The Effect of Hyperglycemic Hyperinsulinemia on Small-Intestinal Mucosal Protein Synthesis in Patients After Surgical Stress

Hyperglycemic hyperinsulinemia cannot stimulate intestinal protein synthesis in healthy individuals but does so in conditions characterized by an altered somatotropic axis such as diabetes. Only in a state of growth hormone resistance (high growth hormone but low insulin like growth factor [IGF-1] concentrations), extra insulin may acutely reverse the impaired, growth-hormone-induced IGF-1 release, thereby exerting anabolic actions at the intestinal tract. Growth hormone resistance can be also found in patients after surgical stress. Therefore, we wanted to test the hypothesis whether hyperglycemic hyperinsulinemia would stimulate ileal protein synthesis in the latter condition. Mass spectrometry techniques (capillary gas chromatography/combustion isotope ratio mass spectrometry) were used to directly determine the incorporation rate of 1-[(13)C]-leucine into ileal mucosal protein. All subjects had an ileostomy, which allowed easy access to the ileal mucosa, and consecutive sampling from the same tissue was performed during continuous isotope infusion (0.16 mumol/kg min). Isotopic enrichments and fractional protein synthesis were determined at baseline (period I) and after a 4-hour glucose infusion (170 mg/kg/h) or after infusion of saline (control group) (period II). In controls, ileal protein synthesis declined significantly during prolonged isotope infusion (period I: 1.11 +/- 0.14%/h, period II: 0.39 +/- 0.13%/h, p < .01). In contrast, ileal protein synthesis remained constant during glucose infusion (period I: 1.32 +/- 0.35%/h, period II: 1.33 +/- 0.21%/h, n.s. vs period I, but p < .005 vs the corresponding value at the end of period II in the control group). Using the continuous tracer infusion technique, ileal protein synthesis seemingly declines over a short time in control subjects. We found evidence that this artificial decline was due to mass effects of a rapidly turning over mucosa protein pool in which an isotopic plateau was reached during the experiment and of which the size amounted to approximately 4% of the total mixed protein pool. Maintenance of ileal protein synthesis during glucose infusion therefore indicates a rise of ileal protein synthesis in a slowly turning over protein pool. This effect in postsurgical patients would be compatible with the concept of intestinal insulin action to depend on the specific clinical state (eg, growth hormone resistance).

Metabolic Mechanisms of Stress Hyperglycemia

Stress hyperglycemia has gained the attention of virtually every physician who encounters critically ill patients, with the emergence of clinical data supporting tight glycemic control and intensive insulinization for optimal outcome. In order to effectively manage stress hyperglycemia, newer theories of critical illness and the interactions of the brain, neuroendocrine axis, and immune system need to be explored. Nonlinear physiologic processes, glucose allostasis, immune-neuroendocrine axis activation, and molecular mechanisms of insulin receptor signal transduction contribute to a novel model of stress hyperglycemia. In chronic critical illness, allostatic overload leads to a plurality of organ-system derangements and eventually death. Intervention not only involves insulinization according to neurofuzzy logic but also targeting more proximate events with cognitive/behavioral therapy and hypothalamic releasing factors.

Balancing work and family demands

Aims: The aim of this study is to analyse how increasing demands from work and family life affect the level of strain and whether there are any significant gender differences in this respect. This is be done by testing the following hypotheses: An increase in work and family demands causes (a) an increased risk of suffering from fatigue; (b) an increased need for working fewer hours. Methods: The hypotheses are analysed by using a longitudinal data set consisting of nearly 9,000 Swedish individuals. Results: Multiple demands increase the risk of suffering from fatigue among both women and men, but it is only among women that an increase in the percentage desiring a reduction in their working hours can be found. Conclusions: The results support the role stress theory, especially among women.

Losartan may prevent the elevation of plasma glucose, corticosterone and catecholamine levels induced by chronic stress

Introduction

Stress is a stimulus that activates the hypothalamic pituitary adrenal (HPA) axis and sympathetic nervous system (SNS). Increased activity of the SNS causes to increment or impairment in blood pressure, heart rate, body temperature and plasma glucose and adrenocorticotrophic hormone (ACTH) levels. Angiotensin II (Ang II), which is a product of the renin-angiotensin system (RAS), is an important factor affecting the activity of the SNS and responses to stress. We suggest that the blockade of Ang II may be worthwhile in the prevention and treatment of diabetes mellitus and cardiovascular diseases affected by stress. Therefore, we investigated the effects of immobilisation stress on blood glucose, norepinephrine (NE), epinephrine (E) and corticosterone levels and the effects of an Ang II receptor antagonist, losartan, on these parameters.

Materials and methods

The rats were kept in small cylindrical cages for 60 min/day for 10 consecutive days to perform chronic immobilisation stress. Losartan (10 mg/kg) was given daily by gavage to Losartan (L) and Losartan + Chronic Stress (L+CS) groups. Control (C) and Chronic Stress (CS) P groups received an equal volume of saline daily by gavage for 10 days. After the last stress regimen, blood samples were collected for plasma glucose, NE, E and corticosteroid measurements.

Results

Plasma glucose, NE, E and corticosterone levels in the CS Group increased significantly compared with the C group. In Group L+CS, the plasma glucose, NE, E and corticosterone levels decreased significantly vs. Group CS. In Group L there was no significant difference vs. Group C.

