Fatigue and cognitive symptoms in patients with diabetes: relationship with disease phenotype and insulin treatment

Neurobehavioral symptoms are frequently reported in patients with diabetes. Nevertheless, the characterization of the specific symptom dimensions that develop in diabetic patients with respect to disease phenotype and treatment status remains obscure. This study comparatively assessed fatigue symptoms and cognitive performance using a dimensional approach in 21 patients with insulin-treated type 1 diabetes, 24 type 2 diabetic patients either insulin-free or undergoing insulin treatment for at least six months, and 15 healthy subjects. Specific dimensions of fatigue were assessed using the Multidimensional-Fatigue-Inventory (MFI). Cognitive performance on tests of choice reaction time, pattern recognition memory and spatial planning was evaluated using the Cambridge-Neuropsychological-Automated-Battery (CANTAB). Body mass index (BMI) and glycated-hemoglobin (HbA1C) concentrations were collected, as well as information on diabetes complications and disease duration. Patients with type 2 diabetes, regardless of insulin treatment status, exhibited higher scores of fatigue, primarily in the dimensions of general and physical fatigue as well as reduced activity. Cognitive alterations, in the form of longer reaction times and impaired spatial planning, were also detected in type 2 diabetic patients treated with insulin. These alterations were overall unrelated to glucose control, as reflected in HbA1C levels, and were not explained by complications and duration of diabetes. No specific alteration was measured in type 1 diabetic patients who exhibited fatigue scores and cognitive performance comparable to healthy participants. While associated with fatigue, increased BMI did not significantly account for the relationship of type 2 diabetes with general fatigue and physical fatigue. BMI, however, modulated the association of type 2 diabetes with reduced activity and the association of insulin-treated type 2 diabetes with psychomotor slowing. These findings reveal specific fatigue and cognitive symptoms in patients with type 2 diabetes and suggest the involvement of differential pathophysiological processes.     

Evidence for an association between an enhanced reactivity of interleukin-6 levels and reduced glucocorticoid sensitivity in patients with fibromyalgia

Pain and fatigue have been identified as core symptoms of fibromyalgia syndrome (FMS). Since both symptoms are also characteristic of hypocortisolemic disorders, reduced cortisol levels have been thought to promote an exacerbation of these FMS core symptoms by an enhanced reactivity of interleukin-6 (IL-6) levels. The aim of the current study was to investigate the pathophysiologic relevance of reduced cortisol levels for manifestation of FMS core symptoms. Twelve female FMS patients with 15 female controls were compared regarding the function of hypothalamus-pituitary-adrenal (HPA) axis and behavioral, endocrine and IL-6 responses after measuring the pressure pain thresholds (PPTs) at tender points. Function of HPA axis was assessed by determining the cortisol awakening response, daytime profile of cortisol secretion, low dose overnight dexamethasone suppression test (DST) and glucocorticoid sensitivity (GC) of inflammatory cytokine production. While endocrine and IL-6 responses were determined by collecting blood and saliva samples behavioral responses were assessed by pain and fatigue recordings of participants before and after PPT measurement using visual analogue scale (VAS). Whereas FMS patients were found not to differ from controls in cortisol awakening response, daytime profile of cortisol secretion and cortisol suppression after overnight DST, they did exhibit a reduced GC sensitivity of inflammatory cytokine production. PPT measurement did induce three times higher cortisol and four times higher IL-6 levels in FMS patients, but no change in their ACTH levels. The enhanced IL-6 reactivity after PPT measurement was accompanied by an increase in the severity of FMS patients' pain and fatigue ratings. The findings of the present study provide evidence for the pathophysiologic relevance of a disturbed glucocorticoid receptor (GR) function, rather than reduced cortisol levels for the maintenance of FMS core symptoms.     

