TGI Friday! Our weekly round-up of recently published research abstracts | 27 December 2013

December 27, 2013

From Psychosomatics, 8 December 2013.

Original article

Chronic fatigue in adult survivors of childhood cancer: Associated symptoms, neuroendocrine markers and autonomic cardiovascular responses

Bernward Zeller(a), Ellen Ruud(a), Jon Havard Loge(b.c), Adriani Kanellopoulos(a), Hanne Hamre(b), Kristin Godang(d), Vegard Bruun Wyller(a)
a) Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway
b) National Resource Center for Late Effects after Cancer Treatment, Department of Oncology Oslo University Hospital, Oslo, Norway
c) Department of Behavioral Sciences in Medicine, University of Oslo, Norway
d) Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital, Oslo, Norway



Chronic fatigue (CF) is a common late effect after childhoodcancer. Based upon findings among patients with the chronic fatigue syndrome (CFS), this study explored symptoms, neuroendocrine markers and autonomic cardiovascular responses associated with CFS in childhood cancer survivors.


Long-term survivors of childhood lymphoma and acute lymphoblastic leukemia reporting CF were compared to survivors without CF. Data included patient-reported outcomes, clinical examination, head-up tilt test (HUT) and neuroendocrine markers in blood and urine.


Of 102 included survivors, 15 were excluded from comparative analyses due to significant comorbidity or pregnancy. Of the remaining 87 participants (median age 33.0 years, follow-up time 25.2 years), 35 had CF and 52 did not have CF. Compared to non-CF controls, CF cases reported significantly (p<.01) higher frequency of symptoms typical of the chronic fatigue syndrome (muscle and/or joint pain, feeling confused/disoriented) and symptoms of autonomic dysfunction (palpitations, feeling intermittently heat and cold, watery diarrhea). CF cases and controls did not differ regarding autonomic cardiovascular responses to orthostatic stress, but the CF group had lower levels of plasma ACTH (p=.002), and higher levels of urine norepinephrine (p=.017).CONCLUSIONS Survivors with CF reported a high symptom-burden compared to controls. There were few differences between the two groups regarding biomarkers, but slight alterations of the hypothalamus-pituitary-adrenal axis and sympathetic nervous activity were detected. CF in cancer survivors has features in common with the chronic fatigue syndrome, but further efforts are required to clarify the pathophysiology.

From Psihologijske Teme, December 2013.

Brief report: Writing about chronic fatigue increases somatic complaints

Marko Jelicic(*), Mincke Frederix, Harald Merckelbach
– Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
* Corresponding author. Marko Jelicic, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. E-mail:


Participants were instructed to imagine that either they or a friend were suffering from chronic fatigue syndrome (CFS) and were asked to fabricate a story about how CFS affected their own or their friend's daily functioning. Control participants were not given an imagination exercise but were asked to write about their study choice. After the writing exercise, all participants completed the Symptom Checklist-90 (SCL-90). Participants who had written a story about how CFS symptoms affected daily life (either their own life or that of a friend) had higher scores on the Somatization subscale of the SCL 90 than controls. This finding resembles the misinformation effect documented by memory research, and suggests that elaborative writing about illness, through its symptom-escalating power, has iatrogenic potential.

From International Immunology, published 16 December 2013.

The Role of Adaptive and Innate Immune Cells in Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis

Ekua Weba Brenu(1,2,*), Teilah K. Huth(2), Sharni L. Hardcastle(2), Kirsty Fuller(2), Manprit Kaur(2), Samantha Johnston(2), Sandra B. Ramos(2), Don R. Staines(2,3) and Sonya M. Marshall-Gradisnik(1,2)
1) School of Medical Science, Griffith University, Gold Coast, Australia
2) The National Centre for Neuroimmunology and Emerging Diseases, Griffith Health Institute, Griffith University, Gold Coast, Australia
30 Queensland Health, Gold Coast Public Health Unit, Robina, Australia
↵*Corresponding author: Ekua Brenu Contact email: Griffith University, Medical Science, 16 High Street, 16 High Street, Southport, Queensland, Australia, 4215, Phone: +61 7 5678 9282


Perturbations in immune processes are a hallmark of a number of autoimmune and inflammatory disorders. Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) is an inflammatory disorder with possible autoimmune correlates, characterised by reduced Natural Killer (NK) cell activity, elevations in regulatory T cells (Tregs)and dysregulation in cytokine levels.