Conclusion

It can be speculated that chronic blockade of RAS may decrease the excess sympathetic responses to stress in cardiovascular diseases and prevent the likely development of Type II diabetes mellitus.

Stress-Induced Cortisol Response and Fat Distribution in Women

Recent studies have shown an association between uncontrollable stress and abdominal fat distribution. It has been suggested that changes in cortisol secretion might represent one possible mechanism for this relationship. This study investigated whether body fat distribution, determined by waist-to-hip ratio (WHR), is related to salivary cortisol levels in response to laboratory stressors. Subjects were 41 overweight women with a Low or a High WHR. Multiple measures of cortisol and mood were obtained during a session of stressful tasks (eg., timed arithmetic) and during a time-matched, control rest session. Also, background life stress and psychological trait variables were assessed. Compared to Low WHR subjects, High WHR subjects secreted significantly more cortisol during the stressful session after 60 minutes of stress, and considering the total area under the curve of secretion. This difference was not seen on the rest day. In terms of background and psychological measures, High WHR subjects were characterized by poorer coping skills and differences in mood reactivity. Specifically, although all subjects became more angry in response to the stressful session, High WHR subjects showed smaller increases in anger. This could indicate that they are more likely to evidence a helpless reaction to uncontrollable stress. These findings support the hypothesis that cortisol secretion might represent a mechanism for the observed association between stress and abdominal fat distribution. Furthermore, differences in coping and appraisal may suggest that a particular psychological pattern might influence the reactivity of the adrenal-cortical system to stress, and subsequent fat distribution.

The role of pre-operative state-anxiety in the determination of intra-operative neuroendocrine responses and recovery

OBJECTIVES

The psychophysiological model of adjustment to surgery predicts associations between (1) heightened pre-operative state-anxiety and intra-operative neuroendocrine responses, (2) neuroendocrine responses and complications; and (3) heightened pre-operative state-anxiety and post-operative recovery. The present study examined these associations.

METHODS

Participants were 39 patients (mean age 71.9+/-6.1 years) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery, patients completed baseline measures of physical and mental functioning using the MOS 36-item Short-Form Health Survey (SF-36). In addition to this, they undertook a 24-hour urine save to measure cortisol and catecholamines. Measures of state-anxiety were completed on the evening prior to surgery. A second 24-hour urine save was started at the time of anaesthetic induction. Follow-up measures of physical and mental functioning were completed 1 month following surgery. All complications were recorded during hospitalization.

RESULTS

There was a significant negative association between pre-operative state-anxiety and intra-operative cortisol (r=-.52, p<or=.001). Using hierarchical regression analysis, pre-operative state-anxiety accounted for 10% of the variance in intra-operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and complications. Pre-operative state-anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning.

CONCLUSIONS

Results from this study show increasing pre-operative anxiety to be associated with lower intra-operative cortisol responses and poorer mental functioning 1 month following surgery.

Health and voice quality in smokers: An exploratory investigation

Thirty-two adults (20 smokers and 12 non-smokers) were examined to determine the effects of cigarette smoking on health (diseases and larynx histology), on fundamental frequency (regularity and jitter) and stress level. The examination consisted of nasovideostroboscopy analysis, history case, electrolaryngography assessment for different task performance and self-assessment of stress. Although not statistically different, results indicate that smokers in comparison to non-smokers show: 1) slightly more health problems; 2) histological larynx changes; 3) a higher level of stress; 4) a lower mean F0 for all speech tasks. A statistically significant difference for percentage jitter was found according to voice status for: 1) vowel [a] (the group with voice problems show higher levels of jitter than both groups without voice problems); 2) vowel [i] (the smokers with voice problems show higher levels of jitter than the smokers without voice problems).

Postoperative parkinsonism and lupus anticoagulant: A model of autoantibody-mediated neurotoxicity in stress

PRIMARY OBJECTIVE

Nigrostriatal hypodopaminergism is the fundamental basis in parkinsonism. It may arise secondarily from a variety of disorders but is rarely mentioned shortly after surgery.

METHODS AND PROCEDURES

To report the clinical course of five patients who had had symptomatic parkinsonism developed shortly after surgery (lumbar laminectomy, prostatectomy and cholestectomy). Appropriate investigations were done to elucidate their pathogenesis.

MAIN OUTCOMES AND RESULTS

There was no remarkable finding of their anesthetic agents, duration of surgery, type of surgery, medical conditions or preoperative screening test. Extensive investigations did not reveal consistent abnormality. However, an abnormal presence of lupus anticoagulant was detected in four patients; primary antiphospholipid antibody syndrome was fulfilled in two of them. The lupus anticoagulant restored to the reference range in another two patients later. Catastrophic antiphospholipid antibody syndrome was not seen. Initially, their parkinsonian symptoms rapidly progressed but slowed down after six months.

CONCLUSION

Lupus anticoagulant possesses neurotoxic property and has been found in cases of movement disorder involving with the central dopaminergism. Surgery, a form of traumatic stress, has been reported to bring on lupus anticoagulant and catastrophic antiphospholipid antibody syndrome. These relationships remind a generation or an enhancement of pathognomic autoantibody vulnerable for dopaminergic toxicity, such as lupus anticoagulant or other antiphospholipid antibody.

