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Published in: BioPsychoSocial Medicine 1/2015

Open Access 01-12-2015 | Research

Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome

Authors: Nagisa Sugaya, Shuhei Izawa, Keisuke Saito, Kentaro Shirotsuki, Shinobu Nomura, Hironori Shimada

Published in: BioPsychoSocial Medicine | Issue 1/2015

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Abstract

Background

The purpose of this study was to investigate the effect of prolonged stress on the salivary adrenal hormones (cortisol, dehydroepiandrosterone [DHEA], DHEA-sulfate [DHEA-S]) of individuals with irritable bowel syndrome (IBS).

Methods

The participants were female college students, including 10 with IBS and 16 without IBS (control group), who were scheduled for a 2-week teaching practice at a kindergarten. Participants were asked to collect saliva for determining adrenal hormones immediately and 30 min after awakening and before sleep, 2 weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice.

Results

Regarding cortisol/DHEA ratio, significantly increased levels were found during the first week of the practice, and a significant interaction between group and time was found; the ratio at 30 min after awakening in the IBS group was higher than that in the control group. For the other adrenal hormone indexes, no significant differences due to the presence of IBS were found.

Conclusions

Individuals with IBS showed an elevated cortisol/DHEA ratio after awakening compared with individuals without IBS, and the elevated ratio peaked under the prolonged stress. The present study suggests that the cortisol effect is dominant in individuals with IBS under prolonged stress.
Literature
1.
go back to reference Fukudo S, Suzuki J. Colonic motility, autonomic function, and gastrointestinal hormones under psychological stress on irritable bowel syndrome. Tohoku J Exp Med. 1987;151:373–86.CrossRefPubMed Fukudo S, Suzuki J. Colonic motility, autonomic function, and gastrointestinal hormones under psychological stress on irritable bowel syndrome. Tohoku J Exp Med. 1987;151:373–86.CrossRefPubMed
2.
go back to reference Fukudo S, Nomura T, Muranaka M, Taguchi F. Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study. J Clin Gastroenterol. 1993;17:133–41.CrossRefPubMed Fukudo S, Nomura T, Muranaka M, Taguchi F. Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study. J Clin Gastroenterol. 1993;17:133–41.CrossRefPubMed
3.
go back to reference Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C. HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology. 1994;29:83–98.CrossRef Kudielka BM, Buske-Kirschbaum A, Hellhammer DH, Kirschbaum C. HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology. 1994;29:83–98.CrossRef
4.
go back to reference Chrousos GP. Stress, chronic inflammation, and emotional and physical well-being: concurrent effects and chronic sequelae. J Allergy Clin Immunol. 2000;106:S275–91.CrossRefPubMed Chrousos GP. Stress, chronic inflammation, and emotional and physical well-being: concurrent effects and chronic sequelae. J Allergy Clin Immunol. 2000;106:S275–91.CrossRefPubMed
5.
go back to reference Elenkov U, Chrousos GP. Stress hormones, Th1/Th2 patterns, pro/anti-inflammatory cytokines and susceptibility to disease. Trends Endocrinol Metab. 1999;10:359–68.CrossRefPubMed Elenkov U, Chrousos GP. Stress hormones, Th1/Th2 patterns, pro/anti-inflammatory cytokines and susceptibility to disease. Trends Endocrinol Metab. 1999;10:359–68.CrossRefPubMed
6.
go back to reference Barbara G, Wang B, Stanghellini V, de Giorgio R, Cremon C, Di Nardo G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–37.CrossRefPubMed Barbara G, Wang B, Stanghellini V, de Giorgio R, Cremon C, Di Nardo G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–37.CrossRefPubMed
7.
go back to reference Buhner S, Li Q, Vignali S, Barbara G, De Giorgio R, Stanghellini V, et al. Activation of human enteric neurons by supernatants of colonic biopsy specimens from patients with irritable bowel syndrome. Gastroenterology. 2009;137:1425–34.CrossRefPubMed Buhner S, Li Q, Vignali S, Barbara G, De Giorgio R, Stanghellini V, et al. Activation of human enteric neurons by supernatants of colonic biopsy specimens from patients with irritable bowel syndrome. Gastroenterology. 2009;137:1425–34.CrossRefPubMed
