Salivary cortisol levels and anxiety in melanoma patients undergoing sentinel lymph node excision under local anesthesia versus general anesthesia: a prospective study.

BACKGROUND: Sentinel lymph node excision (SLNE) can be performed in tumescent local anesthesia (TLA) or general anesthesia (GA). Perioperative cortisol level changes and anxiety are common in surgical interventions and might be influenced by the type of anesthesia. In this study, we intended to determine whether the type of anesthesia impacts the patients' perioperative levels of salivary cortisol (primary outcome) and the feeling of anxiety evaluated by psychological questionnaires (secondary outcome). METHODS: All melanoma patients of age undergoing SLNE at the University Hospital Essen, Germany, could be included in the study. Exclusion criteria were patients' intake of glucocorticoids or psychotropic medication during the former 6 months, pregnancy, age under 18 years, and BMI ≥ 30 as salivary cortisol levels were reported to be significantly impacted by obesity and might confound results. RESULTS: In total, 111 melanoma patients undergoing SLNE were included in our prospective study between May 2011 and April 2017 and could choose between TLA or GA. Salivary cortisol levels were measured three times intraoperatively, twice on the third and second preoperative day and twice on the second postoperative day. To assess anxiety, patients completed questionnaires (Hospital Anxiety and Depression Scale (HADS), State-Trait Anxiety Inventory (STAI)) perioperatively. Patients of both groups exhibited comparable baseline levels of cortisol and perioperative anxiety levels. Independent of the type of anesthesia, all patients showed significantly increasing salivary cortisol level from baseline to 30 min before surgery (T3) (TLA: t = 5.07, p < 0.001; GA: t = 3.09, p = 0.006). Post hoc independent t tests showed that the TLA group exhibited significantly higher cortisol concentrations at the beginning of surgery (T4; t = 3.29, p = 0.002) as well as 20 min after incision (T5; t = 277, p = 0.008) compared to the GA group. CONCLUSIONS: The type of anesthesia chosen for SLNE surgery significantly affects intraoperative cortisol levels in melanoma patients. Further studies are mandatory to evaluate the relevance of endogenous perioperative cortisol levels on the postoperative clinical course. TRIAL REGISTRATION: German Clinical Trials Register DRKS00003076, registered 1 May 2011.

Validity of stress assessment using heart-rate variability in newborns.

BACKGROUND: The process of birth causes stress for neonates, but additional stressors for sick neonates are a matter of concern. As analysis of heart-rate variability (HRV), which reflects autonomic activity, has demonstrated that low-frequency (LF) activity reflects overall autonomic activity, high-frequency (HF) activity reflects parasympathetic activity, and the LF/HF ratio reflects sympathetic activity, HRV has been clinically applied as a non-invasive index of physical stress. In this study, we evaluated whether HRV is useful as a stress index for neonates by analyzing it in comparison with their salivary cortisol level. METHODS: We measured the salivary cortisol level and HRV in 12 healthy neonates and 37 neonates born during between 2014 and 2016 and admitted to the neonatal intensive care unit. These examinations were performed at birth and after approximately 1 week. The changes in parameters with time were examined. RESULTS: The LF and HF values in both groups exhibited significant negative correlations with the salivary cortisol level. In those admitted to the neonatal intensive care unit, the LF and HF values were correlated with gestational age and height. In the healthy neonates, a reduced salivary cortisol level and increase in the LF and HF values were observed approximately 1 week after birth compared with the values at birth, whereas the LF/HF ratio was not correlated with the salivary cortisol level and did not change over time. CONCLUSIONS: The LF and HF values were significantly correlated with the cortisol level, suggesting their usefulness as physiological indices of stress in clinical neonatal care.

Effects of propofol, ketamine-propofol mixture in pediatric dental patients undergoing intravenous sedation: a clinical study.

