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Autophagy has recently been shown to be required for tapetal programmed cell death (PCD) and pollen maturation in rice. A transcriptional regulatory network is also known to play a key role in the progression of tapetal PCD. However, the relationship between the gene regulatory network and autophagy in rice anther development is mostly unknown. Here, we comprehensively analyzed the effect of autophagy disruption on gene expression profile during the tapetal PCD in rice anther development using high-throughput RNA sequencing. Expression of thousands of genes, including specific transcription factors and several proteases required for tapetal degradation, fluctuated synchronously at specific stages during tapetal PCD progression in the wild-type anthers, while this fluctuation showed significant delay in the autophagy-deficient mutant Osatg7-1. Moreover, gene ontology enrichment analysis in combination with self-organizing map clustering as well as pathway analysis revealed that the expression patterns of a variety of organelle-related genes as well as genes involved in carbohydrate/lipid metabolism were affected in the Osatg7-1 mutant during pollen maturation. These results suggest that autophagy is required for proper regulation of gene expression and quality control of organelles and timely progression of tapetal PCD during rice pollen development.

Purpose: Daily variations of physical activity in the elderly remain unclear. We thus used a uniaxial accelerometer/pedometer to examine the variability of step counts for 1 yr, determining the minimum number of days observation needed to obtain reliable estimates of annual physical activity. Methods: Subjects were 37 males and 44 females, healthy Japanese, aged 65-83 yr. The pedometer was worn on the waistband throughout 1 yr, accumulating information on the individual's daily step count. Results: The step count spectrum showed peaks with periods of 2.3, 3.5, and 7.0 d and an aperiodic component that had a greater power at low frequencies (i.e., non-white noise). These characteristics were absent in randomly resequenced data. To ensure that 80% of total variance was attributable to between-subjects variance, 25 and 8 consecutive days of observation were needed in male and female subjects, respectively. To achieve 90% on this same measure of reliability, 105 and 37 consecutive days of observation were required. In contrast, 4 d of randomly timed observations yielded 80% reliability for both men and women, and 11 and 9 d gave 90% reliability in men and women, respectively. If sampling also took account of season and day of the week, the respective observation periods for men and women were reduced to 8 and 4 d (i.e., 2 and 1 consecutive days of sampling every 89 d) for 80% and to 16 and 12 d (i.e., 4 and 3 consecutive days every 89 d) for 90% reliability. Conclusion: When estimating annual step counts, seasonal and/or random sampling of data allows collection of reliable data during substantially fewer days than needed for consecutive observations. [ABSTRACT FROM AUTHOR]

An abstract of the "Sleep is not disrupted by exercise in patients with chronic fatigue syndromes," by F. Togo and colleagues is presented.

Background: Having no or few confidants is found to be associated with more severe mental health problems and a higher prevalence of depression in adults, but research examining this association in adolescents is scarce. Social relationships may be particularly critical during adolescence, as it is an important developmental period during which vulnerability to mental health problems increases. The present study examined the relationship between having no or few confidants and anxiety/depressive symptoms in adolescents., Methods: Cross-sectional self-report survey targeting 7-12th grade students (age range: 12-18) was conducted in public junior and senior high schools in Mie and Kochi, Japan. Data from 17,829 students (49.7% boys) were analyzed. Associations between anxiety/depressive symptoms (12-item General Health Questionnaire; score range: 0-12) and the number of confidants (None, 1-3, or ≥ 4) were examined using multilevel regression analyses. The analyses were stratified by gender and school level (junior/senior high), and adjusted for experiences of being physically abused and bullied and the interactions of these experiences with the number of confidants., Results: Having no or 1-3 confidants was associated with more anxiety/depressive symptoms, compared to having ≥ 4 confidants (p < 0.001) in all stratified groups. Having no confidants was associated with more anxiety/depressive symptoms than having 1-3 confidants (p < 0.001); in senior high boys, no difference was observed between having no confidants and having 1-3 confidants. In addition, in senior high boys, victims of bullying who have confidants reported significantly less anxiety/depressive symptoms than the victims who have no confidants (p < 0.01)., Conclusions: Adolescents who had no or few confidants had more anxiety/depressive symptoms. Attention needs to be paid to better identify these adolescents, and avenues to support them need to be established., (© 2024. The Author(s).)

