Decrease In Cortisol Levels Research Articles

Effect of Probiotics Supplementation on Cortisol Levels: A Systematic Review and Meta-Analysis

Background: Several randomized controlled trials (RCTs) have shown conflicting results on cortisol levels following probiotic administration in healthy and diseased populations. Previous analyses were inconclusive due to limited studies, and evidence is lacking on how these effects vary by health status; region; therapy duration; medications, and use of single or multiple strains. Methods: In this systematic review and meta-analysis (PROSPERO [CRD42024538539]), we searched PubMed, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, ProQuest, and Web of Science Preprints until 13 August 2024, for RCTs on probiotic administration, either alone or combined, across all age groups and without specific medical condition requirements. We applied random-effects meta-analysis, assessed bias using the Cochrane RoB 2 tool, and evaluated evidence certainty with GRADE. Findings: We screened 1739 records and retrieved 46 RCTs (3516 participants). Probiotics supplementation decreased cortisol levels compared to the control arm [46 RCTs; SMD: −0.45; 95% CI: −0.83; −0.07; I2: 92.5%, low certainty]. Among various subgroups; probiotics supplementation decreased the cortisol levels in the subgroups without concomitant medications [37 RCTs; SMD: −0.30; 95% CI [−0.58; −0.03], I2: 88.7%] with a single probiotic strain [30 RCTs; SMD: −0.33; 95% CI: −0.63; −0.028; I2: 88.8%], in a healthy population [35 RCTs; SMD:−0.3; 95% CI: −0.58; −0.03; I2: 88.7] and in the Asia region [21 RCTs; SMD: −0.83; 95% CI: −1.58; −0.07; I2: 95%]. Interpretation: A low level of evidence suggests probiotics might reduce cortisol levels, but more targeted studies are needed to identify variables affecting the response in specific subgroups.

Lacticaseibacillus paracasei 207-27 alters the microbiota-gut-brain axis to improve wearable device-measured sleep duration in healthy adults: a randomized, double-blind, placebo-controlled trial.

Objective: Probiotics have been reported to exert beneficial effects on sleep through the gut-brain axis. Therefore, this randomized, double-blind, placebo-controlled trial assessed the effects of Lacticaseibacillus paracasei 207-27 supplementation on sleep quality and its safety and potential mechanisms. Method and study design: Healthy adults under mild stress aged 18-35 years consumed low or high doses of L. paracasei 207-27 or a placebo for 28 days. Fecal samples, blood samples, and questionnaires were collected at the baseline and the end of the intervention. Sleep quality was measured using wearable devices and Pittsburgh sleep quality index (PSQI) questionnaire. Serum inflammatory markers, corticotropin-releasing hormone, adrenocorticotropic hormone (ACTH), cortisol (COR), γ-aminobutyric acid, and 5-hydroxytryptamine levels were detected using enzyme-linked immunosorbent assay. The gut microbiota was analyzed using 16S rRNA sequencing and bioinformatics. Short-chain fatty acids levels were detected using gas chromatography-mass spectrometry. Results: Both the low-dose and high-dose groups exhibited significant improvements in wearable device- measured sleep duration compared to the placebo group. The global scores of PSQI in three groups significantly decreased after intervention without statistical difference between groups. At the phylum level, the low-dose group exhibited a higher relative abundance of Bacteroidota and a lower Firmicutes-to-Bacteroidetes (F/B) ratio. At the genus level, two treatment groups had higher relative abundance of Bacteroides and Megamonas, alongside lower levels of Escherichia-Shigella. Furthermore, the low-dose group exhibited significant increases in acetic acid, propionic acid, butyric acid, and valeric acid levels, while two treatment groups exhibited a significant decrease in COR levels. Correlation analysis revealed that the increased levels of acetic acid and butyric acid in the low-dose group may be associated with decreased ACTH. Conclusion: L. paracasei 207-27 administration in healthy adults resulted in improvements in gut microbiota community and sleep duration. The mechanisms might involve modulation of the gut microbiota structure to regulate the function of the gut-brain axis, including increases in SCFA levels and decreases in hypothalamic-pituitary-adrenal axis activity. The Chinese clinical trial registry number is ChiCTR2300069453 (https://www.chictr.org.cn/showproj.html?proj=191193, registered 16 May 2023 - retrospectively registered).

