TNF and hydrops fetalis: There is some evidence that pro-inflammatory cytokines (e.g., IL-1β, TNF-α, IL-6) reduce HRV including HF, LF, and total power of HRV (53–56), and extensive studies have reported that various cytokines are associated with the pathogenesis of fatigue in various diseases such as CFS, cancers, and multiple sclerosis (57–59).