Testosterone and Testosterone Binding Globulin (TeBG) in Young Men during Prolonged Stress

The effect of prolonged physical and psychological stress on the testicular function was studied in 8 students (age 22–25 years) of the Norwegian Academy of War during a combat course of 5 days' duration. The average urinary excretion of free cortisol and 17-ketogenic steroids was 81 and 129% higher than the respective control values one week after the course. Plasma cortisol levels increased from 21.7 μg/100 ml at 8 a. m. before the course to 24.6 ( P < 0.05), and serum HGH rose from undetectable levels, < 0.08 ng/ml, to an average value of 12.9 ng/ml ± 3.7 (SD) at 8 a. m. during the course.
A marked suppressive effect on plasma testosterone levels from 5.6 ng/ml ± 1.4 to 0.9 ± 0.5, and no adjustment to stress was observed over a 5 day period. TeBG increased gradually from 26.9 nmol/l ± 9.9 to 52.7 ± 17.7 on day 6, followed by a slow decrease without reaching control values on day 12, suggesting that the decreased plasma testosterone levels probably reflect reduced production and not increased metabolism of testosterone. LH fluctuated during the course, but was significantly higher in the morning immediately following the end of the course than at the start ( P < 0.02). It is postulated that the effect of stress on the plasma testosterone levels is mediated via an action both on the hypothalamus-pituitary level and on the testis.     

Influence of Oral Vitamin E Therapy on Micro-Inflammation and Cardiovascular Disease Markers in Chronic Hemodialysis Patients

Background. The aim of this study was to evaluate the influence of oral vitamin E therapy on serum concentrations of several markers of micro-inflammation and cardiovascular disease in chronic hemodialysis (HD) patients. Methods. 29 HD patients were randomized into two groups: 15 patients were treated orally with 400mg of vitamin E daily for a period of five weeks, and 14 patients received no antioxidant supplementation. Before and after vitamin E therapy, serum concentrations of vitamin E (high-performance liquid chromatography), pregnancy-associated plasma protein-A (immunochemical – TRACE assay), C-reactive protein (nephelometry), intercellular adhesion molecule-1 (ELISA), and E-selectin (ELISA) were measured. HD patients were compared with 16 healthy controls. Results. Baseline serum concentrations of PAPP-A and CRP were significantly higher in HD patients than in healthy controls (PAPP-A: 26.23±11.94 vs. 11.41±1.94 mIU/L, p<0.001; CRP: 5.20±3.50 vs. 3.40±3.80 mg/L, p<0.05). After five weeks of oral vitamin E intake, serum PAPP-A, CRP, ICAM-1, and E-selectin concentrations remained unchanged in both groups of HD patients. Conclusion. Chronic micro-inflammation in HD patients is documented by the elevation of CRP and PAPP-A. A daily oral dose of 400 mg of vitamin E does not seem to be able to reduce enhanced oxidative stress and micro-inflammation in chronic HD patients.     

Stress Effects: A Study of Salivary Cortisol Levels in Third‐year Medical Students

The physical, mental and emotional stresses experienced during the training and careers of physicians have been linked to increased rates of anxiety, depression and suicide. Increased stress leads to alterations in the hypothalamic–pituitary–adrenal (HPA) axis, which can determine multisystem modulations with acute and chronic consequences. This study investigated salivary cortisol patterns in third‐year medical students performing clinical work at a US medical school. Morning and evening salivary cortisol samples were collected from students during the last 2 weeks of each of three successive clinical rotations and while on vacation. Salivary cortisol levels were measured using Siemens radioimmunoassay kits (Siemens Medical Solutions Diagnostics, Los Angeles, CA, USA). Statistical analysis used mixed‐effects regression models. Eleven students submitted 64 salivary samples. Statistically significant blunting of the diurnal cortisol variation was observed in students on inpatient rotations. HPA axis changes occur in third‐year medical students performing inpatient clinical work. These findings can inform curriculum planning, rotation‐specific guidelines and the development of student wellness programmes. Copyright © 2011 John Wiley & Sons, Ltd.     

