Neuroendocrine and cellular mechanisms in stress resilience: From hormonal influence in the CNS to mitochondrial dysfunction and oxidative stress

Recent advancements in neuroendocrinology challenge the long-held belief that hormonal effects are confined to perivascular tissues and do not extend to the central nervous system (CNS). This paradigm shift, propelled by groundbreaking research, reveals that synthetic hormones, notably in anti-inflammatory medications, significantly influence steroid psychosis, behavioural, and cognitive impairments, as well as neuropeptide functions. A seminal development in this field occurred in 1968 with McEven's proposal that rodent brains are responsive to glucocorticoids, fundamentally altering the understanding of how anxiety impacts CNS functionality and leading to the identification of glucocorticosteroids and mineralocorticoids as distinct corticotropic receptors. This paper focuses on the intricate roles of the neuroendocrine, immunological, and CNS in fostering stress resilience, underscored by recent animal model studies. These studies highlight active, compensatory, and passive strategies for resilience, supporting the concept that anxiety and depression are systemic disorders involving dysregulation across both peripheral and central systems. Resilience is conceptualized as a multifaceted process that enhances psychological adaptability to stress through adaptive mechanisms within the immunological system, brain, hypothalamo-pituitary-adrenal axis, and ANS Axis. Furthermore, the paper explores oxidative stress, particularly its origin from the production of reactive oxygen species (ROS) in mitochondria. The mitochondria's role extends beyond ATP production, encompassing lipid, heme, purine, and steroidogenesis synthesis. ROS-induced damage to biomolecules can lead to significant mitochondrial dysfunction and cell apoptosis, emphasizing the critical nature of mitochondrial health in overall cellular function and stress resilience. This comprehensive synthesis of neuroendocrinological and cellular biological research offers new insights into the systemic complexity of stress-related disorders and the imperative for multidisciplinary approaches in their study and treatment.

O-199 Couples presenting to Infertility clinics - Are they really infertile?

Study question

Are couples presenting to infertility clinics actually infertile, or is there an undiagnosed underlying sexual dysfunction whose treatment can lead to natural conception avoiding the need for assisted reproductive techniques?

Summary answer

All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can achieve pregnancy without assisted reproduction

What is known already

Infertility is defined as the inability to conceive after one year of frequent and regular unprotected sexual intercourse (SI). Although sexual histories are a key part of primary care screening guidelines for infertility, they are often overlooked during the infertility work-up. It is postulated that a large proportion of couples presenting to infertility clinics have underlying sexual dysfunction. Treatment through specialist counselling for couples with sexual dysfunction can help achieve pregnancy, negating the need for complex assisted reproductive techniques such as intravaginal insemination (IVI) and intrauterine insemination (IUl).

Study design, size, duration

108 couples were recruited from a national fertility clinic. The duration of the study was 3.5 years, from January 2016 to August 2019. The study was based primarily on surveys, where diagnostic work-up for infertility included tools for measuring sexual dysfunction, such as the IIEF-15 questionnaire. Our objectives were to find the extent of improvement of SI before and after specialist referral, and the time to conceive (TTC) in those with and without sexual dysfunction.

Participants/materials, setting, methods

Couples who never had successful completion of SI (despite producing an ejaculate sample) prior to clinic attendance were included. Treatment via specialist referral was then offered to these patients.

Data were analysed to compare outcomes between those who subsequently had successful SI (“Group A”) and those who had not had successful SI (“Group B”). Both groups were counselled for fertility treatments, such as IVI and IUI. TTC between the groups was analysed using Kaplan-Meier analysis

Main results and the role of chance

Out of 2057 couples presenting to the Infertility Clinic, 128 (5.98%) had never had successful SI. From this, 108 couples were included in the study. Two-thirds of couples revealed sexual difficulties at the beginning of the initial consultation. In men, erectile dysfunction was the predominant cause (70.4%, n = 76). In women, dyspareunia was the leading problem (18.2%, N = 20). Fertility investigations, which included hormone profiles, revealed normal results in most cases.

Treatment via referral to specialist sexual counselling was offered to all couples. Only 33 couples reported successful SI during subsequent visits (Group A). 13 of these 33 couples went on to conceive (11 naturally, 1 by IUI and 1 by IVI). The rest (n = 75), who had no improvement (Group B), had a significantly longer duration of sexual dysfunction, which was also more severe. Out of these 75 couples, 8 conceived (0 naturally, 6 by IVI, and 2 by IUI).The IIEF-15 scores (index for sexual dysfunction) between groups A and B were 10.72 ± 4.28 vs. 8 ± 4.73, P-value 0.0142. Group A couples (less severe sexual dysfunction) conceived earlier than Group B (mean duration 27.2 weeks vs. 48.8 weeks log-rank P value <0.001).

