Frequent cellular phone use modifies hypothalamic-pituitary-adrenal axis response to a cellular phone call after mental stress in healthy children and adolescents: A pilot study.

OBJECTIVE: The hypothalamic-pituitary-adrenal (HPA) axis is the main "gate-keeper" of the organism's response to every somatic or mental stress. This prospective study aims to investigate the HPA-axis response to a cellular phone call exposure after mental stress in healthy children and adolescents and to assess the possible predictive role of baseline endocrine markers to this response. SUBJECTS AND METHODS: Two groups of healthy school-age children aged 11-14 (12.5±1.5) years were included in the study, the one comprising those who are occasional users of a cellular phone (Group A) while the second those who do regularly use one (Group B). Blood samples were obtained from all participants at 8.00 am after a 12-hour overnight fasting for thyroid hormone, glucose, insulin, and cortisol levels determination. The participants performed the Trier Social Stress Test for Children (TSST-C) (5 minoral task followed by 5 min arithmetic task). Salivary cortisol samples were obtained at baseline, 10' and 20' min after the TSST-C and 10' and 20' after a 5 minute cellular phone call. RESULTS: Significant changes in the salivary cortisol levels were noted between 10' and 20' mins after the cellular phone call with different responses between the two groups. Baseline thyroid hormone levels seem to predict the cortisol response to mental stress mainly in group A, while HOMA had no impact on salivary cortisol response at any phase of the test, in either group. CONCLUSIONS: HPA axis response to cellular phone after mental stress in children and adolescents follow a different pattern in frequent users than in occasional users that seems to be influenced by the baseline thyroid hormone levels.

Neurohormonal and cytokine fluctuations following transcatheter closure for an atrial septal defect.

INTRODUCTION: Inflammation and neurohormonal activation are considered to be involved in the development of earlier and/or later complications in congenital heart disease patients, even after a successful repair of the lesion. It is not yet clarified what is the role of the therapeutic interventions in the occurrence of such a response and how it could be associated with possible postoperative complications. AIM: We sought to assess the inflammatory and neurohormonal response to transcatheter closure of secundum type atrial septal defects (ASD) over a six-month follow-up period. We also evaluated the association between the respective markers and catheterization data as well as echocardiographic measurements. METHODS: Plasma concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), N-terminal-proatrial natriuretic peptide (NT-proANP) and N-terminal-probrain natriuretic peptide (NT-proBNP) were assessed and echocardiographic measurements were performed in twenty-eight patients with atrial septal defect prior to, and at the first, second and sixth months post transcatheter closure. Thirty-three age-matched healthy volunteers were also enrolled. RESULTS: IL-6 plasma levels, although higher preoperatively, [physical logarithm (ln) IL-6: 3.37±0.66 vs 2.92±0.44 pg/ml, p=0.015], reached control levels postoperatively, at the end of the third month, whereas TNF-α and IL-10 were not influenced by the procedure. NT-proANP levels were elevated preoperatively compared to the control group (ln NT-proANP 3.78±0.572 vs 3.48±0.30, p=0.031), with a further significant increase during the 1st month (ln NT-proANP 3.78±0.572 vs 4.2±0.42, p=0.006), following the pattern of the left atrial volume enlargement, and remained high even 6 months after the procedure .On the other hand, the initially normal concentrations of NT-proBNP, after a transient significant increase during the first month postoperatively (ln NT-proBNP 3.56±0.94 vs 4.58±0.91, p<0.0001) returned to the controls' levels at the end of the third month. Preoperative concentrations of NT-proANP positively correlated with NT-proBNP concentrations and pulmonary to systemic flow ratio (Qp/Qs). CONCLUSIONS: Transcatheter closure could improve, on a mid- term basis, the inflammatory process but natriuretic peptides' secretion continues in parallel with left atrial volume increase. Further follow up is required to determine the long-term progress of the inflammatory and neurohormonal response to the procedure.

Neurohormonal activity and vascular properties late after aortic coarctation repair.

BACKGROUND: Coarctation of aorta (CoA) patients present cardiovascular complications late after repair the causes of which are not fully understood. Our study investigates the neurohormonal and immune activation and the elastic properties of the aorta and peripheral vessels in adult patients with coarctation of aorta (CoA), late after repair. METHODS: Nineteen adult patients with repaired CoA and 29 matched healthy controls underwent aortic distensibility, stiffness index, a study of the elastic properties of peripheral vessels proximal to the coarctation site and measurement of plasma cytokine and neurohormone levels. RESULTS: Distensibility index was reduced (p=0.02) and stiffness index was increased (p=0.005) in CoA patients compared to control. Augmentation index (p=0.0007) and augmented pressure (p=0.001) were higher in CoA patients and Forearm Blood Flow (FBF) index was reduced (p=0.009). Plasma levels of sICAM-1 (p=0.01), sVCAM-1 (p=0.05), E-selectin (p=0.01), sFas-ligand (p=0.02) and IL-10 (p=0.01) were also elevated in CoA patients vs control. TNF-a, IL-6, Endothelin-1 and NT-pro-BNP levels were not. CONCLUSIONS: Adults with repaired CoA seem to develop a late inflammatory reaction, which reflects a functional problem in all vessels, regardless of the initial lesion. This may explain the late complications of the disease despite early repair and improved surgical procedures.

Heart rate turbulence in adults with repaired tetralogy of Fallot.

BACKGROUND: Tetralogy of Fallot (ToF) patients face an increased risk of sudden cardiac death late after repair. Heart rate turbulence (HRT) indices are well-known predictors of sudden cardiac death. We aimed to estimate whether HRT is impaired in repaired ToF patients compared to healthy controls and relate those HRT parameters to already recognized prognostic markers. METHODS: Continuous ECG recordings were performed in 19 patients late after ToF repair (36.3+/-12.4 years, 26.6+/-7.1 years after repair) and 20 age-matched healthy controls (40.8+/-8.1 years). Turbulence slope (TS) and onset (TO), frequency and time domain heart rate variability parameters and QRS duration were estimated. Volumes of the right (RV) and left ventricle (LV) and ejection fraction (EF) were assessed by cardiovascular magnetic resonance imaging. Cardiopulmonary exercise testing was used to estimate peak oxygen consumption (VO(2)) and VE/VCO(2) slope. RESULTS: TS (15.95+/-9.41 vs 28.73+/-12.24 ms/RRI, p=0.0007) and TO (-0.98+/-2.06% vs -3.45+/-3.25%, p=0.007) were found to be significantly different between ToF patients and controls. TO correlated with LVEF (r=0.47, p<0.05), LVSVi (r=0.50, p=0.03), RVEF (r=0.53, p=0.02), peak VO(2) (r=0.50, p=0.05), VE/VCO(2) slope (r=-0.55, p=0.03) and with heart rate variability frequency domain indices (log LF, r=0.47, p=0.04, log HF, r=0.56, p=0.01). CONCLUSION: HRT indices are impaired in ToF patients late after surgical repair compared to healthy controls and relate to coexisting haemodynamic, ventilatory and autonomic impairment. A clinical prognostic role of HRT may be speculated, which warrants further investigation.