伐地那非治疗高血压患者勃起功能障碍的有效性和安全性

勃起功能障碍(erectile dysfunction,ED)在高血压患者中的发病率明显高于非高血压人群,由于担心联合用药会出现严重不良反应,医生往往不愿为该类患者处方治疗ED的药物。伐地那非是一种新型高选择性磷酸二酯酶5型抑制剂,它对心血管系统的安全性已被多项临床试验所证实。最近进行的一项大型临床研究表明,对于同时服用多种降压药的高血压合并ED患者,伐地那非能够显著改善患者的勃起功能,并且使用安全,尤其对于血压或心率等项指标均未见临床意义的改变。     

Stress and quality of sleep among individuals diagnosed with diabetes

Several studies have suggested that stress and sleep may be related to diabetic disease progression. Cortisol is one physiological indicator of stress that has been well validated in previous research. The primary objectives of the present study were (1) to examine the experiences of stress among patients diagnosed with diabetes and (2) to evaluate the quality of sleep among these participants. Participants (mean age = 34.99 years) were 20 adolescents and adults with Diabetes Mellitus; 13 had Type 1 and 17 were female. Primary measures included actigraphy, the Pittsburgh Sleep Quality Index (PSQI), salivary cortisol and the Perceived Stress Scale (PSS). Participants reported a moderate amount of stress (mean PSS scores = 20.2), slept an average of 6.51 h and exhibited at least one clinical indicator of sleep disturbance. Objectively measured total sleep time was associated with awakening cortisol (r = 0.62, p = 0.004) and PSQI Global scores (r = ‐0.51, p = 0.021). Awakening cortisol and PSS scores were not associated with PSQI Global scores, but were related to specific self‐reported sleep disturbances. Given the interacting physiological pathways of stress and sleep, both of which were evident in this small sample, these variables warrant further study. Copyright © 2009 John Wiley & Sons, Ltd.     

Relationship between Hair Cortisol and Perceived Chronic Stress in a Diverse Sample

Hair cortisol (CORT) is a biomarker of chronic stress via long‐term alterations in hypothalamus–pituitary–adrenal axis activity. Relationships to perceived stress measures, however, have rarely been specifically investigated. A diverse sample of 135 adults participated in a study assessing relationships between chronic stress indicator CORT to perceived stress and health indicators. CORT was not correlated to single perceived domain indices but with a global stress composite. Differences in objective and subjective measures were found for sociodemographics: racial/ethnic identity, sex and socioeconomic status (SES). Race by SES interactions predicted both CORT and perceived stress, but produced a complex and partially unanticipated pattern of results. For minorities, low and high SES showed the highest CORT, with mid‐SES showing the lowest CORT; there was little change in perceived stress at all levels of SES. For non‐minorities, mid‐SES showed the highest CORT, with decreases in both CORT and perceived stress in high SES. The unanticipated findings of deleterious outcomes for high SES minorities highlight the importance of investigating potential stressors and moderators, including perceived discrimination and social identity. Moreover, these results suggest that CORT may not always correlate with single stress indices but may provide a global assessment of chronic stress, with implications for the allostatic load literature. Copyright © 2012 John Wiley & Sons, Ltd.     

Effects of Caffeine Consumption on Autologous Full-Thickness Skin Graft Healing in an Animal Model

Background There exists contradictory evidence that states both the beneficial and deleterious effects of caffeine on wound healing. The general population might unknowingly consume caffeine that negatively affects wound healing. The main objective of this study is to investigate the effect of daily caffeine consumption on wound healing, specifically full-thickness skin graft (FTSG). Methods Forty Sprague–Dawley rats were randomized into four groups of equal size: control-dose (CD), low-dose (LD), medium-dose (MD), and high-dose (HD) caffeine groups. After autologous FTSG, all subjects in the intervention group were given daily pure caffeine gavage. The FTSG was explanted 7 days posttransplant. The graft viability, secondary contraction, and adherence were evaluated macroscopically, while fibroblast and collagen deposition was analyzed microscopically with hematoxylin eosin stain. Results The least graft viability (72.8 ± 20.7%, clinical wound assessment scale [CWAS] 2.4), highest secondary contraction (11.4 ± 10.5%), and fibroblast count (331.8 ± 88.6 cells/5 high power fields) were observed in the MD group. More collagen synthesis was observed in subjects who consumed caffeine. The level of secondary contraction, fibroblast count as well as graft viability and collagen synthesis were positively correlated. Conclusions Daily consumption of caffeine impairs graft viability when given in medium dose and increases collagen synthesis, irrespective of dosage. This study was in experimental rats; the results are not directly translatable to humans.     

