Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent and severe chronic disease drastically impairing life quality. The underlying pathomechanism is incompletely understood yet but there is convincing evidence that in at least a subset of patients ME/CFS has an autoimmune etiology. In this review, we will discuss current autoimmune aspects for ME/CFS. Immune dysregulation in ME/CFS has been frequently described including changes in cytokine profiles and immunoglobulin levels, T- and B-cell phenotype and a decrease of natural killer cell cytotoxicity. Moreover, autoantibodies against various antigens including neurotransmitter receptors have been recently identified in ME/CFS individuals by several groups. Consistently, clinical trials from Norway have shown that B-cell depletion with rituximab results in clinical benefits in about half of ME/CFS patients. Furthermore, recent studies have provided evidence for severe metabolic disturbances presumably mediated by serum autoantibodies in ME/CFS. Therefore, further efforts are required to delineate the role of autoantibodies in the onset and pathomechanisms of ME/CFS in order to better understand and properly treat this disease.     

Evidence in chronic fatigue syndrome for severity‐dependent upregulation of prefrontal myelination that is independent of anxiety and depression

White matter (WM) involvement in chronic fatigue syndrome (CFS) was assessed using voxel‐based regressions of brain MRI against CFS severity scores and CFS duration in 25 subjects with CFS and 25 normal controls (NCs). As well as voxel‐based morphometry, a novel voxel‐based quantitative analysis of T₁‐ and T₂‐weighted spin‐echo (T1w and T2w) MRI signal level was performed. Severity scores included the Bell CFS disability scale and scores based on the 10 most common CFS symptoms. Hospital Anxiety and Depression Scale (HADS) depression and anxiety scores were included as nuisance covariates. By relaxing the threshold for cluster formation, we showed that the T1w signal is elevated with increasing CFS severity in the ventrolateral thalamus, internal capsule and prefrontal WM. Earlier reports of WM volume losses and neuroinflammation in the midbrain, together with the upregulated prefrontal myelination suggested here, are consistent with the midbrain changes being associated with impaired nerve conduction which stimulates a plastic response on the cortical side of the thalamic relay in the same circuits. The T2w signal versus CFS duration and comparison of T2w signal in the CFS group with the NC group revealed changes in the right middle temporal lobe WM, where impaired communication can affect cognitive function. Adjustment for depression markedly strengthened cluster statistics and increased cluster size in both T1w severity regressions, but adjustment for anxiety less so. Thus, depression and anxiety are statistical confounders here, meaning that they contribute variance to the T1w signal in prefrontal WM but this does not correlate with the co‐located variance from CFS severity. MRI regressions with depression itself only detected associations with WM volume, also located in prefrontal WM. We propose that impaired reciprocal brain–body and brain–brain communication through the midbrain provokes peripheral and central responses which contribute to CFS symptoms. Although anxiety, depression and CFS may share biological features, the present evidence indicates that CFS is a distinct disorder. © 2015 The Authors. NMR in Biomedicine published by John Wiley & Sons, Ltd.     

重症监护室护士慢性疲劳综合征与职业紧张的相关性

目的 调查重症监护室护士职业紧张现状与慢性疲劳综合征(CFS)发生率,并探讨其相关性.方法 选取2013年7月-2014年7月在荆州市10所综合性医院任职共235名ICU护士为研究对象,采用自制一般情况调查表、职业紧张量表(OSIR)和疲劳量表-14(FS-14)对其进行调查.结果 ICU护士职业紧张度最高发生在30～39岁年龄段,护龄在10～19 a、学历中专、常白夜班倒班、在编护士以及离婚和丧偶护士群体中,CFS的发生与年龄无关(P＞0.05);疲劳总分、躯体疲劳、脑力疲劳得分分别与职业任务、个体紧张反应得分呈正相关,与个体应变能力得分呈负相关,差异有统计学意义(P＜0.05).结论 ICU护士职业紧张情况较为严重,可通过缓解其职业紧张水平,从而降低患CFS的风险.     

Therapeutic efficacy of intense pulsed light in patients with refractory meibomian gland dysfunction

Purpose

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for treatment of refractory meibomian gland dysfunction (MGD).

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.     

Assessment of intracellular cytokines and regulatory cells in patients with autoimmune diseases and primary immunodeficiencies — Novel tool for diagnostics and patient follow-up

Serum and intracytoplasmic cytokines are mandatory in host defense against microbes, but also play a pivotal role in the pathogenesis of autoimmune diseases by initiating and perpetuating various cellular and humoral autoimmune processes.     

Chronic fatigue phenomena – somatic and relational perspectives

This paper aims to develop therapeutic perspectives on relational and somatic phenomena but also difference and diversity dynamics associated with chronic fatigue as a presenting issue. In common with other complex and severe conditions, chronic fatigue will often appear as a single issue dominating the therapeutic space, a dynamic that may easily obscure sight of the person. The author reviews contemporary literature and considers dynamics associated with chronic fatigue phenomena commonly encountered in the therapeutic relationship. Autonomic nervous and sensory-motor systems also appear crucial for developing better understanding of, and sensitivity for, working with chronic fatigue phenomena.