Ethnicity, education, and the cortisol response to awakening: a preliminary investigation

Objective. To explore the associations among ethnicity, educational attainment, and cortisol secretion. Design. Participants included 63 white (n=31) and African-American (n=32) adult men and women. Subjects provided salivary cortisol samples immediately upon awakening and again, 30 minutes later. Results. Analyses adjusted for relevant covariates revealed a steeper awakening response among whites with higher education compared to other groups. Cortisol levels were significantly lower among African-American participants with lower levels of education. All effects were independent of perceived stress. Conclusions. These preliminary findings demonstrate significant ethnic and education-related differences in awakening cortisol secretion responses. Our data highlight the importance of considering ethnicity and the moderating effects of social class when examining the associations among social contextual factors and cortisol secretion.     

Suspected non-adherence and weekend versus week day differences in the awakening cortisol response

The pronounced rise in cortisol following awakening holds promise as a bio-marker of variables in the psychosocial domain, but its investigation also presents methodological challenges, which we attempted to address in this study. Forty-eight healthy, young students participated and were instructed to collect saliva 0, 15, 30 and 45 min post awakening on two consecutive normal weekdays and two consecutive weekend days (order counterbalanced). Participants' awakening cortisol response (ACR) profiles differed between the weekdays and weekend with trend analysis revealing a steeper rise on weekdays compared to the weekend. These differences were not accounted for by weekday/weekend differences in awakening time and state stress or by perceived stress over the previous month. Total salivary-free cortisol secretion (area under the cortisol curve (AUC)) over the 4 study days was negatively correlated with the measure of longer term stress and awakening time. The mean 4-day rise in cortisol (mean increase: MnInc) was also negatively correlated with awakening time. This awakening time effect was not mediated by stress or vice versa, since both were independent predictors of cortisol. In an attempt to address the ubiquitous problem of non-adherence to the requested saliva sampling regime, known to distort the shape of the ACR, suspected non-adherence (SNA) was examined by identifying instances of profiles showing no cortisol rise from the waking sample to either the 15 or 30 min sample post awakening. Analysis controlling for SNA status had no effect upon the observed associations with Perceived Stress Scale (PSS) and awakening time however it abolished the otherwise highly significant flatter profile at weekends.     

Selective slow-wave sleep deprivation and time-of-night effects on cognitive performance upon awakening

We evaluated the effects of selective slow-wave sleep (SWS) deprivation and time-of-night factors on cognitive performance upon awakening. Ten normal men slept for 6 consecutive nights in the laboratory: 1 adaptation, 2 baseline, 2 selective SWS deprivation, and 1 recovery night. Cognitive performance was assessed by means of a Descending Subtraction Task after 2, 5, and 7.5 h of sleep. There was an almost complete selective SWS suppression during both deprivation nights, and a significant SWS rebound during the recovery sleep. Regarding cognitive performance, a progressive linear decrease of sleep inertia upon successive awakenings was found during all experimental nights except for the recovery night. In addition, a significant decrease of sleep inertia was observed upon the morning awakening of the second deprivation night for the measure of performance speed, and a significant increase of sleep inertia upon the morning awakening of the recovery night for the measure of performance accuracy. The results show that cognitive performance upon awakening is adversely affected by sleep depth and that, during the sleep-wake transition, cognitive performance accuracy is more impaired than performance speed.     

重复经颅磁刺激联合高压氧对颅脑损伤后昏迷患者的促醒疗效观察

目的 研究重复经颅磁刺激(rTMS)联合高压氧(HBO)对颅脑损伤后昏迷患者的促醒疗效.方法 选取2019年1月至2020年8月于滨州医学院附属医院康复科住院的脑外伤后昏迷患者87例,按照随机数字表法分为对照组、HBO组及联合治疗组,每组29例.对照组采用药物和常规康复治疗,HBO组在对照组基础上加用HBO治疗,联合治...     

Immune-awakening Saccharomyces-inspired nanocarrier for oral target delivery to lymph and tumors

Utilization of the intestinal lymphatic pathway will allow extraordinary gains in lymph and tumors cascade-targeted delivery of oral drugs and awakening the innate/adaptive immunity of the body and the lesion microenvironment, in addition to improving oral bioavailability relative to other means of delivery of oral drugs. Here, inspired by the specific invasion route of intestinal microorganisms, we pioneered an immune-awakening Saccharomyces-inspired mesoporous silicon nanoparticle (yMSN) for the ingenious cascade-targeted delivery of therapeutic cancer vaccines and antitumor drugs to lymph and tumors via the intestinal lymphatic pathway. Encouragingly, yMSN high-loaded tumor-specific antigens (OVA, 11.9%) and anti-tumor drugs (Len, 28.6%) with high stability, namely Len/OVA/yMSN, efficiently co-delivered OVA and Len to their desired target sites. Moreover, yMSN concomitantly awakened the innate antitumor immunity of dendritic cells and macrophages, strengthening vaccine-induced adaptive immune responses and reversing macrophage-associated immunosuppression in the tumor microenvironment. Surprisingly, Len/OVA/yMSN treatment resulted in excellent synergistic antitumor efficacy and long-term antitumor memory in OVA-Hepa1-6-bearing mice. This high-performance nanocarrier provides a novel approach for lesion-targeting delivery of oral drugs accompanied with awakening of the innate/adaptive immunity of the lesion environment, and also represents a novel path for the oral delivery of diverse therapeutic agents targeting other lymph-mediated diseases.     

