Chapter 10 Stress

1. Chapter 10 Stress

2. Stress is ……

3. What is stress? • Stress is the nonspecific and systemic response of the body to a wide range of stimulations. • Stress is your mind and body’s response or reaction to a real or imagined threat, event or change.

4. What is stressor? The stimuli or agents that induce stress are termed stressor. Stressor Physical, chemical, biological Cold, heat, toxins, drugs, bacteria. intrinsic factor of body Homeostasis, disease, cancer. Psychological or socio-cultural Threat to self esteem, relationships with other people.

5. What is eustress? Eustressor positive stress occurs when your level of stress is high enough to motivate you to move into action to get things accomplished.

6. What is distress? Distress or negative stress occurs when your level of stress is either too high or too low and your body and/or mind begin to respond negatively to the stressors.

7. General adaptation syndrome (GAS) • Alarm stage • Resistance stage • Exhaustion stage

8. Basic manifestation to stress response Stressor Neuroendocrine response CA、GC↑ Cellular and humoral responses AAP、HSP↑ Functional and metabolic responses

9. Locus ceruleus-norepinephrine neurons-sympathetic/adrenal medulla axis↑ 神经内分泌反应 CA↑ Hypothalamus-pituitary-adrenal cortex axis↑↑ GC↑ Rest hormonal responses to stress Neuroendocrine response

10. 社会心理应激 情绪反应 Cerebralcortex Limbic system Paraventricular nucleus 躯体刺激 CRH Locus ceruleus Pituitary ACTH Adrenal medulla Adrenal cortex CA GC Locus ceruleus - Norepinephrine （LC-NE）

11. Basic effects of LC-NE • Effects of CNS • Effects of peripheral • Functional and metabolic responses in body

12. Stress CA↑ A cell  receptor（+） Glucagon↑ B cell  receptor（+） Insulin↓ Blood sugar↑ Glycogenolysis ↑ Lipodieresis↑ Meeting the require to energy Energy consumption↑ Tissue decomposition↑ （bad results） Energy metabolism

13. Locus ceruleus-norepinephrine neurons-sympathetic/adrenal medulla axis↑ 神经内分泌反应 CA↑ Hypothalamus-pituitary-adrenal cortex axis↑↑ GC↑ Rest hormonal responses to stress Neuroendocrine response

14. 社会心理应激 情绪反应 Cerebralcortex Limbic system Paraventricular nucleus 躯体刺激 CRH Locus ceruleus Pituitary ACTH Adrenal medulla Adrenal cortex CA GC Hypothalamic-pituitary-adrenal（HPA）

15. Rest hormonal responses to stress

16. Cellular and humoral responses • Acute phase proteins (APP) • Heat shock proteins (HSP)

17. Acute phase proteins (APP) • Acute phase response • Acute phase protein • Negative acute phase protein

18. Cellular and humoral responses • Acute phase proteins (APP) • Heat shock proteins (HSP)

19. What is HSP? • HSP are a family of stress protein whose synthesis is upregalated in response to a variety of enviromental insults such as “heat stress”.

20. Classification of HSP • ■结构性HSP • 为细胞的结构蛋白,正常时即存在于细胞内，帮助新生的蛋白质进行正确的折叠(folding) 、移位(translocation ) 、复性(renaturation)和降解( degradation ) ，称为“Molecular chaperone”。 ■诱生性HSP 由各种应激原诱导生成，参与受损蛋白质的修复或移除，保护细胞免受严重损伤，加速修复；提高细胞对应激原的耐受性。

21. Stress Regulation of HSP gene expresion

22. Stress Effects of stress on the body 1. Effects stress on metabolism 【Characteristic】 Metabolic rate↑ Decomposition↑ Synthesis↓ （1）High metabolic rate （2）Glycometabolism （3）Fat metabolism （4）Protein metabolism

23. Coping with Stress • Don’t let it start. Even though you can’t always control the situations you are in, you can control the way you respond to it. • Make a goal. Setting goals helps you stay in better control of your life. • Decide what’s important. Prioritize what is important in your life. • Take a rest. Take time to do things you like doing. • Believe in yourself. Believe that you can do it, and that you can get rid of it. Fight for it! • Think “I can”. Believe that you can stop your stress.  • Laugh at yourself. Being able to laugh at yourself when you make a mistake can keep you from becoming stressed. • Talk it out. When you have a problem, instead of holding it in, talk to someone.  • Make up your mind. Make up your mind about what you have to do with your stress, and how to control it.   • Get some help. You're not the only person to have this problem, so get help from someone that has had the same experience.  Try to avoid or relieve stress and you’ll be happier and healthier.

24. Case presentation A 32-year-old man was severely burned by gasoline. The examination showed a 78% of skin surface was burned, most of which were Ⅱ degree. After an emergent treatment of debridement and fluid replacement, the patient was hospitalized into burn ward. On the second day, the patient complained of discomfort in the upper part of abdomen, and then vomited about 200 ml of coffer-colored bloody juice. Endoscopic examination revealed scattered erosions throughout the stomach, most of which were shallow, round shaped, and in diameter of about 2 mm. A bigger ulcer was found in the fundus of stomach, and oozing of blood from it was obvious. The bleeding was stopped by endoscopic hemostasis. The patient negated any history of “stomach disease”. Discussion: • Why has the patient the erosion, bleeding in his stomach? What is the name of this disease? • What is the pathogenic mechanism of this patient’s stomach problem? • Does this kind of stomach erosion specifically occur in burned patients? If not, try to illustrate several other causes, which can induce the same stomach problem.