BACKGROUND & AIMS: :Fatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex- and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.

背景与目标： ：疲劳是慢性肾脏疾病患者的常见症状，但很少在移植后进行检查。我们确定了肾移植受者（KTR）中严重疲劳的患病率，影响和相关因素。病历和问卷用于评估肾功能，供体特征，疲劳（清单个人力量），功能障碍（疾病影响概况），工作状态，体重指数（BMI），疼痛，抑郁症状，社会支持和睡眠问题。 180个参与的KTR。将KTR与性别和年龄相匹配的基于人群的对照进行了比较。与匹配的对照组（22％; P = 0.001）相比，KTR严重疲劳（39％）的频率明显更高。严重疲劳的KTR比非严重疲劳的接受者具有更大的功能障碍（效应量≥0.7）P <0.001，而有酬工作的频率更低（27％比48％，P = 0.005）。单因素分析表明，严重疲劳的KTR经常从死者的肾脏获得肾脏，BMI更高，疼痛更多，社会支持差异，抑郁症状和睡眠问题。在多变量分析（n = 151）中，后两个关联仍然显着。严重疲劳是KTR的高度普遍和致残的症状。此外，与特定的移植相关因素相比，肾移植后的严重疲劳与行为和社会心理因素的相关性更高。研究结果对疲劳管理有影响。

BACKGROUND & AIMS: :Soccer entails intermittent exercise with bouts of short, intense activity punctuating longer periods of low-level, moderate-intensity exercise. High levels of blood lactate may sometimes be observed during a match but the active recovery periods at submaximal exercise levels allow for its removal on a continual basis. While anaerobic efforts are evident in activity with the ball and shadowing fast-moving opponents, the largest strain is placed on aerobic metabolism. On average, competitive soccer corresponds to an energy expenditure of about 75% maximal aerobic power. The energy expenditure varies with playing position, being highest among midfield players. Muscle glycogen levels can be reduced towards the end of a game, the level of reduction being reflected in a decrease in work rate. Blood glucose levels are generally well-maintained, although body temperature may rise by 2 degrees C even in temperate conditions. The distance covered by players tends to under-reflect the energy expended. Unorthodox modes of motion-running backwards and sideways, accelerating, decelerating and changing direction-accentuate the metabolic loading. These are compounded by the extra requirements for energy associated with dribbling the ball and contesting possession. The overall energy expended is extreme when players are required to play extra-time in tournaments. Training, nutritional and tactical strategies may be used to reduce the effects of fatigue that may occur late in the game.

背景与目标： ：足球需要间歇性运动，短而激烈的运动可以打断较长时间的低水平，中等强度的运动。有时在比赛中会观察到高水平的血乳酸，但是在低于最大运动水平的活跃恢复期可以连续去除乳酸。厌氧运动明显表现在对球和阴影快速移动的对手的活动中，但最大的压力在于有氧代谢。平均而言，竞技足球对应的能量消耗约为最大有氧能力的75％。能量消耗随比赛位置而变化，在中场球员中最高。肌肉糖原水平可以在比赛快结束时降低，降低水平反映在工作效率的降低上。血糖水平通常保持良好，尽管即使在温和条件下，体温也会升高2摄氏度。玩家所覆盖的距离往往不足以反映所消耗的能量。向后和向侧面运动，加速，减速和改变方向的非正统运动模式会加重新陈代谢负荷。与运球和比赛拥有权相关的额外能量需求进一步加剧了这些问题。当要求球员在比赛中加班时，总的精力消耗是极端的。训练，营养和战术策略可用于减少比赛后期可能出现的疲劳影响。

BACKGROUND & AIMS: :Guidelines for the management of cancer-related fatigue (CRF) emphasize evidence-based strategies for reducing this common symptom in patients with cancer. Exercise has the largest body of data supporting its benefits in reducing CRF. Patient education and counseling also are considered integral to effective CRF management. Additional interventions can be pharmacologic or nonpharmacologic, although a combination of approaches may be employed. Several factors known to be associated with CRF may be particularly amenable to treatment.