This study aimed to evaluate the clinical effects, complications (peri- and postoperative), depth of sedation, recovery times, and changes in anxiety levels in paediatric dental patients receiving intravenous sedation with propofol and ketamine-propofol mixtures. This prospective clinical study included 69 healthy children (ASA 1) aged 3-7 years. The patients were assigned randomly to propofol group (n = 23), which received propofol; 1:3 ketofol group (n = 23), which received 1:3 ketofol; or 1:4 ketofol group (n = 23), which received 1:4 ketofol. The bispectral index (BIS) and Ramsay Sedation Scale (RSS) score were recorded at intervals of 5 min to measure the depth of sedation, and vital signs were evaluated. Peri- and postoperative complications and recovery times were recorded. Anxiety levels were also evaluated using the Facial Image Scale (FIS) and changes in saliva cortisol levels (SCLs) before and after the intravenous sedation procedure. The Kruskal‒Wallis test and Wilcoxon signed-rank test were used to determine pre- and posttreatment parameters. Dunn's test for post hoc analysis was used to determine the differences among groups. Children's pre- and posttreatment anxiety levels did not differ significantly according to FIS scores, and increases in SCLs were detected in 1:3 ketofol and 1:4 ketofol groups after dental treatment was completed. Compared with those in the other groups, the BIS values of the patients in 1:4 ketofol indicated a slightly lower depth of sedation. The recovery time of the patients in 1:3 ketofol was longer than that of patients in propofol and 1:4 ketofol. The incidence of postoperative complications (agitation, hypersalivation, nausea/vomiting, and diplopia) did not differ among the groups. Ketamine-propofol combinations provided effective sedation similar to that of propofol infusion without any serious complications during dental treatment performed under intravenous sedation. The ketofol infusion increased the anxiety level of paediatric dental patients to a greater extent than the propofol infusion.

Effect of Tai Chi on Young Adults with Subthreshold Depression via a Stress-Reward Complex: A Randomized Controlled Trial.

BACKGROUND: Subthreshold depression is a highly prevalent mood disorder in young adults. Mind-body exercises, such as Tai Chi, have been adopted as interventions for clinical depressive symptoms. However, the possible effect and underlying mechanism of Tai Chi on subthreshold depression of young individuals remain unclear. This randomized controlled study aimed to evaluate the effects of Tai Chi training and tested the combined stress and reward circuitry model for subthreshold depression. RESULTS: A total of 103 participants completed this trial, with 49 in the 12-week 24-style Tai Chi group and 54 participants in control group. Our results showed significantly lower scores on depressive symptoms (P = 0.002) and anxiety symptoms (P = 0.009) and higher scores on quality of life (P = 0.002) after Tai Chi training. There were significant reductions in salivary cortisol levels (P = 0.007) and putamen gray matter volume (P < 0.001) in the Tai Chi group. The changes in cortisol levels and putamen gray matter volume had direct (bootstrapping confidence interval [- 0.91, - 0.11]) and indirect effects (bootstrapping confidence interval [- 0.65, - 0.19]) on the changes induced by Tai Chi training on depressive symptoms, respectively. CONCLUSION: The stress-reward complex results indicated an interaction between lowering stress levels and increasing reward circuitry activity associated with the alleviation of depressive symptoms among participants. The 12-week Tai Chi training was effective in improving the symptoms and quality of life of young adults with subthreshold depression. Trial Registration Chinese Registry of Clinical Trials (Registration Number: ChiCTR1900028289, Registered December 12, 2019).

Dogs' Stay in a Pet Hotel - Salivary Cortisol Level and Adaptation to New Conditions.

The aim of this study was to assess salivary cortisol level in dogs during admission and a three-day stay in a pet hotel. The study involved 20 dogs admitted to a pet hotel for a stay lasting for at least three consecutive days. The study group consisted of 10 small dogs and 10 medium-sized dogs, eight females and 12 males. Saliva was collected each day to assess cortisol levels. A stay in a hotel is a stressful situation for dogs, as evidenced by the increase in the salivary cortisol level. The highest salivary cortisol level was observed on the day of admission to the hotel. The median salivary cortisol level in the dogs on the consecutive days was 2.7 ng/ml on admission, 2.1 ng/ml after 24 hours, and 1.9 ng/ml after 48 hours. Depending on the size of the dog, the median salivary cortisol level was 2.8 ng/ml, 2.9 ng/ml and 2.4 ng/ml in the small dogs and and 2.2 ng/ml, 1.7 ng/ml and 1.2 ng/ml in the medium sized dogs on the consecutive days.