8604 Ectopic Cushing’s Syndrome Associated with a Metastatic Pancreatic Mixed Neuroendocrine Non-neuroendocrine Neoplasm (MiNEN) with Amphicrine Features

Abstract Disclosure: A. DeMarsilis: None. C. Jiang: None. O. Lavrynenko: None. D. Motavalli: None. C. Musurakis: None. Z.H. Taxin: None. E.D. Rosen: Advisory Board Member; Self; Source Bio, Inc.. Consulting Fee; Self; Novartis Pharmaceuticals, Gensaic. M.S. Irwig: None. Background: Ectopic Cushing’s Syndrome (CS) makes up 9-18% of ACTH-dependent CS cases, of which fewer than 15% are attributed to pancreatic neuroendocrine tumors (1). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) are rare, aggressive carcinomas, often driven by high-grade neuroendocrine components, with a poor prognosis (2). Amphicrine neoplasms contain neuroendocrine and exocrine components in the same cell. Clinical Case: A 34 year-old woman with asthma, hypertension, and depression presented with new onset lower extremity edema, facial hirsutism, mood changes, polyuria and polydipsia. She had an elevated morning serum cortisol of 52 ug/dL (normal < 20) with plasma ACTH 42 pg/mL (normal < 50), 24-hour urine free cortisol of 1003 mcg (normal < 50), K+ of 2.6 mEq/L, and fasting glucose 164 mg/dL. CT showed multiple hepatic lesions, pulmonary nodules, a pancreatic tail lesion, and lymphadenopathy concerning for metastatic disease. Her adrenal glands were thickened bilaterally without nodules. A pituitary MRI was normal. These findings were concerning for ectopic CS. She was admitted due to rapidly developing symptoms. Potassium, insulin, sitagliptin, and prophylactic anticoagulation were started. Spironolactone and ketoconazole were initiated while awaiting biopsy results of liver and pancreas lesions. Osilodrostat was not available and a trial of metyrapone was poorly tolerated. The liver and pancreatic tail lesion biopsy revealed metastatic MiNEN with amphicrine features, of pancreatic origin, with Ki67 proliferation index of 70%. Section staining of pancreas and liver biopsies were negative for ACTH. A Ga-68 Dotatate scan showed minimal uptake, so octreotide was not prescribed. Palliative chemotherapy was planned. Although ketoconazole was titrated to 1600 mg/day, urine free cortisol levels and serum free cortisol levels did not reach target. Cushing disease was considered but not suspected, as ACTH levels remained modest despite a relative decrease in cortisol level. Given significant morbidity from uncontrolled hypercortisolism, and plans for urgent initiation of systemic chemotherapy, after multidisciplinary discussion the patient was treated with a surgical bilateral adrenalectomy. Post-operative morning serum cortisol measured 8.3 ug/dL. After one week, palliative chemotherapy with FOLFIRINOX (oxaliplatin, leucovorin, fluorouracil, and irinotecan) was initiated. She was discharged home on stress dose steroids with plan for taper. Conclusion: Ectopic ACTH secretion is a rare phenomenon, particularly when presenting with a rare case of metastatic pancreatic MiNEN with amphicrine features, associated with significant morbidity. To improve tolerance and survival of further treatment, early surgical bilateral adrenalectomy should be considered.

8733 Adrenal Crisis In A Patient Diagnosed With Primary Adrenal Insufficiency Following COVID-Vaccination

Abstract Disclosure: A. Hayat: None. N. Aslam: None. Primary adrenal insufficiency, or Addison's disease, is characterized by the inadequate production of cortisol and often requires lifelong hormone replacement therapy. COVID-19 vaccines have demonstrated overall safety, but this report explores a unique case of adrenal crisis post-vaccination in a patient with pre-existing adrenal insufficiency. A 38-year-old female, diagnosed with primary adrenal insufficiency, received her second dose of a COVID-19 vaccine. Within 48 hours after vaccine administration , she presented to the emergency department with severe fatigue, hypotension, nausea, and abdominal pain. Clinical examination and laboratory tests confirmed an adrenal crisis, with markedly decreased cortisol levels, hyponatremia, hyperkalemia, and an elevated ACTH level. The patient was promptly treated with intravenous hydrocortisone and saline fluids. Close monitoring of vital signs and cortisol levels was maintained, with a gradual tapering of hydrocortisone as the patient's symptoms improved. The importance of stress-dose steroids during illness or vaccination in patients with adrenal insufficiency is underscored. This case highlights that the Healthcare providers should be aware of this rare but severe complication and consider appropriate monitoring and stress-dose steroid coverage in susceptible populations. Presentation: 6/3/2024