背景与目标： ：癌症相关疲劳（CRF）的管理指南强调了以证据为基础的策略，以减少癌症患者的这种常见症状。锻炼具有最大的数据量，支持其减少CRF的益处。病人的教育和咨询也被认为是有效的CRF管理不可或缺的部分。尽管可以采用多种方法，但是其他干预措施可以是药物治疗的，也可以是非药物治疗的。已知与CRF相关的几种因素可能特别适合治疗。

BACKGROUND & AIMS: :This paper describes the prevalence of mood disturbance, sleep disturbance, fatigue and pain (MSFP), either alone or in combination in patients receiving cancer therapy, and determines its impact and whether it is a predictor for functional status and the impairment of quality of life (QoL). This is a cross-sectional study using secondary data from a sample of 214 patients being treated by chemotherapy or radiotherapy. In all, 87%, 68%, 66% and 38% of the patients reported MSFP respectively. Co-occurrence of any three and all of the four symptoms, were reported separately at rates of 29% and 31%. Patients with all four symptoms recorded significantly lower Karnofsky Performance Scale (KPS) scores (mean 77.7 ± 12.9) and QoL scores (mean subscales scores 9.0-17.6) than those with none or up to any three of the symptoms (P < 0.001). Regression of the KPS and QoL scores against the MSFP revealed an increase in the explained variance of 25%, 43%, 27%, 37% and 41% respectively for KPS, physical, emotional, functional and total QoL. The results suggest that MSFP are highly prevalent, whether alone or in combination, in patients receiving cancer therapy, and may negatively influence the patient's functional status and QoL during cancer therapy.

背景与目标： ：本文描述了接受癌症治疗的患者中单独或联合使用时情绪障碍，睡眠障碍，疲劳和疼痛（MSFP）的患病率，并确定其影响以及它是否是功能状态和质量下降的预测指标生活（QoL）。这是一项横断面研究，使用了来自214名正在接受化学疗法或放射疗法治疗的患者的样本的辅助数据。总计分别有87％，68％，66％和38％的患者报告了MSFP。分别报告了这三种症状和所有四种症状的并发发生率，分别为29％和31％。与没有或没有任何三种症状的患者相比，所有四种症状的患者记录的Karnofsky绩效量表（KPS）评分（平均77.7±12.9）和QoL评分（平均子评分为9.0-17.6）均显着降低（P <0.001）。 KPS和QoL得分相对于MSFP的回归显示，KPS，身体，情绪，功能和总QoL的解释方差分别增加了25％，43％，27％，37％和41％。结果表明，MSFP在接受癌症治疗的患者中非常普遍，无论是单独使用还是组合使用，都可能对癌症治疗期间的患者功能状态和QoL产生负面影响。

BACKGROUND & AIMS: :Virtual rehabilitation has been used during decades to provide a more personalized, controlled, and enjoyable experience on upper-limb motor rehabilitation. Since novel virtual reality (VR) technologies are now accessible and highly immersive, the challenge for a wide dissemination of virtual rehabilitation in clinical scenarios has shifted from the hardware robustness to the software intelligence. A sophisticated technique that provides physiological intelligence to novel human-computer interaction (HCI) applications is biocybernetic adaptation. The concept emerges from the electrophysiological computing field, and it proposes using body signals to detect human states (e.g. workload or fatigue) and modulate the virtual activity accordingly. This paper evaluates the effects of using biocybernetic adaptation in a virtual rehabilitation game that aims to encourage users to exert at a desirable intensity level while interacting with the virtual environment. The system relies on surface-electromyography (sEMG) signals to detect fatigue levels in real-time and adapt the game challenge dynamically. Perceived fatigue levels, game user experience, and game performance parameters are assessed after playing the game, considering two different visualization modalities: non-immersive (conventional flat screen) and immersive (VR headset). Results revealed how the biocybernetic system in the immersive condition not only produced lower levels of perceived fatigue compared with the non-immersive, but also, created a more enjoyable and positive experience in a controlled experiment with 24 healthy subjects. Moreover, participants in the immersive condition showed a better performance in the virtual game and higher usability levels scored by users compared with the non-immersive condition. To conclude, we highlight the importance of combining novel immersive approaches with physiologically aware systems to enhance the benefits of virtual rehabilitation therapies.

