Levodopa improves physical fatigue in Parkinson's disease: a double-blind, placebo-controlled, crossover study.

We quantitatively investigated the effect of carbidopa/levodopa (25/100) on physical fatigue during finger tapping and force generation in a double-blind, placebo-controlled crossover study. Parkinson's disease (PD) subjects were randomly assigned to carbidopa/levodopa or placebo for Visit 1 or 2 and participated in the following two studies: (1) Finger tapping. Twenty-five PD patients used their index fingers to strike two keys 20 cm apart on a musical instrument digital interface (MIDI) keyboard. The slopes of the regression line of dwell time and movement time were used to assess the rate of fatigue development. (2) Force generation. Twelve PD patients contracted the wrist extensors maximally to obtain a baseline maximum voluntary contraction (BMVC) force. Then they repetitively contracted the wrist extensors at 50% of the BMVC for 7 seconds and rested for 3 seconds. An interval maximum voluntary contraction (IMVC) was measured every three repetitions. Fatigue was defined as an IMVC of less than 60% of the BMVC. The slope of the regression line of IMVC was used to assess the rate of force decline. These two studies were repeated 1 hour after carbidopa/levodopa (25/100) or placebo. Subjects filled out the Multidimensional Fatigue Inventory (MFI) at the beginning of the first visit. Results showed that the slope of dwell time decreased with levodopa but not with placebo (P = 0.004). The rate of force decline also decreased with levodopa but not with placebo (P = 0.01). The subscores in the dimension of physical fatigue in the MFI did not correlate with the rate changes in dwell time or the rate changes in force decline. We concluded that (1) levodopa improves physical fatigue in finger tapping and force generation, (2) physical fatigue in Parkinson's disease is at least partially related to dopamine deficiency, and (3) the MFI measures different aspects of physical fatigue compared with those measured by finger tapping and force generation.     

Predicted and Measured Muscle Forces after Recoveries of Differing Durations Following Fatigue in Functional Electrical Stimulation

Abstract: Using ³¹P nuclear magnetic resonance (NMR) spectroscopy, the bioenergetics of paralyzed muscles activated by functional electrical stimulation (FES) were studied in vivo during fatigue and recovery on paraplegic subjects. During the activation phase of the muscle, the muscle force was also monitored. The phosphorus metabolites were found to vary systematically during fatigue and to recover slowly to their rest state values after cessation of FES. During fatigue, a good correlation was found between the decaying force and each of the profiles of phos-phocreatine, inorganic phosphorus, and intracellular pH. A musculotendon 5 element model was proposed for the activated muscle to predict its force generation capacity. A fatigue recovery function, based on the metabolic profiles, was introduced into the model. This model allowed us to predict the force expected to be developed as a function of the time after recovery of given time durations. Validation experimental measurements of force were carried out and included recurrent fatigue tests, both in the initially un-fatigued state and at various times in the postfatigue stage of the muscle. Comparison of the predicted and measured forces indicated satisfactory agreement of the results. The developed model of muscle dynamics should help to design a strategy for reducing muscle fatigue under FES.     

视觉近点测定修布和验布作业视疲劳的初步探讨

应用视觉近点测定评价纺织厂不同作业工人的视疲劳。检查了32名修布工人和38名验布工人。同一工厂的33名保育员作对照组。结果表明:视觉近点的测定指标比调查受试者主诉的眼视觉症状更为敏感。修布和验布组在工作后,作业者的视觉近点比上班前明显变远,但时照蛆工作前后无明显变化。三组视觉近点比较,发现修布和验布组视觉近点的变化。提示由修布和验布作业引起的视觉疲劳,可以通过测定视觉近点来进行评价。     

Fibromyalgia syndrome: the beneficial effects of exercise.

This article highlights positive outcomes for a convenience sample of six women (49-64 years of age) with fibromyalgia syndrome (FMS) who participated in an exercise program over 5 years. This group showed improvement with various FMS symptoms,fitness, and psychosocial factors early in the program, then showed further improvement as a result of adding new exercises to the protocol during the fourth and fifth years. Data suggest that certain people with FMS can improve their functional capacity with exercise over time, and move to even higher levels of physical function while aging and coping with FMS. Practical advice is provided for rehabilitation nurses regarding exercise and FMS.     

