Search

Introduction Inflammation is drawing attention as pathway between psychosocial stress and health, and basal HPA axis activity has been suggested to exert a consistent regulatory influence on peripheral inflammation. Here we studied the relationship between basal HPA axis activity and inflammatory and HPA axis acute stress reactivity. Methods We recruited 48 healthy individuals and collected saliva for diurnal cortisol sampling at 6 points. Participants were previously exposed to the Trier Social Stress Test (TSST) on two consecutive days. Plasma interleukin-6 (IL-6) and salivary cortisol reactivity to acute stress were measured, and their relationships with basal HPA axis activity were analyzed. Results Steeper cortisol awakening response (CAR) linear increase was related with stronger cortisol stress reactivity (γ = 0.015; p = 0.042) and marginally significantly with greater habituation (γ = 0.01; p = 0.066). Greater curvilinearity of CAR was related with stronger cortisol reactivity (γ = −0.014; p = 0.021) and greater cortisol habituation (γ = −0.011; p = 0.006). Steeper daily linear decline was related with significant or marginally significantly stronger cortisol and IL-6 reactivity (cortisol: γ = −0.0004; p = 0.06; IL-6: γ = −0.028; p = 0.031) and greater habituation (cortisol: γ = −0.002; p = 0.009, IL-6: γ = −0.015; p = 0.033). Greater curvilinearity of daily decline was related with stronger IL-6 reactivity (γ = 0.002; p = 0.024) and also greater cortisol and IL-6 habituation (cortisol: γ = 0.00009; p = 0.03, IL-6: γ = 0.001; p = 0.024). Conclusions Patterns of basal HPA axis activity that are related with healthier outcomes were found to be related with stronger initial cortisol and IL-6 reactivity and greater habituation. This is an important step in understanding the long-term health implications of acute stress responsiveness, and future studies should employ longitudinal designs to identify the direction of these relationships.

Effective adjustment of the stress systems to repeated stress is regarded as an adaptive response of the organism facing environmental threats. Given the intertwined relationship between the stress systems and the inflammatory system, it could be expected that inflammatory processes should adapt to repeated stress as well. However, only little is known about adaptational processes of the different components of the immune system in response to repeated stress, and how these might be related to adaptational processes of the hypothalamus-pituitary-adrenal (HPA) axis. We here examined N=22 healthy participants (mean age 23years, 50% female) and exposed them to a standardized laboratory stressor twice, 24h apart. Plasma interleukin 6 (IL-6), salivary cortisol and psychometric parameters were assessed repeatedly up to 120min post stress. Results revealed a significant day by time interaction for cortisol (F=5.06; p=0.013) and IL-6 (F=4.42; p=0.041), indicating habituation of HPA axis and sensitization of inflammatory stress responses. Cortisol habituation and inflammatory sensitization were inversely related when controlling for sex (r=-0.44; p=0.044). Explorative analyses revealed significant associations between the IL-6 response on the second exposure with perceived stress (r=0.58; p=0.004), vital exhaustion (r=0.57; p=0.009), depression (r=0.47; p=0.026) and purpose in life (r=-0.50; p=0.04). These findings may help to increase understanding of the still only rudimentary understood interplay of adaptational processes of endocrine and immune responses to repeated stress and might indicate a link between inflammatory disinhibition and psychological indicators of well-being.

Ante el descubrimiento de una masa anexial, conviene ante todo descartar una urgencia quirurgica que pueda comprometer la funcion ovarica. Estas urgencias estan dominadas por las torsiones anexiales. En ausencia de urgencia terapeutica, un estudio completo (clinico, pruebas de imagen y biologico) debe permitir estimar el riesgo de malignidad y discutir la indicacion operatoria, asi como la via de abordaje quirurgica. Otros elementos pueden entrar en juego en la indicacion terapeutica: la existencia de infertilidad, en particular en caso de endometriosis, y el riesgo de torsion, sobre todo en caso de quistes de gran tamano. Este articulo revisa de manera practica los principales problemas que se plantean ante el descubrimiento de un tumor ovarico supuestamente benigno.

