Although research has linked the central nervous system with changes in immunoresponsivity, research on the possible role of the central nervous system in altering reticuloendothelial activity is lacking. This study investigated the possible relationship between hypothalamic structures and changes in responsivity of the reticuloendothelial system. Eight male albino rats received bilateral electrode implants in the ventromedial area of the hypothalamus and, following brain stimulation, reticuloendothelial activity was assessed 3, 6, 12, 24, and 96 hours after stimulation. Brain stimulation decreased phagocytic activity of the reticuloendothelial system. These findings may increase our understanding of a possible neural mechanism underlying relationships between stress and resistance to disease states.

Introdução: A vulnerabilidade dos profissionais de enfermagem ao estresse está associada à exposição crônica aos estressores cotidianos de trabalho e, consequentemente, aos efeitos cumulativos dos mediadores primários e secundários do estresse. Embora vários estudos tenham relatado o elevado nível de estresse dos profissionais de enfermagem, pouco se sabe a respeito das implicações biológicas do estresse no trabalho, expressas na carga alostática e no ritmo de secreção dos hormônios de cortisol um dos principais hormônios do estresse. Isto particularmente é importante visto que a carga alostática aumenta o risco do indivíduo desenvolver transtornos relacionados ao estresse como síndromes cardiovasculares, metabólicas, endócrinas, emocionais e cognitivas. Neste sentido, questiona-se se os profissionais de enfermagem apresentam sobrecarga do sistema adaptativo de reação do estresse (carga alostática), bem como alterações no ritmo de secreção de cortisol (hiper ou hipocortisolemia) ao longo do dia e o risco para o desenvolvimento de doenças relacionadas ao estresse. Objetivo: Descrever a frequência de profissionais de enfermagem com carga alostática elevada e ritmo atípico de secreção de cortisol. Analisar se a carga alostática elevada está associada ao ritmo atípico de secreção de cortisol. Método: Foram incluídos 142 profissionais de enfermagem do turno diurno randomicamente selecionados, alocados nas unidades ambulatório, clínica médica, clínica cirúrgica, centro cirúrgico, pronto socorro infantil e adulto, unidade de terapia intensiva adulto e pediátrica de um hospital universitário. Para avaliação do padrão diurno de secreção de cortisol foram coletadas amostras de saliva em dois dias úteis consecutivos de trabalho e, para a análise dos biomarcadores foram coletadas, em um único dia, amostras de sangue de todos os participantes, bem como, verificada sua pressão arterial e medidas antropométricas. A carga alostática foi analisada por mediadores neuroendócrinos, metabólicos, cardiovasculares e imunológicos. Os dados foram armazenados e analisados utilizando o programa estatístico SPSS versão 14.0 e o nível de significância adotado foi de 5%. Resultados: 31% dos profissionais de enfermagem apresentaram padrão atípico (inconsistente ou flat) de secreção de cortisol e 47,2% carga alostática elevada. Não houve associação entre o ritmo de secreção de cortisol e a carga alostática. Conclusão: Quase metade dos profissionais de enfermagem apresentaram sinais de desgaste do sistema biológico regulador da resposta de estresse, sugerindo que o trabalho possa estar associado a esta sobrecarga e destacando a vulnerabilidade destes trabalhadores ao desenvolvimento de doenças relacionadas ao estresse / Background: The vulnerability of nursing professionals to stress is associated with chronic exposure to everyday stressors and, therefore, with the cumulative effects of primary and secondary stress mediators. Despite the fact that several studies have reported the high stress level of nursing professionals, little is known about the biological implications of stress at work, expressed in the allostatic load and in the rhythm of cortisol secretion, one of the main hormones of stress. This is especially important since the allostatic load increases the risk of an individual to develop stress-related disorders like cardiovascular syndromes, metabolic, endocrine, cognitive and emotional. In this aspect, there are questions whether the nursing professionals present overload on the stress adaptive reaction system (allostatic load), as well as, changes in the rhythm of cortisol secretion (hyper or hypocortisolemia) throughout the day and the risk of developing stress-related diseases. Objective: To describe the frequency of nursing professionals with high allostatic load and atypical rhythm of cortisol secretion. To analyze whether the high allostatic load is associated with atypical rhythm of cortisol secretion. Methods: We included 142 nursing professionals day shift randomly selected, allocated in the outpatient units, medical clinic, surgical clinic, surgery, children and adults emergency room and adult intensive care unit in a pediatric teaching hospital. To evaluate the daytime pattern of cortisol secretion, saliva samples were collected in two work day and, for the analysis of biomarkers, were collected in a single day, blood samples from all participants, as well as, checked his blood pressure and anthropometric measurements. Allostatic load was analized by neuroendocrine, metabolic, cardiovascular and immune mediators. The data was stored and analyzed using the program SPSS version 14.0 and the statistical significance level adopted was 5%. Results: 31% of nursing professionals showed atypical pattern (inconsistent or \"flat\") of secretion of cortisol and 47.2% showed high allostatic load. There was no association between the rate of secretion of cortisol and the allostatic load. Conclusion: Nearly half of nursing professionals showed signs of wear in the biological system stress response regulator, suggesting that the job can be associated with this overload and highlighting the vulnerability of these workers to the development of stress-related diseases.