7247 Adrenal Insufficiency In Advanced Cirrhosis: A ‘Shocky’ Clinical Dilemma

Abstract Disclosure: L. Aboishava: None. A. Pareek: None. A. Mertens: None. A. Erokhin: None. Background: In patients with advanced cirrhosis, profound hypoproteinemia can complicate the laboratory assessment of the hypothalamic-pituitary-adrenal axis, but a clinical phenotype of persistent hypotension and suboptimal cortisol response to ACTH stimulation raises the question of whether adrenal insufficiency could also be a contributing factor. Clinical Case: A 65-year-old man with a history of cirrhosis complicated by esophageal varices, ascites, encephalopathy and hepatorenal syndrome was admitted to the ICU with worsening fatigue, profound hypotension, and respiratory arrest. He was started on pressors, antibiotics and was also intubated for a short time. A broad workup was negative for cardiac or infectious causes of shock and showed decreased total protein and albumin (1.6 g/dl (3.5-5.2), with normal serum sodium and potassium. The patient had no previous history of adrenal disease or corticosteroid use. Workup for adrenal insufficiency was initiated and showed decreased morning blood serum cortisol (10.6 ug/dl (2.5-19.5)) and ACTH (<5.0 pg/ml (7.2-63)), as well as suboptimal cortisol response on ACTH stimulation testing (12.5 ug/dl initially, 16.7 ug/dl after stimulation). Head CT on admission was negative for intracranial pathology, and lab results showed normal TSH and mildly increased prolactin of 36.2 ng/ml (4.0-15.0). Pt was started on IV hydrocortisone 50 mg TID. Glucocorticoid therapy didn’t improve his state significantly but was continued with a gradual tapering down of the dose. After intense treatment in the ICU the patient’s state was stabilized. Unfortunately, an endoscopy performed for worsening anemia and blood in stools showed gastric cancer. The patient was transferred to comfort care after a discussion of goals of treatment and died within the next 24 hours. Conclusion: The nature of decreased cortisol levels in patients with cirrhosis is most likely multifactorial, due to impaired hepatic synthetic function, dysregulation of hormone-binding protein balance, abnormal ACTH secretion, and other factors. Impaired corticosteroid-binding globulin synthesis might affect the ratio of globulin-bound and free hormone fractions and alter the accuracy of cortisol assays. Whether adrenal insufficiency is truly one of the complications of advanced cirrhosis contributing to persistent hypotension, or a mere laboratory finding is difficult to answer. It is also yet to be determined whether patients with advanced cirrhosis might benefit from screening and treatment of adrenal insufficiency in circumstances of persistent hypotension, and studies are needed to decide on optimal diagnostic tests to recognize the disease and develop treatment algorithms. Presentation: 6/3/2024

Study the Effect of Drakshasava on Dopamine, Serotonin and Cortisol Levels and Behavioural Changes in Acute and Chronic Stress Model in Wistar Rats

Drakshasava is a formulation used as a general tonic also for anxiety, anaemia in the Ayurveda. Our previous study reports for antidepressant property were very promising. This study aims to elucidate the antidepressant mechanisms of Drakshasava by examining its effects on key neurotransmitters and stress hormones, as well as observing related behavioral changes in Wistar rats under stress models. Methods: Wistar rats weighing 150-200 gms were divided into six groups consisting of 6 rats in each group. Two animal models, acute stress (AS) and unpredictable chronic mild stress (UCMS) were used. Drug treatment was given as per groups orally, Drakshasava in the dose of 2ml & 4ml/kg and Fluoxetine standard comparator 10mg/kg for next 7 days for AS. In UCMS group stress was given for 15 days and drug treatment was given along with the stress from day 15-21. Sucrose preference test (SPT) done on day 0 & 8 in AS and on day 0, 15, 22 in UCMS model rats and at the end Forced Swim test (FST) was performed. Blood withdrawal done for estimation of serum Dopamine, Serotonin and cortisol levels with ELISA kit on day 8 in AS & 22 in UCMS. Data obtained analysed with Graph Pad Prism 6. Result: Decrease in Dopamine (p<0.05) and Serotonin (p<0.01) while increase (p<0.01) in cortisol levels was seen in (depressed) disease control group rats in comparison with control group. Both doses of Drakshasava showed significant reduction in immobility time in FST and improved sucrose preference and was found to be effective in both the models of depression. Increase in serum serotonin (p<0.01) and dopamine (p<0.05) levels was evident while at the same time, (p<0.05) cortisol level reduction was seen in all drug treated rats. Findings observed in the FST and SPT were correlated with the biochemical findings. Effects seen with Drakshasava were comparable with that of Fluoxetine. Conclusion: Drakshasava increased serum serotonin and dopamine levels while decreasing cortisol levels in both acute and chronic animal models of depression. These effects were comparable to those observed with the standard antidepressant drug, Fluoxetine.

Dexmedetomidine leads to the amelioration of stress response to surgery.

