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da Silva Oliveira Barbosa E, Roggero EA, González FB, Fernández RDV, Carvalho VF, Bottasso OA, Pérez AR, Villar SR. Evidence in Favor of an Alternative Glucocorticoid Synthesis Pathway During Acute Experimental Chagas Disease. Front Endocrinol (Lausanne) 2019; 10:866. [PMID: 31998227 PMCID: PMC6961479 DOI: 10.3389/fendo.2019.00866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
It is well-established that infectious stress activates the hypothalamus-pituitary-adrenal axis leading to the production of pituitary adrenocorticotropin (ACTH) and adrenal glucocorticoids (GCs). Usually, GC synthesis is mediated by protein kinase A (PKA) signaling pathway triggered by ACTH. We previously demonstrated that acute murine Chagas disease courses with a marked increase of GC, with some data suggesting that GC synthesis may be ACTH-dissociated in the late phase of this parasitic infection. Alternative pathways of GC synthesis have been reported in sepsis or mental diseases, in which interleukin (IL)-1β, prostaglandin E2 (PGE2), and/or cAMP-activated guanine nucleotide exchange factor 2 (EPAC2) are likely to play a role in this regard. Accordingly, we have searched for the existence of an ACTH-independent pathway in an experimental model of a major parasitic disease like Chagas disease, in addition to characterizing potential alternative pathways of GC synthesis. To this end, C57BL/6 male mice were infected with T. cruzi (Tc), and evaluated throughout the acute phase for several parameters, including the kinetic of GC and ACTH release, the adrenal level of MC2R (ACTH receptor) expression, the p-PKA/PKA ratio as ACTH-dependent mechanism of signal transduction, as well as adrenal expression of IL-1β and its receptor, EPAC2 and PGE2 synthase. Our results reveal the existence of two phases involved in GC synthesis during Tc infection in mice, an initial one dealing with the well-known ACTH-dependent pathway, followed by a further ACTH-hyporesponsive phase. Furthermore, inflamed adrenal microenvironment may tune the production of intracellular mediators that also operate upon GC synthesis, like PGE2 synthase and EPAC2, as emerging driving forces for GC production in the advanced course of Tc infection. In essence, GC production seems to be associated with a biphasic action of PGE2, suggesting that the effect of PGE2/cAMP in the ACTH-independent second phase may be mediated by EPAC2.
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Affiliation(s)
| | - Eduardo A. Roggero
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
| | - Florencia B. González
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
| | - Rocío del Valle Fernández
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
| | - Vinicius Frias Carvalho
- Laboratory of Inflammation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation (INCT-NIM), Rio de Janeiro, Brazil
| | - Oscar A. Bottasso
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
| | - Ana R. Pérez
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
- Center for Research and Production of Biological Reagents (CIPREB), Faculty of Medical Sciences, National University of Rosario, Rosario, Argentina
| | - Silvina R. Villar
- Institute of Clinical and Experimental Immunology of Rosario (IDICER-CONICET-UNR), Rosario, Argentina
- Center for Research and Production of Biological Reagents (CIPREB), Faculty of Medical Sciences, National University of Rosario, Rosario, Argentina
- *Correspondence: Silvina R. Villar ;
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Ling XM, Fang F, Zhang XG, Ding M, Liu QAX, Cang J. Effect of parecoxib combined with thoracic epidural analgesia on pain after thoracotomy. J Thorac Dis 2016; 8:880-7. [PMID: 27162662 DOI: 10.21037/jtd.2016.03.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thoracotomy results in severe postoperative pain potentially leading to chronic pain. We investigated the potential benefits of intravenous parecoxib on postoperative analgesia combined with thoracic epidural analgesia (TEA). METHODS Eighty-six patients undergoing thoracic surgery were randomized into two groups. Patient-controlled epidural analgesia (PCEA) was used until chest tubes were removed. Patients received parecoxib (group P) or placebo (group C) intravenously just 0.5 h before the operation and every 12 h after operation for 3 days. The intensity of pain was measured by using a visual analogue scale (VAS) and recorded at 2, 4, 8, 24, 48, 72 h after operation. The valid number of PCA, the side effects and the overall satisfaction to analgesic therapy in 72 h were recorded. Venous blood samples were taken before operation, the 1(st) and 3(rd) day after operation for plasma cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 and tumor necrosis factor-α level. The occurrence of residual pain was recorded using telephone questionnaire 2 and 12 months after surgery. RESULTS Postoperative pain scores at rest and on coughing were significantly lower with the less valid count of PCA and greater patient satisfaction in group P (P<0.01). Adverse effect and the days fit for discharge were comparable between two groups. The cortisol levels in placebo group were higher than parecoxib group at T2. The level of ACTH both decreased in two groups after operation but it was significantly lower in group P than that in group C. There were no changes in plasma IL-6 and TNF-α levels before and after analgesia at T1 and T2 (P>0.05). The occurrence of residual pain were 25% and 51.2% separately in group P and C 3 months postoperatively (P<0.05). CONCLUSIONS Intravenous parecoxib in multimodal analgesia improves postoperative analgesia provided by TEA, relieves stress response after thoracotomy, and may restrain the development of chronic pain.