8.
9.
go back to reference Tache Y, Martinez V, Million M, Rivier J. Corticotropin releasing factor and the brain-gut motor response to stress. Can J Gastroenterol. 1999;13:18A–25.CrossRefPubMed Tache Y, Martinez V, Million M, Rivier J. Corticotropin releasing factor and the brain-gut motor response to stress. Can J Gastroenterol. 1999;13:18A–25.CrossRefPubMed
10.
go back to reference Fukudo S, Nomura T, Hongo M. Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut. 1998;42:845–9.CrossRefPubMedPubMedCentral Fukudo S, Nomura T, Hongo M. Impact of corticotropin-releasing hormone on gastrointestinal motility and adrenocorticotropic hormone in normal controls and patients with irritable bowel syndrome. Gut. 1998;42:845–9.CrossRefPubMedPubMedCentral
11.
go back to reference Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, et al. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology. 2006;130:304–11.CrossRefPubMed Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, et al. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology. 2006;130:304–11.CrossRefPubMed
12.
go back to reference Elsenbruch S, Lovallo WR, Orr WC. Psychological and physiological responses to postprandial mental stress in women with the irritable bowel syndrome. Psychosom Med. 2001;63:805–11.CrossRefPubMed Elsenbruch S, Lovallo WR, Orr WC. Psychological and physiological responses to postprandial mental stress in women with the irritable bowel syndrome. Psychosom Med. 2001;63:805–11.CrossRefPubMed
13.
go back to reference Elsenbruch S, Lucas A, Holtmann G, Haag S, Gerken G, Riemenschneider N, et al. Public speaking stress-induced neuroendocrine responses and circulating immune cell redistribution in irritable bowel syndrome. Am J Gastroenterol. 2006;101:2300–7.CrossRefPubMed Elsenbruch S, Lucas A, Holtmann G, Haag S, Gerken G, Riemenschneider N, et al. Public speaking stress-induced neuroendocrine responses and circulating immune cell redistribution in irritable bowel syndrome. Am J Gastroenterol. 2006;101:2300–7.CrossRefPubMed
14.
go back to reference Posserud I, Agerforz P, Ekman R, Björnsson ES, Abrahamsson H, Simrén M. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut. 2004;53:1102–8.CrossRefPubMedPubMedCentral Posserud I, Agerforz P, Ekman R, Björnsson ES, Abrahamsson H, Simrén M. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut. 2004;53:1102–8.CrossRefPubMedPubMedCentral
15.
go back to reference Sugaya N, Izawa S, Kimura K, Ogawa N, Yamada CK, Shirotsuki K, et al. Adrenal hormone response and psychophysiological correlates under psychosocial stress in individuals with irritable bowel syndrome. Int J Psychophysiol. 2012;84:39–44.CrossRefPubMed Sugaya N, Izawa S, Kimura K, Ogawa N, Yamada CK, Shirotsuki K, et al. Adrenal hormone response and psychophysiological correlates under psychosocial stress in individuals with irritable bowel syndrome. Int J Psychophysiol. 2012;84:39–44.CrossRefPubMed
16.
go back to reference Chang L, Sundaresh S, Elliott J, Anton PA, Baldi P, Licudine A, et al. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome. Neurogastroenterol Motil. 2009;21:149–59.CrossRefPubMed Chang L, Sundaresh S, Elliott J, Anton PA, Baldi P, Licudine A, et al. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome. Neurogastroenterol Motil. 2009;21:149–59.CrossRefPubMed
17.
go back to reference Eriksson EM, Andren KI, Eriksson HT, Kurlberg GK. Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers. World J Gastroenterol. 2008;14:4889–96.CrossRefPubMedPubMedCentral Eriksson EM, Andren KI, Eriksson HT, Kurlberg GK. Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers. World J Gastroenterol. 2008;14:4889–96.CrossRefPubMedPubMedCentral
18.
go back to reference Izawa S, Sugaya N, Ogawa N, Nagano Y, Nakano M, Nakase E, et al. Episodic stress associated with writing a graduation thesis and free cortisol secretion after awakening. Int J Psychophysiol. 2007;64:141–5.CrossRefPubMed Izawa S, Sugaya N, Ogawa N, Nagano Y, Nakano M, Nakase E, et al. Episodic stress associated with writing a graduation thesis and free cortisol secretion after awakening. Int J Psychophysiol. 2007;64:141–5.CrossRefPubMed