To determine the impact of intravenous Dexmedetomidine (Dex) administered perioperatively on stress response markers in patients undergoing ENT surgeries. This randomized interventional study was conducted at POFs Hospital and NUMS affiliated WMC, Wah Cantt, in collaboration with IIMC Rawalpindi, Pakistan, from October 2021 to April 2022. One hundred patients aged between 15-60 years, after satisfying the inclusion standards were randomly divided into two groups C and D. Group-C (n=50) received normal saline in addition to the standard anesthesia protocol. The intervention Group-D (n=50) was administered 1µg/kg dexmedetomidine hydrochloride intravenously over 10 minutes just before the induction followed 0.5μg/kg/hr as maintenance dose till the end of surgery. Serum inflammatory biomarkers (interleukins-6, TNF-α and cortisol) were measured in blood samples in both groups, taken at 0 (T0), 30 minutes(T1), and two hours (T2) time intervals and analyzed by using Enzyme-linked immunosorbent assay (ELISA). Data was statistically analyzed using SPSS 23. The patients receiving Dex showed marked decrease in serum levels of cortisol, TNF- α and interleukins-6, from 139.73 to10.18, 99.51 to 0.96 and 85.09 to 0.96 respectively. Comparison between C and D groups revealed significant differences (p≤0.05) in these serum biomarkers. In the present study, intravenous Dex suppressed the intraoperative rise in levels of cytokine secretion and enhanced smooth recovery with no incidence of nausea and vomiting. These effects could be attributed to the anti-inflammatory effects of dexmedetomidine.

Enhancing Growth and Health in Weanling Pigs: The Impact of Monzogranite Supplementation.

Monzogranite is known for its high surface area and cation exchange capacity, which play a crucial role in ameliorating the challenges by enhancing nutrient adsorption and facilitating nutrient availability during the weaning period. Weaned crossbred piglets (Duroc × Yorkshire × Landrace), initially weighing 5.36 ± 0.26 kg, were allocated into four treatments with 6 replicates each (10 pigs per replicate). The treatments encompassed CON (basal diet), Z0.1 (0.1% monzogranite supplementation in basal diet), Z0.2 (0.2% monzogranite supplementation), and Z0.3 (0.3% monzogranite supplementation). In phase 1, a linear increase in total average daily gain (ADG) was observed across treatment groups, with a concomitant linear increase in ADG and gain-to-feed ratio (G/F). The overall results showed a linear increase in ADG and G/F. A linear decrease in aspartate aminotransferase and lactate dehydrogenase levels was observed across treatment groups. Conversely, no significant differences were noted in the levels of albumin, alkaline phosphatase, alanine aminotransferase, high-density lipoprotein, low-density lipoprotein, total cholesterol, blood urea nitrogen, triglycerides, and gamma-glutamyl transferase among the treatment groups. Faecal scoring indicated a linear reduction in scores at Day 7 among the treatment groups. However, no significant differences were observed at Days 14 and 28. The assessment of immunoglobulins demonstrated a significant increase in both immunoglobulin G and immunoglobulin A levels in the Z0.1 treatment group compared to the CON. In both phase 1 and phase 2, a linear decrease in cortisol levels was evident. In conclusion, a linear increase in total ADG and G/F during phase 1, sustained across both phases, suggests monzogranite potential to enhance growth performance. Moreover, stress mitigation was shown through a consistent linear decrease in cortisol levels across phases. These findings underscore monzogranite multifaceted impact, emphasizing its potential as a dietary supplement to enhance growth, liver health, and stress resilience in weanling pigs.

Prediction of molecular targets for antidepressant potential of hydroalcoholic extract of Tamarindus indica using network pharmacology approach and evaluating its efficacy in Chronic Unpredictable Mild Stress model in mice.

The prevalence of psychological disorders has surged since the 1990s, posing a significant global health burden with depressed individuals averaging six lost hours per week and contributing to over 20% of all missed workdays. Current antidepressants, while effective for some, have limited efficacy, dietary restrictions, and adverse effects, including liver damage and hypertension. Natural remedies offer promising therapeutic potential with minimal side effects. Tamarindus indica (TI) is a plant that grows in the shape of a tree. Network pharmacology of TI revealed the key targets MAPK, D1-6, 5HT, DAT, MAO, COMT, PKA, PKC, AKT, and VMAT, which are linked to prominent key pathways such as dopaminergic and serotonergic. The cell viability assays on SH-Sy5y cells indicated a favourable safety profile with an IC50 of 573.99µg/ml and further, the in vivo efficacy was observed through Chronic Unpredictable Mild Stress (CUMS) model in mice. The hydroalcoholic extract of TI demonstrated antidepressant effects, significantly reducing immobility time in the Tail Suspension Test (TST) and Forced Swim Test (FST). Additionally, locomotor activity, assessed via the Open Field Test (OFT), was significantly increased in the treatment group compared to CUMS mice. Biochemical analyses revealed elevated Brain Derived Neurotropic Factor (BDNF), decreased cortisol levels, and reduced catechol-O-methyltransferase (COMT) concentration in TI-treated (50mg/kg) groups. These findings underscore the potential of TI as a natural antidepressant, offering a promising avenue for further therapeutic development in depression management. The current study did not evaluate the level of neurotransmitters in the brain, which will be evaluated in future studies.