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Affiliation(s)
- Xiao-Min Ling
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fang Fang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Guang Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming Ding
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qiu-A-Xue Liu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Acar D, Erkılıç EK, Gümüş T, Şahin D, Dinçel AS, Kanbak O. The Effects of Different Anaesthetic Techniques on Surgical Stress Response During Inguinal Hernia Operations. Turk J Anaesthesiol Reanim 2015; 43:91-9. [PMID: 27366474 PMCID: PMC4917164 DOI: 10.5152/tjar.2014.49092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare the effects of 3 different kinds of anaesthesia on stress response induced by surgery. METHODS Sixty patients aged between 25-70 American Society of Anesthesiologists (ASA) I-II group to undergo inguinal herniography were included in this study. Patients were randomly divided into 3 groups of 20. Group 1 received general anaesthesia with sevoflurane/air/remifentanil, patients in Group 2 received total intravenous anaesthesia (TIVA) with propofol/air/remifentanil and Group 3 received spinal anaesthesia induced by hyperbaric bupivacaine, adjoined by remifentanil sedation. Mean arterial pressure (MAP), heart rate and SpO2 values were recorded preoperatively, intraoperatively and postoperatively at certain periods. Cortisol, leptin and glucose levels were preoperatively detected. Intervals were as; 15 minutes prior to the induction of anaesthesia, at intraoperative first hour and at the postoperative third and twenty-forth hours. RESULTS MAP and heart rate values were similar in the inhalational anaesthesia and TIVA groups but relatively higher in the spinal anaesthesia group. Blood glucose levels were elevated, insulin levels were decreased in all groups, at the intraoperative first hour. Biphasic variation in blood leptin levels was observed in all groups, as the levels were lower than the preoperative control values at the intraoperative first and postoperative third hours and significantly higher at the postoperative twenty-forth hour. There was a significant decrease in cortisol level percentage change in the TIVA group at the intraoperative 1st hour, increasing in the other groups. CONCLUSION We concluded that TIVA supresses the stress response induced by surgery better by lowering cortisol levels, leading to a lower increase in blood glucose levels and a lower decrease in blood insulin levels when compared to others. Furthermore, leptin levels were increased at the postoperative twenty-forth hour. The lower increase at the postoperative twenty-forth hour in the TIVA group can be correlated with the anaesthetic agent.
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Affiliation(s)
- Derya Acar
- Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ezgi Karakaş Erkılıç
- Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey
| | - Tülin Gümüş
- Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey
| | - Duygu Şahin
- Department of Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aylin Sepici Dinçel
- Department of Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Orhan Kanbak
- Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey
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Petrowski K, Wintermann GB, Kirschbaum C, Bornstein SR. Dissociation between ACTH and cortisol response in DEX-CRH test in patients with panic disorder. Psychoneuroendocrinology 2012; 37:1199-208. [PMID: 22277728 DOI: 10.1016/j.psyneuen.2011.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Panic disorder (PD) has been associated with the altered circadian rhythm of the hypothalamic-pituitary-adrenocortical (HPA) axis. The findings regarding the stress-specific functioning of the HPA-system are inconsistent. It is also unclear whether the HPA-system response after the Corticotropin-Releasing-Hormone (CRH) challenge becomes altered. METHODS For this study, the dexamethasone-corticotropin-releasing-hormone (DEX-CRH) test was implemented to assess the HPA-axis reactivity indicated by the plasma adreno-corticotropin-hormone (ACTH) and the cortisol release. The sample included 32 patients diagnosed with PD in a Structured Clinical Interview (SCID). Fourteen male and eighteen female patients, [mean age = 33.50 years, SD = 12.76] were matched with 32 healthy controls by age and gender. Moreover, a sample of patients with unipolar depression (n = 21, ten females) was examined as a clinical control group. RESULTS In healthy controls as well as in patients with PD and patients with unipolar depression, the ACTH and the cortisol response increased significantly due to the CRH injection after dexamethasone pre-treatment. There were differences between the healthy controls and the patients with PD in the plasma cortisol response pattern, however, not in the ACTH. The patients with PD showed a decreased CRH-induced plasma cortisol response. A median-split gave evidence that patients suffering from PD longer than two years showed a remarkably higher HPA-axis reactivity under CRH-injection than patients suffering from PD two years or less. CONCLUSION These findings provide strong evidence that patients with PD show some dissociation between ACTH and cortisol response under the DEX-CRH test with strong indicators that the length of the duration of the psychopathology is a risk factor for an increased reactivity of the HPA-axis in patients with PD.