A Multidimensional Model for Understanding Cancer Pain

The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment.

Circulatory effects of stress in essential hypertension

Hemodynamics and plasma catecholamines were studied during mental arithmetics and cold pressor test in thirteen patients with essential hypertension. Blood pressure was significantly increased by both forms of "stress". Cold pressor test caused a significant increase in total peripheral resistance, while mental arithmetics increased heart rate and cardiac output significantly. Thus, different forms of "stress" can increase blood pressure by totally different hemodynamic mechanisms. Acute cardioselective and non-selective beta-receptor blockade did not affect the hemodynamic reaction pattern during cold pressor test. The increase in heart rate and cardiac output during mental arithmetics was blocked by non-selective but not with cardioselective beta-blockade. Both beta-blockers were, however, inefficient in preventing the blood pressure elevation induced by mental arithmetics. Plasma noradrenalin was significantly increased during mental arithmetics after both cardioselective and non-selective beta-blockade compared to placebo. During cold pressor test there was a significant increase in noradrenalin only after non-selective beta-blockade. Adrenalin in plasma was significantly increased only during mental arithmetics after cardioselective beta-blockade. The pathogenesis of essential hypertension is complex and still not fully understood. Both hereditary (1) and environmental factors such as salt intake (2) and stress (3,4,5) are probably of importance as risk factors for essential hypertension. Animal studies have shown that different forms of stress can produce permanent hypertension due to structural changes in the resistance vessels (6). Against this background we decided to investigate acute hemodynamic effects of two well-defined types of "stress", e.g. mental arithmetics and cold pressor test in patients with essential hypertension and to study if the hemodynamic reactions could be modified by cardioselective and non-selective beta-receptor blockade. Catecholamines in plasma were studied before, during and after "stress".

Stress as a Trigger of Attacks in Menière's Disease. A Case-Crossover Study

BACKGROUND

Menière's disease is defined as the presence of recurrent, spontaneous episodic vertigo, hearing loss (HL), aural fullness, and tinnitus. The occurrence of attacks is unpredictable. The etiology is still unknown, but the disease has a pathologic correlate in hydropic distension of the endolymphatic system. Earlier studies have shown increased incidence of stress on the same day as vertigo attacks, but it has not been determined whether stress occurring on the day of the vertiginous episode came before or after the onset of the vertigo.

METHODS

A case-crossover study including 46 patients with active Menière's disease.

MAIN OUTCOME MEASURE

Relative risks with 95% confidence intervals (CI).

FINDINGS

During the study period, 153 Menière's attacks were reported. Twenty-four (52%) of the 46 patients reported attacks. Twelve of the 153 (8%) attacks occurred within 3 hours after exposure to emotional stress. The relative risk of having an attack was 5.10 (95% CI 2.37-10.98) during 3 hours after being exposed to emotional stress. Twenty-nine percent of the patients with attacks had at least one attack after exposure to emotional stress. For mental stress, the relative risk was 4.16 (95% CI 1.46-11.83) and the hazard period 1 hour, but only five attacks were exposed. No excess risk was found after physical stress.

INTERPRETATION

Being exposed to emotional stress increases the risk of getting an attack of Menière's disease during the next hour, and the hazard period is possibly extended up to 3 hours.

[AGML due to stressor and acid secretion]

AGML is produced by various causes. Major causes are stressor and drugs, for example, NSAIDs. However, it contains various causes: hypovolemic shock, burning, and accident of central nervous system. In this chapter, pathological conditions of AGML, especially, acid secretion and defence mechanism are discussed.

A systematic review of stress and psychological factors as possible risk factors for periodontal disease

BACKGROUND

Clinical observations and epidemiologic studies suggest that some negative life events and psychological factors may contribute to an increased susceptibility to periodontal disease. The aim of the present study was to systematically review the evidence from case-control studies, cross-sectional studies, and prospective clinical trials reporting on the influence of stress and psychological factors on periodontal disease. The focused question addressed in this systematic review was whether the scientific evidence is enough to consider stress and psychological factors as risk factors for periodontal disease.

METHODS

A literature search was conducted using two databases (MEDLINE and the Cochrane Oral Health Group specialist trials register) in addition to searching reference lists of original and review articles. The search strategy used was the combination of the terms: "stress," "periodontal disease," and "psychosocial disorders." Studies were selected if they were published in dental journals between January 1, 1990 and April 1, 2006; only human studies and studies with adults and middle-aged subjects were included. Suitable variables included control for the potential effect of confounding factors, adequate criteria to define periodontal disease, adequate criteria for establishing stress, and methodologic quality. Only English-language articles were considered, and unpublished data were not sought. Two reviewers independently extracted information regarding quality and study characteristics in duplicate. The studies were assessed regarding their methodologic characteristics, statistical analysis, characteristics of the periodontal outcome measures, and psychological measurements.