Neuromusic: Music and its Influence on the Purchase Process in the Markets

Music the art of combining sounds, maintains a sequence of time with harmony, melody and rhythm, generates changes in cognitive processes, improves concentration, memory, influences mood, produces changes in emotions, helps control anxiety, increases motivation, and decreases cortisol levels, the stress hormone, activates the hormone of happiness and rest, serotonin and melatonin. The objective was to analyze the influence of music in the purchase process and decision. The approach was qualitative-quantitative, exploratory level, descriptive statistics was applied to identify the main trends and musical genres. The survey was carried out online, in the "La Condamine" market (November-December 2022). The sample 354 customers. The results of the investigation determined that customers enjoy listening to instrumental sounds in the food court, and in the vegetable, fruit and vegetable section; and the musical genre pop and/or reggaeton in the clothing section. The survey data was corroborated with the results of the biometric eyes tracking equipment in eight participants, attention, meditation and blinking were analyzed, with two sounds, sound 1: folk music and sound 2: pop; the average of the evaluations determined the level of acceptance of the participants for the musical genre, confirming the traditional survey with the results of the biometric equipment. Hearing goes beyond what can be perceived with sight and smell; there are sounds and melodies that connect us with emotions (laugh, cry, enjoy) and memories. It is concluded, (i) consider the musical genre according to the segment, (ii) the hours of greatest influx of customers, (iii) areas or sections of the market with greater or lesser product sales, (iv) slow music in places with more expensive products to extend their stay in the establishment.

EVALUATION OF VARIOUS FILTERS IN RECIRCULATION AQUACULTURE SYSTEMS ON SURVIVAL RATE, CORTISOL, GROWTH AND OSMOTIC PERFORMANCE IN CHANNA MARULIOIDES AS DOMESTICATION EFFORT

This study aims to determine the effectiveness of various filter materials in RAS such as synthetic materials and organic materials and there an impact on plasma cortisol, osmotic performance rate, growth rate and survival rate of Channa marulioides. The cultivation process in the RAS system is carried out for 100 days with 50 individuals in each different treatment, namely T1: Synthetic filter; T2: Organic filter; T3: Mixture of synthetic and organic filter; Control: No Filter and RAS. Measurements of plasma cortisol and osmotic performance levels were carried out at the beginning and end of cultivation which had an impact on growth and survival rates. The results of the study showed a decrease in cortisol levels (ng/ml), namely: T1: 9.24, T2: 9.66, T3: 10.37 which showed that there was no significant difference in each treatment (P> 0.05) but in T1, T2, and T3 were significantly different with control treatment: 1.32 (P<0.05). The same trend occurred when observing the level of osmotic performance with the highest decrease in T3 on 6 scales; T2 on a scale of 5.5; T1 has 5 scales, and Control has 3 scales. Reducing the level of cortisol and osmotic performance hormones with the RAS system can increase energy efficiency by reducing stress levels, and osmotic performance so that it can be optimized for growth and survival in adaptation.

Long-term carbaryl exposure leads to behavioral abnormalities and reproductive toxicity in male marine medaka through apoptosis-mediated HPA and HPG axes dysregulation

Carbaryl is a widely used carbamate pesticide that has been detected in the marine environment, but its effects on marine fish are still unknown. This study was aimed to investigate the effects of long-term exposure of carbaryl on male marine medaka. For this purpose, we set up five exposure concentration groups of 0, 0.1, 1, 10, and 100 µg/L for 180 days. On the one hand, we observed increased aggression and decreased ability to avoid predators in males after exposure, which was affected by the levels of HPA-axis hormones, especially decreased cortisol level. On the other hand, after exposure, HPG axis hormone levels and gene transcription levels were disturbed. Males exhibited a decreased gonadosomatic index and a notable reduction in mature sperm proportion and the F1 generation displayed a significant increase in malformation rate. Additionally, the number of apoptotic cells and the transcription level of apoptosis-related genes in the brains of male marine medaka substantially increased after exposure. Apoptosis of brain cells may be responsible for the disturbance of HPA and HPG axes, consequently leading to behavioral and reproductive abnormalities. These findings provide novel insights into evaluating the toxic effects of carbaryl on male marine medaka and emphasizing the criticality of exploring the potential environmental risks posed by carbaryl in the marine environment, thus providing toxicity value basis for further strengthening marine environmental monitoring and the protection of biological resources.