Introduction: Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers., Methods: Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors)., Results: The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively., Conclusions: Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kusaka, Foo, Yamaguchi, Yukawa, Arai, Sawamura, Togo and Sasaki.)

Objective: Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers., Design: Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants., Setting: A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions., Participants: A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis., Results: The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality., Conclusions: Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

Study Objectives: Despite considering it as a common geriatric condition, sarcopenia is linked to various behavioral factors that may be changeable. As sleep is one of the important routines in physiological homeostasis, further investigating the underlying relationships of sleep behavior with sarcopenia is urgently needed. We examined the association between sleep parameters (ie, sleep duration, bedtime, wake time, or midsleep time) and sarcopenia risks in older adults, in the total sample and age group subsamples., Methods: A total of 1,068 older adults in Taiwan were included. Data on bedtime, wake time, and sleep duration were collected through telephone interview. Midsleep time was calculated by the midpoint of bedtime and wake time. Sarcopenia was screened by the SARC-F questionnaire composed of 5 questions (the strength, assistance in walking, rising from a chair, climbing stairs, and falls) as well as higher scores was related to greater risks. Generalized additive models were conducted to examine the nonlinear relationships between sleep parameters and sarcopenia risks., Results: The covariate-adjusted analysis showed that a reverse J-shaped relationship for sleep duration and sarcopenia risk ( P < .001) and a significant association for wake time and the SARC-F score ( P  = .009) in total sample, with considering age-related interaction. No associations were found in the other sleep parameters (bedtime and midsleep time) and sarcopenia in older adults. Similar associations were observed between wake time and the SARC-F score across age groups, while diverse associations of sleep duration with the SARC-F score were found in different age groups., Conclusions: The sleep pattern is significantly associated with sarcopenia risks in aging adults. Improving inappropriate sleep behaviors in older adults is suggested to prevent a decline in muscle function and promote healthy aging., Citation: Huang W-C, Lin C-Y, Togo F, et al. Nonlinear associations between sleep patterns and sarcopenia risks in older adults. J Clin Sleep Med . 2022;18(3):731-738., (© 2022 American Academy of Sleep Medicine.)

Background: School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers., Methods: Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students., Results: The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%)., Conclusions: MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems., (© 2021. The Author(s).)

Study Objectives: The aim of this research was to investigate the relationships between objectively measured sleep duration and physical function in older adults., Methods: We recruited community-dwelling older adults aged ≥ 60 years old in Taipei City, Taiwan. Sleep duration was measured with accelerometers and recorded as the total hours of sleep per night for each participant. The following physical functions were assessed: 1) grip strength (measured by handgrip dynamometer), 2) balance (1-leg standing test), 3) lower body strength (5-timed chair stand), 4) basic mobility (timed up and go test), 5) gait speed (5-m walk test). The relationships between sleep duration and physical function outcomes were analyzed using generalized additive models, controlling for objectively measured sedentary behavior and moderate-to-vigorous physical activity, and other sociodemographic variables., Results: A total of 121 older adults (men = 28.9%; mean age = 70.0 ± 5.0 years) was included in this study. A positive association of sleep duration with grip strength was found after adjusting for covariates (P = .005). No significant associations were observed between sleep duration and the other physical function outcomes., Conclusions: For older adults, lengthening their sleep duration may be helpful to enhance the grip strength. This result has implications for improving their health by targeting better performance in specific physical functions. Further studies of sleep duration and physical function among older adults should investigate the underlying mechanisms., (© 2021 American Academy of Sleep Medicine.)