RESULTS

Of the 58 articles identified in the search, 10 were excluded because they were reviews and 34 did not comply with the selection criteria. Fourteen articles (seven case-control studies, six cross-sectional studies, and one prospective clinical trial) were included in the analysis; their quality and main study characteristics were assessed according to the criteria preestablished in the protocol of the study. With regard to the results of the studies, 57.1% found a positive outcome between psychosocial factors/stress and periodontal disease, 28.5% observed a positive outcome for some characteristics and a negative outcome for others, and 14.2% found a negative outcome.

CONCLUSIONS

Within the limitations of this systematic review, the majority of studies showed a positive relationship between stress/psychological factors and periodontal disease. However, in the future, well-designed and more representative studies should be considered to confirm these factors as a risk for periodontal disease.

Diabetes mellitus as a risk factor for cancer: stress or viral etiology?

Diabetes mellitus (DM) is a metabolic disorder. Currently over 230 million patients demonstrate already an epidemic scale of the disease. It is a lifelong progressive disease with a high mortality worldwide: every 10 seconds one patient dies on DM-related consequences. Whereas cardio-vascular complications are well-known for DM, it is relatively new consideration that diabetic patients are highly predisposed to cancer. Particularities of molecular pathomechanisms of cancer in diabetes are currently largely unclear. Disturbed glucose/insulin homeostasis is DM-specific stress factor resulting in increased production of Reactive Oxygen Species (ROS) and oxidative damage to chromosomal and mitochondrial DNA frequently observed in diabetic patients. Long-term accumulation of DNA mutations is well-acknowledged as triggering cancer. DNA-repair is highly energy consuming process which provokes increased mitochondrial activity. Particularly dangerous is a provoked activity of damaged mitochondria which leads to the "vicious circle" lowing energy supply and potentiating ROS production. Mitochondrial dysfunction is the well-acknowledged risk factor for neuro/degenerative diseases--one of possible pathomechanisms for various complications developed secondary to diabetes. At the same time, mitochondrial dysfunction might be implicated in pathomechanisms of diabetes-provoked cancer. There is a growing body of evidence that DM predisposes to almost all cancer types with some particular preferences. Frequently suffering from compromised immune response, diabetic patients is high-risk group for infectious disorders including viral infections. In its turn, viral infections are known to be implicated in cancer pathology. This review considers both stress and viral infections as possible etiology of cancer in diabetes.

[Inflammatory/anti-inflammatory mechanisms in the brain following exposure to stress]

INTRODUCTION

Most of the biological systems that go to make up an organism can be affected by stress. The central nervous system not only plays an essential role in regulating the general response to stress, but it is also one of its main targets. The consequences may be positive (for example, a state of alertness) or negative (neuropsychiatric pathologies). More specifically, exposure to certain stressing stimuli can trigger a neuroinflammatory process.

DEVELOPMENT

Reports have appeared describing how an excessive neuroinflammatory response makes a decisive contribution to the functional and structural damage that is often observed in stress-related neurological and neuropsychiatric diseases, such as post-traumatic stress syndrome, depression and schizophrenia. The inflammatory process generated by exposure to stress is characterised by a complex release of a chain of different cell mediators, such as cytosines, transcription factors, prostaglandins, free radicals, and so forth. In parallel to this, it has been proved that the anti-inflammatory pathway of deoxyprostaglandins is activated after stress in the central nervous system, and this activation could constitute an endogenous mechanism that regulates the inflammatory process itself.

CONCLUSIONS

In the future, further studies and a deeper understanding of this endogenous pathway could make it into a new, interesting preventive or neuroprotective strategy for use in a number of pathologies that have a clear harmful inflammatory component, such as cerebral ischaemia, Alzheimer's and Parkinson's diseases, as well as those mentioned earlier as being related to exposure to stress.

Musculoskeletal symptoms in New Zealand dental therapists: prevalence and associated disability

OBJECTIVE

To determine the prevalence and associations of disability due to musculoskeletal symptoms among practising New Zealand dental therapists.

DESIGN

Cross-sectional survey of a random sample of dental therapists.

METHOD

A postal questionnaire was sent out to all 483 registered dental therapists who were New Zealand Dental Therapists' Association (NZDTA) members in 2005.

RESULTS

Usable responses were obtained from 323 therapists (98.8% female; mean age 49.2; age range 23 to 72). The most commonly reported problems in the previous year were neck (56.8%), lower back (54.0%) or shoulder symptoms (52.4%). Fewer of those working regularly with a dental assistant reported shoulder symptoms, but they had a higher prevalence of hip/thigh symptoms. Overall, the prevalence of disability ranged from approximately one in five (neck) to one in three (elbows or lower back) of those reporting symptoms.

CONCLUSIONS

The prevalence of musculoskeletal symptoms among New Zealand dental therapists is high, with neck, shoulder and lower back symptoms being particularly common. The impact of those symptoms on sufferers' daily lives is considerable. Both therapists and employers need to examine ways of minimising musculoskeletal stress in order to minimise the incidence of new cases, and to support sufferers so that they are not lost prematurely from a workforce group which is already struggling to maintain sufficient practising numbers.

[The practice guideline 'Acne' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice]

The strength of the second revision of the practice guideline 'Acne' from the Dutch College of General Practitioners (NHG) lies mainly in bringing its therapy up to date. The guideline also points out psychosocial problems that can arise with acne, but discounts stress and diet as the possible cause. Schedules showing a medical plan of action and information on medications complete this clear and practical guideline.