The purpose of this paper is to examine innate and adaptive immune cell phenotypes and functional characteristics that have not been previously examined in CFS/ME patients. 30 patients with CFS/ME and 25 non-fatigued controls were recruited for this study. Whole blood samples were collected from all participants for the assessment of cell phenotypes, functional properties, receptors, adhesion molecules, antigens and intracellular proteins using flow cytometric protocols.

The cells investigated included NK cells, dendritic cells (DCs), neutrophils, B cells, T cells, γδT cells and Tregs. Significant changes were observed in B cell subsets, Tregs, CD4+CD73+CD39+ T cells, cytotoxic activity, granzyme B, neutrophil antigens, TNF-α and IFN-γ in the CFS/ME patients in comparison to the non-fatigued controls.

Alterations in B cells, Tregs, NK cells and neutrophils suggest significant impairments in immune regulation in CFS/ME and these may have similarities to a number of autoimmune disorders.

From Physical Therapy, e-published 20 December 2013.

Can recovery of peripheral muscle function predict cognitive task performance in Chronic Fatigue Syndrome with and without Fibromyalgia?

Kelly Ickmans(1,2,3), Mira Meeus(2,3,4), Margot De Kooning(1,3,5), Luc Lambrecht(6), Nathalie Pattyn(7,8), and Jo Nijs(1,3)
1) Pain in Motion Research Group, Department of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
2) Pain in Motion Research Group, Division of Musculoskeletal Physiotherapy, Department of Health Care Sciences, Artesis University College, Antwerp, Belgium.
3) Pain in Motion Research Group, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
4) Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.
5) Department of Neurology, Faculty of Medicine, University of Antwerp.
6) Private practice of internal medicine, Ghent, Belgium.
7) Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel.
8) VIPER Research Unit, Royal Military Academy, Brussels, Belgium.
* Mailing address: Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium (



Both good physical and cognitive functioning have a positive influence on the execution of activities of daily living. Patients with chronic fatigue syndrome (CFS) as well as patients with fibromyalgia (FM) have marked cognitive deficits. Furthermore, a good physical and functional health status may have a positive impact on a variety of cognitive skills. A link that has already been observed in young and old healthy individuals, but in patients with CFS evidence is limited.


To examine whether recovery of upper limb muscle function could be a significant predictor of cognitive performance in patients with CFS and CFS with comorbid FM. Furthermore, this study determined whether cognitive performance is different in CFS patients with and without comorbid FM.


A case-control design.


Eighteen patients with CFS-only, 30 patients with CFS+FM, and 30 healthy inactive controls were studied. Participants first completed three performance-based cognitive tests designed to assess selective and sustained attention, cognitive inhibition, and working memory capacity. Seven days later, they performed a fatiguing upper limb exercise test with subsequent recovery measures.


Recovery of upper limb muscle function was found to be a significant predictor of cognitive performance in patients with CFS. Patients with CFS+FM, but not patients with CFS-only showed significantly decreased cognitive performance compared with the controls.


The cross-sectional nature of this study does not allow for inferences of causation.


The results suggest that a better physical health status could predict better mental health in patients with CFS. Furthermore, they underline disease heterogeneity, suggesting that reducing this in future research is important to better understand and uncover mechanisms regarding the nature of divers impairments in these patients.

From Neuropsychology, e-published, 23 December 2013.

Cognitive functioning in people with Chronic Fatigue Syndrome: A comparison between subjective and objective measures

Cockshell, Susan J.; Mathias, Jane L.



The purpose of this study was to examine the relationship between subjective and objective assessments of memory and attention in people with chronic fatigue syndrome (CFS), using tests that have previously detected deficits in CFS samples and measures of potential confounds.


Fifty people with CFS and 50 healthy controls were compared on subjective (memory and attention symptom severity, Cognitive Failures Questionnaire, Everyday Attention Questionnaires) and objective (California Verbal Learning Test, Rey-Osterreith Complex Figure Test, Paced Auditory Serial Addition Test, Stroop task) measures of memory and attention. Fatigue, sleep, depression, and anxiety were also assessed.


The CFS group reported experiencing more cognitive problems than the controls, but the two groups did not differ on the cognitive tests. Scores on the subjective and objective measures were not correlated in either group. Depression was positively correlated with increased severity of cognitive problems in both the CFS and control groups.


There is little evidence for a relationship between subjective and objective measures of cognitive functioning for both people with CFS and healthy controls, which suggests that they may be capturing different constructs. Problems with memory and attention in everyday life are a significant part of CFS. Depression appears to be related to subjective problems but does not fully explain them.

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