Weight status and self-weight perception are related to social relationship issues. Studies have suggested links between non-normal weight status or weight perception and youths having fewer confidants, but these relationships are unclear and remain to be studied. This preliminary cross-sectional study examined the effects of weight status and weight perception on the number of confidants in adolescents. Self-report data from 15,279 grade 7-12 students (54.2% boys) were analyzed. The number of confidants (0-3 or ≥ 4) was examined, according to five weight status categories (underweight, low-normal weight, mid-normal weight (reference), high-normal weight, overweight, with Body Mass Index corresponding to ≤ 18.5, ≤ 20.0, ≤ 22.5, ≤ 25.0 and > 25.0 in adults, respectively), and five weight perception categories (too thin, a bit thin, good (reference), a bit fat, too fat). Boys and girls who were overweight and those who perceived themselves to be too fat were significantly more likely to have few confidants. High-normal weight in girls and self-perception of being a bit fat in boys were also associated with having few confidants. In boys, underweight and self-perception of being too thin were additionally associated with having few confidants. Adolescents with non-normal weight status or weight perception may have fewer confidants and require more social support., Competing Interests: The authors have declared that no competing interests exist.

There is growing interest in within-person associations of objectively measured physical and physiological variables with psychological states in daily life. Here we provide a practical guide with SAS code of multilevel modeling for analyzing physical activity data obtained by accelerometer and self-report data from intensive and repeated measures using ecological momentary assessments (EMA). We review previous applications of EMA in research and clinical settings and the analytical tools that are useful for EMA research. We exemplify the analyses of EMA data with cases on physical activity data and affect and discuss the future challenges in the field.

Objective: Galvanic vestibular stimulation (GVS) delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information. The purpose of this study was to examine the effect of an imperceptible level noisy GVS on ocular vestibular-evoked myogenic potentials (oVEMPs) in response to bone-conducted vibration (BCV)., Materials and Methods: oVEMPs to BCV were measured during the application of white noise GVS with an amplitude ranging from 0 to 300 µA [in root mean square (RMS)] in 20 healthy subjects. Artifacts in the oVEMPs caused by GVS were reduced by inverting the waveforms of noisy GVS in the later half of the stimulus from the one in the early half. We examined the amplitudes of N1 and N1-P1 and their latencies., Results: Noisy GVS significantly increased the N1 and N1-P1 amplitudes ( p  < 0.05) whereas it had no significant effects on N1 or P1 latencies ( p  > 0.05). Noisy GVS had facilitatory effects in 79% of ears. The amplitude of the optimal stimulus was 127 ± 14 µA, and it increased the N1 and N1-P1 amplitude by 75.9 ± 15% and 47.7 ± 9.1%, respectively, as compared with 0 µA session ( p  < 0.05)., Conclusion: Noisy GVS can increase the amplitude of oVEMPs to BCV in healthy subjects probably via stochastic resonance. The results of the present study suggest that noisy GVS may improve static and dynamic postural stability by enhancing the function of the vestibular afferents.

Objectives: Our study examines differences in eating behaviour between day workers and rotating shift workers, and considers whether diurnal preference could explain the differences., Methods: Japanese female nurses were studied (39 day workers and 123 rotating shift workers, aged 21-63 years) using self-administered questionnaires. The questionnaires assessed eating behaviours, diurnal preference and demographic characteristics. The questionnaire in the Guidelines for the management of obesity disease issued by the Japan Society for the Study of Obesity was used to obtain scores for the levels of obesity-related eating behaviours, including cognition of constitution, motivation for eating, eating as a diversion, feeling of satiety, eating style, meal contents and temporal eating patterns. The Japanese version of the Morningness-Eveningness (ME) questionnaire was used to measure self-rated preference for the degree to which people prefer to be active in the morning or the evening (ME)., Results: The scores for meal contents and temporal eating patterns in rotating shift workers were significantly higher than those in day workers. The ME score of rotating shift workers was significantly lower, indicating greater eveningness/less morningness among rotating shift workers. Multivariate linear regression revealed that the ME score was significantly negatively associated with temporal eating patterns and showed a negative association with the score for meal contents at a trend level, while current work shift was not significantly correlated with the scores., Conclusions: These results suggest that eating behaviours for rotating shift workers are associated with a more unbalanced diet and abnormal temporal eating patterns and that the associations may be explained by diurnal preference rather than by rotating shift work., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Vestibular dysfunction causes postural instability, which is prevalent in the elderly. We previously showed that an imperceptible level of noisy galvanic vestibular stimulation (nGVS) can improve postural stability in patients with bilateral vestibulopathy during the stimulus, presumably by enhancing vestibular information processing. In this study, we investigated the after-effects of an imperceptible long-duration nGVS on body balance in elderly adults. Thirty elderly participants underwent two nGVS sessions in a randomised order. In Session 1, participants received nGVS for 30 min twice with a 4-h interval. In Session 2, participants received nGVS for 3 h. Two-legged stance tasks were performed with eyes closed while participants stood on a foam rubber surface, with and without nGVS, and parameters related to postural stability were measured using posturography. In both sessions, the postural stability was markedly improved for more than 2 h after the cessation of the stimulus and tended to decrease thereafter. The second stimulation in Session 1 caused a moderate additional improvement in body balance and promoted the sustainability of the improvement. These results suggest that nGVS can lead to a postural stability improvement in elderly adults that lasts for several hours after the cessation of the stimulus, probably via vestibular neuroplasticity.