Relationship Between Lipids and Bone Mass in 2 Cohorts of Healthy Women and Men

A number of recent findings seem to indicate that fat and bone metabolism are strictly connected. We investigated the relationship between lipid profile and bone mineral density (BMD) in 236 either pre- or postmenopausal women, aged 35–81 years, attending our osteoporosis center (clinic group). In order to verify the consistency of the results, 265 men and 481 women aged 68–75, participating in a population-based epidemiological investigation (community cohort), were also studied. Lumbar spine, femoral neck, total hip and total body BMD, total body fat, % fat mass and lean mass were measured using dual energy X-ray absorptiometry (DXA). In the clinic group, lumbar spine and hip BMD Z score values were both strongly related to all measured serum lipids: the relationship was negative for HDL cholesterol (P < 0.05) and Apo A lipoprotein (P < 0.000) and positive for LDL cholesterol (P < 0.05), Apo B lipoprotein (P < 0.001) and triglycerides (P < 0.05). When BMD values were adjusted for body weight and BMI, most relationships remained statistically significant. In the community cohort, total body and hip BMD values were strongly related in both men and women to age, body weight, height, BMI, fat mass, lean mass, % fat mass. Total body and hip BMD were significantly related to serum lipids in both women and men. The relationship was negative for HDL cholesterol and positive for total cholesterol, triglycerides and LDL cholesterol. Most of these relationships (triglycerides, HDL cholesterol, LDL/HDL cholesterol ratio in women, and all measured lipids in men) remained statistically significant (P values ranging from 0.000 to 0.03) when the BMD values were adjusted also for anthropometric measures (body weight, height, fat mass). This study demonstrates for the first time that the lipid profile is strictly related to bone mass in both men and women. The interpretation of this association remains hypothetical but it might open new perspectives for understanding the mechanisms controlling bone metabolism.     

前列腺素E1治疗先心病并肺动脉高压

为了解前列腺素Ｅ１对先天性心脏病合并肺动脉高压的治疗作用。对２９例先天性心脏病（ＣＨＤ）合并肺动脉高压（ＰＨ）病儿，用前列腺素Ｅ１（ＰＧＥ１）进行治疗。用量为每分钟１００～２００ｎｇ／ｋｇ，每天持续治疗４～５小时，连续用药４～７天。结果：用药后肺内核素计数、动脉血氧饱和度、右心射血指数皆有不同程度的改善。结论：ＣＨＤ合并ＰＨ的病儿，其心（主要是右心）、肺功能皆有异常，应用ＰＧＥ１治疗后可明显改善其心、肺功能，而且用药时间越长，这种改善就越明显     

妊娠合并心血管疾病的麻醉处理

妊娠合并心血管疾病是产科手术麻醉中的难点,成功处理该类患者要求麻醉医生必须了解该类患者的病理生理特点,做好充分的术前准备以及术中灵活的应变措施．同时还要加强与产科医生,心脏病医生等的团队合作。     

Cross‐sectional and Longitudinal Relationships between Perceived Stress and C‐reactive Protein in Men and Women

To date, an examination of the longitudinal relationship between perceived stress and C‐reactive protein (CRP) is limited. We explored the relationship between perceived stress and CRP concurrently and across 2 and 4 years in 383 men and women. Multiple linear regressions examined the cross‐sectional and longitudinal relationships between baseline stress and counter‐stress scores with CRP at baseline, 2 years after baseline and 4 years after baseline, while controlling for covariates (age, smoking status, anti‐inflammatory use, oral contraceptive use, physical activity, menopausal status, years since onset of menopause, post‐menopausal hormone use and body mass index). Results indicate that stress and counter‐stress were not related to CRP in either men or women at study baseline or 2 years later. Across a 4‐year time frame, higher stress values were related to higher CRP values in women, but not men. Counter‐stress was not related to CRP values in men or women across the 4 years. This study highlights the importance of examining the cross‐sectional and longitudinal relationship between perceived stress and inflammation separately in men and women. Copyright © 2013 John Wiley & Sons, Ltd.     