Does work with visual display units impair visual activities after work?

It is well established that visual display unit (VDU) operators complain of visual fatigue and visual stress during after-work hours. The present study was divided into two parts. In the first part, standard eye examinations were performed on a group of VDU workers (n = 32) and a control group (n = 15); those subjects who were found to have correct vision (n = 16 and 13, respectively) participated in the second part. The eye examinations revealed that on the average, the VDU workers suffered more than twice as many visual impairments as the controls. In those with correct vision, the near point of accommodation was measured at the beginning of the workday at the start of the week, and at the end of the workday, four days later. In the VDU group, the decrease in accommodation was uniformally distributed between zero and 1.0 diopter, whereas among the non-VDU workers, 77% of the decrease was between zero and 0.25 diopter. The dynamic range of accommodation in the VDU workers on the second examination was smaller than on the first. We conclude that some of the visual stress and visual fatigue that developed at work hindered visual activities after work.     

急性缺血性卒中大血管闭塞性质的判断与取栓方式和材料的选择

血管内机械取栓是治疗大血管闭塞性急性缺血性卒中的有效治疗方法。应结合病史、发
病形式及影像学检查等综合判断病变性质；依据病变性质并参考手术路径，个性化选择支架取栓、
抽吸取栓、球囊/支架血管成形术、动脉溶栓任一种或多种方法联合取栓；并依据手术方式选择手
术材料，以快速高效地完成手术。     

Physiological consequences of a high work of breathing during heavy exercise in humans

The healthy respiratory system has a remarkable capacity for meeting the metabolic demands placed upon it during strenuous exercise. For example, in order to regulate alveolar partial pressure of oxygen and carbon dioxide during heavy workloads, a 20-fold increase in alveolar ventilation can occur. The high metabolic costs and subsequent increased work of breathing associated with this ventilatory increase can result in a number of limitations to the healthy respiratory system. Two examples of respiratory system limitations that are associated with a high work of breathing are expiratory flow limitation and exercise-induced diaphragmatic fatigue. Expiratory flow limitation can lead to an inability to increase alveolar ventilation () in the face of increasing metabolic demands, resulting in gas exchange impairment and diminished endurance exercise performance. Furthermore, the high ventilatory requirements of endurance athletes and the inherent anatomical differences in females could make these groups more susceptible to expiratory flow limitation. Fatigue of the diaphragm has also been documented after strenuous exercise and may be related to a mechanism which increases sympathetic vasoconstrictor outflow and reduces limb blood flow during prolonged exercise. This competition between the muscles of respiration and locomotion for a limited cardiac output may have dramatic consequences for exercise performance. This brief review summarizes the literature as it pertains to the work of breathing, expiratory flow limitation, and exercise-induced diaphragmatic fatigue in healthy humans.     

Chronic fatigue syndrome: traditional and community-based approaches to rehabilitation

Chronic fatigue syndrome (CFS) is a controversial condition defined by 6 months or more of unexplained fatigue, and at least four out of eight cognitive and physical symptoms. Over the past 2 decades, CFS has been the subject of significant debate regarding its definition, cause and recommended treatment. Because a cure for the syndrome has not yet been located, efforts to improve functioning and overall quality of life through rehabilitation represent the most practised form of treatment to date. However, controversy remains as to which approach to rehabilitation is most effective for individuals with CFS. Interventions which take place within real‐world environments and utilise community‐based organizations such as centres for independent living offer a newly explored means of support and rehabilitation. The present paper reviews a variety of approaches to rehabilitation for individuals with CFS, describing their applications with different types of patients, and providing critical commentary on the research methodologies used to evaluate them. Innovative community‐based rehabilitation programmes and their outcomes are described as an alternative with some promise that may compliment more traditional approaches.