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Testicular Adrenal Rest Tumors: Current Insights on Prevalence, Characteristics, Origin, and Treatment
Abstract
This review provides the reader with current insights on testicular adrenal rest tumors (TARTs), a complication in male patients with congenital adrenal hyperplasia (CAH). In recent studies, an overall TART prevalence of 40% (range, 14% to 89%) in classic patients with CAH is found. Reported differences are mainly caused by the method of detection and the selected patient population. Biochemically, histologically, and molecularly, TARTs exhibit particular adrenal characteristics and were therefore thought to originate from aberrant adrenal cells. More recently, TARTs have been found to also exhibit testicular characteristics. This has led to the hypothesis of pluripotent cells as the origin of TARTs. High concentrations of ACTH could cause hyperplasia of these pluripotent cells, as TARTs appear to be associated with poor hormonal control with concomitant elevated ACTH. Unfortunately, as yet there are no methods to prevent the development of TARTs, nor are there guidelines to treat patients with TARTs. Intensified glucocorticoid treatment could improve fertility status in some cases, although studies report contradicting results. TARTs can also lead to irreversible testicular damage, and therefore semen cryopreservation could be offered to patients with TARTs. Further research should focus on the etiology and pharmacological treatment to prevent TART development or to treat TARTs and improve the fertility status of patients with TARTs.
Journal Article
Induction of altered states of consciousness during Floatation-REST is associated with the dissolution of body boundaries and the distortion of subjective time
Floatation-REST (Reduced Environmental Stimulation Therapy) minimizes stimulation of the nervous system by immersing subjects in an environment without sound or light while they effortlessly float in thermoneutral water supersaturated with Epsom salt. Here we investigated the relationship between altered states of consciousness (ASC) and its association with the affective changes induced by Floatation-REST. Using a within-subject crossover design, 50 healthy subjects were randomized to 60 min of Floatation-REST or 60 min of Bed-REST (an active control condition that entailed lying supine on a warm waterbed in a dark and quiet room). Following Floatation-REST, subjects felt significantly more relaxed, less anxious, and less tired than after Bed-REST. Floatation-REST also induced significantly more pronounced ASC characterized by the dissolution of body boundaries and the distortion of subjective time. The loss of body boundaries mediated the loss of anxiety, revealing a novel mechanism by which Floatation-REST exerts its anxiolytic effect.
Journal Article
Rest : why you get more done when you work less
\"For most of us, overwork is the new normal and rest is an afterthought. In our busy lives, rest is defined as the absence of work: late-night TV binges, hours spent trawling the internet, something to do once we've finished everything else on our to-do lists. But dismissing rest stifles our ability to think creatively and truly recharge. In Rest, Silicon Valley consultant Alex Pang argues that we can be more successful in all areas of our lives by recognizing the importance of rest: working better does not mean working more, it means working less and resting better. Treating rest as a passive activity secondary to work undermines our chances for a rewarding and meaningful life. Whether by making space for daily naps, as Winston Churchill did during World War II; going on hours-long strolls like Charles Darwin; or spending a week alone in a cabin like Bill Gates, pursuing what Pang calls \"deliberate rest\" is the true key to fulfillment and creative success. Drawing on rigorous scientific evidence and revelatory historical examples, Rest overturns everything our culture has taught us about work and shows that only by resting better can we start living better\"-- Provided by publisher.
BOOK
Reduced default mode network functional connectivity in patients with recurrent major depressive disorder
Major depressive disorder (MDD) is common and disabling, but its neuropathophysiology remains unclear. Most studies of functional brain networks in MDD have had limited statistical power and data analysis approaches have varied widely. The REST-meta-MDD Project of resting-state fMRI (R-fMRI) addresses these issues. Twenty-five research groups in China established the REST-meta-MDD Consortium by contributing R-fMRI data from 1,300 patients with MDD and 1,128 normal controls (NCs). Data were preprocessed locally with a standardized protocol before aggregated group analyses. We focused on functional connectivity (FC) within the default mode network (DMN), frequently reported to be increased in MDD. Instead, we found decreased DMN FC when we compared 848 patients with MDD to 794 NCs from 17 sites after data exclusion. We found FC reduction only in recurrent MDD, not in first-episode drug-naïve MDD. Decreased DMN FC was associated with medication usage but not with MDD duration. DMN FC was also positively related to symptom severity but only in recurrent MDD. Exploratory analyses also revealed alterations in FC of visual, sensory-motor, and dorsal attention networks in MDD. We confirmed the key role of DMN in MDD but found reduced rather than increased FC within the DMN. Future studies should test whether decreased DMN FC mediates response to treatment. All R-fMRI indices of data contributed by the REST-meta-MDD consortium are being shared publicly via the R-fMRI Maps Project.
Journal Article
Why we dream : the transformative power of our nightly journey
Science journalist and lucid dreamer Alice Robb examines why we dream and how we can improve our dream life.
Book
Intermittent versus continuous enteral nutrition attenuates increases in insulin and leptin during short-term bed rest
Purpose
To compare endocrine responses to intermittent vs continuous enteral nutrition provision during short-term bed rest.