背景与目标： ：数十年来，虚拟康复已被用于为上肢运动康复提供更个性化，可控制和令人愉悦的体验。由于新型虚拟现实（VR）技术现在已经可以访问并且具有高度沉浸性，因此在临床场景中广泛传播虚拟康复的挑战已经从硬件的健壮性转变为软件的智能性。一种为复杂的人机交互技术提供生理智能的先进技术是生物计算机适应。该概念来自电生理计算领域，并且提出使用身体信号来检测人的状态（例如工作量或疲劳）并相应地调节虚拟活动。本文评估了在虚拟康复游戏中使用生物cybernetic适应的效果，该游戏旨在鼓励用户在与虚拟环境互动的同时以理想的强度进行锻炼。该系统依靠表面肌电图（sEMG）信号实时检测疲劳程度并动态适应游戏挑战。考虑到两种不同的可视化模式：非沉浸式（常规纯平屏幕）和沉浸式（VR头戴式耳机），在玩完游戏后评估感知的疲劳水平，游戏用户体验和游戏性能参数。结果表明，沉浸状态下的生物神经网络系统不仅比非沉浸状态下产生的疲劳感更低，而且在24名健康受试者的对照实验中创造了更加令人愉悦和积极的体验。而且，与非沉浸状态相比，沉浸状态的参与者在虚拟游戏中表现出更好的性能，并且用户获得了更高的可用性级别。总而言之，我们强调了将新颖的沉浸式方法与具有生理意识的系统相结合以增强虚拟康复疗法的益处的重要性。

BACKGROUND & AIMS: BACKGROUND:Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. METHODS:Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. RESULTS:Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. CONCLUSIONS:The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

背景与目标： 背景：很少有研究探讨患者对CFS / ME的治疗经验。这项研究旨在通过捕获英国NHS专家CFS / ME服务所治疗患者的观点来填补这一空白。
方法：在2014年6月至9月期间，对三名门诊NHS专家CFS / ME服务之一中完成治疗的16名成年人进行了半结构式访谈。访谈采用恒定比较技术进行主题分析，尤其要注意对比观点。
结果：确定了三个主题：“专业服务之旅”； “有助于或阻碍治疗的事情”；和“支持系统”。在这些主题中，确定了9个子主题。形成参与者体验的因素很明显，包括毅力和乐观情绪等个人特征，以及灵活性和与临床医生之间的积极支持关系等服务因素。参与者描述了专家服务如何发挥独特作用，这与疾病的争议性质有关。许多参与者在参加专科服务之前经历了缺乏验证以及医疗和社会支持的经历。患者转诊前的生活经历以及他们对出院的担忧，凸显了CFS / ME患者在我们社会中继续经历的艰辛和障碍。
结论：本研究中CFS / ME患者的经验表明，NHS专家CFS / ME服务在患者改善生活质量的旅程中起着至关重要的作用。这种改善是通过一个过程来实现的，该过程包括验证患者的经历，接受变更，实用的建议和支持以及治疗效果。

BACKGROUND & AIMS: :Paraspinal muscle fatigability during various trunk extension tests has been widely investigated by electromyography (EMG), and its task-dependency is established recently. Hip extensor muscle fatigability during the Sorensen test has been reported. The aim of the present experiments was to evaluate the task-dependency of back and hip extensor muscle fatigue during two variants of the Sorensen test. We hypothesized that the rate of muscular fatigue of the hip and back extensor muscles varies according to the test position. Twenty healthy young males with no history of low back pain volunteered to participate in this cross-sectional study. They were asked to perform two body weight-dependent isometric back extension tests (S1 = Sorensen test; S2 = modified Sorensen on a 45 degrees Roman chair). Surface EMG activity of the paraspinal muscles (T10 and L5 levels) and hip extensor muscles (gluteus maximus; biceps femoris) was recorded, and muscular fatigue was assessed through power spectral analysis of the EMG data by calculating the rate of median power frequency change. We observed hip extensor muscle fatigue simultaneously with paraspinal muscle fatigue during both Sorensen variants. However, only L5 level EMG fatigue indices showed a task-dependency effect between S1 and S2. Hip extensor muscles appear to contribute to load sharing of the upper body mass during both Sorensen variants, but to a different extent because L5 level fatigue differs between the Sorensen variants. Our findings suggest that task-dependency has to be considered when EMG variables are compared between two types of lumbar muscle-fatiguing tasks.