Relation of substance P to stress and catecholamine metabolism

Most research on substance P deals with its presumed function in the nervous system. Both excitatory and inhibitory actions have been observed in pharmacological studies. For example, substance P has a dual action on nociception in mice: it produces analgesia or hyperalgesia, depending on the dose and on the individual sensitivity to pain. This is interpreted to mean that substance P is capable of normalizing responsiveness to pain. Thus substance P could be classified as a regulatory peptide, or 'regulide'. A similar normalizing action of substance P was found in stress-induced disorders of sleep, behaviour and blood pressure in rats. The mechanism of this normalizing action is not yet clear. The decrease in activity observed for dopamine beta-hydroxylase and phenylethanolamine N-methyltransferase in adrenal glands of rats treated with the peptide may serve as a preliminary hypothesis.

Nmnat delays axonal degeneration caused by mitochondrial and oxidative stress

Axonal degeneration is a prominent feature of many neurological disorders that are associated with mitochondrial dysfunction, including Parkinson's disease, motor neuron disease, and inherited peripheral neuropathies. Studies of the Wld(s) mutant mouse, which undergoes delayed Wallerian degeneration in response to axonal injury, suggest that axonal degeneration is an active process. Wld(s) mice also have slower axonal degeneration and disease progression in numerous models of neurodegenerative disease. The Wld(s) mutation results in the production of a chimeric protein that contains the full-length coding sequence of nicotinamide mononucleotide adenylyltransferase 1 (Nmnat1), which alone is sufficient for axonal protection in vitro. To test the effects of increased Nmnat expression on axonal degeneration induced by mitochondrial dysfunction, we examined dorsal root ganglion (DRG) neurons treated with rotenone. Rotenone induced profound axonal degeneration in DRG neurons; however, this degeneration was delayed by expression of Nmnat. Nmnat-mediated protection resulted in decreased axonal accumulation and sensitivity to reactive oxygen species (ROS) but did not affect the change in the rate of rotenone-induced loss in neuronal ATP. Nmnat also prevented axonal degeneration caused by exposure to exogenous oxidants and reduced the level of axonal ROS after treatment with vincristine, further supporting the idea that Nmnat promotes axonal protection by mitigating the effects of ROS.

Stress, memory and Bosnian war veterans

The aim of this study was to analyze cognitive dysfunction in PTSD. The testing included 79 Bosnian Army veterans, who participated in Bosnian war from 1992 to 1995. Out of 79 tested war veterans, 45 of developed PTSD while 34 did not. The veterans without PTSD where included in the control group. All the war veterans were of the same education level (secondary education) and between 30 and 50 years of age. Rivermead Behavioral Memory Test - RBMT was applied to all the subjects. The test was originally developed for the purpose of everyday memory problems identification. Clear goal of the 10 RBMT subtests is simulation of everyday life situations. PTSD group achieved significantly lower results than the control group. Results of the total score showed highly significant difference between PTSD and control group. Value of the t-test is t=10,056 with significance level of p<0,001. The same conclusion stands for any RBMT subtest. Numerous psychological studies on PTSD patients show more prominent psychological deficit in war veterans. Our study clearly confirms that finding.

Day/night differences in stress-induced gastric lesions in rats with an intact pineal gland or after pinealectomy

The formation of acute gastric lesions depends upon the balance between the aggressive factors promoting mucosal damage and the natural defense mechanisms. Previous studies have shown that melatonin inhibits gastric acid secretion, enhances the release of gastrin, augments gastric blood flow (GBF), increases the cyclooxygenase-2 (COX-2)-prostaglandin (PG) system and scavenges free radicals, resulting in the prevention of stress-induced gastric lesions. Besides the pineal gland, melatonin is also generated in large amounts in the gastrointestinal tract and due to its antioxidant and anti-inflammatory properties; this indole might serve as local protective endogen preventing the development of acute gastric damage. The results of the present study indicate that stress-induced gastric lesions show circadian variations with an increase in the day time and a decline at night. These changes are inversely related to plasma melatonin levels. Following pinealectomy, stress-induced gastric mucosal lesions were more pronounced both during the day and at night, and were accompanied by markedly reduced plasma melatonin levels with a pronounced reduction in mucosal generation of prostaglandin E(2) (PGE(2)), GBF and increased free radical formation and by small rise in plasma melatonin during the dark phase. We conclude that stress-induced gastric ulcerations exhibit a circadian variation with an increase in the day and attenuation at night and that these fluctuations of gastric stress ulcerogenesis occur also after pinealectomy, depending upon the interaction of COX-PG and free radicals, probably mediated by the changes in local gastric melatonin.

[Influence of prenatal stress on free radical oxidation lipids, both proteins and activity of superoxiddismutase in neurones and glial cells of the rat brain cortex]

Processes of free radical oxidation of protein, lipids, and activity of superoxiddismutase in neurons and glial cells of the rat brain cortex in ontogenesis and after prenatal stress. Irrespective of age, the level of free radical oxidation of lipids and proteins in neurons is higher in comparison with the glia. The same was found in the study of superoxiddismutase activity. After prenatal stress, the level of free radical oxidation of lipids is reduced both in neurons, and in the glia. On the contrary, the contents of oxidation of proteins rises in neurons on the average fourfold. Activity of superoxiddismutase in animals who had suffered from prenatal stress is considerably reduced in neurons remaining unchanged in glial cells.

