mediate the relationship between occupational stress and fatigue. Methods A total of 167 nurses in Shaoxing Municipal Hospital were selected by cluster random sampling in April, 2018.Their fatigue status was assessed by Chinese version of multidimensional fatigue scale, occupational stress was assessed by occupational stress inventory revised edition, and trait coping style was assessed by trait coping style questionnaire.The data were analyzed by SPSS22.0. Results A total of 164 valid questionnaires were obtained, the physical fatigue score was (22.9±9.3)points, the decreased activity score was (6.7±2.7)points, the decreased motivation score was (6.6±2.6)points, the mental fatigue score was (9.0±4.0)points, the total fatigue score was (47.3±13.5)points.The total fatigue scores of nurses with different ages(F=2.520, P=0.043), nursing years(F=3.388, P=0.020), educational background(t=-2.571, P=0.011), professional title(F=3.743, P=0.026), departments(F=4.412, P=0.001) and night shift frequency(F=3.412, P=0.019) were significantly different.The total fatigue scores were positively correlated with negative coping(r=0.274, P=0.009), occupational tasks(r=0.351, P=0.007) and stress response(r=0.348, P=0.004) respectively.Negative coping styles partially mediated the relationship between occupational stress and fatigue.The total effect of occupational stress on fatigue was 0.066, the ratio of negative coping to total effect was 49.62%. Conclusion There are many factors influencing nurses' fatigue, and negative coping styles play a mediating role between occupational stress and fatigue. Key words: Nurse; Fatigue; Occupations; Catatonia; Positive coping; Negative coping; Night shift; Mediating effect

Comparing Verum and Sham Acupuncture in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis.

Objectives Acupuncture is often used for relieving symptoms of fibromyalgia syndrome (FMS). Our aim is to ascertain whether verum acupuncture is more effective than sham acupuncture in FMS. Methods We collected RCTs to investigate the effects of verum acupuncture and sham acupuncture on pain, sleep quality, fatigue, and general status in FMS patients. The databases used for data retrieval were PubMed, Central Cochrane, EMBASE, PsycINFO, CNKI, VIP, OASIS, KoreaMed, and RISS. Selection/exclusion from the retrieved records was performed according to prespecified criteria, and the final selected records were assessed according to the Cochrane risk of bias tool. The results of the included trials were synthesized on the basis of outcomes, and subgroup analysis depended on the type of add-on sham acupuncture that was performed. Results Ten RCTs (690 participants) were eligible, and eight RCTs were eventually included in the meta-analysis. The synthesis showed a sizable effect of verum acupuncture compared with sham acupuncture on pain relief (standardized mean difference (SMD) −0.49, Z = 3.26, P=0.001; I2 = 59%), improving sleep quality (SMD −0.46, Z = 3.24, P=0.001; I2 = 0%), and reforming general status (SMD −0.69, Z = 6.27, P < 0.00001; I2 = 4%). However, efficacy on fatigue was insignificant (SMD −0.10, Z = 0.51, P=0.61; I2 = 46%). When compared with a combination of simulation and improper location of needling, the effect of verum acupuncture for pain relief was the most obvious. Conclusions Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and reforming general status in FMS posttreatment. However, evidence that it reduces fatigue was not found.

Faktor Yang Mempengaruhi Kelelahan Kerja Pada Petugas Kebersihan Di Rumah Sakit Dr. Tadjuddin Chalid Kota Makassar

International Labor Organization (ILO) that every year as many as two million workers die from workplace accidents caused by fatigue. Fatigue is a reduction in physical and mental abilities as a result of excessive physical, mental or emotional use that can reduce almost all physical abilities including strength, speed, reaction speed, coordination, and decision making or balance. This study aims to analyze the factors that affect the work fatigue of janitors at Dr. Hospital. Tadjuddin Chalid Makassar. This research is an analytic observational study with a cross sectional study design equipped with quantitative method approach, the respondents of this study were 57 people, the sampling method used in this study was saturated samples, with analysis The statistical tests used were univariate and bivariate with the Statistical Product Program and Service Solution (SPSS). Research results on janitors at Dr. Hospital. Tadjuddin Chalid Makassar, namely: there is no influence of age on work fatigue on janitors, there is no influence of sex on work fatigue on janitors, there is no effect on nutritional status of work fatigue on janitors, there is no influence of Hb levels on work fatigue on officers cleanliness, there is no long-term influence on work fatigue on janitors, there is an effect of workload on work fatigue on janitors. The conclusion is that the workload has an effect on work fatigue for janitors at Dr. Hospital. Tadjuddin Chalid Makassar, was advised by janitors to optimize the resting time given so as to reduce fatigue during work.