Estudos apontam a substância cinzenta periaquedutal (PAG) como um sítio crítico para a expressão de vários comportamentos motivados. A porção rostrolateral da PAG (PAGrl), tem um papel chave na regulação da motivação na caça predatória, e modularia mecanismos de recompensa associados ao comportamento alimentar e busca por droga, a partir de projeções para área tegmental ventral e núcleo acumbens; o que dependeria da ligação com neurônios orexinérgicos da área hipotalâmica lateral (LHA). A PAGrl, está mobilizada nos comportamentos de busca por droga assim como na caça predatória. As principais regiões que aferentam a PAGrl são áreas do córtex pré-frontal medial (mPFC) onde a PAGrl integraria tais aferencias e modularia a LHA. Os resultados corroboram com a hipótese, pois lesões no mPFC diminuíram a busca por droga e vimos que neurônios da PAGrl mobilizados no comportamento, que recebem aferências do mPFC, seriam os mesmos que se projetam para LHA e que a PAGrl teria papel crítico na promoção do comportamento de busca por droga no CPP para sulfato de morfina. / Studies show a periaqueductal gray (PAG) as a critical place for an expression of motivated behaviors. The rostrolateral portion of PAG (PAGrl), is a key role in the regulation of motivation in predatory hunting, and modulates, reward mechanisms associated with drug and food seeking, through projections to ventral tegmental area and the nucleus accumbens; what would depend on the connection with orexin neurons of the lateral hypothalamic area (LHA). The PAGrl, is mobilized in predatory hunting as drug seeking. The main region that sends projections to PAGrl is the medial prefrontal cortex (mPFC), where PAGrl integrate such afferent and modulates the LHA. Our results corroborate the hypothesis, because mPFC injuries, decreased drug seeking and we observed that PAGrl neurons mobilized in behavior, and also receive afferents from mPFC, would be the same as projecting to LHA, thus PAGrl had critical role in promotion of drug seeking behavior during the CPP for morphine sulfate.