Limitations, reasons for caution

The main limitations of this study include a small sample size and a small minority of couples refusing to undergo specialist counselling despite having sexual difficulties as they were only interested in assisted reproductive interventions such as IUl and IVI. These limitations hinder the internal/external validity of the study.

Wider implications of the findings

All couples presenting with infertility should be asked about sexual function. If sexual dysfunction is diagnosed, a signicant proportion can be helped to achieve pregnancy without assisted reproduction. In the cases of couples with persistent sexual difficulty, assisted reproductive techniques like IUI and IVI give a reasonable pregnancy rate.

Trial registration number

Not applicable

P-118 Timed Intercourse exacerbates the risk of sexual dysfunction in men & women without an improvement in time to pregnancy

Study question

Investigate the differences in sexual dysfunction and time to pregnancy between infertile couples pursuing timed intercourse and Regular Intercourse (RI at least twice a week).

Summary answer

TI significantly increased the risk of SD compared to RI for both males and females after adjusting all other contributing factors.

What is known already

Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple.

Study design, size, duration

This prospective cohort study recruited 371 infertile couples who had been trying to conceive for more than a year, presenting to three regional infertility clinics between January 2016 and December 2018. 283 couples pursued TI and 88 couples pursued RI for a year, with all couples having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse.

Participants/materials, setting, methods

The SD score of both partners was assessed at the first visit using the validated Arizona Sexual Experiences Scale (ASEX) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). TTP was determined using Kaplan Meier Analysis in couples for whom natural conception was possible and no reversible fertility pathology was identified.

Main results and the role of chance

Timed Intercourse (TI) involves aligning sexual intercourse to the time around ovulation to increase the chance of conception in couples trying to conceive. Whilst TI is often advocated to increase conception rates and potentially accelerate the time to pregnancy (TTP) for infertile couples, the stressful nature of this approach may be associated with adverse effects such as sexual dysfunction (SD) within the couple.

TI significantly increased the risk of SD compared to RI for both males (Odds ratio [OR] 15.24, 95% confidence interval [CI] 7.96-29.15) and females (OR 5.52, 95% CI 2.38- 12.78), after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI carried a higher risk of developing erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between TI and RI (p = 0.1365).

Limitations, reasons for caution

TI, a well-known strategy for increasing conception rates, did not improve time to natural conception compared to regular sexual intercourse. In contrast, the risk of sexual dysfunction in both men and women was significantly higher in TI, compared with RI.

Wider implications of the findings

This large study raises the question of effectiveness of the long-held belief that TI (intercourse limited around the ovulation-time, based on different methods of ovulation-prediction) improves pregnancy outcomes.

Trial registration number

N/A

Microwave magnetoimpedance and ferromagnetic resonance in Pr0.6Sr0.4MnO3

We report the magnetic field dependence of electrical impedance (magnetoimpedance) of a ferromagnetic Pr0.6Sr0.4MnO3 sample carrying alternating current (ac) of frequency f = 1 MHz to 3 GHz measured using an impedance analyzer and broad band ferromagnetic resonance (f = 2 to 18 GHz) measured using a coplanar wave guide based spectrometer. Ac magnetoresistance is much larger than dc magnetoresistance and its sign at low magnetic fields changes from negative to positive with increasing frequency of the ac current. The field dependence of ac magnetoresistance shows a peak around H dc = 0 for low frequencies but a double peak feature emerges at H dc = ±H p at higher frequencies and it shifts to higher magnetic field as the frequency of ac current increases. The field derivative of microwave power absorption measured by the broad band spectrometer shows features of ferromagnetic resonance and the resonance field increases with increasing frequency of microwave radiation following Kittel's equation for ferromagnetic resonance. A close correlation is found between the ferromagnetic resonance line shape and the positive peak in the ac magnetoresistance, which suggests the possibility of electrical detection of ferromagnetic resonance using high frequency current injected into a conducting magnetic sample.

Evaluation of Phytochemical Screening and Anti Inflammatory Activity of Leaves and Stem of Mikania scandens (L.) Wild

Background:

The greatest disadvantage in the presently available potent synthetic anti-inflammatory drugs lies in their toxicity and reappearance of symptoms after discontinuation. Hence, people are returning to the natural products with the hope of safety and security. Several species of Mikania have been reported to have anti-inflammatory properties.

Aim:

The present study aims to assess the anti-inflammatory activity of the ethanolic extract of the leaves and stem of Mikania scandensin vivo and in vitro.

Materials and Methods:

The in vitro bioassay consisted of assaying the effect of the extracts against denaturation of protein (egg albumin) and measuring the absorbance. In vivo anti-inflammatory activity was checked by measuring the percentage inhibition of carrageenan-induced rat paw edema after oral administration of the extracts to male Wistar rats.

Results:

The plant extracts revealed the presence of tannins, alkaloids, steroids and flavonoids in both the leaf and stem extracts. The in vitro study of leaf extracts of M. scandens demonstrated that at 16000 μg/ml concentration a better anti-inflammatory activity was exhibited which is more than the stem extracts. Similarly in the in vivo study, carrageenan induced inflammation was significantly antagonized by M. scandens leaf extract, with inhibition of 50% at 1000 mg/kg.

