Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

A Study on the Correlation between Salivary Cortisol Content and Anxiety and Depression in Pregnant and Postpartum Women

Objective: To analyze the correlation between salivary cortisol content and anxiety and depression in pregnant and postpartum women. Method: 300 pregnant and postpartum women who were admitted from January 2021 to December 2021 were selected as the research subjects. They were all tested with the Hamilton Anxiety Scale (HAMA) and the Edinburgh Postnatal Depression Scale (EPDS). 40 pregnant women with anxiety and depression were selected as the observation group, and 50 normal pregnant women were selected as the control group, adopting logistic regression analysis to investigate the correlation between salivary cortisol and postpartum anxiety and depression during pregnancy. Result: The salivary cortisol levels in the observation group were significantly higher than those in the control group before bedtime, after waking up the next day, 15 minutes after waking up, 30 minutes after waking up, 60 minutes after waking up, and 1 hour before lunch (p < 0.05). Maternal depression and anxiety were not related to age, weight, gestational age, negative events, or history of adverse pregnancy and childbirth (p > 0.05). Maternal depression and anxiety are closely related to salivary cortisol levels and educational background (p Conclusion: There is a close correlation between anxiety and depression and an increase in cortisol levels, suggesting that the salivary cortisol awakening response during pregnancy has a predictive effect on the occurrence of postpartum depression.

Effect of Cognitive Behavioral Intervention on Plasma Cortisol in Patients with Breast Cancer PTSD

Objective: To investigate the effect of cognitive behavioral intervention on plasma cortisol in patients with breast cancer PTSD before surgery. Methods: SCL-90, EPQ-N and cognitive behavior intervention were performed on 30 patients with PTSD, 30 patients without PTSD and 30 normal subjects, and their fasting blood was collected to analyze cortisol in the morning. Results: The scores of SCL-90 and EPQ-N in patients with breast cancer PTSD were significantly higher than those in non-PTSD patients and normal subjects (P < 0.01). After cognitive behavioral intervention, the plasma cortisol level of breast cancer PTSD patients was significantly decreased (P Conclusion: Compared with non-PTSD breast cancer patients and normal control group, breast cancer PTSD patients had more serious psychological problems, worse emotional stability and higher plasma cortisol level. Cognitive-behavioral intervention can effectively reduce plasma cortisol levels in breast cancer patients with PTSD.

How Music Intervention Lowered Participants’ Morning Cortisol—Qualitative Case Stories

Non-pharmacological interventions for improved home care of persons with dementia and their family caregiver are and will be increasingly important for society. A music intervention study was performed on persons with persons with dementia and family caregiver. The persons with dementia and family caregiver were instructed to choose a daily routine for joint listening to recorded music. They selected the music they were interested in from a menu. The intervention period lasted for two months. Both persons with dementia and family caregiver provided daily saliva samples for the assessment of stress-related steroid hormones. In previous reports we have reported that the morning cortisol levels decreased significantly among the family caregiver when the intervention group was compared to a control group. In the present study we report narratives from four dyads, two of whom with beneficial effects of the music intervention, one dyad with no clear beneficial effects and one dyad with mixed results. The narratives illustrate the strong cohesive effect that the joint music listening could have, leading to improved social functioning paralleled by decreased morning cortisol levels particularly in the family caregiver. The narratives also illustrate reasons for failed effects.

Evaluation of Clinical Characteristics and Plasma Cortisol Concentrations in Individuals with COVID-19 and Post-COVID Syndrome