背景与目标： ：肌电图（EMG）已广泛研究了各种躯干伸展测试过程中的椎旁肌疲劳性，并且最近确定了其任务依赖性。据报道，在Sorensen测试中，髋伸肌易疲劳。本实验的目的是评估Sorensen测试的两个变体中背部和臀部伸肌疲劳的任务相关性。我们假设髋部和后伸肌的肌肉疲劳率根据测试位置而变化。 20名没有下腰痛史的健康年轻男性自愿参加了这项横断面研究。他们被要求进行两项与体重有关的等距后伸测试（S1 = Sorensen测试； S2 =在45度罗马椅上的改良Sorensen）。记录椎旁肌（T10和L5水平）和臀部伸肌（臀大肌；股二头肌）的表面肌电活动，并通过计算肌电频率中位数变化率，通过肌电图数据的功率谱分析评估肌肉疲劳。我们在两个Sorensen变体中同时观察到了髋部伸肌疲劳和椎旁肌疲劳。但是，只有L5级EMG疲劳指数显示出S1和S2之间的任务依赖效应。髋关节伸肌似乎在两个Sorensen变体中都有助于上半身的负荷分配，但是由于L5级疲劳在Sorensen变体之间不同，因此程度不同。我们的发现表明，在两种类型的腰肌疲劳任务之间比较EMG变量时，必须考虑任务依赖性。

BACKGROUND & AIMS: :Three types of overlap occur among the disease states chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and posttraumatic stress disorder (PTSD). They share common symptoms. Many patients meet the criteria for diagnosis for two or more of these disorders and each disorder appears to be often induced by a relatively short-term stress which is followed by a chronic pathology, suggesting that the stress may act by inducing a self-perpetuating vicious cycle. Such a vicious cycle mechanism has been proposed to explain the etiology of CFS and MCS, based on elevated levels of nitric oxide and its potent oxidant product, peroxynitrite. Six positive feedback loops were proposed to act such that when peroxynitrite levels are elevated, they may remain elevated. The biochemistry involved is not highly tissue-specific, so that variation in symptoms may be explained by a variation in nitric oxide/peroxynitrite tissue distribution. The evidence for the same biochemical mechanism in the etiology of PTSD and FM is discussed here, and while less extensive than in the case of CFS and MCS, it is nevertheless suggestive. Evidence supporting the role of elevated nitric oxide/peroxynitrite in these four disease states is summarized, including induction of nitric oxide by common apparent inducers of these disease states, markers of elevated nitric oxide/peroxynitrite in patients and evidence for an inductive role of elevated nitric oxide in animal models. This theory appears to be the first to provide a mechanistic explanation for the multiple overlaps of these disease states and it also explains the origin of many of their common symptoms and similarity to both Gulf War syndrome and chronic sequelae of carbon monoxide toxicity. This theory suggests multiple studies that should be performed to further test this proposed mechanism. If this mechanism proves central to the etiology of these four conditions, it may also be involved in other conditions of currently obscure etiology and criteria are suggested for identifying such conditions.