The effect of occupational noise exposure on systolic blood pressure, diastolic blood pressure and salivary cortisol level among automotive assembly workers.

Introduction. Both auditory and non-auditory health can be affected by exposure to occupational noise. The aim of this study was to evaluate the association of high occupational noise (at three levels) with systolic blood pressure (SBP), diastolic blood pressure (DBP) and salivary cortisol concentration in an automotive factory. Methods. This study was carried out on 78 male workers from a factory who worked in the warehouse unit (control group: 60-70 dB(A)) and assembly units (two test groups: 75-85 and 85-95 dB(A)). Data were collected through questionnaires and measurement of SBP, DBP, saliva cortisol concentration and body mass index (BMI), prior to and post occupational noise exposure. The measurements were performed twice/day and repeated after 10 days. Results. For each occupational noise level group, there was no significant association between cortisol level with age and BMI. The SBP and DBP in all groups increased significantly. Also, the average cortisol levels were similar in different groups before noise exposure, but were statistically different after occupational noise exposure. Conclusions. High occupational noise exposure increases the cortisol level and blood pressure, which are the major risk factors of cardiovascular disease.

Effect of one time coffee fragrance inhalation on working memory, mood, and salivary cortisol level in healthy young volunteers: a randomized placebo controlled trial.

BACKGROUND: Olfactory system regulates the brain which controls emotional memory. Coffee is one of the most consumed beverages in the world. Drinking coffee shows beneficial effects for mood, memory, and psychomotor performance. This work aimed to determine the effects of inhaling coffee fragrance on memory, mood, and salivary cortisol level in healthy young volunteers. METHODS: Eighty young males and females, aged between 18-22 years old, were randomly assigned into two groups: a placebo group inhaling scent from carbon powder and a coffee fragrance group inhaling coffee fragrance. Subjects were assigned to inhale either placebo or coffee fragrance for five minutes. Before and after inhalation period, the clinical assessments were assigned to each subject including computerized assessment battery test for cognitive performance, and self-related visual analogue mood scales for evaluation of mood score. The salivary cortisol level was assessed with cortisol ELISA kit. In addition, the blood pressure and heart rate were also evaluated. RESULTS: Inhalation of coffee fragrance enhanced cognitive parameters, including continuity of attention, quality of memory, and speed of memory, and also increased the mood score of alertness. However, there were no significant changes in salivary cortisol level, blood pressure, and heart rate between pre-and post-inhalation. CONCLUSIONS: One time of coffee fragrance inhalation may enhance working memory and stimulates alertness. However, inhaling coffee fragrance does not reduce stress or modulate autonomic response to stress.

Examining the effect of Early Life Stress on autonomic and endocrine indicators of individual stress reactivity.

Early life stress (ELS) is associated with altered stress reactivity and an increased risk for the development of psychopathological conditions in later life. However, depending on whether autonomic or endocrine measures were used as indicators of stress reactivity, previous studies reported conflicting findings of either increased or decreased stress reactivity after ELS experience. In the present study we therefore aimed to investigate the effect of ELS on both autonomic and endocrine indicators (heart rate and salivary cortisol) of individual stress reactivity and applied a psychosocial stress task in a sample of healthy participants with and without exposure to mild to moderate ELS. Results showed no significant effects of ELS on autonomic and endocrine indicators of individual stress reactivity. Importantly though, heart rate proved as more sensitive than salivary cortisol with regard to differentiating between stress and control conditions and thereby as a more feasible indicator of an individual's stress reactivity. Accordingly, our data suggest that sole reliance on salivary cortisol as an indicator of stress reactivity might lead to an oversight of more subtle effects of psychosocial stress.