COVID-19 generates systematic alterations in humans both in active stages of infection and over time, called post-COVID syndrome. Cortisol is a hormone that is overexpressed in inflammation and cellular stress processes. Its main function is to return to physiological homeostasis, so its evaluation together with other clinical parameters can allow us to determine the degree of systemic affectation by COVID-19. Objective: To evaluate changes in clinical parameters and plasma cortisol concentrations in patients with active COVID-19 and post-COVID syndrome. Material and Methods: Healthy patients, in stages of mild infection, critical and with post-COVID syndrome, were recruited, obtaining, through clinical diagnoses and interviews, their main clinical characteristics, in addition to plasma, in which cortisol concentrations were determined using competitive ELISA. Results: The critical stage group had higher frequencies of comorbidities, clinical symptoms, as well as more altered laboratory parameters compared to the other subgroups. In the post-COVID syndrome group after the initial infection, most laboratory parameters recovered, however, several clinical symptoms remained latent over time. The determination of cortisol showed an increase in its concentration, being higher in patients in critical stage and with post-COVID syndrome. Conclusion: COVID-19 disease generates clinical alterations that trigger an increase in plasma cortisol. These alterations increase as the stages of infection become more severe and some of them remain altered in patients with post-COVID syndrome.

Effects of relaxation breathing exercise on fatigue and cortisol level among Indonesian gynecological cancer patients undergoing chemotherapy:a pilot study

Objective:This study aimed to determine the effect of the relaxation breathing exercise(RBE)on fatigue and cortisol levels among Indonesian women with gynecological cancer undergoing chemotherapy.Methods:This pilot study consecutively recruited 44 gynecological cancer patients to receive RBE(22)or usual care(22).Cortisol level was measured before and after completion of the intervention(day 8).Fatigue was measured using the Piper Fatigue Scale(PFS).Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale(HADS)at the baseline days of the study for days 1,4,and 8.The obtained data were analyzed using Fisher’s exact test,the independent t-test,and the Mann-Whitney U test.Results:There were significant increases in cortisol levels within the groups,either the intervention or control groups,respectively(P-value=0.0003 and 0.001).Despite there being no statistical significance between the intervention and control groups,there were noticeable differences in the cortisol levels,indicating the extreme increase in cortisol levels in the control group(Median[IQR1-IQR3]:2.30[0.99-9.09];Min-Max:0.43-23.38)compared with the intervention group(Median[IQR1-IQR3]=2.97[1.26-5.18];Min-Max=0.39-6.91).Conclusions:RBE helps prevent a significant increase in cortisol levels that can alleviate fatigue for women with gynecological cancer.Further research was recommended to compare several intervention modalities for fatigue and cancer-related symptom management based on cortisol level changes.

Serum vascular endothelial growth factor and cortisol expression to predict prognosis of patients with hypertensive cerebral hemorrhage

BACKGROUND Cerebral hemorrhage is a common and severe complication of hypertension in middle-aged and elderly men.AIM To investigate the correlation between vascular endothelial growth factor(VEGF)and cortisol(Cor)and the prognosis of patients with hypertensive cerebral hemorrhage.METHODS A hundred patients with hypertensive intracerebral hemorrhage were enrolled from January 2020 to December 2022 and assigned to the hypertensive intracerebral hemorrhage group.Another 100 healthy people who were examined at our hospital during the same period were selected and assigned to the healthy group.Peripheral venous blood was collected,and serum Cor and VGEF levels were measured through enzyme linked immunosorbent assay.RESULTS A statistically significant difference in serum Cor and VGEF levels was observed among patients with varying degrees of neurological impairment(P<0.05).Serum Cor and VGEF levels were significantly higher in the severe group than in the mild-to-moderate group.Cor and VEGF levels were significantly higher in patients with poor prognoses than in those with good prognoses.Multiple logistic regression analysis revealed that serum Cor and VGEF levels were independent factors affecting hypertensive intracerebral hemorrhage(P<0.05).CONCLUSION Cor and VGEF are associated with the occurrence and development of hypertensive cerebral hemorrhage and are significantly associated with neurological impairment and prognosis of patients.