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Affiliation(s)
- Katja Petrowski
- Institute of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
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Lesur O, Roussy JF, Chagnon F, Gallo-Payet N, Dumaine R, Sarret P, Chraibi A, Chouinard L, Hogue B. Proven infection-related sepsis induces a differential stress response early after ICU admission. Crit Care 2010; 14:R131. [PMID: 20615266 PMCID: PMC2945098 DOI: 10.1186/cc9102] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 02/03/2010] [Accepted: 07/09/2010] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Neuropeptides arginine-vasopressin (AVP), apelin (APL), and stromal-derived factor-1α (SDF-1α) are involved in the dysfunction of the corticotropic axis observed in septic ICU patients. Study aims were: (i) to portray a distinctive stress-related neuro-corticotropic systemic profile of early sepsis, (ii) to propose a combination data score, for aiding ICU physicians in diagnosing sepsis on admission. METHODS This prospective one-center observational study was carried out in a medical intensive care unit (MICU), tertiary teaching hospital. Seventy-four out of 112 critically ill patients exhibiting systemic inflammatory response syndrome (SIRS) were divided into two groups: proven sepsis and non sepsis, based on post hoc analysis of microbiological criteria and final diagnosis, and compared to healthy volunteers (n = 14). A single blood sampling was performed on admission for measurements of AVP, copeptin, APL, SDF-1α, adrenocorticotropic hormone (ACTH), cortisol baseline and post-stimulation, and procalcitonin (PCT). RESULTS Blood baseline ACTH/cortisol ratio was lower and copeptin higher in septic vs. nonseptic patients. SDF-1α was further increased in septic patients vs. normal patients. Cortisol baseline, ACTH, PCT, APACHE II and sepsis scores, and shock on admission, were independent predictors of sepsis diagnosis upon admission. Using the three first aforementioned categorical bio-parameters, a probability score for predicting sepsis yielded an area under the Receiver Operating Curve (ROC) curves better than sepsis score or PCT alone (0.903 vs 0.727 and 0.726: P = 0.005 and P < 0.04, respectively). CONCLUSIONS The stress response of early admitted ICU patients is different in septic vs. non-septic conditions. A proposed combination of variable score analyses will tentatively help in refining bedside diagnostic tools to efficiently diagnose sepsis after further validation.
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Affiliation(s)
- Olivier Lesur
- Soins intensifs médicaux, département de Médecine, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
- Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Jean-Francois Roussy
- Soins intensifs médicaux, département de Médecine, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
- Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Frederic Chagnon
- Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Nicole Gallo-Payet
- Département de Physiologie et Biophysique, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Robert Dumaine
- Département de Physiologie et Biophysique, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Philippe Sarret
- Département de Physiologie et Biophysique, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Ahmed Chraibi
- Département de Physiologie et Biophysique, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Lucie Chouinard
- Département de Physiologie et Biophysique, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Bruno Hogue
- Centre de recherche clinique Étienne-Lebel (CRCEL) CHUS, Université de Sherbrooke, 3001, 12th Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
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Dissociation of ACTH and glucocorticoids. Trends Endocrinol Metab 2008; 19:175-80. [PMID: 18394919 DOI: 10.1016/j.tem.2008.01.009] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 01/31/2008] [Accepted: 01/31/2008] [Indexed: 01/11/2023]
Abstract
It is increasingly clear that significant differential regulation of pituitary and adrenal gland activation exists, leading to a dissociation of plasma adrenocorticotropic hormone and corticosteroid secretion during fetal, postnatal and adult life. An increasing number of preclinical and clinical studies report dissociation of adrenocorticotropic hormone and cortisol levels in critical illness, inflammation and mental disorders. Mechanisms involve an altered adrenal sensitivity, aberrant receptor expression or modulation of adrenal function by cytokines, vasoactive factors or neuropeptides. The degree of dissociation has been associated with the level of complications of sepsis, surgery, malignant disease and depression. The separation of adrenocorticotropic hormone and corticosteroid secretion is of clinical relevance and should be incorporated into our view on endocrine stress regulation.
