TGI Friday! Our weekly round-up of recently published research abstracts | 4 July 2014

July 4, 2014

From Frontiers in Neurology, 23 June 2014. Full text available

Original Research ARTICLE

Sleep disturbances and autonomic dysfunction in patients with postural orthostatic tachycardia syndrome

Julia Mallien(2), Stefan Isenmann(2), Anne Mrazek(2) and Carl-Albrecht Haensch(1)
1) Department of Neurology, Maria Hilf Kliniken Mönchengladbach, Germany
2) Department of Neurology, HELIOS Klinkum Wuppertal, University of Witten/Herdecke, Germany


Many patients with Postural Tachycardia Syndrome (PoTS) suffer from fatigue, daytime sleepiness and sleeping disturbances.

The objective of this study was to compare subjective and objective sleep quality of PoTS patients with a group of healthy controls.

All patients completed a Pittsburgh Sleep Quality Index questionnaire and the Epworth Sleepiness Scale. The patients sleep architecture, heart rate and heart rate variability measurements were taken during one night at the sleep laboratorium.

All Data was collected at the Sleep Unit, at Helios Klinikum Wuppertal. 38 patients diagnosed with PoTS were compared to 31 healthy controls, matched in age and gender. Patients with PoTS reached significantly higher scores in sleep questionnaires, which means that they were more sleepy and had a lower sleep quality.

Polysomnography showed a significantly higher proportion of stage 2 sleep. The results of heart rate variability analysis in different sleep stages confirmed changes in autonomic activity in both groups. PoTS patients, however, showed a diminished variability of the LF band, HF band and LF/HF ratio in different sleep stages. It can therefore be gathererd that PoTS could be considered as potential differential diagnosis for sleep disturbances since PoTS patients had a subjective diminished sleep quality, reached higher levels of daytime sleepiness and showed a higher proportion of stage 2 sleep.

PoTS patients showed furthermore a reduction of LF/HF ratio variability in different sleep stages.

From the International Journal of Case Reports and Images, August 2014. Links to provisional full report.


“Flowers” in the blood: A novel paired erythrocyte arrangement in a patient with chronic fatigue syndrome following infectious mononucleosis

Carrie E Burdzinski
Assistant Professor, Department of Biology, Delta College, University Center, Michigan, USA



Chronic fatigue syndrome is a debilitating conditioN characterized by persistent fatigue, post-exertional malaise, myalgia, arthralgia, lymph node tenderness, impaired memory and concentration, autonomic irregularities, and other specific symptoms affecting multiple body systems.

Diverse hypotheses have been investigated to ascertain the disease etiology. Some of these include metabolic and mitochondrial deficiencies, exposure to environmental toxins, dysautonomia associated with orthostatic intolerance, autoimmune reactions, neuroendocrine aberrations, and chronic viral infections. However, a consistently observed biomarker for chronic fatigue has not
been identified. A comprehensive, standardized strategy for accurate diagnosis and successful treatment remains elusive.


A 28-year-old Caucasian female presented with chronic fatigue persisting for nine months following infectious mononucleosis. Laboratory evaluation excluded classic causes of fatigue. Peripheral blood smear examination revealed numerous pairs of unusual nondiscocytic C-shaped erythrocytes, coupled in perpendicular crosses resembling four-petalled flowers. The presence of the erythrocyte pairs abated with the patient’s recovery from chronic fatigue syndrome over a 24-month period. This erythrocyte arrangement has not been reported elsewhere in medical literature.


A novel erythrocyte “flower” formation was identified in a patient with chronic fatigue syndrome. The presence of this arrangement paralleled the course of the illness and was no longer observed upon recovery.

The physiological relevance of the structure remains a subject for future research. Several hypotheses are suggested, including enhanced membrane deformability resulting from elevated catecholamine levels, and immunemediated agglutination, possibly stemming from viral infection.

From Exercise Immunology Review, 2014 (actual date of publication not known).

Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review.

Jo Nijs(1-3), Andrea Nees(2), Lorna Paul(4), Margot De Kooning(1-3), Kelly Ickmans(1-3), Mira Meeus(1,5,6), Jessica Van Oosterwijck(1,2,5)
1) Pain in Motion research group,
2) Departments of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgiu
3) Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
4) Nursing and Health Care, School of Medicine, University of Glasgow, Glasgow, United Kingdom
5) Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium 6 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium


An increasing number of studies have examined how the immune system of patients with Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis, responds to exercise. The objective of the present study was to systematically review the scientific literature addressing exercise-induced immunological changes in CFS patients compared to healthy control subjects. A systematic literature search was conducted in the PubMed and Web of science databases using different keyword combinations.

We included 23 case control studies that examined whether CFS patients, compared to healthy sedentary controls, have a different immune response to exercise. The included articles were evaluated on their methodological quality.

Compared to the normal response of the immune system to exercise as seen in healthy subjects, patients with CFS have a more pronounced response in the complement system (i.e. C4a split product levels), oxidative stress system (i.e. enhanced oxidative stress combined with a delayed and reduced anti-oxidant response), and an alteration in the immune cells' gene expression profile (increases in post-exercise interleukin-10 and toll-like receptor 4 gene expression), but not in circulating pro- or anti-inflammatory cytokines.

Many of these immune changes relate to post-exertional malaise in CFS, a major characteristic of the illness. The literature review provides level B evidence for an altered immune response to exercise in patients with CFS.

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