Application of mindfulness-based stress reduction in patients with non-small-cell lung cancer under chemotherapy

Objective To explore the effect of mindfulness-based stress reduction (MBSR) on cancer-related fatigue and mental status of patients with non-small-cell lung cancer (NSCLC) who receive chemotherapy. Methods By convenience sampling, 67 patients with NSCLC receiving chemotherapy in the First People's Hospital of Lianyungang in Jiangsu Province were selected from June 2017 to December 2018 in this study. According to their admission time, they were divided into the observation group (n=34) and control group (n=33) . Conventional nursing care was given for the control group, apart from that, the MBSR exercise was adopted for the observation group, once a week and 8 times in total. Cancer Fatigue Scale (CFS) , Self-rating Anxiety Scale (SAS) , and Self-Rating Depression Scale (SDS) were used to compare the scores of their cancer fatigue, anxiety and depression between the two groups. Results Finally, 31 patients in the observation group and 32 patients in the control group completed the study. Before intervention, there was no statistical difference in CFS and each dimensional score in CFS, SAS and SDS scores between the two groups (P>0.05) ; after 8 weeks' intervention of MBSR, the CFS score and each dimensional score in CFS, SAS and SDS scores of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05) . Conclusions MBSR can effectively improve the NSCLC patients' cancer-related fatigue and reduce the level of anxiety and depression. Key words: Neoplasms, non-small-cell lung; Cancer-related fatigue; Mindfulness-based stress reduction; Anxiety; Depression

Improvement after Bariatric Surgery in Chronic Thromboembolic Pulmonary Hypertension: A Novel Treatment Target

Introduction The complex interaction between obesity and pulmonary arterial hypertension (PAH) remains ill defined.There is a paucity of evidence that weight loss per se, can positively impact the hemodynamics of a patient with significant pulmonary hypertension. Herein, we present the first case of hemodynamic and functional improvement following bariatric surgery in a patient with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and morbid obesity. Case A 66 year old male with a medical history significant for multiple pulmonary embolism (PE) and morbid obesity was evaluated for chronic thromboembolic pulmonary hypertension (CTEPH). Echocardiogram and right heart catheterization were significant for severe pulmonary hypertension. Therefore, he was started on pulmonary hypertension medical therapy with riociguat and ambristentan, in addition to anticoagulation. He experienced a dramatic clinical response to medical therapy. Despite hemodynamic improvement, the patient remained symptomatic with significant fatigue, exertional dyspnea, and poor functional status as highlighted by a six minute walk distance of only 128 meters. Patient was referred for bariatric surgery with a gastric sleeve, after which he successfully lost 95 pounds in six months. Post operative right heart catheterization demonstrated normal PVR and cardiac output. His echocardiogram revealed normal RV size and function. His six minute walk distance also nearly quadrupled from 128 meters to 512 meters, consistent with WHO Functional Class I. Conclusion We report the first case of hemodynamic improvement in pulmonary vascular disease following massive weight loss. This case illustrates the interplay of obesity and pulmonary hypertension while also highlighting the major cardiovascular benefits of bariatric surgery in this population. Weight loss accomplished through surgical means may augment the existing PH treatment paradigm.

Prevalence and risk factors of sleep disturbances in breast cancersurvivors: systematic review and meta-analyses.

Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with rising incidence numbers. In Belgium, one out of eight women will be diagnosed with breast cancer. Fortunately, 80% of those breast cancer patients will still be alive 10years after diagnosis due to improvements in screening and treatment strategies. However, an important portion of the breast cancer survivors (BCS) will face side effects, such as sleep disturbances, long after treatment ends. It has been demonstrated that untreated insomnia in BCS negatively impacts mood, physical symptoms, pain sensitivity, fatigue, and quality of life. Furthermore, insomnia is increasingly considered an independent risk factor for future depression in BCS. The importance of understanding sleep disturbances in cancer populations has been highlighted and recognized as warranting further research. Therefore, the purpose of this systematic review was to determine the prevalence and the risk factors for the development of sleep disturbances in BCS. PubMed, Web of Science, and PEDro were systematically screened for studies encompassing data regarding the prevalence or risk factors of sleep disturbances in BCS. If possible, meta-analyses were performed. Subgroup analyses were undertaken based on the methodological quality, study design, type of sleep disturbance, and the use of a measurement tool with strong psychometric properties to investigate significant heterogeneity (I2> 50%) across studies. A total of 27 studies were found eligible. The pooled estimate for sleep disturbances prevalence is 0.40 (95% confidence interval (CI) = [0.29-0.52], I2= 100%, p< 0.00001) and ranged from 0.14 (95% CI= [0.04-0.24]) to 0.93 (95% CI = [0.91-0.95]). Subgroup analyses did not reduce the heterogeneity among studies. Meta-analyses were performed for seven risk factors. Significant differences for the odds of developing sleep disturbances were found for hot flashes (pooled OR (ORp) 2.25, 95% CI = [1.64-3.08], I2= 0%, p= 0.90), race (ORp 2.31, 95% CI = [1.56-3.42], I2= 0%, p= 0.47), and menopause (ORp 1.84, 95% CI = [1.11-3.06], I2= 0%, p= 0.70). After withdrawing the studies that did not rely on the use of a measurement tool with strong psychometric properties, pain (ORp 2.31, 95% CI = [1.36-3.92], I2= 27%, p= 0.25), depressive symptoms (ORp 3.20, 95% CI [2.32-4.42], I2= 0%, p= 0.63), and fatigue (ORp 2.82, 95% CI = [1.98-4.02], I2= 0%, p= 0.60) became significant as well, with a substantial decrease of heterogeneity. Prevalence for sleep disturbances ranged from 0.14 to 0.93 with the vast majority of the studies investigating insomnia and sleep-wake disturbances. High heterogeneity makes it difficult to draw firm conclusions. Pain, depressive symptoms, hot flashes, fatigue, non-Caucasian race, and menopausal status were significantly associated with increased odds for developing sleep disturbances.

Psychological correlates of sleep quality in lung cancer patients under chemotherapy: A single-center cross-sectional study.

Disturbed sleep is a common complaint of lung cancer patients undergoing active oncologic treatment. We aimed to clarify the extent to which psychological symptoms, coping strategies, and social support interfere with sleep quality and whether they mediate the relationship between sleep quality and fatigue or functional capacity in a sample of chemotherapy treated lung cancer patients. Lung cancer patients attending an oncology unit for scheduled chemotherapy cycles completed questionnaires assessing their sleep quality, fatigue, depression, anxiety, stress, coping, social support, symptoms of pain, dyspnea, and cough, and sleep hygiene practices. Demographic and disease-related characteristics were obtained from patients' medical records and treating physicians rated their functional status. Multivariate regression and mediation analyses were applied to test the study's hypotheses. One hundred nineteen patients were enrolled, 58.2% of whom were identified as poor sleepers. After adjusting for age, gender, comorbidities, concomitant medications, cancer stage, prior and ongoing treatment, sleep hygiene, and symptoms, there was a statistically significant association between poor sleep quality and anxiety (odd`s ratio [OR] 1.17 [95% CI, 1.01-1.35]), stress (OR 1.14 [95% CI, 1.04-1.25]), and positive coping (OR 1.15 [95% CI, 1.02-1.31]). Poor sleep quality was an independent correlate of fatigue (B 1.56 [95% CI, 0.61-2.50]) and low performance status (OR 5.17 [95% CI, 1.60-16.72]); stress symptoms partially mediated the relationship between sleep quality and fatigue (P = .030). Higher psychological burden predict sleep disturbances and contribute to increased fatigue in lung cancer patients undergoing chemotherapy. Effective psychoeducational interventions may benefit these populations.