O córtex pré-frontal (PFC) participa do controle do comportamento de busca por droga e se projeta para a coluna rostrolateral da substância cinzenta periaquedutal (PAGrl) que por sua vez se projeta para o sistema orexinérgico da área hipotalâmica lateral (LHA) que controla comportamentos que oferecem recompensa através de projeções para o sistema dopaminérgico mesolímbico. O objetivo do trabalho é investigar a participação da PAGrl e a sua relação com o PFC e com o sistema orexinérgico da LHA na expressão do comportamento de busca por droga. Submetemos ratos Wistar ao condicionamento de preferência por lugar para sulfato de morfina e notamos que o PFC, a PAGrl e a LHA estão ativados em animais que expressaram tal comportamento. Após, realizamos lesões neuroquímicas bilaterais no PFC e notamos a ausência da busca pela droga nestes animais e da diminuição da ativação da PAGrl e do sistema orexinérgico da LHA. Posteriormente realizarmos lesões neuroquímicas por NMDA na PAGrl e notamos a ausência do comportamento e diminuição de duplas marcações para Fos e orexina na LHA. Os resultados indicam que a PAGrl exerceria um papel crítico para o comportamento de busca por droga, integrando aferências provenientes do PFC para modular os neurônios orexinérgicos da LHA. / The prefrontal cortex (PFC) is involved with planning of the drug seeking behavior and projects itself to the rostrolateral periaqueductal gray (PAGrl) that through projections for the orexin neurons in the lateral hypothalamic area (LHA), participates in the control of behavior that offer rewards. The LHA controls drug reward through projections for the mesolimbic dopaminergic system. This study aims to investigate the relationship between the PFC, PAGrl and orexin neurons in the LHA in drug seeking behavior. We did a morphine conditioned place preference (CPP) procedure in intact, bilateral PAGrl-lesioned and bilateral PFC-lesioned Wistar rats and investigated the pattern of Fos expression. The intact animals displayed such behavior and presented an increase in Fos activation in the PFC, rlPAG and LHA orexinergic neurons. Conversely, PAGrl-lesioned and PFC-lesioned animals did not display this behavior and reduced the activation of orexin neurons in the LHA. PFC-lesioned animals presented a reduction of the Fos activation in the rlPAG. The results suggest a pathway involving the PFC, PAGrl and LHA orexinergic cell group underlying the CCP, where the rlPAG would integrate inputs from the PFC to control the LHA orexinergic cell group.

A redução na pressão parcial de O2 é detectada pelos quimiorreceptores periféricos que sinalizam ao sistema nervoso central para que haja uma correção na homeostasia. Estudos neuroanatômicos mostram que neurônios C1 enviam projeções para núcleo paraventricular do hipotálamo (PVH), mas, pouco descrevem a participação desta via em uma situação de hipóxia. Ademais, o envolvimento de mecanismos neuroimunes no controle neural cardiorrespiratório durante a hipóxia não está esclarecido. Neste estudo mostramos que neurônios catecolaminérgicos do BVLr/C1 ativados por hipóxia se projetam para o PVH, e que a integridade destes neurônios é essencial para que neurônios do PVH sejam ativados por hipóxia. Além disso, o tratamento com minociclina alterou a expressão de mediadores inflamatórios no BVLr e PVH, a expressão de Fos e as repostas respiratória e autônoma desencadeadas pela hipóxia. Estes resultados conferem uma importante caracterização sobre a distribuição dos neurônios catecolaminérgicos do BVLr/C1 que são ativados por hipóxia e se projetam para o PVH. Além de mostrar que a hipóxia pode desencadear mecanismos neuroimunes que possivelmente envolvem a participação da microglia e também recrutam a via neural C1- PVH. / The reduction in the O2 partial pressure is detected by the peripheral chemoreceptors that send information to central nervous system to correct the homeostasis. Neuroanatomical studies show that C1 neurons send projections to the paraventricular hypothalamic nucleus (PVH), but rather describe the involvement of this pathway in a hypoxic situation. Furthermore, the potential involvement of neuroimmune mechanisms in cardiorespiratory neural control during hypoxia is unclear. In this study we show that catecholaminergic neurons localized in rostral ventrolateral medulla (RVLM) / C1 cells activated by hypoxia send projections to the PVH, and the integrity of these neurons is essential for PVH neurons be activated by hypoxia. Moreover, treatment with Minocycline changed the expression of inflammatory mediators in RVLM and PVH, the expression of Fos in these nucleus, and respiratory and autonomic responses elicited by hypoxia. These findings provide an important characterization of the distribution of catecholaminergic RVLM / C1 neurons that are activated by hypoxia and project to the PVH. In addition to showing that hypoxia can trigger neuroimmune mechanisms that possibly involve the microglia activity and also recruit the C1/PVH neural pathway.