Unlabelled: Milnacipran, a serotonin/norepinephrine reuptake inhibitor, has been approved by the US Food and Drug Administration for the treatment of fibromyalgia (FM). This report presents the results of a randomized, double-blind, placebo-controlled trial of milnacipran conducted to test the hypotheses that a) similar to patients with chronic fatigue syndrome, patients with FM have increased ventricular lactate levels at baseline; b) 8 weeks of treatment with milnacipran will lower ventricular lactate levels compared with baseline levels and with ventricular lactate levels after placebo; and c) treatment with milnacipran will improve attention and executive function in the Attention Network Test compared with placebo. In addition, we examined the results for potential associations between ventricular lactate and pain. Baseline ventricular lactate measured by proton magnetic resonance spectroscopic imaging was found to be higher in patients with FM than in healthy controls (F1,37 = 22.11, P < .0001, partial η(2) = .37). Milnacipran reduced pain in patients with FM relative to placebo but had no effect on cognitive processing. At the end of the study, ventricular lactate levels in the milnacipran-treated group had decreased significantly compared with baseline and after placebo (F1,18 = 8.18, P = .01, partial η(2) = .31). A significantly larger proportion of patients treated with milnacipran showed decreases in both ventricular lactate and pain than those treated with placebo (P = .03). These results suggest that proton magnetic resonance spectroscopic imaging measurements of lactate may serve as a potential biomarker for a therapeutic response in FM and that milnacipran may act, at least in part, by targeting the brain response to glial activation and neuroinflammation., Perspective: Patients treated with milnacipran showed decreases in both pain and ventricular lactate levels compared with those treated with placebo, but, even after treatment, levels of ventricular lactate remained higher than in controls. The hypothesized mechanism for these decreases is via drug-induced reductions of a central inflammatory state., (Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.)

Aims: Improving knowledge and beliefs about mental health (or mental health literacy [MHL]) may promote appropriate help-seeking by adolescents who are suffering from mental health problems. We developed a concise, school-staff-led MHL program and examined its effects., Methods: The participants comprised 118 grade-9 students (61 boys and 57 girls). The program consisted of two 50-min sessions, and was given by a schoolteacher. The effects of the program were evaluated before, immediately after and 3 months after the program, using a self-report questionnaire., Results: Knowledge of mental health/illnesses and desirable behavior for help-seeking were significantly improved immediately after (post-test, P < 0.001, and P < 0.001, respectively) and 3 months after the program (3-month follow up, P < 0.001 and P < 0.001, respectively), compared with the test before the delivery of the program (pre-test, Wilcoxon signed rank test). Proportions of the correct diagnoses of vignette cases of major depression and schizophrenia were significantly (P < 0.001) elevated from 38.3% and 19.1% (pre-test) to 94.7% and 93.6% (post-test), and 91.5% and 86.2% (3-month follow up). Intentions to seek help and to provide peers with help with mental health problems were also significantly (P < 0.001) elevated at post-test and at 3 months compared with the pre-test., Conclusions: A concise, school-staff-led program may have a significant effect on the improvement of MHL in secondary school students., (© 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.)