血清Cortisol和血浆AT-Ⅱ在围手术期开胸患者体内水平的探讨

目的:通过测定开胸患者术前及术毕血清皮质醇(Cortisol)和血浆血管紧张素Ⅱ(AT-Ⅱ)的水平,探讨应激前后开胸患者体内血清Cortisol和血浆AT-Ⅱ的变化。方法:无严重高血压、心脏病、垂体瘤及其它相关影响体内Cortisol、AT-Ⅱ水平疾病且具有手术指征的开胸患者35例(男18,女17),平均年龄(58.1±10.6)岁,分别在术前及术毕时采血,应用放射免疫分析测定血清Cortisol和血浆AT-Ⅱ的水平。结果:经配对t检验,结果显示开胸患者术毕血清Cortisol和血浆AT-Ⅱ与术前相比明显增高,存在显著性差异(t=-3.686～-3.575,P≤0.01);收缩压及心率,存在显著性差异(t=-2.35～4.72,P=0～0.025<0.05)。控制性别与年龄后,经部分相关分析,术毕心率与AT-Ⅱ呈显著正相关(r=0.41,P=0.035<0.05);与术毕Cortisol呈正相关(r=0.42,P=0.019<0.05)。结论:开胸患者术毕血清Cortisol、血浆AT-Ⅱ和心率明显增高。术后应密切监测开胸患者血清Cortisol及AT-Ⅱ的水平,作好相应的护理,以减少其它并发症的发生几率。

Changes of serum adrenocorticotropic hormone and cortisol levels during sleep seizures

Objective Measuring the serum concentrations of adrenocorticotropic hormone （ACTH） and cortisol in epileptic seizures during sleep to investigate their link to the EEG changes. Methods Pre-surgical evaluation was performed by videoEEG monitoring using 24 channel recording. Thirty six epilepsy patients could be attributed to two groups： 28 patients had spontaneous seizures, and the other 8 patients whose seizures were induced by bemegride. Another 11 persons with confirmed psychogenic non-epileptic seizures （PNES） served as control group. Blood samples were obtained at five points： wake （08：00 a.m.）, sleep （00：00 a.m.）, and shortly before, during and after an epileptic seizure. The serum ACTH and cortisol were measured and analyzed by chemiluminescent immunoassay. Results The levels of ACTH and cortisol in serum underwent significant changes： declining below the average sleep-level shortly before seizures, increasing during seizures, and far above the average wake-level after seizures （P 〈 0.001）. Such changes did not occur in the control group （P 〉 0.05）. The ACTH and cortisol levels had no significant difference between spontaneous group and bemegride-induced group （P 〉 0.05）. Conclusion The serum concentrations of ACTH and cortisol during sleep seizures are linked with pre-ictal and ictal EEG changes in epilepsy patients.

优秀射箭运动员训练及比赛周期唾液Cortisol与SIgA变化的规律性研究

以国家射箭队24名集训队员在集训期和参加国际比赛的唾液Cortisol和SIgA变化作为研究数据,观察训练期和比赛期两者的差异,分析运动员的应激状况,查看比赛期的变化规律,探求合理的干预手段。研究发现:比赛期与训练周期的基础值相比较,运动员的唾液Cortisol上升,而SIgA则下降,其中男运动员在第1、4天升高显著(P<0.01),女运动员头3天上升明显(P<0.01);男运动员的SIgA在第1天下降明显(P<0.01),吃得开女运动员前3天的都有显著下降(P<0.01);优秀射箭运动员唾液Cortisol在比赛周期上升,SIgA则下降,两者存在着一定的负相关;男子射箭运动员的应激反应上比女子更加敏感和迅速,女子运动员则表现缓慢而平稳。