抗疲劳药物的研究进展

疲劳已成为当今人们关注热点问题之一,该文分析了疲劳产生原因及机制,从中药及化学药物两个方面对近年来抗疲劳药物的研究进展进行了综述,并评述了它们的现有问题和未来发展方向。     

采用简易疲乏量表评价中医药治疗对肺癌化疗性疲乏的影响

目的:采用简易疲乏量表中国版(BFI-C)、肺癌症状分级量化表评价中医药治疗对肺癌化疗性疲乏的影响。方法:将67例符合课题纳入标准的肺癌将行化疗患者随机分为治疗组(33例)和对照组(34例),两组患者均按照既定化疗方案施行化疗,治疗组于化疗第1天开始服用健脾益气化痰自拟方加减治疗,对照组未给予其他干预措施。分别在化疗前、化疗第3天(化疗后)和化疗第14天(治疗后)采用BFI-C对所有患者进行评估,同时对两组患者的中医证候评分进行评价,比较两组的评价结果。结果:化疗前,两组患者的综合疲乏程度、综合疲乏影响评分及中医证候积分比较,差异均无统计学意义(P>0.05);化疗后,两组患者的上述评分均显著升高(P<0.01);治疗后,两组患者的上述评分均显著降低(P<0.01),且治疗组的评分较对照组降低更加明显(P<0.01)。结论:①部分因化疗引起的癌性疲乏在一定程度上可自行缓解。②中医药治疗可降低肺癌化疗性疲乏的程度,改善患者的相关症状,提高其生存质量。     

Actual and perceived sleep: associations with daytime functioning among postpartum women

Sleep and wake have a homeostatic relation that influences most aspects of physiology and waking behavior. Sleep disturbance has a detrimental effect on sleepiness and psychomotor vigilance. The purpose of this study was to identify which actual or perceived sleep characteristics accounted for the most variance in daytime functioning among postpartum mothers. Seventy first-time postpartum mothers' actual sleep (actigraphically estimated: total sleep time, number of wake bouts, length of nocturnal wake, and sleep efficiency) and perceived sleep (self-reported: number of awakenings, wake time, and sleep quality) were measured along with their daytime functioning (Stanford Sleepiness Scale [SSS], Epworth Sleepiness Scale [ESS], Visual Analogue of Fatigue Scale [VAFS], and morning Psychomotor Vigilance Test [PVT]). Data were repeatedly collected from the same sample during postpartum weeks 2, 7, and 13. Four stepwise linear regressions were calculated for each postpartum week to examine which objective and/or subjective variable(s) accounted for the most variance in daytime functioning. The SSS and VAFS were both most consistently associated with perceived sleep quality. The ESS was most consistently associated with actual total sleep time. PVT performance was most consistently associated with estimates of actual and perceived sleep efficiency. Actual and perceived sleep profiles were differentially associated with specific daytime functions. These results from postpartum mothers may indicate that populations who experience specific forms of sleep disturbance (e.g. fragmentation and/or deprivation) may also experience specific daytime conditions.     

Muscarinic receptors within the ventromedial hypothalamic nuclei modulate metabolic rate during physical exercise

The involvement of muscarinic cholinoceptors within the ventromedial hypothalamic nuclei (VMH) on the exercise-induced increase in oxygen consumption (VO(2)) was investigated. Rats were fitted with bilateral cannulae into the VMH for local delivery of drugs. On the day of the experiments, the animals were submitted to running exercise (20 m/min; 5% grade) until the point of fatigue. VO(2) was continuously measured after bilateral injections of either 0.2 μL of 5 × 10(-9)mol methylatropine or 0.15M NaCl solution into the VMH. Control experiments were conducted in freely moving rats on the treadmill. Muscarinic blockade within the VMH reduced time to fatigue by 32% and enhanced the increase in VO(2) from the 8th until the 17th min of exercise when compared to the control trial. In fact, time to fatigue was negatively correlated to the rate of increase in VO(2) (r(2)=0.747; P<0.001). However, bilateral injections of methylatropine in freely moving rats did not change VO(2) in comparison to saline injections. In conclusion, muscarinic cholinoceptors within the VMH are activated during exercise to modulate the increase in metabolic rate. Furthermore, blocking muscarinic transmission leads to a faster increase in VO(2) that is associated with the early interruption of exercise.     

Darbepoetin alfa for anemia in patients with low or intermediate-1 risk myelodysplastic syndromes and positive predictive factors of response

Abstract

Background:

Current guidelines support the use of erythropoiesis-stimulating agents for the treatment of anemia associated with low-risk myelodysplastic syndromes (MDS).     