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Marana E, Scambia G, Colicci S, Maviglia R, Maussier ML, Marana R, Proietti R. Leptin and perioperative neuroendocrine stress response with two different anaesthetic techniques. Acta Anaesthesiol Scand 2008; 52:541-6. [PMID: 18339160 DOI: 10.1111/j.1399-6576.2008.01589.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stress response to surgery is modulated by several factors, including magnitude of the injury, pain, type of procedure and choice of anaesthesia. Our purpose was to compare intra- and post-operative hormonal changes during total intravenous anaesthesia (TIVA) using propofol and remifentanil vs. sevoflurane anaesthesia in a low stress level surgical model (laparoscopy). METHODS We randomly allocated 18 patients undergoing laparoscopic surgery for benign ovarian cysts in two groups to receive either TIVA (group A=9) or sevoflurane anaesthesia (group B=9). Perioperative plasma levels of norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol and leptin were measured. Blood samples were collected pre-operatively (time 0), 30 min after the beginning of surgery (time 1), after extubation (time 2), and 2 h (time 3) and 4 h after surgery (time 4). RESULTS The comparative analysis between the groups shows significantly higher values of NE (P<0.001 at time 1 and P<0.01 at time 3), E (P<0.001 at times 1 and 2; P<0.01 at time 3 and P<0.05 at time 4), ACTH (P<0.001 at times 1 and 2; P<0.05 at time 3) and cortisol (P<0.001 at times 1 and 2; P<0.01 at time 3; P<0.05 at time 4) in group B. The serum values of leptin were not significantly different between the two groups. CONCLUSION The choice of anaesthesia does not seem to affect the leptin serum levels but influences the release of stress response markers: ACTH, cortisol, NE and E.
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Affiliation(s)
- E Marana
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Rome, Italy.
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Relationships between adrenocorticotropic hormone and cortisol are altered during clustered nursing care in preterm infants born at extremely low gestational age. Early Hum Dev 2007; 83:341-8. [PMID: 16979857 DOI: 10.1016/j.earlhumdev.2006.08.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 08/03/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the effects of clustered nursing care on hypothalamic pituitary axis (HPA) responses in preterm infants in the neonatal intensive care unit. AIMS To examine facial responses, adrenocorticotropic hormone (ACTH) and cortisol levels, and the relationship between ACTH and cortisol in preterm infants in two gestational age groups (extremely low gestational age [ELGA: < or =28 weeks]; very low gestational age [VLGA: 29-31 weeks]) under basal conditions and in response to routine nursing procedures. STUDY DESIGN Within subjects' cross-over design in random order. SUBJECTS Ninety preterm infants with no postnatal steroid exposure were studied at 32+/-1 weeks postconceptional age. OUTCOME MEASURES Facial actions, ACTH and cortisol levels were measured after a 30 minute rest period and in response to routine clustered nursing care (CC). Changes in facial actions were analyzed using repeated measures ANOVA. MANOVA or Mann-Whitney U tests were used to determine differences in ACTH and cortisol between gestational age groups. Spearman rank correlations were used to examine relationships between perinatal variables and facial, ACTH and cortisol levels. RESULTS All infants had significantly increased facial responses to CC (p=0.001). Infants having experienced higher numbers of skin breaking procedures 24 h before basal assessment had higher basal cortisol levels (r=0.30, p=0.01). In response to CC, ELGA infants showed no correlation between ACTH and cortisol levels; VLGA infants showed a strong, positive correlation (r=0.62, p=0.02). CONCLUSION The pattern of relationship between ACTH and cortisol differs depending on gestational age at birth in response to clustered nursing care. Prior pain alters responsiveness and HPA dysregulation is apparent in ELGA infants.