Acute stress induces increases in plasma inflammatory mediators, which do not habituate to repeated stress. Inflammation is a risk factor for age-related illnesses, highlighting the need to understand factors controlling inflammation. No studies have examined changes in pro- and anti-inflammatory gene expression in response to repeated acute stress in humans.RNA was isolated from peripheral blood before, 30 and 120min after exposure of n=32 healthy human participants to the Trier Social Stress Test (TSST) on two days. Gene expression of interleukin (IL)-6, IL-1β, nuclear factor (NF)-κB and IκB was measured repeatedly on both days. We further assessed leukocyte numbers, plasma IL-6, and salivary cortisol.Stress induced IL-6 (F=44.7; p0.001) and cortisol responses (F=18.6; p0.001). Cortisol responses habituated (F=5.1, p=0.003), but IL-6 responses did not (n.s.). All genes increased in response to initial stress (IL-6: F=3.8; p=0.029; IL-1β: F=7.1; p=0.008; NF-κB: F=5.1; p=0.009; IκB: F=4.7; p=0.013) and showed habituation to repeated stress (IL-6: t=2.3; p=0.03; IL-1β: t=3.9; p=0.001; NF-κB: t=2.1; p=0.041; IκB: t=3.1; p=0.005). Day 1 responses of IL-1β and IκB were not explained by changes in leukocyte populations, but IL-6 and NF-κB, as well as most day 2 changes were not independent of leukocyte populations.Stress response and habituation of pro- and anti-inflammatory gene expression as found here might indicate that even on an intracellular level, inflammatory responses to acute stress are adaptive in that they respond to initial, but habituate to repeated, similar stress. Future studies will need to test whether non-habituation is predictive of disease.

Overweight and obese individuals, who comprise approximately two-thirds of the U.S. population, are at increased risk for developing a range of diseases. This increased risk may be due in part to maladaptive stress responses within this group, including heightened low-grade inflammation and HPA axis non-habituation. In this study we tested the relationship between adiposity, plasma interleukin-6 (IL-6) and HPA axis responses to repeated stress.Sixty-seven healthy participants were exposed to the Trier Social Stress Test (TSST) on two consecutive days. We collected saliva for cortisol measurements at baseline and at 1, 10, 30, 60 and 120min post-TSST, and blood for plasma IL-6 measurements at baseline and 30 and 120min post-TSST.Stress exposure induced significant increases of cortisol and IL-6 on both days (cortisol: F=38, p0.001; IL-6: F=90.8; p0.001), and repeated exposure was related with cortisol habituation (F=8.2; p0.001) and IL-6 sensitization (F=5.2; p=0.022). BMI and body fat were related with higher cortisol responses to repeated stress (BMI: beta=0.34; p=0.014; body fat: beta=0.29; p=0.045), and with higher IL-6 responses to repeated stress (BMI: beta=0.27, p=0.044; body fat: beta=0.37; p=0.006).Taken together, individuals with higher measures of adiposity showed less efficient HPA axis habituation as well as sensitization of IL-6 responses to repeated acute stress. These findings point to maladaptive stress response patterns in overweight humans, which, through exposure to higher levels of inflammatory mediators, might partially explain diseases related with overweight and/or obesity.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 1 - p. 19-25

Today, hysterectomy is, after caesarean section, the most frequent surgical intervention performed in fertile women. Introduced in 1989, laparoscopic hysterectomy remains poorly diffused: today, less than 5% of all hysterectomies remain done by laparoscopy. Nevertheless after a correct learning curve, laparoscopic hysterectomy finds perfect indications in benign and even some malignant indications. In these conditions, the complication rate is similar to those of the other surgical routes. Currently the limitations of this technique are the very bulky uterus, contraindicated uterine morcellation, the lengthening of the operative time potentially generated by this technique, and the lack of experienced instructors.