Methods
Twenty healthy men underwent 7 days of bed rest, during which they were randomized to receive enteral nutrition (47%E as carbohydrate, 34%E as fat, 16%E as protein and 3%E as fibre) in a continuous (CONTINUOUS;
n
= 10; 24 h day
−1
at a constant rate) or intermittent (INTERMITTENT;
n
= 10; as 4 meals per day separated by 5 h) pattern. Daily plasma samples were taken every morning to assess metabolite/hormone concentrations.
Results
During bed rest, plasma leptin concentrations were elevated to a lesser extent with INTERMITTENT vs CONTINUOUS (iAUC: 0.42 ± 0.38 vs 0.95 ± 0.48 nmol L
−1
, respectively;
P
= 0.014) as were insulin concentrations (interaction effect,
P
< 0.001) which reached a peak of 369 ± 225 pmol L
−1
in CONTINUOUS, compared to 94 ± 38 pmol L
−1
in INTERMITTENT (
P
= 0.001). Changes in glucose infusion rate were positively correlated with changes in fasting plasma GLP-1 concentrations (
r
= 0.44,
P
= 0.049).
Conclusion
Intermittent enteral nutrition attenuates the progressive rise in plasma leptin and insulinemia seen with continuous feeding during bed rest, suggesting that continuous feeding increases insulin requirements to maintain euglycemia. This raises the possibility that hepatic insulin sensitivity is impaired to a greater extent with continuous versus intermittent feeding during bed rest. To attenuate endocrine and metabolic changes with enteral feeding, an intermittent feeding strategy may, therefore, be preferable to continuous provision of nutrition.
This trial was registered on clinicaltrials.gov as NCT02521025.
Journal Article
Should we all just take 10? A meta-analysis of wakeful rest
According to previous research, if people rest quietly for a brief period of time after learning, they have better memory (i.e., reduced forgetting) after a delay compared to when they engage in a cognitively demanding task. We call this the
wakeful rest effect
. It has been observed with different kinds of study items, interference tasks, and delay intervals involving younger adults, older adults, and patients with amnesia. Despite the sometimes-presumed robustness of the effect, many studies have failed to observe significant results, particularly in healthy young adult populations. This random-effects meta-analysis combined 142 effect sizes from 51 studies to evaluate the evidence for the wakeful rest effect and to identify the sources of variation. Meta-regression was also done. As expected, there were larger effects for patient populations than for healthy populations, as well as weaker effects for younger than older adults. The results of this meta-analysis can inform further research on the potential benefits of wakeful rest.
Journal Article
Limited musculoskeletal benefits of artificial gravity combined with cycling during bed rest: Results from the BRACE study
Prolonged exposure to microgravity, simulated via 6° head‐down tilt bed rest (HDT), induces musculoskeletal deconditioning and negatively impacts body composition. This study evaluated whether a combination of aerobic exercise with artificial gravity (AG) offers superior protection in comparison to exercise alone. Twenty‐four healthy male participants completed 60 days of HDT, randomized into control (C), exercise‐only (EX) and exercise with AG (EX‐AG) groups. Muscle volume, intramuscular fat, body composition and isokinetic strength were assessed via whole‐body MRI and isokinetic dynamometry. All groups experienced thigh fat‐free muscle volume loss: C (10.5% ± 2.6%), EX (6.9% ± 2.4%) and EX‐AG (4.3% ± 2.4%), with EX‐AG showing significantly less atrophy than C ( p < 0.001). Compared with C, EX‐AG preserved more muscle in both anterior ( p < 0.001) and posterior ( p < 0.05) compartments, whilst EX preserved more muscle only anteriorly ( p < 0.05). The fat ratio increased more in C (8.9% ± 6.0%) compared with EX‐AG (−0.8% ± 3.8%; p < 0.05) but not EX (6.5% ± 9.8%). Muscle fat infiltration increased across all groups (C, 7.0% ± 3.7%; EX, 6.2% ± 4.3%; EX‐AG, 3.1% ± 4.7%) but was not different between groups ( p > 0.05). Maximal isokinetic torque decreased in all groups over all measured angular velocities but was not different between groups ( p > 0.05). This is the first study to investigate the combination of AG and exercise as a countermeasure to body composition changes induced by long‐term bed rest. We showed that EX‐AG provided partial protection against muscle atrophy and fat accumulation but did not outperform exercise alone in preserving muscle quality, strength or overall body composition. What is the central question of this study? Does a combination of aerobic exercise with artificial gravity provide superior protection against skeletal muscle atrophy and unfavourable body composition changes during prolonged bed rest, in comparison to exercise alone? What is the main finding and its importance? Our results demonstrate that the combination of aerobic exercise and artificial gravity offers partial protection against bed rest‐induced muscle atrophy and fat accumulation. However, it does not confer additional benefits over exercise alone in preserving muscle quality, strength or overall body composition. These findings inform the design of efficient countermeasures for musculoskeletal health in microgravity analogues.
Journal Article