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Kudoh A, Takase H, Katagai H, Takazawa T. Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion. Neuroimmunomodulation 2005; 12:60-6. [PMID: 15756054 DOI: 10.1159/000082365] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 01/18/2004] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate changes in plasma interleukin (IL)-6, cortisol or noradrenaline concentrations after surgery in elderly patients with postoperative confusion. METHODS We studied 80 patients aged 70-90 years undergoing abdominal surgery and measured plasma IL-6, cortisol or noradrenaline concentrations before surgery, at the end of surgery, and 24 and 48 h after surgery. RESULTS Plasma IL-6 concentrations in elderly patients with postoperative confusion were 83.2 +/- 30.5, 49.3 +/- 14.1 and 42.9 +/- 19.4 pg.ml(-1) at the end of surgery, and 24 and 48 h after surgery, respectively, being significantly higher than in elderly patients without postoperative confusion (58.0 +/- 37.5, 36.1 +/- 20.0 and 28.2 +/- 16.7 pg.ml(-1)). Plasma cortisol concentrations in elderly patients with postoperative confusion (42.2 +/- 7.8, 38.3 +/- 8.3 and 33.1 +/- 8.4 microg.dl(-1) at the end of surgery, and 24 and 48 h after surgery, respectively) were significantly higher than in elderly patients without postoperative confusion (32.9 +/- 6.7, 30.4 +/- 8.6 and 25.6 +/- 6.5 microg.dl(-1), respectively). There were no significant differences in plasma norepinephrine concentrations at all sampling points between elderly patients with and without postoperative confusion. However, plasma IL-6 and cortisol concentrations were related in elderly patients with postoperative confusion (at the end of surgery and 24 and 48 h after surgery). However, there was no relationship between plasma IL-6 and cortisol concentrations 24 and 48 h after surgery in elderly patients without postoperative confusion. CONCLUSION Elderly patients with postoperative confusion had increased plasma IL-6 and cortisol concentrations. The interaction between IL-6 and cortisol after surgery is associated with developing postoperative confusion in the elderly patients.
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Affiliation(s)
- Akira Kudoh
- Department of Anesthesiology, Hirosaki National Hospital, Hirosaki, Japan
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Cho YM, Kim MS, Shin CS, Park DJ, Park KS, Yang HK, Lee KU, Cho BY, Lee HK, Kim SY. Dynamic change in plasma leptin level during the perioperative period. Horm Res Paediatr 2003; 59:100-4. [PMID: 12589115 DOI: 10.1159/000068579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the association of plasma leptin level with insulin, which is known as a metabolic regulator of leptin, and various stress-related factors during the perioperative period. METHODS Thirty-one patients undergoing gastrectomy were enrolled and blood samples were obtained preoperatively, intraoperatively, immediately after operation, and on the first and second postoperative days. RESULTS The plasma leptin level showed a triphasic response. Immediately after operation, the leptin level was the lowest, while the serum cortisol and interleukin-6 (IL-6) levels had their peak (PHASE 1). On the first postoperative day, the leptin level had its peak with the serum cortisol and IL-6 level remaining elevated (PHASE 2). On the second postoperative day, while the serum cortisol and IL-6 levels still remained elevated, the plasma leptin level fell to the preoperative value (PHASE 3). The plasma leptin level correlated well with the insulin level at all time points during the study period. CONCLUSION Our results suggest a possible role of leptin in harmonizing neuroendocrine and immune responses with energy balance.
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Affiliation(s)
- Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kudoh A, Takahira Y, Katagai H, Takazawa T. Schizophrenic patients who develop postoperative confusion have an increased norepinephrine and cortisol response to surgery. Neuropsychobiology 2002; 46:7-12. [PMID: 12207140 DOI: 10.1159/000063569] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to investigate the relationship between postoperative confusion and the plasma norepinephrine (NE), adrenocorticotropin (ACTH) or cortisol response to surgery in schizophrenic patients. We studied 50 schizophrenic patients and 35 control patients who underwent orthopedic surgery and perioperatively measured plasma NE, ACTH and cortisol levels. Postoperative confusion during 72 h after the end of the operation occurred in 14 of 50 schizophrenic patients (28%) and in 2 of 35 control patients (6%). Plasma NE levels 15 min after skin incision, the next day, the second day and the third day after operation in schizophrenic patients with postoperative confusion (668.0 +/- 59.2, 522.0 +/- 96.5, 463.2 +/- 71.2 and 398.9 +/- 56.2 pg/ml, respectively) were significantly higher than those in schizophrenic patients without confusion (524.1 +/- 62.6, 342.4 +/- 38.6, 311.2 +/- 58.3 and 314.1 +/- 77.1 pg/ml, respectively). Plasma cortisol levels 15 min after the skin incision and the next and second days after operation in schizophrenic patients with postoperative confusion (23.6 +/- 3.2, 21.1 +/- 4.3 and 19.9 +/- 4.4 microg/dl, respectively) were significantly higher than those in schizophrenic patients without confusion (15.2 +/- 4.5, 14.3 +/- 5.1 and 13.8 +/- 3.8 microg/dl, respectively). In conclusion, the occurrence of postoperative confusion in schizophrenic patients is associated with an increase in plasma norepinephrine and cortisol levels during and after surgery.
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Affiliation(s)
- Akira Kudoh
- Department of Anesthesiology, Hirosaki National Hospital, University of Hirosaki School of Medicine, Hirosaki, Aomori, Japan
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