血清Cortisol及ACTH在糖调节受损和DM2患者中的变化及意义

目的:探讨血清皮质醇(Cortisol)及促肾上腺皮质激素(ACTH)在糖调节受损(IGR)和2型糖尿病(DM2)患者中的变化及意义。方法:比较糖调节受损组、DM2组与正常对照组在8:00及24:00两次的血清Cortisol和ACTH水平;并进一步将糖调节受损组分为糖耐量减低(IGT)组和空腹血糖受损(IFG)组分别与DM2组比较8:00及24:00两次的血清Cortisol和ACTH水平。结果:①IGR和DM2组患者8:00及24:00两次的Cortisol和ACTH较正常对照组升高,差异有统计学意义(P<0.01或P<0.05);②DM2组8:00血清Cortisol和ACTH水平低于IGT组和IFG组,差异有统计学意义(P<0.01或P<0.05);③IGR和DM2患者血清Cortisol及ACTH水平相关分析显示Cortisol、ACTH间呈正相关(r=0.4002、0.4231,P<0.05)。结论:IGR和DM2患者体内存在以血清Cortisol及ACTH分泌增高为主要表现的HPA轴功能紊乱,且随病情进展HPA轴有功能"耗竭"的趋势。

Effect of Zinc Deficiency on Blood Cortisol and ACTH Concentrations,Cerebrum Cortex NO Synthase Activity in Rat

The effects of zinc deficiency on the serum cortisol and adrenocorticotrophic hormone (ACTH) concentration,and the cerebrum nitric oxide synthase (NOS) activity in rats were studied.Growing rats were allotted to three groups,which were zinc deficiency (ZD),paired fed (PF) and zinc supplementation after feeding zinc deficient food for 21 days (ZS).The duration of feed test was 35 days.Compared with PF rats,serum cortisol concentration in ZD ones was significantly increased,whereas serum ACTH concentration and cerebrum NOS activity were significantly decreased.The results suggested that zinc might influence the metabolism of hypothalamic hypophysial adrenocortical axis and NOS.

椎管内麻醉和全麻对患者血清Cortisol、IL-6、TNF-α水平的影响

文献报告，细胞因子在镇痛中的作用广泛受到临床和科研工作者的关注。IL-6是体内许多细胞产生的一种具有生物活性的刺激因子，为机体复杂的细胞因子网络中的重要成员。皮质醇（Corfisol）是从肾上腺皮质束状带分泌到血循环中，一般以多种形式存在：一种结合状态，主要与糖皮质类固醇结合蛋白结合，占90％，少量与白蛋白结合。

IL-6,TNF-α,CRP,cortisol在围手术期监测中的意义

目的 探讨IL - 6,TNF -α ,CRP ,cortisol在围手术期监测中的作用。方法 Ⅱ ,Ⅲ期胃癌 (A组 )、低位直肠癌 (B组 )各 13例和食管贲门癌 (C组 ) 11例 ,均接受根治性切除术 ,对照组 ( 10例 )为择期小手术。所有患者于术前 1d、术后 2h、术后 1,6d取血 ,测定血浆IL - 6,INF -α ,CRP ,cortisil含量 ,以及体外内毒素 (LPS)刺激全血释放TNF -α含量的变化。结果 ①A ,B ,C 3组患者术后 2hIL - 6含量显著升高 (P <0 0 5 ) ,术后 1d则明显回落 ,出现并发症患者IL - 6呈过度升高 ;②术后 1d 3组CRP含量显著高于对照组 (P <0 0 5 ) ;③各组手术前后TNF -α无显著改变 (P >0 0 5 ) ;全血受LPS刺激后 ,3组术后 2hTNF -α释放量较其他时点及对照组显著降低 (P <0 0 5 ) ;④A ,C组术后 2hcortisol显著升高 (P <0 0 5 )。结论 监测术后血浆IL - 6,CRP ,cortisol含量及LPS刺激全血TNF -α释放量的变化有利于创伤程度和预后的判断 。