Objective: Higher body mass index (BMI) values have been reported in rotating shift workers compared with regular daytime workers. This study examines the relationship between work schedule and BMI, and considers whether lifestyle habits could explain the relationship., Methods: Japanese female nurses (1179 day workers and 1579 rotating shift workers, aged 20-59) were studied using self-administered questionnaires. The questionnaires assessed height, weight, and dietary intake, physical activity, and sleep (lifestyle) habits., Results: The BMI of shift workers was significantly higher than that of day workers. Shift workers consumed significantly higher amounts of sugar-sweetened beverages and slept for significantly shorter durations on nights between days on the day shift compared with day workers-factors which were also independently associated with higher BMI. In addition, multivariable linear regression coefficients for BMI showed a significant correlation with rotating shift work (β = 0.051), after controlling for lifestyle habits., Conclusions: Higher consumption of sugar-sweetened beverages and shorter sleep duration were associated with rotating shift work and higher BMI. This should be taken into consideration in preventing obesity in real-life shift work situations. Other shift work-related factors, such as abnormal timing of meals and/or sleep, should also be identified., (© 2014 The Obesity Society.)

It has not hitherto been clarified whether there is an association between dietary behavior and circadian variation in autonomic nervous system activity among shift workers. This study examines diurnal 24-h rhythm in heart rate variability (HRV) and dietary behavior among rotating shift workers, while taking into account the sleep-wake cycle and physical activity. The subjects were 11 female and 2 male nurses or caregivers working in a rotating 2-shift system at a health care facility. All the subjects were asked to undergo 24-h electrocardiograph and step count recordings, and to record the time of each meal and the amounts of each food and beverage consumed. Coarse graining spectral analysis was used for approximately 10-min segments of HRV to derive the total power (TOT: >0.04 Hz) of the periodic components and the integrated power of periodic components in the low-frequency (LF: 0.04-0.15 Hz) and high-frequency (HF: >0.15 Hz) ranges. Then the ratio of HF power to TOT (HF nu) and the ratio of LF power to HF power (LF/HF) were calculated to assess cardiac vagal tone and cardiac sympathovagal balance, respectively. Single cosinor analysis was used to obtain 24-h period variations in both variables of HRV. Acrophases of HF nu and LF/HF expressed in time since awakening were significantly (p<0.05) delayed for subjects having breakfast at a later time after awakening. Multivariable regression analysis indicated that the timing of breakfast, the ratio of energy intake at dinner to total energy intake, and total energy intake were correlated to the acrophases of HF nu and/or LF/HF. These results suggest that the phase angle between circadian variation in cardiac autonomic nervous system activity and the sleep-wake cycle may be associated with dietary behavior in shift workers.

Purpose: Being bullied is associated with the manifestation of suicidal feelings, which sharply increase in middle(-late) adolescence. Whether or not bullied middle(-late) adolescents with suicidal feelings seek help is therefore a critical issue, given that help-seeking plays a key role in the prevention of suicide. The aim of the present study is to investigate the effects of bullying, suicidal feelings and the interaction between these two factors on help-seeking behavior in adolescents., Methods: Japanese middle(-late) adolescents (aged 15-18 years; n = 9484) were studied using self-report questionnaires. The rate of adolescents who actually sought help was examined for bullying status and suicidal feelings., Results: The rate of adolescents who sought help was significantly higher when they were bullied (p<0.001) and also when they had mild suicidal feelings (p<0.001), but not when they displayed serious suicidal feelings. In the case of adolescents who were bullied, however, having suicidal feelings significantly decreased the rate of help-seeking (OR = 0.47, p<0.05 and OR = 0.32, p = 0.002 for having mild and serious suicidal feelings, respectively). The decrease was remarkable when suicidal feelings were serious. Specifically, the decrease was significant in seeking help from peers and family members, who are the most frequent source of the help for adolescents, when they had serious suicidal feelings (OR = 0.21, p<0.01 and OR = 0.13, p<0.001, respectively)., Conclusions: Suicidal feelings may interfere with help-seeking behavior, which could be critical in suicide prevention in bullied middle(-late) adolescents.