背景与目标： 疾病状态慢性疲劳综合症（CFS），纤维肌痛（FM），多种化学敏感性（MCS）和创伤后应激障碍（PTSD）之间发生三种类型的重叠。他们有共同的症状。许多患者符合两种或两种以上疾病的诊断标准，每种疾病似乎通常是由相对短期的压力所致，随后是慢性病理，这表明压力可能通过诱导自我延续的恶性行为而起作用。循环。有人提出了这种恶性循环机制来解释CFS和MCS的病因，原因是一氧化氮及其有效氧化剂过氧化亚硝酸盐的含量升高。提出了六个正反馈回路来起作用，使得当过亚硝酸盐水平升高时，它们可能仍保持升高状态。涉及的生物化学不是高度组织特异性的，因此症状的变化可以用一氧化氮/过亚硝酸盐组织分布的变化来解释。此处讨论了PTSD和FM病因学中相同的生化机制的证据，尽管不如CFS和MCS广泛，但仍具有启发性。总结了支持升高一氧化氮/过氧亚硝酸盐在这四种疾病状态中作用的证据，包括这些疾病状态的常见表观诱导剂对一氧化氮的诱导作用，患者中一氧化氮/过氧亚硝酸盐升高的标志物以及升高的一氧化氮的诱导作用的证据。动物模型中的氧化物。该理论似乎是第一个为这些疾病状态的多重重叠提供机械解释的理论，它还解释了它们许多常见症状的起源以及与海湾战争综合症和慢性一氧化碳毒性后遗症的相似性。该理论建议应进行多项研究，以进一步测试这种提议的机制。如果此机制证明对这四种情况的病因至关重要，则它也可能与目前尚不清楚的病因的其他情况有关，并提出了确定此类情况的标准。

BACKGROUND & AIMS: OBJECTIVE:To compare the cardiovascular response during postural challenge of patients with fibromyalgia (FM) to those with chronic fatigue syndrome (CFS). METHODS:Age and sex matched patients were studied, 38 with FM, 30 with CFS, and 37 healthy subjects. Blood pressure (BP) and heart rate (HR) were recorded during 10 min of recumbence and 30 min of head-up tilt. Differences between successive BP values and the last recumbent BP, their average, and standard deviation (SD) were calculated. Time curves of BP differences were analyzed by computer and their outline ratios (OR) and fractal dimensions (FD) were measured. HR differences were determined similarly. Based on the latter measurements, each subject's discriminant score (DS) was computed. RESULTS:For patients and controls average DS values were: FM: -3.68 (SD 2.7), CFS: 3.72 (SD 5.02), and healthy controls: -4.62 (SD 2.24). DS values differed significantly between FM and CFS (p < 0.0001). Subgroups of FM patients with and without fatigue had comparable DS values. CONCLUSION:The DS confers numerical expression to the cardiovascular response during postural challenge. DS values in FM were significantly different from DS in CFS, suggesting that homeostatic responses in FM and CFS are dissimilar. This observation challenges the hypothesis that FM and CFS share a common derangement of the stress-response system.

背景与目标： 目的：比较纤维肌痛（FM）和慢性疲劳综合征（CFS）的体位激发期间的心血管反应。
方法：对年龄和性别相匹配的患者进行了研究，其中38例患有FM，30例患有CFS，以及37例健康受试者。在横卧10分钟和抬头倾斜30分钟期间记录血压（BP）和心率（HR）。计算了连续BP值与最后一个横卧BP之间的差，它们的平均值和标准差（SD）。用计算机分析血压差异的时间曲线，并测量其轮廓比（OR）和分形维数（FD）。 HR差异的确定方法相似。基于后面的测量，计算每个受试者的判别分数（DS）。
结果：对于患者和对照组，平均DS值分别为：FM：-3.68（SD 2.7），CFS：3.72（SD 5.02）和健康对照组：-4.62（SD 2.24）。 FM和CFS之间的DS值差异显着（p <0.0001）。有疲劳和无疲劳的FM患者亚组的DS值相当。
结论：DS将数字表达赋予姿势挑战期间的心血管反应。 FM中的DS值与CFS中的DS显着不同，这表明FM和CFS中的稳态响应不同。该观察结果挑战了以下假设：FM和CFS共享压力响应系统的常见偏差。

BACKGROUND & AIMS: :Objectives: Migrant farmworkers face many hardships in both their working and living environments including dangerous and demanding tasks, long hours, and inadequate rest. This study sought to explore gender differences in the reporting of fatigue and pain and to identify predictors of fatigue and pain among migrant farmworkers in Nebraska (n = 241). Methods: Bivariate tests were used to assess associations among study variables. Linear and generalized linear mixed effect models were used to assess gender as a predictor of fatigue and pain respectively while controlling for covariates. Results: Females reported significantly higher levels of fatigue (M score = 15.5, SD = 6.1 compared to M score = 12.8, SD = 4.3) than their male counterparts. Females were also more likely to report pain (56.9% of females compared to 36.3% of males). Being female, pain, hours of sleep, and job demands were significant predictors of fatigue. Fatigue and job-related injury were the only significant predictors of pain. Conclusions: There are gender-related disparities in the reporting of fatigue and pain among Latino/a migrant farmworkers. Extra precautions need to be taken to protect worker health and safety and reduce fatigue, particularly for female workers. Implications for employers, supervisors, and healthcare providers are discussed.