Depression, cortisol and somatoform dissociative symptoms

OBJECTIVE

According to recent findings neuroendocrine response related to dissociative symptoms is related to dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis but HPA axis functioning as related to dissociation is only partially understood.

METHOD

With the aim to test the relationship between basal serum cortisol and dissociative symptoms measured as somatoform and psychic dissociation we performed clinical testing and biochemical analysis in 30 inpatients with diagnosis of unipolar depression (mean age 41.46, SD=13.68).

RESULTS

The results show that cortisol as an index of HPA axis functioning manifests significant relationship to somatoform dissociative symptoms (r=-0.40; p=0.014).

CONCLUSIONS

The result indicates relationship between HPA-axis reactivity and somatoform dissociative symptoms in unipolar depressive patients and suggests that somatoform dissociation presents a defense mechanism related to a passive coping response.

Surgical stress and accelerated tumor growth

BACKGROUND

Delay in the initiation of radiotherapy after surgery is associated with an increase in local regional recurrence. A possible mechanism might be that remaining tumor cells proliferate significantly faster as a result of induced angiogenic cytokines. The growth rate of tumors arising from the inoculation of L44 tumor cells in the wound bed after surgical removal of L44 tumors was determined.

MATERIALS AND METHODS

L44 tumors growing in the flank of female BN rats were surgically removed. In the wound bed, 5x10(6) L44 cells, harvested from the in vitro cell line, were injected. L44 cells were also injected in the contralateral flank and in control rats with and without surgical intervention. Tumor volumes as a function of time after injection of cells were recorded. From the attained volume at day 7, the cell doubling time was calculated, assuming 10(9) cells per cm3.

RESULTS

Tumors arising in the wound bed had the fastest growth rate as compared to the tumors in the contralateral flank or tumors in control rats with or without surgical intervention.

CONCLUSION

The results clearly indicate accelerated tumor growth after surgical stress. This indicates that delay in the initiation of radiotherapy after surgery with tumor cells remaining, results in a larger tumor burden and hence a higher probability of local recurrence.

[Impact of stress on plasticity of brain structures and development of chosen psychiatric disorders]

The emotional state of human being may lead to sustained changes in structure of central nervous system. That is why the role of stress in pathogenesis of mental diseases becomes so important. Stress in its wild meaning, not only has an influence on neurotransmitting in central nervous system, but also through varied neuroendocrine and immunological mechanisms takes effect in permanent brain changes. Changes in stress regulating mechanisms as well as activating cooperating neurotransmitters seem to play fundamental role in pathogenesis of particular mental disorders. Lately, authors pay special attention to the role of trauma in development of psychosis. Many researchers underline the role of PTSD in decreasing hippocampus capacity. Oversecretion of cortisol being result of severe stress seems to be the hypothesis explaining decreased hippocampus capacity through initiating neurodegenerative processes. Awareness of negative effects of stress should result in undertaking prevention as well as appropriate therapeutic approach among people exposed to stress.

Prenatal dexamethasone 'programmes' hypotension, but stress-induced hypertension in adult offspring

Low birth weight in humans is predictive of hypertension in adult life. Although the mechanisms underlying this link remain unknown, fetal overexposure to glucocorticoids has been implicated. We previously showed that prenatal dexamethasone (DEX) exposure in the rat lowers birth weight and programmes adult hypertension. The current study aimed to further investigate the nature of this hypertension and to elucidate its origins. Unlike previous studies, we assessed offspring blood pressure (BP) with radiotelemetry, which is unaffected by stress artefacts of measurement. We show that prenatal DEX during the last week of pregnancy results in offspring of low birth weight (14% reduction) that have lower basal BP in adulthood ( approximately 4-8 mmHg lower); with the commonly expected hypertensive phenotype only being noted when these offspring are subjected to even mild disturbance or a more severe stressor (up to 30 mmHg higher than controls). Moreover, DEX-treated offspring sustain their stress-induced hypertension for longer. Promotion of systemic catecholamine release (amphetamine) induced a significantly greater rise of BP in the DEX animals (77% increase) over that observed in the vehicle controls. Additionally, we demonstrate that the isolated mesenteric vasculature of DEX-treated offspring display greater sensitivity to noradrenaline and other vasoconstrictors. We therefore conclude that altered sympathetic responses mediate the stress-induced hypertension associated with prenatal DEX programming.