Bentonite-supplemented diets improved fish performance ammonia excretion haemato-biochemical analyses immunity antioxidants and histological characteristics of European seabass Dicentrarchus labrax

The purpose of this research was to examine the potential effects of bentonite (BN) supplemented diets on growth, feed utilization, blood biochemistry, and histomorphology of Dicentrarchus labrax. Six treatments in triplicate were tested: B0, B0.5, B1.0, B1.5, B3.0, and B4.5, which represented fish groups fed diets supplemented with 0, 0.5, 1, 1.5, 3, and 4.5% BN, respectively. For 84 days, juveniles’ seabass (initial weight = 32.73 g) were fed diets containing 46% protein, three times daily at 3% of body weight. With a 5% daily water exchange, underground seawater (32 ppt) was used. Findings revealed significant improvements in water quality (TAN and NH3), growth (FW, WG and SGR) and feed utilization (FCR, PER and PPV) in fish fed BN-supplemented diets, with the best values in favor of the B1.5 group. Additional enhancements in kidney function indicators (urea and uric acid) and liver enzymes were observed in fish of the BN-treated groups along with a decrease in cholesterol level in the B1.5 group. Further improvements in fish innate immunity (hemoglobin, red blood cells, glucose, total protein, globulin, and immunoglobulin IgM), antioxidant activity (total antioxidative capacity and catalase), and decreased cortisol levels in fish of the BN-treated groups. Histological examinations of the anterior and posterior intestines and liver in groups B1.5 and B3 revealed the healthiest organs. This study recommends BN at a concentration of 1.5% as a feed additive in the Dicentrarchus labrax diet.

State and trait cognitions differentially affect cyclicity of mood and cortisol in individuals with and without premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) is characterized by a cyclical symptom course. Previous research provides limited findings on possible menstrual-cycle-related psychological and psychoendocrinological processes in PMDD. By using ambulatory assessment (AA), we aimed to compare mood and cortisol cyclicity in individuals with PMDD and healthy controls (HC), and to assess effects of habitual and momentary repetitive negative thinking (RNT) and present moment awareness (PMA) on mood and cortisol across the cycle in both groups. Individuals with PMDD and HC (n = 60 each) completed baseline questionnaires on habitual RNT and PMA. Momentary rumination and PMA, positive and negative affect (NA), and saliva-cortisol were assessed over four consecutive days during both the follicular and the late-luteal phase. Individuals with PMDD showed mood cyclicity indicating mood worsening while HC showed cortisol cyclicity indicating decreasing cortisol levels toward the late-luteal phase. In individuals with PMDD, lower habitual RNT and higher habitual PMA predicted better mood only during the follicular phase whereas lower momentary rumination and higher momentary PMA predicted better mood during the late-luteal phase. No effects on cortisol activity were found. In HC, higher habitual PMA predicted lower NA during the late-luteal phase whereas lower momentary rumination and higher momentary PMA predicted stronger cortisol reduction toward the late-luteal phase. While favorable habitual cognitions might not protect individuals with PMDD against premenstrual mood deterioration, respective momentary cognitions may reflect possible protective factors, suggesting an opportunity for microinterventions to directly target late-luteal-phase-specific state processes in affected individuals. The lack of cortisol cyclicity might represent an endocrinological marker for PMDD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prenatal perceived stress and urinary cortisol as risk factors for ASD and non-typical developmental outcomes in the MARBLES study

BackgroundFindings for prenatal stress, previously measured through stressful life event surveys items or biomarkers, in association with ASD are inconsistent. We prospectively examined prenatal perceived stress and prenatal urinary cortisol (PUC) in association with ASD and other non-typical developmental (Non-TD) outcomes in the child in a high familial likelihood cohort. MethodsThe Perceived Stress Scale questionnaire was used to measure perceived stress in the longitudinal Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) Study. Cortisol was measured through 24-hr urine collections. At three years of age, an algorithm consisting of scores from the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL) was used to classify children with ASD, Non-TD, or typically developing (TD) outcomes. Relative risk ratios (RRR) with TD as the reference were estimated using multinomial logistic regression. ResultsIncreased perceived stress was associated with Non-TD in trimester 1 (RRR 1.10; 95% CI: 1.00, 1.21) and ASD in trimesters 2 and 3 (RRR 1.08; 95% CI: 1.02, 1.14 and RRR 1.08; 95% CI: 1.03, 1.14, respectively). Results with PUC were non-significant but were in the direction consistent with previous findings suggesting that decreased cortisol levels are associated with higher likelihood of ASD. ConclusionsFindings support the hypothesis that higher perceived stress is associated with increased likelihood of ASD and possibly Non-TD, relative to TD. This suggests that stress reduction interventions during pregnancy could serve as preventative measures that help optimize the child’s long-term health. Larger studies are needed to replicate these findings.