Many studies have shown that short sleep duration and/or poor sleep quality is associated with increasing rates of cardiovascular (CVD) mortality and morbidity. One hypothesized explanation for this association has been that sleep loss is a type of chronic stress that induces dysregulation of biological systems that ultimately increase the risk of CVD. One biological system that has been thought to link sleep loss and CVD is the hypothalamus-pituitary-adrenal (HPA) axis. A number of studies using small or convenience samples have addressed the effects of sleep deprivation on cortisol. Only a few studies have examined the association of habitual short sleep duration and/or poor sleep quality with changes in the diurnal cortisol in population based-samples; those studies vary in their methodology and in findings. Another biological system that has been thought to link sleep loss and CVD is the autonomic nervous system (ANS), through overactivation of the sympathetic nervous system (SNS) and/or probably a withdrawal of the parasympathetic nervous system. Experimental studies have shown an association between the sleep stages and markers of the sympathetic system. However, very few studies of habitual sleep duration/sleep quality and ANS markers have been conducted. Even fewer studies have examined the association of habitual sleep duration and/or sleep quality and ANS responses to a stress challenge in a population-based sample. The findings again have been inconsistent probably due to the use of different methodology and different samples. This dissertation used measures of salivary diurnal cortisol as well as cortisol responses to a stress challenge protocol to assess the relationship of habitual sleep duration and/or sleep quality with diurnal cortisol profile in natural conditions and in response to a stress challenge protocol in a laboratory setting. Diurnal cortisol was assessed from up to 16 samples of salivary cortisol for two days. Cortisol responses to a stress challenge were assessed from four salivary samples taken during the stress challenge that was performed in a different day than the diurnal cortisol collection. To examine the relationship of habitual sleep duration and/or sleep quality and markers of the ANS, this dissertation used continuous cardiovascular measures (heart rate and heart rate variability) and four salivary amylase samples obtained during the stress challenge. The stress challenge included mental stress and orthostatic stress. Sleep duration and sleep efficiency (an objective measure of sleep quality) were assessed from 7-day actigraphy and sleep diaries. Insomnia symptoms (a subjective measure of sleep quality) were also assessed using a questionnaire that included the Women’s Health Initiative Insomnia rating scale (WHIIRS). We used mixed models so as to account for the repeated measures of diurnal salivary cortisol levels as well as the responses (reactivity and recovery) to the stress challenge tests. Chapter 1 presents an introduction to this dissertation discussing the relationship between short sleep duration and/or poor sleep quality and CVD morbidity and mortality. Chapter 2 presents a systematic literature review of studies of the association between habitual sleep duration and/or sleep efficiency and markers of neuro-endocrine systems: HPA and ANS. These are plausible mechanisms that link short and/or poor sleep to CVD morbidity and mortality. Chapter 3 presents our analyses of the relationship between short sleep duration and/or poor sleep quality and features of the diurnal cortisol. We hypothesized that those participants whose slept < 6 hours per night or whose sleep efficiency was < 85% would have higher cortisol levels on awakening, flatter cortisol awakening responses (CAR), and higher evening cortisol levels than participants who slept longer or slept better. We found that short sleepers had higher evening cortisol than the longer sleepers and that this association persisted after the adjustment for several known confounders. In chapter 4, we examined how the same groups of participants responded in terms of hormones (cortisol and amylase) and cardiovascular indices (heart rate (HR) and HR variability (HRV)) to a stress challenge test. We hypothesized that those participants who slept for a shorter time or whose sleep was of poorer quality would have more exaggerated responses to and less recovery from a stress challenge test than participants who slept longer or slept better. We found that participants with insomnia had exaggerated high frequency-HRV (HF-HRV) orthostatic reactivity. In an extended analysis, we found that participants who slept less than 7 hours/night had exaggerated heart rate reactivity to a mental stress test compared to participants who slept 7 or more hours/night, but this association was attenuated after adjustment for naps. Paradoxically, we also found that participants who slept less than 7 hours had higher HF-HRV recovery from mental stress compared to longer sleepers (≥7 hours). Short sleep duration or low sleep efficiency was not associated with cortisol or amylase responses to the stress challenge protocol. These findings suggest that sustained high evening cortisol levels and cardiovascular responses to a stress challenge may be among the mechanisms linking short/poor sleep and CV disease.