En la actualidad, la histerectomia es la intervencion quirurgica que mas se practica en las mujeres de edad fertil, despues de la cesarea. Aunque comenzo a efectuarse en 1989, la histerectomia por via laparoscopica tuvo dificultades para imponerse y hoy en dia menos del 5% de las histerectomias se llevan a cabo por esta via. Sin embargo, despues de un periodo de entrenamiento adecuado, la practica de la laparoscopia presta utilidad en las histerectomias efectuadas por afecciones benignas o malignas, con un indice de complicaciones comparable al de las demas vias de acceso. Los limites actuales de la tecnica son uteros muy voluminosos, contraindicacion de la fragmentacion uterina, prolongacion del tiempo quirurgico y la carencia de instructores con experiencia.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 5 - p. 499-501

Uterine leiomyomas are by far the most common benign genital tumors. The prevalence rates vary from 20% to 50%. Myomectomy is a standard surgical treatment and is prescribed for patients who wish to preserve their fertility. The laparoscopic approach allows a shorter hospital stay, faster recovery, less intraoperative blood loss, less postoperative pain, and possibly fewer adhesions than abdominal myomectomy when performed by skilled surgeons. Myomectomy is associated with the risk of excessive blood loss and adhesions formation. Reports of disseminated intravascular coagulation complicating this type of surgery are rare, and no prior cases have been reported in the literature after the use of 4% icodextrin. Randomized trials support the use of absorbable adhesion barriers to reduce adhesion formation. A case of disseminated intravascular coagulation after laparoscopic multiple myomectomy with the use of 4% icodextrin solution is described.

Background Previous research indicates that ethnic differences in subjective social status (SSS), inflammatory markers, and stress reactivity may exist. However, no studies have examined the relationship between SSS and ethnicity in the context of IL-6 responses to repeated stress. Methods Eighty-five adults (51% female, mean age = 37.9 years) completed the Trier Social Stress Test (TSST) on two consecutive days. Blood samples were collected at 1 minute prior and 30 minutes and 2 hours post-TSST for measurement of plasma IL-6. Community and United States SSS were assessed using MacArthur ladders. Results The sample consisted of n = 80 participants (n = 51 white, n = 29 non-white). Both TSSTs induced increases in plasma IL-6 (F = 65.1, p 0.001 ), with higher responses to the second exposure (F = 7.85, p = 0.006). Community SSS was positively associated with IL-6 responses to the first TSST (r = 0.24, p = 0.03) but not the second (r = −0.01, p = 0.9). Whites rated themselves higher than nonwhites in SSS (Community, trend, p = 0.053; US, p = 0.009). Regression analyses revealed a significant SSS by NW interaction predicting IL-6 responses to the first TSST (beta = 0.82, p = 0.046), with higher SSS predicting elevated IL-6 responses only in non-whites. Conclusions Subjective Social Status ratings were sensitive to race and predicted IL-6 responses to the TSST in only non-white individuals. Ethnicity and SSS may play a role in social evaluation, a key component of social stress. More research is needed to determine the nature these associations.

Rationale Depressive symptoms are associated with exaggerated inflammatory and altered cortisol stress responses. Cortisol has been shown to stimulate IkB gene expression, which counteracts pro-inflammatory cytokine production. Increased inflammation is a risk factor for disease, highlighting the need to understand factors controlling inflammation. No studies have examined IkB expression in response to acute stress in relation with depressive symptoms. Methods We recruited n = 48 healthy individuals and exposed them to the Trier Social Stress Test (TSST). Stress responses of plasma Interleukin-6, salivary cortisol, as well as inhibitory kappa-B (IkB) gene expression in peripheral blood, were measured before, as well as 30, and 120 min after stress. We also assessed self-reported depressive symptoms, post-stress mood, and stress appraisals. Results Stress exposure induced increases in IL-6 and cortisol (IL-6: F = 42.41, p 0.001 ; cortisol: F = 15.98, p 0.001 ). IkB expression increased after stress with a peak at 30 min and recovery at 120 min (F = 13.11, p 0.001 ). Depressive symptoms were positively related with IkB expression 30 min after stress (beta = 0.30, p = 0.05), and this relationship was mediated by decreases in positive affect. Conclusions: These show that in individuals with more depressive symptoms, acute stress translates into upregulated gene expression of inhibitory kappaB, which might be mediated through stronger decreases in mood. Higher IkB might allow better down regulation of inflammation, but could also be a response to stronger inflammatory reactivity in general.