Effects of exercise on dynamic aspects of sleep have not been studied. We hypothesized exercise altered dynamic sleep morphology differently for healthy controls relative to chronic fatigue syndrome (CFS) patients. Sixteen controls (38 ± 9 years) and 17 CFS patients (41 ± 8 years) underwent polysomnography on baseline nights and nights after maximal exercise testing. We calculated transition probabilities and rates (as a measure of relative and temporal transition frequency, respectively) between sleep stages and cumulative duration distributions (as a measure of continuity) of each sleep stage and sleep as a whole. After exercise, controls showed a significantly greater probability of transition from N1 to N2 and a lower rate of transition from N1 to wake than at baseline; CFS showed a significantly greater probability of transition from N2 to N3 and a lower rate of transition from N2 to N1. These findings suggest improved quality of sleep after exercise. After exercise, controls had improved sleep continuity, whereas CFS had less continuous N1 and more continuous rapid eye movement (REM) sleep. However, CFS had a significantly greater probability and rate of transition from REM to wake than controls. Probability of transition from REM to wake correlated significantly with increases in subjective fatigue, pain, and sleepiness overnight in CFS - suggesting these transitions may relate to patient complaints of unrefreshing sleep. Thus, exercise promoted transitions to deeper sleep stages and inhibited transitions to lighter sleep stages for controls and CFS, but CFS also reported increased fatigue and continued to have REM sleep disruption. This dissociation suggests possible mechanistic pathways for the underlying pathology of CFS.

A major hypothesis regarding the cause of chronic fatigue syndrome (CFS) is immune dysregulation, thought to be reflected in upregulated proinflammatory cytokines leading to the symptoms that are characteristic of this illness. Because the symptoms worsen with physical exertion or sleep loss, we hypothesized that we could use these stressors to magnify the underlying potential pathogenic abnormalities in the cytokine systems of people with CFS. We conducted repeat blood sampling for cytokine levels from healthy subjects and CFS patients during both postexercise and total sleep deprivation nights and assayed for protein levels in the blood samples, mRNA activity in peripheral blood lymphocytes (PBLs), and function in resting and stimulated PBLs. We found that these environmental manipulations did not produce clinically significant upregulation of proinflammatory cytokines. These data do not support an important role of immune dysregulation in the genesis of stress-induced worsening of CFS.

Unlabelled: Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are chronic multisymptom illnesses with substantial clinical and diagnostic overlap. We have previously shown that, when controlling for aerobic fitness and accounting for comorbid FM, CFS patients do not exhibit abnormal cardiorespiratory responses during maximal aerobic exercise compared with healthy controls, despite differences in pain and exertion., Purpose: The purpose of the present study was to examine cardiac and perceptual responses to steady-state submaximal exercise in CFS patients and healthy controls., Methods: Twenty-one CFS patients (13 CFS with comorbid FM (CFS + FM)) and 14 controls completed 20 min of submaximal cycling exercise. Impedance cardiography was used to determine cardiac responses during exercise. Systolic blood pressure (SBP), RPE, and leg muscle pain were also measured. Data were analyzed using a doubly multivariate, repeated-measures MANOVA to model the exercise response., Results: There was a significant multivariate time-by-group interaction (P < 0.05). The CFS + FM group exhibited an exercise response characterized by higher stroke index, ventilatory equivalents for oxygen and carbon dioxide and RPE, lower SBP, and similar HR responses compared to controls., Conclusions: The present results extend on our previous work with maximal exercise and show that CFS and CFS + FM differ in their responses to steady-state exercise. These results highlight the importance of accounting for comorbid conditions when conducting CFS research, particularly when examining psychophysiological responses to exercise.