Vários estudos têm sugerido que o estresse pode ser um dos fatores relacionados com à grande variabilidade cognitiva observada em idosos. Esta associação se explica porque o cortisol, principal classe de hormônios do estresse em humanos, apresenta alta afinidade por receptores específicos localizados no hipocampo, amígdala e região pré-frontal, estruturas associadas ao aprendizado e à memória. Concentrações cronicamente elevadas de cortisol estão associadas à atrofia hipocampal e baixo desempenho cognitivo. Entretanto, o efeito do estresse agudo no desempenho da memória ainda se encontra inconclusivo em idosos. Isto é particularmente relevante, uma vez que, idosos com comprometimento cognitivo patológico apresentam concentração elevada de cortisol, que por sua vez, está associada com rápida progressão da doença. Assim, o objetivo do estudo foi analisar a relação entre desempenho da memória e resposta neuroendócrina e cardiovascular de estresse em idosos saudáveis. Foram selecionados aleatoriamente 100 idosos alfabetizados, predominantemente do sexo feminino, sem prejuízo cognitivo e funcional, moradores da cidade de São Paulo. A resposta neuroendócrina de estresse foi avaliada a partir concentração de cortisol salivar enquanto que a reação cardiovascular a partir da pressão arterial e frequência cardíaca antes, durante e após a exposição do participante a um estressor psicossocial agudo (Trier Social Stress Test TSST). O TSST envolve duas tarefas: falar em público e realizar cálculos aritméticos mentalmente diante de uma banca examinadora. O desempenho da memória foi avaliado mediante aplicação do teste Pares de Palavras (PP) 20 minutos antes do TSST para evocação imediata e aprendizado e 15 minutos após o fim do TSST para evocação tardia. Foi observado aumento de 96% na concentração de cortisol 15 minutos após o TSST, bem como elevação da pressão arterial em relação à situação basal. Ademais, observamos redução significativa do escore do teste PP após o TSST e correlação negativa entre concentração de cortisol, evocação imediata e tardia dos PP. Os resultados revelam influência do estresse agudo no desempenho da memória, particularmente da evocação tardia, de idosos, destacando a vulnerabilidade destes indivíduos aos efeitos neurotóxicos do cortisol na memória e, consequentemente ao desenvolvimento de transtornos cognitivos. / Several studies have suggested that stress may be a factor related to cognitive variability observed in the elderly. This association exists because cortisol, the main class of stress hormones in humans, has a high affinity to specific receptors located in the hippocampus, amygdala and prefrontal regions, structures associated with learning and memory. Chronically elevated cortisol concentrations are associated with hippocampal atrophy and low cognitive performance. However, the effect of acute stress on memory performance is still inconclusive in the elderly. This is particularly relevant, since elderly patients with pathological cognitive impairment present high cortisol level, which in turn is associated with rapid disease progression. The objective of the study was to analyze the relationship between memory performance and neuroendocrine as well as cardiovascular response stress in healthy elderly. One hundred elderly randomly selected, literate, predominantly female, with no cognitive impairment and functional, residents of the city of São Paulo were included. The neuroendocrine response to stress was evaluated using salivary cortisol while the cardiovascular reactivity was assessed through blood pressure and heart rate measured before, during and after exposure to a participant\'s acute psychosocial stressor (\"Trier Social Stress Test\" - TSST). The TSST involves two tasks: public speaking and performing mental arithmetic in front of an examining board. The memory performance was evaluated by the Pairs of Words test (PW) 20 minutes before the TSST for immediate recall and learning and 15 minutes after the end of TSST for delayed recall. It was observed an increase of 96% in the cortisol concentration 15 minutes after the TSST, as well as increased blood pressure compared to baseline. Furthermore, we observed significant reduction in the PP score after TSST and negative correlation between cortisol concentration, immediate and delayed recall of PP. The results revealed influence of acute stress on memory performance, particularly to delayed recall, of older adults, highlighting the vulnerability of older adults to the neurotoxic effects of cortisol on memory and, therefore, to the development of cognitive disorders.

Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent. The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis. The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)? The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not. While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment. Saliva cortisol samples were collected during the test in order to measure variation in cortisol output. The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p &lt; .05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p &lt; .05), and furthermore improve the physiological stress-response (p &lt; .05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.

Thesis (Ph. D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Vita. Bibliography: 255-274.

Thesis (Ph. D.)--Ohio State University, 2006. / Available online via OhioLINK's ETD Center; full text release delayed at author's request until 2009 May 24