Rationale: Acute stress is accompanied by an inflammatory response and some individuals show sensitization to repeated stress. Increased peripheral inflammation is a risk factor for many age-related illnesses, highlighting the need to understand factors controlling inflammation. No studies have examined changes in pro- and anti-inflammatory gene expression in response to repeated acute stress in humans. Methods: We recruited n = 31 healthy individuals and examined gene expression of IL-6, IL-1beta, RelA and IkappaB before, 30 and 120 min after exposure to the Trier Social Stress Test (TSST) on two days. We assessed the inflammatory response by measuring plasma IL-6, and cortisol as the major anti-inflammatory stress hormone. Results: Stress exposure induced inflammatory and cortisol responses (IL-6: F = 49.3, p F = 13.7, p ∗ time interaction F = 4.2, p = 0.011) but IL-6 responses did not (n.s.). IL-6 and IL-1beta gene expression increased on Day 1, but not on Day 2 (day ∗ time interaction: IL-6: F = 106, p = 0.001; IL-1beta: F = 7.9, p = 0.006). RelA expression increased on both days (time effect F = 5.0, p = 0.013). IkB expression increased then decreased below baseline on Day 1, and decreased post-TSST on Day 2 (day ∗ time interaction: F (2,54) = 5.4, p = 0.08). There was no relationship between IL-1Beta, IkB, and RelA with plasma IL-6 or cortisol, or between cortisol and plasma IL-6. Conclusions: Taken together, results show a response pattern of pro- and anti-inflammatory gene expression characterized by differential stress responses and habituation patterns that are in disjunction with patterns of cortisol and plasma IL-6 responses to repeated stress. This indicates that increases in plasma concentrations of inflammatory cytokines are unlikely to originate solely from de novo transcription within PBMCs, but that alternative or additional sources of plasma inflammatory cytokines need to be explored.

Objectifs Evaluer 3 methodes d’imagerie : EEV ; IRM endocavitaire et en reseau phase pour definir l’envahissement digestif et guider le geste chirurgical. Materiels et methodes Quarante-sept patientes avec endometriose profonde posterieure operees furent explorees a titre systematique par EEV, IRM endocavitaire (cul-de-sac vaginal posterieur) et en reseau phase (3 plans SpT2, Fat-Sat EGT1 pre, post Gd). Correlations chirurgicales et anatomopathologiques. Criteres d’evaluation : siege, morphologie, intensite, envahissement digestif, lesions associees. Resultats Taille : 1-5 cm. Localisation : cul-de-sac (38), cloison recto-vaginale (4), retro-uterin (5). Parmi 43 patientes ayant eu une resection digestive avec envahissement de la musculeuse, 32 vrais positifs en EEV (epaississement hypoechogene homogene de l’hyposignal de la musculeuse) et 41 en IRM (hypersignal de la muqueuse digestive au contact de l’hyposignal homogene ou heterogene du nodule en SpT2). Pas de faux positif. Deux faux negatifs en IRM, 11 en EEV. L’IRM endovaginale etait superieure pour les petites masses du cul-de-sac et de la cloison recto-vaginale. Lesions associees multiples (ligaments utero-sacres, torus, ovaires) mieux detectees en IRM reseau phase. Conclusion L’IRM est superieure a l’EEV pour l’atteinte digestive avec un aspect specifique (hypersignal de la paroi au contact) et le bilan pelvien. L’IRM endovaginale est utile pour certaines localisations.