Differential response of TRHergic neurons of the hypothalamic paraventricular nucleus (PVN) in female animals submitted to food-restriction or dehydration-induced anorexia and cold exposure

TRH neurons of the hypothalamic paraventricular nucleus (PVN), regulate pituitary-thyroid axis (HPT). Fasting activates expression of orexigenic peptides from the arcuate nucleus, increases corticosterone while reduces leptin, and pro-TRH mRNA levels despite low serum thyroid hormone concentration (tertiary hypothyroidism). TRH synthesis is positively regulated by anorexigenic peptides whose expression is reduced in fasting. The model of dehydration-induced anorexia (DIA) leads to decreased voluntary food intake but peptide expression in the arcuate is similar to forced-food restriction (FFR), where animals remain hungered. We compared the response of HPT axis of female Wistar rats submitted to DIA (2.5% saline solution, food ad libitum, 7 days) with FFR (provided with the amount of food ingested by DIA) and naïve (N) group fed ad libitum, as well as their response to acute cold exposure. Pro-TRH and pro-CRH mRNA levels in the PVN were measured by RT-PCR, TRH content, serum concentration of TSH and thyroid hormones by radioimmunoassay. DIA rats reduced 80% their food consumption compared to N, decreased PVN pro-CRH expression, serum estradiol and leptin levels, increased corticosterone similar to FFR. HPT axis of DIA animals failed to adapt: FFR presented tertiary hypothyroidism and DIA, primary. Response to cold stimulation leading to increased pro-TRH mRNA levels and TRH release was preserved under reduced energy availability in FFR rats but not in DIA, although the dynamics of hormonal release differed: TSH release augmented only in naïve; thyroxine in all but highest in DIA, and triiodothyronine in FFR and DIA suggesting a differential regulation of deiodinases.

[Current conception of stress and adaptation subject to new data of tissue hypoxia genesis]

State-of-the-art conception of stress is represented as an interrelation between stress, tissue hypoxia and adaptation. Under the influence of stressors the cell metabolism changes with producing of chemical substances capable pathologically to get bound with cell receptors. These substances change in cells optimal energy transformation (biochemical stage) and disturb cell functions (pharmacological stage). Biochemical and pharmacological stages of stress in uncellulates and in human cells are homotypic. The clinical stage of stress is typical only for humans and animals. Dysfunction of plane muscles (PM) myocytes leads to local microcirculation disturbances, transitory hypoxia and partial disorder in affected organ function. Local microcirculation disturbances are accompanied by serotonin release from damaged platelets, which leads to complete functional recovery of PM myocytes, microcirculation and affected organ function, or to formation of local "mute" focuses of tissue necrosis--the adaptation is effective. Insufficient serotonin release from damaged platelets leads to extension of hypoxia focus, lesion, tissue necrosis. The stress loses its nonspecificity and turns into infarction of myocard, brain etc., with specific clinical course--the adaptation is not effective.

[Stress related mucosal disease prophylaxis in intensive care unit patients]

Among the patients admitted to the Intensive Care Unit there frequently occur disturbances of the upper gastrointestinal tract. They can be found as stress ulcerations which in turn may lead to bleeding. The high incidence of stress ulcers and bleedings from the upper gastrointestinal tract is associated with disturbances of gastric acid secretion, an interrupted integrity of gastric mucosa and abnormal motor activity of gastrointestinal tract. The presence of clinically important bleeding results in prolonged hospitalization and increased mortality. The aim of this study is twofold; first, the pathogenesis and the consequences of stress-related mucosal disease are elucidated. Afterwards, the prophylaxis modalities are presented on the basis of the latest medical literature.

Stress lysis in childhood leukemia

Children with acute lymphoblastic leukemia (ALL) can experience a decrease in their white blood count (WBC) prior to chemotherapy, a phenomenon commonly attributed to the administration of allopurinol and hydration. We reviewed the records of 20 children with newly diagnosed ALL prior to the administration of allopurinol and found that 80% of patients experienced a decrease in their WBC (median decrease 14,000/mm(3)) in the less than 24-hr interval between evaluation at the referring center and admission to our hospital (P = 0.002). The basis for this often-observed phenomenon appears to be that leukemic cells rapidly lyse in response to the stress-induced release of endogenous corticosteroids.

Functional hypothalamic amenorrhea: current view on neuroendocrine aberrations

Functional hypothalamic amenorrhea (FHA) is defined as a non-organic and reversible disorder in which the impairment of gonadotropin-releasing hormone (GnRH) pulsatile secretion plays a key role. There are main three types of FHA: stress-related amenorrhea, weight loss-related amenorrhea and exercise-related amenorrhea. The spectrum of GnRH-luteinizing hormone (LH) disturbances in FHA is very broad and includes lower mean frequency of LH pulses, complete absence of LH pulsatility, normal-appearing secretion pattern and higher mean frequency of LH pulses. Precise mechanisms underlying the pathophysiology of FHA are very complex and unclear. Numerous neuropeptides, neurotransmitters and neurosteroids play important roles in the physiological regulation of GnRH pulsatile secretion and there is evidence that different neuropeptides may be involved in the pathophysiology of FHA. Particular attention is paid to such substances as allopregnanolone, neuropeptide Y, corticotropin-releasing hormone, leptin, ghrelin and beta-endorphin. Some studies reveal significant changes in these mentioned substances in patients with FHA. There are also speculations about use some of these substances or their antagonists in the treatment of FHA.

Stress, depression, and neuroplasticity: a convergence of mechanisms

Increasing evidence demonstrates that neuroplasticity, a fundamental mechanism of neuronal adaptation, is disrupted in mood disorders and in animal models of stress. Here we provide an overview of the evidence that chronic stress, which can precipitate or exacerbate depression, disrupts neuroplasticity, while antidepressant treatment produces opposing effects and can enhance neuroplasticity. We discuss neuroplasticity at different levels: structural plasticity (such as plastic changes in spine and dendrite morphology as well as adult neurogenesis), functional synaptic plasticity, and the molecular and cellular mechanisms accompanying such changes. Together, these studies elucidate mechanisms that may contribute to the pathophysiology of depression. Greater appreciation of the convergence of mechanisms between stress, depression, and neuroplasticity is likely to lead to the identification of novel targets for more efficacious treatments.