留置尿管时机对全麻苏醒期不良反应的影响

目的探讨全麻手术患者术中留置导尿管的最佳时机,减轻术前患者插尿管的痛苦,减少不良反应的发生,保证医疗护理的安全。方法选择我科2014年6月-2015年10月150例全麻手术术前需导尿的成年患者,按数字表法随机分为A、B、C组,A组患者术前在病房导尿并留置尿管,B组患者在全麻插管后导尿并留置尿管;C组患者在麻醉诱导期为患者进行导尿并留置尿管。比较三组患者导尿前及导尿时的生命体征、全麻复苏期躁动、舒适度的情况及麻醉复苏时间。结果通过分组研究,C组即麻醉诱导期留置导尿管患者在全麻复苏期躁动最少,尿道刺激症状少,舒适度增加,患者的满意度提高。结论麻醉诱导期留置导尿管,既可减少全麻苏醒期躁动的发生,又增加了患者的舒适感,提高患者的满意度。     

手厥阴经电刺激联合高压氧对脑外伤后昏迷患者的促醒作用

目的：探讨手厥阴经电刺激联合高压氧对脑外伤后昏迷患者的促醒作用。方法：选取2015年12月至2018年12月沧州中西医结合医院收治的脑外伤昏迷患者100例作为研究对象,按照住院号单双分为对照组和观察组,每组50例。2组均予以常规治疗,观察组再予以手厥阴经电刺激治疗,疗程均为4周。比较2组患者治疗前、治疗后椎-基底动脉血流速度、格拉斯哥昏迷评分（GCS评分）、生命质量变化并比较,评价2组疗效、苏醒率和苏醒时间。结果：观察组患者在改善患者左椎动脉、基底动脉的收缩期峰值血流速度（Vs）、舒张期血流速度（Vd）、平均血流速度（Vm）、左椎动脉、基底动脉搏动指数（PI）、GCS评分、脑电图评分量表（EEG评分）、残废等级量表（DRS评分）、心理功能、日常生活、社会功能、物质功能评分均优于对照组患者,且观察组患者治疗有效率高于对照组,平均苏醒时间低于对照组患者,差异有统计学意义（P<0.05）。结论：手厥阴经电刺激联合高压氧脑外伤后昏迷具有促醒作用,这可能和该方法能改善脑部血流量,促进脑部病理生理恢复,缓解昏迷和脑功能障碍有关。     

老年脑出血后患者昏迷苏醒时间的多因素分析

目的 探讨影响老年脑出血后患者昏迷苏醒时间的相关因素。方法 选取本院2012年6月～2015年10月收治的82例老年脑出血昏迷患者为研究对象,以性别、年龄、术前格拉斯哥昏迷评分(GCS, Glasgow Coma Scale)、脑血肿量、血肿是否破入脑室、高血压病史、是否气管切开、治疗、并发感染等为自变量,昏迷至苏醒的时间为因变量,先进行单因素分析,对有统计学意义的变量采用Cox回归模型进行多因素分析。结果 单因素分析显示,术前GCS评分≤5分、脑血肿量>50 mL、血肿破入脑室、高血压病史、气管切开、未采用盐酸纳洛酮联合正中神经电刺激治疗、并发感染的患者昏迷苏醒时间更长(P<0.05); 多因素分析显示,血肿破入脑室、气管切开、并发感染是导致昏迷苏醒时间延长的危险性因素(P<0.05),术前GCS评分高与采用盐酸纳洛酮联合正中神经电刺激治疗可能是昏迷苏醒时间的保护性因素(P<0.05)。结论 血肿破入脑室、气管切开、并发感染、术前GCS评分低是导致老年脑出血患者昏迷苏醒时间延长的主要影响因素,应尽量选择盐酸纳洛酮联合正中神经电刺激治疗方案,强化无菌医疗操作,加强抗感染护理干预,以缩短苏醒时间及改善预后。     

The relation between early life adversity, cortisol awakening response and diurnal salivary cortisol levels in postpartum women

Early life adversity has been associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in both children and adults. However, in adulthood, most studies have focused on the effects of early adversity on HPA axis stress reactivity rather than the cortisol awakening response or diurnal cortisol profiles. The goal of this study was to examine the cumulative effects of early life adversity on the cortisol awakening response (CAR) and diurnal cortisol profiles in a sample of postpartum women. Ninety women between 2 and 6 months postpartum completed two retrospective reports assessing adverse early life experiences (maltreatment and consistency of care). Eighteen women reported having experienced both parental loss and some form of childhood maltreatment and 36 women reported having experienced one type of early life adversity, either parental loss or maltreatment. HPA axis function was assessed through salivary cortisol collections over two consecutive days for measurement of the cortisol awakening response (n=61) and diurnal cortisol rhythm (n=90). Women who reported experiencing adverse early life experiences exhibited a tendency towards higher levels of awakening cortisol compared to women who reported no adverse early life experiences (p=.07). These higher awakening cortisol levels were sustained throughout the morning in the groups who experienced early adversity, with all groups exhibiting the typical diurnal decline in the afternoon and evening (p<.05). Women reporting early adversity exhibited more heterogeneity in their diurnal cortisol levels across the two collection days (p<.01). Our findings suggest that in a community sample of postpartum women, early adversity is associated with current HPA axis function. These findings may have implications for the nature of mother-infant interactions.