Evaluation of Effects of Lavender and Peppermint Aromatherapy Using Sensitive Salivary Endocrinological Stress Markers

By measuring the sensitive salivary endocrinological stress markers cortisol and chromogranin A (CgA), we investigated effects on stress of lavender and peppermint aromas. Groups of volunteers were each exposed to an airborne organic essential oil: either lavender or peppermint or, for control, odourless jojoba. Saliva samples were collected immediately before and after the 10‐min exposure and 5 and 10 min later. Salivary cortisol and CgA levels were evaluated by enzyme‐linked immunosorbent assay. After exposure, in the peppermint aroma group, salivary cortisol statistically significantly decreased and salivary CgA statistically significantly increased. No similar changes were found in either the lavender aroma or the control group. These findings suggest that peppermint aroma may be useful for relieving stress. Copyright © 2011 John Wiley & Sons, Ltd.     

Smoking Is Associated with Sex-Specific Effects on Bone Microstructure in Older Men and Women

Background: Smoking is a risk factor for fracture, but the mechanism by which smoking increases fracture risk is unclear. Methods: Musculoskeletal health was compared with dual energy X-ray absorptiometry (DXA), high resolution peripheral quantitative computed tomography (HR-pQCT), trabecular bone score, and vertebral fracture assessment in current and past smokers and nonsmokers from a multiethnic study of adults ≥ age 65. Skeletal indices were adjusted for age and weight. Results: Participants (n = 311) were mean age (±SD) 76.1 ± 6.5 years, mostly female (66.0%) and non-white (32.7% black/39.4% mixed race/26.3% white). Mean pack-years was 34.6 ± 20.4. In men (n = 106), weight and BMI were lower (both p < 0.05) in current vs past smokers. Male smokers consumed half the calcium of never and past smokers. BMD by DXA did not differ by smoking status at any skeletal site in either sex. Current male smokers had 13.5%–15.3% lower trabecular bone score vs never and past smokers (both p < 0.05). By HR-pQCT, trabecular volumetric BMD was 26.6%–30.3% lower and trabeculae were fewer, thinner and more widely spaced in male current vs past and never smokers at the radius (all p < 0.05). Cortical indices did not differ. Tibial results were similar, but stiffness was also 17.5%–22.2% lower in male current vs past and never smokers (both p< 0.05). In women, HR-pQCT trabecular indices did not differ, but cortical porosity was almost twice as high in current vs never smokers at the radius and 50% higher at the tibia (both p < 0.05). Conclusions: In summary, current smoking is associated with trabecular deterioration at the spine and peripheral skeleton in men, while women have cortical deficits. Smoking may have sex-specific skeletal effects. The consistent association with current, but not past smoking, suggests the effects of tobacco use may be reversible with smoking cessation.     

Effects of a cognitive stress challenge on myocardial perfusion and plasma cortisol in coronary heart disease patients with depression

Although it is well established that coronary heart disease (CHD) patients with depression exhibit increased mortality compared with equally ill cardiac patients without depression, the mechanisms mediating this effect remain obscure. Depression is characterized by vulnerability to stress and heightened stress responsiveness, and stress can theoretically act through several biological pathways to contribute to excess mortality from CHD. Mechanisms connecting stress, depression and cardiovascular mortality have not been previously explored in detail. The purpose of this study was to assess the effects of stress and depression on myocardial perfusion and plasma cortisol concentrations in CHD patients. Patients with CHD with and without depression (n = 28) underwent single photon emission computed tomography imaging of myocardial perfusion at rest and during a stressful cognitive challenge. Severity of ischaemia was measured by summing perfusion defect scores across myocardial segments and subtracting out rest from stress scores. Plasma cortisol concentrations were measured at baseline and in response to the stressful challenge. There were no differences in stress‐induced myocardial ischaemia or plasma cortisol response to stress between CHD patients with and without depression. Depressed CHD patients with a history of psychological trauma (n = 5) had an increase in stress‐induced ischaemia scores [7; standard deviation (SD) = 5] compared with CHD patients with depression without a history of psychological trauma (2 SD = 2) and CHD patients without depression or psychological trauma (1; SD = 2) (F = 8.51; degree of freedom = 2,23; p = 0.007). Eighty per cent of CHD/depression trauma‐exposed subjects had stress‐induced ischaemia as opposed to 38 per cent of CHD/depression subjects without trauma exposure and 23 per cent of subjects with CHD without depression or trauma. Self‐reported nervousness during the cognitive stressor was correlated with stress‐induced ischaemia. These preliminary findings suggest that depression with a history of prior exposure to traumatic stress is associated with increased risk for stress‐induced cardiovascular ischaemia. Copyright © 2008 John Wiley & Sons, Ltd.     