背景与目标： ：目标：农民工在工作和生活环境中都面临许多困难，包括艰巨而艰巨的任务，长时间工作和休息不足。这项研究旨在探讨内在疲劳和痛苦报告中的性别差异，并确定内布拉斯加州外来务工人员中疲劳和痛苦的预测因素（n = 241）。方法：双变量检验用于评估研究变量之间的关联。线性和广义线性混合效应模型用于评估性别，分别作为疲劳和疼痛的预测指标，同时控制协变量。结果：女性报告的疲劳水平明显高于男性（M评分= 15.5，SD = 6.1，而M评分= 12.8，SD = 4.3）。女性也更容易报告疼痛（女性为56.9％，而男性为36.3％）。作为女性，疼痛，睡眠时间和工作需求是疲劳的重要预测指标。疲劳和与工作有关的伤害是疼痛的唯一重要预测指标。结论：在拉丁裔/移民农民工的疲劳和疼痛报告中，存在与性别相关的差异。需要采取额外的预防措施以保护工人的健康和安全并减少疲劳，特别是对于女性工人。讨论了对雇主，主管和医疗保健提供者的影响。

BACKGROUND & AIMS: :The effects of different knee joint angles and fatigue on the neuromuscular control of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles were investigated in 17 (11 men, 6 women) young subjects. The electromyogram (EMG) activities and the force generation capacities were monitored before and after a fatigue protocol at three different knee joint angles, 90 degrees, 150 degrees, 175 degrees of knee extension, on three occasions. In response to randomly triggered light signals, the subjects performed three isometric maximal voluntary contraction (IMVC) that lasted for 4 to 8 s. This was then followed by the fatigue protocol which consisted of six bursts of contractions fixed at 30 s on and 10 s off. Immediately after the exercise to fatigue, the subjects performed another three IMVC in response to the light signals. Repeated measures ANOVA were performed to examine the effects of fatigue at these three positions on the electromechanical delay (EMD), median frequency (fmed), peak force (Fpeak) and root mean square (rms)-EMG:Fpeak quotient of VMO and VL. The results revealed a significant effect of the three knee joint angles on the EMD before the fatigue (P < 0.05). The fatigue protocol induced a significant decrease in Fpeak at all the three positions (P < 0.01). However, the fatigue induced a significant decrease of fmed at only 90 degrees and 150 degrees of knee extension (P < 0.01). This occurred in parallel with the lengthening of EMD at these two joint angles (P < 0.01 and P < 0.05). The effects of fatigue on the fmed and EMD were not significant between VMO and VL at all three angles. The insignificant difference in fmed and EMD between VMO and VL at the three knee positions before and after fatigue indicated that no preferential onset activation between VMO and VL had occurred.

背景与目标： ：在17名（11名男性，6名女性）年轻受试者中，研究了不同膝关节角度和疲劳程度对内侧斜肌（VMO）和外侧肌（VL）的神经肌肉控制的影响。在三个不同的膝关节角度（90度，150度，175度膝关节伸展）进行疲劳试验之前和之后，监测肌电图（EMG）活动和力量产生能力。响应随机触发的光信号，受试者进行了3个等距的最大自愿收缩（IMVC），持续了4到8 s。然后是疲劳方案，该方案由固定在30 s开和10 s关的六次收缩爆发组成。运动至疲劳后，受试者立即响应光信号进行了另外三个IMVC。重复测量ANOVA，以检查这三个位置的疲劳对机电延迟（EMD），中频（fmed），峰值力（Fpeak）和均方根（rms）-EMG的影响：VMO和VL的峰商。结果表明，疲劳前，三个膝关节角度对EMD的影响显着（P <0.05）。疲劳方案导致所有三个位置的Fpeak显着降低（P <0.01）。但是，疲劳仅在膝盖伸展90度和150度时导致fmed显着降低（P <0.01）。这与在两个关节角处的EMD延长同时发生（P <0.01和P <0.05）。 VMO和VL在所有三个角度上，疲劳对fmed和EMD的影响均不显着。疲劳前后三个膝盖位置的VMO和VL之间的fmed和EMD差异不显着，表明VMO和VL之间没有发生优先的发作激活。