Conclusion:

The ethanolic extract of both leaf and stem of M. scandens showed potent anti-inflammatory activity. In comparison the leaf extract found to be more potent in both the conditions in vivo and in vitro, comparing with the standard drug diclofenac sodium and traditional control rumalaya perhaps due to the presence of phytochemicals like alkaloids and flavonoids in the plant.

Sliding wear behavior of submicron-grained alumina in biological environment

Sliding wear behavior of sintered alumina with grain sizes between 0.45 and 4 microm was studied in bovine serum environment with unidirectional pin-on-disc wear testing machine. Submicron grained alumina of average grain size of G=0.45 microm exhibits lowest wear factor among the others. It was found that grain pull out or localized grain dislodgement caused by coalescence of grain boundary microcracks is the basic wear mechanism of submicron grained alumina though the extent of cracking and pull-out was substantially less than that with higher grained material. However, in few cases, some areas where substantial volume of material was removed following pull-out of cluster of grains have also been observed.

Radiation-induced brain disorders in patients with pituitary tumours

Radiation-induced brain disorders (RIBD) are uncommon and they are grave sequelae of conventional radiotherapy. In the present report, we describe the clinical spectrum of RIBD in 11 patients who received post-surgery conventional megavoltage irradiation for residual pituitary tumours. Of these 11 patients (nine men, two women), seven had been treated for non-functioning pituitary tumours and four for somatotropinomas. At the time of irradiation the age of these patients ranged from 30 to 59 years (mean, 39.4 +/- 8.3; median, 36) with a follow-up period of 6-96 months (mean, 18.3 +/- 26.4; median, 11). The dose of radiation ranged from 45 to 90 Gy (mean, 51.3 +/- 13.4; median, 45), which was given in 15-30 fractions (mean, 18.6 +/- 5.0; median, 15) with 2.8 +/- 0.3 Gy (median, 3) per fraction. The biological effective dose calculated for late complications in these patients ranged from 78.7 to 180 Gy (mean, 99.1 +/- 27.5; median, 90). The lag time between tumour irradiation and the onset of symptoms ranged from 6 to 168 months (mean, 46.3 +/- 57.0; median, 57). The clinical spectrum of RIBD included new-onset visual abnormalities in five, cerebral radionecrosis in the form of altered sensorium in four, generalized seizures in four, cognitive dysfunction in five, dementia in three and motor deficits in two patients. Magnetic resonance imaging (MRI)/CT of the brain was suggestive of radionecrosis in eight, cerebral oedema in three, cerebral atrophy in two and second neoplasia in one patient. Associated hormone deficiencies at presentation were hypogonadism in eight, hypoadrenalism in six, hypothyroidism in four and diabetes insipidus in one patient. Autopsy in two patients showed primitive neuroectodermal tumour (PNET) and brainstem radionecrosis in one, and a cystic lesion in the left frontal lobe following radionecrosis in the other. We conclude that RIBD have distinctive but varying clinical and radiological presentations. Diabetes insipidus and PNET as a second neoplastic disorder in adults following pituitary irradiation have not been reported previously.

Real-time volume haptic rendering of non-linear viscoelastic behavior of soft tissue through dynamic atomic unit approach

The aim of computer haptics is to enable the user to touch, feel and maneuver virtual objects using a haptic interface. As the user "feels" the virtual object by applying force through the interface, complex calculations have to be done in real-time to generate a feedback force appropriate to the material properties of the object being "touched". In this paper we propose a method for modeling soft bodies, which incorporate non-linear, viscoelastic, anisotropic behavior that will enable real-time user interaction and still satisfy the high force-feedback frequency requirements. In this paper, we restrict the user interaction with virtual objects to palpation.

Chordomas and chondrosarcomas of the skull base: results and complications of surgical management

Object

Chordomas and chondrosarcomas are rare and difficult to treat tumors for which the optimum treatment modality remains controversial. The aim of this study was to evaluate the surgery-related results and complications in a series of patients in whom radical resection was the treatment of choice.

Methods

The authors conducted a retrospective analysis of the surgery-related results and complications associated with chordoma and chondrosarcoma in 64 patients of whom 33 (52%) had previously undergone some form of treatment. Total or near-total excision was achieved in 56% and this rate increased to 68% in patients without prior treatment. The main complications were postoperative cerebrospinal fluid leakage, intraoperative arterial injury, and new-onset cranial nerve deficits. Arterial injury occurred only and perioperative death occurred more often in patients who had undergone previous treatment.

Conclusions

Analysis of the results provides support for a policy of radical excision of chordomas and chondrosarcomas at the time of first presentation. A higher incidence of procedure-related complications is found in patients who have already undergone surgery and radiotherapy.