146例严重肺动脉高压者二尖瓣替换术疗效分析

评价风湿性二尖瓣病变伴重度肺高压病人的手术效果。采用方差分析、卡方检验对肺动脉收缩压（ＳＰＡＰ）≥９．３３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）并接受二尖瓣替换术（ＭＶＲ）的１４６病人的临床资料进行分析，将其分为４组。Ａ组：极重度肺高压（ＳＰＡＰ≥１３．３ｋＰａ）；Ｂ组：心功能严重低下组（心脏指数ＣＩ≤３３．３４）；Ｃ组：心功能减低或正常组（３３．３４≤ＣＩ≤６６．６８）；Ｄ组：高心排血量组（ＣＩ≥６６．６８）。其中每组按一次和二次手术再分为２个亚组。结果示一次手术组总死亡率为５．３％；Ａ１、Ｂ１、Ｃ１、Ｄ１４组术前临床情况、所用术式和心脏阻断时间等无差异，但Ｂ１组低心排（２４．２％）早期死亡率（１５．２％）明显高于其它３组（Ｐ＜０．０５），而Ｄ组无死亡。二次手术组总死亡率为２８．２％；各亚组低心排及死亡率均明显高于一次手术各组。由此认为，二尖瓣病变伴重度肺动脉高压病人，ＭＶＲ后低心排和早期死亡率与术前心脏指数有关。当心脏指数＞３３．３４时，即使肺动脉压和全肺阻力同时极度增高者，术后低心排和死亡率亦不因此增加。当ＣＩ＜３３．３４时，术后低心排及早期死亡率较高。重度肺动脉高压者施行二次ＭＶＲ手术时风险性较大     

刺五加注射液与茶碱、咖啡因体外对精子运动功能影响的比较研究

目的:比较刺五加注射液与茶碱、咖啡因体外对精子运动功能的影响。方法:由12例弱精子症患者通过手淫获得并经上游优化处理的精子分别与一定浓度的刺五加注射液(10g/L)、咖啡因(7mmol/L)和茶碱(3mmol/L)一起孵化0h、1h、3h后,采用计算机辅助精液分析系统(CASA)检测精子的运动参数(精子活动率、前向性运动百分率、直线运动速度、曲线运动速度)。结果:刺五加注射液在体外能显著提高人精子活动率,前向性运动精子百分率,精子直线运动速度和曲线运动速度,其改善精子运动功能优于茶碱和咖啡因,差异均有显著性(P<0.05)。结论:中药刺五加注射液在体外能显著改善人精子的运动功能。     

Individual Differences in the Psychobiological Response to Psychosocial Stress (Trier Social Stress Test): The Relevance of Trait Anxiety and Coping Styles

The main objective of this study was to investigate the contribution of some personality traits to the physiological and psychological response to a standardized laboratory psychosocial stressor (trier social stress test). Cortisol and affective response (anxiety and mood) were analysed in a mixed‐sex group composed of 35 young adults who participated in a crossover design (18 men and 17 women). After verifying a statistically significant response to the trier social stress test in all parameters studied in both sex groups, exploratory cluster analyses were carried out to identify sub‐groups based on their psychophysiological responses. These analyses showed two different groups: subjects displaying lower psychological response along with higher cortisol response (cluster 1) compared with the group with high affective reactivity along with lower cortisol response (cluster 2). Interestingly, we also found significant differences in trait anxiety and coping styles when the two clusters were compared. Subjects in cluster 1 showed lower scores on trait anxiety and higher scores on active coping, whereas the subjects in the second cluster obtained higher scores on anxiety and on coping focused on emotions and mental disengagement. These findings support the importance of personality traits and coping styles in understanding the overall integrative psychobiological responsiveness to social stress. Copyright © 2014 John Wiley & Sons, Ltd.