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  • Fatigue is best defined as difficulty in initiating or sustaining voluntary activities
  • The fatigue sensation is thought to be one of the signals for the body to suppress physical activity in order to regain health.
  • Poly I:C injection induced prolonged upregulation of IFN-α mRNA in the cerebral cortex, hippocampus, and hypothalamic regions continuing for more than a week.

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  • A growing movement, exemplified by the Society for Participatory Medicine (www.ParticipatoryMedicine.org) and the annual Stanford Medicine X conference (http://medicinex.stanford.edu/), asserts that patients and clinicians must collaborate. Central to its belief is that whereas the physician brings training and clinical expertise, patients bring their life experience, their deep investment in the outcome of their case, their skills and resilience, and a unique perspective on needs and priorities. The movement recognises patient autonomy as a valid priority and patients’ hearts and minds as essential contributions to the best possible care. We believe that medicine cannot achieve its potential if it ignores the voice of thinking patients.

     

    This movement is not anti-physician, it’s about partnership.

    • What is a joint attorney?

       

      You can appoint any number of attorneys in the same lasting power of attorney. You need to decide whether the attorneys should act:

       
         
      • jointly - meaning they work together on all matters
      •  
      • jointly and severally - where they may act together or separately, as they choose.
      •  
       

      You can specify in the lasting power of attorney that the attorneys must act jointly for specific decisions, such as selling a house, and jointly and severally for all other decisions.

  • exuberant stimulation of cytokine-producing cells seen in the first 3 years of the illness leads to an “exhaustion” of the cytokine-producing cells thereafter
  • We did not pursue proteomic discovery with the goal of identifying noncytokine biomarkers
  • were conducted using only blood samples. Although blood is more easily obtained than cerebrospinal fluid, analysis of the latter may enable unique insights into immune activation in the central nervous system

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  • The new research suggests that these infections throw a wrench in the immune system’s ability to quiet itself after the acute infection, to return to a homeostatic balance; the immune response becomes like a car stuck in high gear. “It appears that ME/CFS patients are flush with cytokines until around the three-year mark, at which point the immune system shows evidence of exhaustion and cytokine levels drop,”
  • “Early diagnosis may provide unique opportunities for treatment that likely differ from those that would be appropriate in later phases of the illness.”

  • The new research suggests that these infections throw a wrench in the immune system's ability to quiet itself after the acute infection, to return to a homeostatic balance; the immune response becomes like a car stuck in high gear

  • The research team plans to publish data later this year on changes in individual cytokine profiles over time, tracking more closely how they fluctuate with the reported severity of symptoms and other factors, Dr. Hornig said.

  • Comparison is vs baseline (no control group), on a par with PACE Trial SMC group
     Note that these figures are a before/after comparison, with no control group to allow for any natural improvement or placebo effect. This study uses the same Fatigue and Physical Function measures as the PACE trial, and the patients in this study did about as well as the SMC group ("specialised" medical care, no CBT or GET), and less well than the PACE CBT/GET patients who had the same treatments.
     
     This study vs PACE SMC, baseline to 12 months
     Fatigue: -6.8 vs -4.5 (ie improved more* than PACE SMC)
     Physical Function: +4.4 vs +11.6 (ie improved less* than PACE SMC)
     
     *Physical Function difference between this study and PACE is almost certainly statistically significant due to the very large sample sizes, though the difference in fatigue might not be.
     
     This suggests that 'out in the wild', CBT and GET (and any othr treatment offered) are, overall, no better than SMC. 
     
     
     
         

  • . We conclude that after physically demanding exercise, CFS subjects demonstrated impaired cognitive processing compared with healthy individuals
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