Neuraxial Anesthesia and Analgesia During Cardiothoracic Surgery: A Narrative Review.

The purpose of this review is to synthesize and examine the literature on the use of neuraxial anesthesia and analgesia during cardiothoracic surgery. As cardiothoracic procedures often require systemic anticoagulation, neuraxial techniques are quite often underutilized due to the theoretical risk of epidural hematoma. In this review, we seek to examine the literature to review the indications and contraindications and to explore if neuraxial anesthesia and analgesia has a role in cardiothoracic surgery. Neuraxial techniques have multiple advantages during cardiothoracic surgery including coronary vasodilation, decreased sympathetic surge, and a decreased cortisol level leading to overall reduction in stress response. Multiple studies have shown an improvement in pain scores, reduction in pulmonary complications, faster extubation times, with minimal complications when neuraxial techniques are utilized in cardiothoracic surgeries. Given the numerous advantages and minimal complications of neuraxial techniques in cardiothoracic surgeries, we hope its utilization continues to increase. Moving forward, we hope additional studies continue to reaffirm the benefits of neuraxial anesthesia and analgesia for cardiothoracic surgeries to improve its utilization.

(273) Influences of Oral Dehydroepiandrosterone (DHEA) Administration on Hormonal Profile, Menopausal Clinical Symptoms and Sexual Function in Early Postmenopausal Symptomatic Women

Abstract Introduction Dehydroepiandrosterone (DHEA) and its sulfate (DHEAs) are steroid hormones secreted by the adrenal glands. The aging process is associated with decreased levels of DHEA and DHEAs, which are the initial causes of many age-related changes. Objective We aimed to evaluate the effects of oral administration of DHEA (50mg/day) on hormonal profile, menopausal clinical symptoms and sexual function in early postmenopausal symptomatic Caucasian women at baseline and after 2, 4 and 6 months of treatment. Methods For our prospective clinical trial, 42 symptomatic early postmenopausal women (50–55±3.5 years) were selected. Participants were divided into two groups. The study group (n-22) received oral DHEA 50mg/day for 6 months and the control group (n-20) received placebo. Serum levels of DHEA, DHEAs, androstenedione (A4), allopregnanolone (3α,5α- THP), progesterone (P4), 17OH progesterone (17OHP), cortisol, testosterone (T), dihydrotestosterone (DHT), estrone (E1), estradiol (E2), SHBG, LH, FSH and β-Endorphin were determined at baseline and after 2, 4 and 6 months of treatment. The results of the Menopause Rating Scale (MRS) and the McCoy Female Sexuality Questionnaire (MFSQ) were evaluated before and after the treatment. Results During the treatment period in the study group, a progressive increase in serum levels of DHEA, DHEAs, A4, T, DHT, E2, E1, 3α,5α-THP and β-Endorphin were observed. P4 and 17OHP levels showed only a slight increase. By the 4th month of treatment and final data, a decrease in cortisol levels was observed. LH and FSH levels gradually decreased. SHBG levels remained constant. After 6 months of treatment, assessing the results of the MRS in the DHEA group showed a progressive improvement of menopausal symptoms. The results of the McCoy questionnaire were also improved in the study group. Conclusions DHEA administration had a significant effect on certain endocrine parameters in early postmenopausal symptomatic Caucasian women, was associated with improvements of menopausal physical symptoms, sexual function and psycho-emotional parameters. Our findings support the hypothesis that administration of DHEA in symptomatic postmenopausal women restores both androgenic and estrogenic milieu and reduces most of the clinical symptoms caused by the changes of these environments during postmenopausal period. On this basis we can assume, that DHEA may be considered as a potentially effective medication for MHT. However, conducting further, more specific clinical trials are needed. Disclosure No.

Stress Biomarkers Transferred Into the Female Reproductive Tract by Seminal Plasma Are Associated with ICSI Outcomes.