Background: The refinement of the use of platelet-derived growth factors that has occurred over the last decade has led to a broadening of the fields of use, in particular for new treatments in orthopaedics aimed at improving tissue regeneration., Materials and Methods: Twenty-seven patients, aged between 18 and 81 years, with a diagnosis of degenerative joint disease lasting for more than 1 year were treated. The patients were divided into two groups, one with arthritis of the knee, the other with degenerative cartilage disease of the knee. Both groups were treated with a therapeutic protocol consisting of a cycle of three infiltrations of platelet-rich plasma at weekly intervals.The extemporaneous preparation was made from a sample of about 8 mL of venous whole blood collected into a specific Fibrin Polymer 2 test-tube from RegenLab(®) and centrifuged before addition of calcium gluconate.During the initial pre-treatment evaluation, specific questionnaires were administered, the Numerical Rating Scale (NRS) for subjective measurement of pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); these assessments were repeated 7 days after the end of the treatment and at 6 months during the follow-up., Results: The parameters evaluated improved in both groups after treatment and there was a further improvement after 6 months of follow-up; furthermore, there was a substantial decrease in pain right after the first infiltration., Discussion: The patients were treated on an out-patient basis by a specifically created multidisciplinary team comprising a transfusion specialist, an orthopaedist and a radiologist, who collaborate in a symbiotic manner. The out-patient protocol exploits the regenerative properties of platelet-rich plasma, which is a low cost treatment; in practice, a diagnostic-therapeutic programme of lower intensity, but of high technical and professional quality is created. The strategy also reduces both the number of hospital services and the pharmacological support required, thereby optimising the use of health care resources.

The symptoms of chronic fatigue syndrome (CFS) are consistent with cytokine dysregulation. This has led to the hypothesis of immune dysregulation as the cause of this illness. To further test this hypothesis, we did repeated blood sampling for cytokines while patients and matched healthy controls slept in the sleep lab. Because no one method for assaying cytokines is acknowledged to be better than another, we assayed for protein in serum, message in peripheral blood lymphocytes (PBLs), and function in resting and stimulated PBLs. We found no evidence of proinflammatory cytokine upregulation. Instead, in line with some of our earlier studies, we did find some evidence to support a role for an increase in interleukin-10, an anti-inflammatory cytokine. Although the changes were small, they may contribute to the common complaint in CFS patients of disrupted sleep.

Purpose: Patients with chronic fatigue syndrome (CFS) report that exertion produces dramatic symptom worsening. We hypothesized this might be due to the exacerbation of an underlying sleep disorder, which we have previously demonstrated to exist., Methods: Female patients with CFS and matched healthy controls with no evidence of major depressive disorder were studied with overnight polysomnography on a baseline night and on a night after their performance of a maximal exercise test., Results: CFS patients as a group had evidence for disturbed sleep compared with controls. Although exercise improved sleep for healthy subjects, it did not do this for the group as a whole. When we stratified the sample on the basis of self-reported sleepiness after a night's sleep, the patient group with reduced morning sleepiness showed improvement in sleep structure, whereas those with increased morning sleepiness continued to show evidence for sleep disruption., Conclusions: Sleep is disturbed in CFS patients as a group, but exercise does not exacerbate this sleep disturbance. Approximately half the patients studied actually sleep better after exercise. Therefore, activity-related symptom worsening is not caused by worsened sleep.

This systematic review evaluates and summarizes the evidence of association between work-related factors and heart rate variability (HRV) in workers. We reviewed English articles indexed in MEDLINE under the key words: work, worker, occupational, industrial, and heart rate variability. Studies were included if one or more of the dependent variables was one of the time- or frequency-domain indexes of HRV [standard deviation of all normal-to-normal (NN) intervals (SDNN), mean of the 5-min standard deviations of NN intervals calculated over several hours (SDNN index), the root mean squared differences of successive NN intervals (RMSSD), integrated spectral powers of high (HF, > 0.15 Hz) and low frequency (LF, 0.04-0.15 Hz) HRV, and the LF/HF ratio] as recommended by the European Society of Cardiology and the North American Society of Pacing Electrophysiology. Physical and chemical work environments (i.e. exposure to occupational toxicants and hazardous environments), psychosocial workload (i.e. job stressors), and working time (i.e. shift work) had been examined and identified as having associations with low HF power. These findings may indicate that research into parasympathetic nervous system activity should be focused to protect cardiovascular health at work. We also propose the use of very low and ultralow frequency HRV components in autonomic research for workers' health.