[Aggravating factors of rosacea]

Rosacea is a chronic, inflammatory skin disease which is mainly localized in the central region of the face. Papules and pustules appear on the erythematic ground. Rosacea is common in population. Four subtypes of rosacea (erythematoteleangiectatic rosacea, ETR; papulo - pustular rosacea, PPR; ocular rosacea and phymatous rosacea) are classified (according to current classification) and one variant rosacea (granulomatous rosacea, GR). It is considered that an attempt to determine of triggering factors of rosacea should be the first step to treatment. Then it should be tried to eliminate contact with them. The aim of this study was an analysis of triggering factors of rosacea. 43 women and 26 men treated in the Dermatology Outpatient's Clinic of Jagiellonian University School of Medicine in Cracow were enrolled in the study. All patients were asked which factors trigger skin changes according to them. Patients mentioned most often: stress (58 percent), sun exposure (56.5 per. cent), alcohol (33.3 percent), exercise (29 percent), drinking coffee (21.7 percent) and hot meals (20.3 percent). They regarded the sun as the most strongly aggravating factor of rosacea (29.2 percent). It seems, that elimination and reduction of contact with aggravating factors is still an undervalued aspect of rosacea's treatment. Patients' motivation for use of prevention seems to be also very important. Knowledge about aggravating factors of rosacea, coming directly from patients' observations, may help in more effective treatment.

[Heavy burdens and complex disease--an integrated perspective]

Complex chronic diseases require an increasing proportion of society's resources and represent a growing challenge. Valid biomedical models of etiology, pathogenesis, treatment and prognosis are inadequate for understanding these diseases. The article discusses current knowledge about the impact of stress on the immune-, hormonal - and central nervous systems, and integrates this knowledge with a phenomenological understanding of the body in an attempt to explain the complex chronic fatigue syndrome. The medical significance of the individual's biography is highlighted, and the inadequacy of statistically grounded biomedical research when aiming to understand complex disease is presented. By regarding human beings as persons who experience bodily and who both create and convey meaning, we claim to have transgressed the mind-body-dichotomy in complex disease development. The dichotomy converges in the living body.

Prenatal stress alters limbo-corticostriatal Homer protein expression

Early environmental stress influences developmental processes resulting in alterations in behavior and brain function, including abnormalities in glutamate neurotransmission. Here, we assessed the influence of prenatal stress on limbo-corticostriatal expression of Homer proteins that are critical elements in glutamatergic signaling. Pregnant, female Sprague-Dawley rats were subjected to either no treatment or to restraint stress 3 times per day for the last 7 days of gestation. At 21 d of age, offspring were sacrificed and brain tissue was rapidly extracted. Immunoblotting revealed regionally specific increases in certain Homer protein isoforms within prefrontal cortex and limbic structures, whereas the striatum exhibited a reduction in Homer 1a levels. These findings indicate that stress during development can produce enduring perturbations in Homer protein expression that likely contribute to glutamatergic and behavioral abnormalities observed following early environmental stress.

Trypanosoma cruzi: Plasma corticosterone after repetitive stress during the acute phase of infection

An increased level of plasma corticosterone is one manifestation of severe environmental or physiologic stress. The stress response mediated by the hypothalamic-pituitary-adrenal axis is already known to suppress immunoglobulin production and to impair immune function, but there are few studies relating stress and plasma corticosterone to the outcome of Trypanosoma cruzi infection. In this study, male Wistar rats were infected with the Y strain of T. cruzi and then subjected to repetitive stress by exposure to ether vapor for 1min twice a day during the acute phase of infection. Stressed animals showed decreased lytic antibody activity and lowered levels of peritoneal macrophages. Despite an increase in the weight of the spleen, histological analyses demonstrated tissue alterations, the presence of amastigote nests, and a complete absence of activated lymphoid follicles. These results suggest that stress-induced increases in plasma corticosterone can suppress the immune response and worsen tissue injury during the acute phase of T. cruzi infection.

[Prolactin response to stress in patients with systemic lupus erythematodes (SLE), rheumatoid arthritis (RA) and in healthy controls]

Prolactin is a one of the stress hormones, like the growth hormone, ACTH, cortisol and catecholamins. Among its wide range of functions is the important role of controlling the immune response which is, unlike in the case of cortisol, of stimulatory nature. For this activity, it is monitored as a factor influencing the progress and course of autoimmune diseases. The authors of the paper monitored prolactin response to stress in a normal stress situation, i.e. blood collection. A significant difference was detected between the levels of prolactin in 3 successive blood collections in 30 minute intervals (P < 0.001). Prolactin responded by a prompt increase in the serum level, followed by a relatively fast linear decrease. There was no difference in the response between the SLE and RA patient groups and the healthy population. Therefore we conclude that this is a normal reaction of the organism because acute response to stress in patients with autoimmune diseases is the same as in healthy persons.