This study aimed to determine whether male stress is related to seminal stress biomarkers and pregnancy achievement in women exposed to their partner's seminal plasma (SP) in the intracytoplasmic sperm injection (ICSI) cycle. In this pilot prospective study, 20 couples undergoing ICSI, as well as 5 fertile sperm donors and 10 saliva donors, were investigated. Women were exposed to their partner's SP via unprotected sexual intercourse during the ICSI cycle and intravaginal application on the day of ovum pick-up (Day-OPU). Semen samples were collected from male partners by masturbation on the Day-OPU. Saliva and serum samples were collected prior to masturbation. Body fluids were frozen at - 80°C until assayed. Biomarkers of activity of the sympathetic adrenomedullary axis (salivary alpha-amylase and adrenaline), sympathetic neural axis (noradrenaline and dopamine), hypothalamic-pituitary-adrenal (HPA) system (cortisol), and immune system (C-reactive protein and interleukin (IL)-18) were estimated to examine their association with SP composition and clinical pregnancy achievement. The clinical pregnancy rate was 45.0%. In the unsuccessful ICSI group, blunted levels of salivary and serum cortisol were found compared to the successful ICSI group and the fertile sperm donors. With regard to seminal markers, decreased cortisol level and elevated noradrenaline, noradrenaline/cortisol ratio, and lL-18 levels were strongly associated with ICSI failure (areas under the ROC curves were, 0.813, 0.848, 0.899, and 0.828, respectively). These findings confirm that stress response systems activity affects SP composition, which in turn is associated with ICSI outcomes in women exposed to their partner's SP during an ICSI cycle.

The Effects of Actively Warming the Patient on Maternal and Infant Well-Being in a Cesarean Section Operation

PurposeIntraoperative warming is recommended for surgical patients under anesthesia, but there are insufficient studies on this topic in cesarean delivery patients under spinal anesthesia. The purpose of this study was to determine the effects of active warming on the mother and newborn during elective cesarean section. DesignThis research was carried out in an experimental design with a pretest-posttest randomized intervention and control group. MethodsThe research was conducted with 34 women (17 intervention and 17 control), who gave birth by cesarean section. The study examined outcomes for both mother and newborn. Women in the intervention group were heated by both active (warmed with carbon fiber resistive underbody heaters during surgery) and passive heating (preoperative- socks, nonelectrified wool blankets, etc). Only passive heating methods were applied to the women in the control group (preoperative). Neonatal Activity - Pulse - Grimace - Appearence - Respiration (APGAR) score, body temperature, cortisol, and blood glucose levels in the intervention and control groups were evaluated, while body temperature and shivering conditions were evaluated in the mother. FindingsBody temperature and first minute APGAR score of the infants in the intervention and control groups after cesarean section were 36.88 ± 0.27, 36.52 ± 0.32 (P = .002); 7.00 ± 0.36, 7.47 ± 0.64 (P = .009), respectively. Cortisol and blood glucose levels in the intervention and control groups were 3.55 ± 1.09, 4.51 ± 0.70 (P = .010), 77.94 ± 7.07, 72.47 ± 10.24 (P > .05), respectively. The body temperatures of the women in the intervention and control groups at 15, 30, and 45 minutes were significantly different (P < .05), while they were similar (P > .05) at 60 minutes. Oxygen saturation measured at 30 minutes during the operation was 97.10 ± 1.41 in the intervention group and 95.20 ± 1.78 in the control group (P < .05). ConclusionsActive warming before, during, and after cesarean section affected body temperature, pulse, respiration, blood pressure, and oxygen saturation of women, and while it increased the body temperature and APGAR score of newborns, it decreased cortisol level.

Loneliness in older adults with diabetes mellitus: a scoping review

ABSTRACT This scoping review aimed to explore and synthesize existing research on predictors of loneliness, and the impact of loneliness on physiological and psychological health outcomes and health behaviors in older adults with diabetes. Results from 12 studies showed that low education, being unmarried/divorced/separated, having diabetes-related complications, being physically inactive, having diabetes distress, being of a certain race/ethnicity, being female, having depressive symptoms, and being younger age were consistently identified as predictors of loneliness. In addition, loneliness was found to affect both psychological (depressive symptoms and negative perceptions of diabetes) and physiological health outcomes (increased postprandial blood glucose and A1C levels, decreased cortisol levels, increased MCP-1 levels, slower gait speed, and weaker hand grip) and health behaviors (decreased engagement in physical activity, increased disability in activities of daily living and instrumental activities of daily living, and increased likelihood of antidepressant use). The results of this scoping review suggest that loneliness is a complex issue for older adults with diabetes and its effects are far-reaching. Therefore, further research should be conducted to explore the potential causal relationships between loneliness and physiological and psychological health outcomes and to identify the best interventions to reduce loneliness in older adults with diabetes. For healthcare providers, it is important to recognize that loneliness is an appropriate risk factor for older adults with diabetes that may affect psychological and physiological health outcomes and health behaviors and to address it through interventions such as social support programs, group therapy, or psychosocial counseling.