Physiological and/or pathological implications of the dynamics of sleep stage transitions have not, to date, been investigated. We report detailed duration and transition statistics between sleep stages in healthy subjects and in others with chronic fatigue syndrome (CFS); in addition, we also compare our data with previously published results for rats. Twenty-two healthy females and 22 female patients with CFS, characterized by complaints of unrefreshing sleep, underwent one night of polysomnographic recording. We find that duration of deep sleep (stages III and IV) follows a power-law probability distribution function; in contrast, stage II sleep durations follow a stretched exponential and stage I, and REM sleep durations follow an exponential function. These stage duration distributions show a gradually increasing departure from the exponential form with increasing depth of sleep toward a power-law type distribution for deep sleep, suggesting increasing complexity of regulation of deeper sleep stages. We also find a substantial number of REM to non-REM sleep transitions in humans, while this transition is reported to be virtually nonexistent in rats. The relative frequency of this REM to non-REM sleep transition is significantly lower in CFS patients than in controls, resulting in a significantly greater relative transition frequency of moving from both REM and stage I sleep to awake. Such an alteration in the transition pattern suggests that the normal continuation of sleep in light or REM sleep is disrupted in CFS. We conclude that dynamic transition analysis of sleep stages is useful for elucidating yet-to-be-determined human sleep regulation mechanisms with pathophysiological implications.

Introduction: We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal., Methods: We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase., Results: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group., Conclusion: CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.

Seasonal changes in ambient temperature and day length are thought to modify habitual physical activity. However, relationships between such environmental factors and the daily physical activity of older populations remain unclear. The present study thus examined associations between meteorological variables and the number of steps taken per day by elderly Japanese. Continuous pedometer counts over a 450-day period were collected from 41 healthy subjects (age 71+/-4 years), none of whom engaged in any specific occupational activity or exercise programs. An electronic physical activity monitor was attached to a belt worn on the left side of the body throughout the day. Daily values for mean ambient temperature, duration of bright sunshine, mean wind speed, mean relative humidity, and precipitation were obtained from local meteorological stations. The day length was calculated from times of sunrise and sunset. Based on the entire group of 41 subjects (ensemble average), a subject's step count per day decreased exponentially with increasing precipitation (r2=0.19, P<0.05). On days when precipitation was <1 mm, the step count increased with the mean ambient temperature over the range of -2 to 17 degrees C, but decreased over the range 17-29 degrees C. The daily step count also tended to increase with day length, but the regression coefficient of determination attributable to step count and mean ambient temperature (r2=0.32, P<0.05) exceeded that linking the step count and day length (r2=0.13, P<0.05). The influence of other meteorological factors was small (r2

The physiological significance of the fractal component of short-term, spontaneous heart rate variability (HRV) in humans remains unclear. The aim of the present study was to gain further information about the respective fractal components by extracting them from HRV, blood pressure variability (BPV), and instantaneous lung volume (ILV) time series via coarse graining spectral analysis in nine healthy subjects during waking and sleep states. The results show that the contribution made by the fractal component to the total variance in the beat-to-beat R-R interval declined significantly as the depth of non-rapid eye movement (non-REM) sleep increased, that the ILV time series was largely periodic (i.e., nonfractal), and that BPV was unaffected by sleep stage. Finally, the fractal component of HRV during REM sleep was found to be quite similar to that seen during waking. These results suggest that mechanisms involving electroencephalographic desynchronization and/or conscious states of the brain are reflected in the fractal component of HRV.