急性颅脑损伤颅内出血患者治疗前后测定血浆Cortisol、TNF-α和IL-6水平的临床意义

目的:为了探讨急性颅脑损伤颅内出血患者治疗前后测定血浆皮质醇(cortisol)、TNF-α和IL-6水平的临床意义。方法:RIA和超敏免疫分析测定了84例急性颅脑损伤颅内出血患者(其中46例重症和38例轻症)治疗前后血浆皮质醇、TNF-α和IL-6水平,并与35例正常对照组进行了比较性分析。结果:84例急性颅脑损伤颅内出血患者治疗前血浆皮质醇(8h和24h)、TNF-α和IL-6水平均较35例正常对照组明显增高(P均<0.01),而且重症明显高于轻症(P均<0.05),表示其随着疾病的严重程度而增加。治疗后,32例重症患者血浆皮质醇(8h和24h)、TNF-α和IL-6水平明显降低(P<0.05～<0.01)。30例轻症患者血浆皮质醇(8h和24h)、TNF-α和IL-6水平恢复正常(P均>0.05)。结论:血浆皮质醇(8h和24h)、TNF-α和IL-6水平的增加是急性颅脑损伤颅内出血的应激反应,并参与病理生理过程,是观察治疗效果和预后的有效指标。

Relationship between Levels of Testosterone and Cortisol in Saliva and Aggressive Behaviors of Adolescents

Objective To explore the endocfinal factors which influence the aggressive behavior of adolescents. Methods The levels of cortisol （CORT）, testosterone （T）, prolactin （PRL）, and growth hormone （GH） in saliva from 20 aggressive students and 20 non-aggressive control students were measured by radioimmunoassay （RIA）. The students were matched for their gender, age, grade, stage of pubertal development, and economic status of their families. Results The salivary T levels were 22.20±14.50 pg/mL and 19.54±12.52 pg/mL in aggressive male and female students, 13.20±6.85 pg/mL and 5.24±3.03 pg/mL in non-aggressive male and female students （P〈0.05）. The male aggressive students had a lower level of CORT in saliva than non-aggressive male students （P〈0.05）. There were no significant differences in the salivary levels of PRL or GH between the aggressive and non-aggressive groups. Correlation analysis revealed a negative relationship in male students between the salivary CORT levels and the aggression factor scores of the child behavior checklist （CBCL）. In addition, the data also showed a positive relationship between the salivary T levels and the aggression factor scores of CBCL in female students. Multiple linear regression analysis showed that the salivary CORT level was an independent predictive factor for aggressive behaviors in adolescent boys. The higher the CORT level, the less aggressive the boys were. Conclusion CORT and T levels may play a certain role in adolescent aggressive behaviors.

Conceptus elongation in ruminants: roles of progesterone, prostaglandin, interferon tau and cortisol

The majority of pregnancy loss in ruminants occurs during the first three weeks after conception, particularly during the period of conceptus elongation that occurs prior to pregnancy recognition and implantation. This review integrates established and new information on the biological role of ovarian progesterone （P4）, prostaglandins （PGs）, interferon tau （IFNT） and cortisol in endometrial function and conceptus elongation. Progesterone is secreted by the ovarian corpus luteum （CL） and is the unequivocal hormone of pregnancy. Prostaglandins （PGs） and cortisol are produced by both the epithelial cells of the endometrium and the trophectoderm of the elongating conceptus. In contrast, IFNT is produced solely by the conceptus trophectoderm and is the maternal recognition of pregnancy signa that inhibits production of luteolytic pulses of PGF2α by the endometrium to maintain the CL and thus production of P4. Available results in sheep support the idea that the individual, interactive, and coordinated actions of P4, PGs, IFNT and cortisol regulate conceptus elongation and implantation by controlling expression of genes in the endometrium and/or trophectoderm. An increased knowledge of conceptus-endometrial interactions during early pregnancy in ruminants is necessary to understand and elucidate the causes of infertility and recurrent early pregnancy loss and provide new strategies to improve fertility and thus reproductive efficiency.

血清皮质醇(Cortisol)径向薄层层析法

人体血清(血浆)皮质醇含量测定是研究垂体-肾上腺皮质分泌功能的重要指标,已应用于诊断柯兴氏综合征和阿狄森氏病,也应用于中医肾阳虚证研究工作。我们采用非传统的径向展开法(点状加样。