BACKGROUND & AIMS: :Fatigue is reported as the most common symptom by patients with multiple sclerosis (MS). The physiological and functional parameters related to fatigue in MS patients are currently not well established. A new wearable wireless body measurement system, named Fatigue Monitoring System (FAMOS), was developed to study fatigue in MS. It can continuously measure electrocardiogram, body-skin temperature, electromyogram and motions of feet. The goal of this study is to test the ability of distinguishing fatigued MS patients from healthy subjects by the use of FAMOS. This paper presents the realization of the measurement system including the design of both hardware and dedicated signal processing algorithms. Twenty-six participants including 17 MS patients with fatigue and 9 sex- and age-matched healthy controls were included in the study for continuous 24 h monitoring. The preliminary results show significant differences between fatigued MS patients and healthy controls. In conclusion, the FAMOS enables continuous data acquisition and estimation of multiple physiological and functional parameters. It provides a new, flexible and objective approach to study fatigue in MS, which can distinguish between fatigued MS patients and healthy controls. The usability and reliability of the FAMOS should however be further improved and validated through larger clinical trials.

背景与目标： ：疲劳被报告为多发性硬化症（MS）患者最常见的症状。与MS患者疲劳相关的生理和功能参数目前尚不明确。开发了一种新的可穿戴无线人体测量系统，称为疲劳监测系统（FAMOS），用于研究MS的疲劳状况。它可以连续测量心电图，皮肤温度，肌电图和脚的运动。这项研究的目的是通过使用FAMOS来测试将疲劳MS患者与健康受试者区分开的能力。本文介绍了测量系统的实现，包括硬件设计和专用信号处理算法。该研究包括26名参与者，包括17名MS疲劳患者以及9名性别和年龄匹配的健康对照者，以进行24小时连续监测。初步结果显示，疲劳的MS患者与健康对照者之间存在显着差异。总之，FAMOS支持连续数据采集以及多种生理和功能参数的估计。它提供了一种新的，灵活的，客观的方法来研究MS的疲劳，可以区分疲劳的MS患者和健康对照者。但是，FAMOS的可用性和可靠性应通过更大的临床试验得到进一步改善和验证。

BACKGROUND & AIMS: AIM:To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. BACKGROUND:Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. METHOD:A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. RESULTS:Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. CONCLUSION:The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. RELEVANCE TO CLINICAL PRACTICE:Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

背景与目标： 目的：测量接受血液透析的终末期肾病（ESRD）患者的疲劳和身体机能，并研究疲劳与身体机能之间的关系。
背景：疲劳和身体机能减退是接受ESRD血液透析的人最容易感到不适的症状之一。研究表明，增加活动水平可降低癌症患者的疲劳程度并改善其身体机能。建立血液透析患者的两个概念之间是否存在联系是确定改善健康所必需的潜在疲劳减轻策略的第一步。
方法：采用定量探索性相关设计，对46位个体完成多维疲劳量表，医学成果研究简短形式36项问卷和人口统计学调查表。
结果：结果表明疲劳普遍存在，身体疲劳得分最高。减少活动和全身疲劳。发现在身体机能上有很大的局限性。一般疲劳与身体机能之间存在显着的中等程度的负相关关系，表明随着身体机能水平的提高，疲劳程度降低。男性和女性的总体疲劳评分之间也发现了显着差异。发现总体身体机能，年龄和就业状况之间存在重要关系。
结论：该研究表明ESRD患者普遍存在疲劳和身体机能障碍。但是，随着身体机能的增强，疲劳程度降低；与临床护理有关的发现。
与临床实践的关系：了解疲劳程度和运动价值与临床实践有关，因此有必要在临床环境中评估疲劳和身体机能。

BACKGROUND & AIMS: AIMS:To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. BACKGROUND:Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. DESIGN:Qualitative design. METHODS:Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. RESULTS:Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. CONCLUSION:This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach.