脑梗死急性期疲劳与血尿酸、血糖、抑郁及功能障碍的相关性分析

目的：明确卒中急性期疲劳与血尿酸（UA）、血糖、抑郁及功能障碍的相关性,探讨卒中后疲劳（post-stroke fatigue,PSF）可能的相关因素。方法病例组来自2012年6月至2013年9月在沈阳市红十字会医院神经内科住院治疗的急性脑梗死患者,共312例。对照组为我院健康体检中心同期的健康体检者,共312人。用疲劳严重度量表（Fatigue Severity Scale,FSS）评价疲劳的状况,FSS评分≥4分诊断为疲劳。据此将病例组分为疲劳组（F组）与非疲劳组（NF组）。用抑郁自评量表（Self-rating Depression Scale,SDS）评价抑郁的程度,SDS 评分≥50分诊断为抑郁。用 NIHSS 评分来评价卒中的严重程度,用MRS评分评价患者功能障碍的程度。记录患者的年龄、性别及慢性病史,并于患者入院后第二天检测血糖及UA水平。结果病例组疲劳的发病率（40.4%）明显高于对照组（4.8%）,差异有统计学意义（χ2＝112.892;P＜0.001）。在病例组中,F组抑郁的发病率、MRS评分及血糖水平均明显高于NF组,而UA水平则明显低于NF组（P＜0.001）。两组的年龄、性别、慢性病史及NIHSS评分无明显差别（P＞0.05）。在F组中, MRS评分、SDS评分及血糖水平与FSS评分成正相关（P＜0.001）,UA水平与FSS评分成负相关（P＜0.001）,而年龄和NIHSS评分与FSS评分无关（P＞0.05）。结论在脑梗死急性期疲劳与UA、血糖、抑郁及功能障碍的水平密切相关。这为研究PSF的病因及发病机制提供了理论依据,为探索PSF的治疗开拓了新的思路。     

足三里烧山火针法为主治疗脾肾阳虚型慢性疲劳综合征临床疗效研究

目的：观察足三里烧山火针法治疗脾肾阳虚型慢性疲劳综合征的临床疗效。方法：采用随机对照的方法,将57例慢性疲劳综合征患者分为足三里烧山火治疗组（30例）和常规针刺对照组（27例。）,治疗3个疗程。结果：（1）两组间疾病疗效比较：足三里烧山火针法治疗组有效率为96．67％;常规针刺对照组有效率为88．89％。（2）治疗后两组在疲劳严重程度量表（FSS）评分及中医证候评分均显示治疗组低于对照组,差异有统计学意义（P〈0．05）。结论：足三里烧山火针法治疗慢性疲劳综合征,在改善患者疲劳程度、缓解中医脾肾阳虚症状方面有显著临床疗效。     

长蛇灸治疗脾肾两虚型慢性疲劳综合征随机对照研究

目的 观察长蛇灸治疗脾肾两虚型慢性疲劳综合征的临床疗效。方法 将60例患者随机分为治疗组和对照组。治疗组采用长蛇灸配合俞募配穴针灸治疗,对照组采用俞募配穴针灸治疗,连续治疗4星期。对比两组患者临床疗效以及治疗前后疲劳量表、疼痛视觉模拟评分（VAS）、抑郁状态问卷（PSI）评分情况。结果 治疗组总有效率为63.3%,对照组总有效率为41.4%,两组比较差异有统计学意义（P＜0.05）。治疗组治疗后躯体疲劳积分、脑力疲劳积分、疲劳总分均显著降低（P＜0.05,P＜0.01）,对照组治疗后躯体疲劳积分、疲劳总分均有所降低（P＜0.05）,而脑力疲劳积分无明显变化（P＞0.05）;两组治疗后躯体疲劳积分、脑力疲劳积分、疲劳总分比较差异均有统计学意义（P＜0.05）。治疗组治疗后VAS评分显著降低（P＜0.01）,对照组治疗后VAS评分有所降低（P＜0.05）;两组治疗后VAS比较差异有统计学意义（P＜0.05）。治疗组治疗后DSI评分显著降低（P＜0.05）,对照组治疗后DSI评分无明显变化（P＞0.05）;两组治疗后DSI评分比较差异有统计学意义（P＜0.05）。结论 长蛇灸配合俞募配穴针灸可提高脾肾两虚型慢性疲劳综合征患者的疗效。