背景与目标： 目的：探讨慢性疲劳综合症患者和全科医生的经验和期望，以开发高级护士从业人员在比利时东部和西部法兰德斯省为实现跨壁实施而开发的异常疲劳的诊断护理路径中的潜在作用。
背景：患有慢性疲劳综合症的患者经历了至少6个月的丧失工作能力的慢性疲劳。由于存在关于该疾病的原因和进展的许多不确定性，因此患者必须应对怀疑和怀疑的态度。可能无法获得医疗保健，这可能导致不适当的治疗和指导。
设计：定性设计。
方法：对比利时的慢性疲劳综合症患者和全科医生进行了单独的半结构式访谈。在2014-2015年的9个月内收集了数据。所有访谈都被录音，并使用开放式探索性主题编码进行转录，以进行定性分析。
结果：对15例患者和15名全科医生进行了访谈。确定了三个主题：感觉与诊断混杂，缺乏一位中央中介和协调不足。与会者强调需要教育，知识和中介者，以在适当的时候提供相关信息并建立信任关系。
结论：这种定性探索强调了在指导慢性疲劳综合征和异常疲劳患者的指导上存在明显的缺陷。在这些患者的透壁护理中，作为高级中介人员的高级护理从业人员可以促进跨学科/多学科的合作和有效的沟通，提供教育并确保结构化和协调的方法。

BACKGROUND & AIMS: OBJECTIVES:Memory is an important brain function, and is impaired with brain lesions. Resection of the lesion is one solution for that, but presurgical planning (PSP) is needed to guide the surgery for maximum removal of the lesion, as well as maximum preservation of the function. Functional Magnetic Resonance Imaging (fMRI) is one of the best approaches for such a purpose, but performing an fMRI study needs careful consideration of the factors which influence its results. Studies have shown that mental fatigue does have the potential to alter brain functions, and therefore this study aims to identify if mental fatigue should also be considered as a confounding factor when performing an fMRI study, particularly for clinical purposes. PATIENTS AND METHODS:Using 57 healthy young volunteers, face and word encoding tasks were performed, with half of the participants performing the memory tasks after a set of language tasks and half of them before that. RESULTS:The results showed that mental fatigue led to increased activity in the bilateral thalamus and caudate in the face encoding task, and in the right thalamus, posterior cingulate and medial temporal lobe in word encoding. In addition, activation was declined with mental fatigue in the left lingual, precuneus, and posterior cingulate gyri in face encoding. CONCLUSION:This study has shown the importance of the number and sequence of cognitive/mental tasks when performing an fMRI study, which could help to obtain more reliable fMRI maps in clinical applications. This finding is also important for performing research/cognitive studies using fMRI.

背景与目标： 目的：记忆是重要的大脑功能，并受到脑部损伤的损害。切除病灶是解决该问题的一种方法，但是需要术前计划（PSP）来指导手术，以最大程度地切除病灶并最大程度地保留功能。功能磁共振成像（fMRI）是实现此目的的最佳方法之一，但是进行fMRI研究需要仔细考虑影响其结果的因素。研究表明，精神疲劳确实具有改变大脑功能的潜力，因此，本研究旨在确定在进行功能磁共振成像研究时，特别是出于临床目的，是否也应将精神疲劳视为混杂因素。
患者和方法：使用57名健康的年轻志愿者，执行了面部和单词编码任务，其中一半的参与者在执行一组语言任务之后执行记忆任务，而另一半则在此之前。
结果：结果表明，精神疲劳导致面部编码任务中双侧丘脑和尾状核的活动增加，而单词编码中右丘脑，后扣带和颞中叶的活动增加。此外，在面部编码中，左舌，前突和后扣带回的精神疲劳导致激活降低。
结论：这项研究显示了进行功能磁共振成像研究时认知/心理任务的数量和顺序的重要性，这可能有助于在临床应用中获得更可靠的功能磁共振成像图。这一发现对于使用功能磁共振成像进行研究/认知研究也很重要。