19.
go back to reference Izawa S, Saito K, Shirotsuki K, Sugaya N, Nomura S. Effects of prolonged stress on salivary cortisol and dehydroepiandrosterone: A study of a two-week teaching practice. Psychoneuroendocrinology. 2012;37:852–8.CrossRefPubMed Izawa S, Saito K, Shirotsuki K, Sugaya N, Nomura S. Effects of prolonged stress on salivary cortisol and dehydroepiandrosterone: A study of a two-week teaching practice. Psychoneuroendocrinology. 2012;37:852–8.CrossRefPubMed
20.
go back to reference Weik U, Deinzer R. Alterations of postawakening cortisol parameters during a prolonged stress period: Results of a prospective controlled study. Horm Behav. 2010;58:405–9.CrossRefPubMed Weik U, Deinzer R. Alterations of postawakening cortisol parameters during a prolonged stress period: Results of a prospective controlled study. Horm Behav. 2010;58:405–9.CrossRefPubMed
21.
go back to reference Kirschbaum C, Pirke KM, Hellhammer DH. The ‘Trier Social Stress Test’ – a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28:76–81.CrossRefPubMed Kirschbaum C, Pirke KM, Hellhammer DH. The ‘Trier Social Stress Test’ – a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28:76–81.CrossRefPubMed
22.
go back to reference Evans P, Hucklebridge F, Clow A. Mind, Immunity and Health—the Science of Psychoneuroimmunology. London: Free Association Books; 2000. p. 49–52. Evans P, Hucklebridge F, Clow A. Mind, Immunity and Health—the Science of Psychoneuroimmunology. London: Free Association Books; 2000. p. 49–52.
23.
go back to reference Norbiato G, Bevilacqua M, Vago T, Taddei A, Clerici M. Glucocorticoids and immune function in the human immunodeficiency virus infection: a study in hypercortisolemic and cortisol-resistant patients. J Clin Endocrinol Metab. 1997;82:3260–3.PubMed Norbiato G, Bevilacqua M, Vago T, Taddei A, Clerici M. Glucocorticoids and immune function in the human immunodeficiency virus infection: a study in hypercortisolemic and cortisol-resistant patients. J Clin Endocrinol Metab. 1997;82:3260–3.PubMed
24.
go back to reference Roger M, Loria RM, Ben-Nathan D. Steroids, stress and the neuroimmune axis. In: Levy A, Grauer E, Ben-Nathan D, de Kloete ER, editors. New Frontiers in Stress Research. Amsterdam: Harwood Academic Publishers; 1998. p. 163–74. Roger M, Loria RM, Ben-Nathan D. Steroids, stress and the neuroimmune axis. In: Levy A, Grauer E, Ben-Nathan D, de Kloete ER, editors. New Frontiers in Stress Research. Amsterdam: Harwood Academic Publishers; 1998. p. 163–74.
25.
go back to reference Sripada RK, Marx CE, King AP, Rajaram N, Garfinkel SN, Abelson JL, et al. DHEA enhances emotion regulation neurocircuits and modulates memory for emotional stimuli. Neuropsychopharmacology. 2013;38:1798–807.CrossRefPubMedPubMedCentral Sripada RK, Marx CE, King AP, Rajaram N, Garfinkel SN, Abelson JL, et al. DHEA enhances emotion regulation neurocircuits and modulates memory for emotional stimuli. Neuropsychopharmacology. 2013;38:1798–807.CrossRefPubMedPubMedCentral
26.
go back to reference Izawa S, Sugaya N, Shirotsuki K, Yamada KC, Ogawa N, Ouchi Y, et al. Salivary dehydroepiandrosterone secretion in response to acute psychosocial stress and its correlations with biological and psychological changes. Biol Psychol. 2008;79:294–8.CrossRefPubMed Izawa S, Sugaya N, Shirotsuki K, Yamada KC, Ogawa N, Ouchi Y, et al. Salivary dehydroepiandrosterone secretion in response to acute psychosocial stress and its correlations with biological and psychological changes. Biol Psychol. 2008;79:294–8.CrossRefPubMed
27.
go back to reference Labbate LA, Fava M, Oleshansky M, Zoltec J, Littman A, Harig P. Physical fitness and perceived stress. Relationships with coronary artery disease risk factors. Psychosomatics. 1995;36:555–60.CrossRefPubMed Labbate LA, Fava M, Oleshansky M, Zoltec J, Littman A, Harig P. Physical fitness and perceived stress. Relationships with coronary artery disease risk factors. Psychosomatics. 1995;36:555–60.CrossRefPubMed
28.
go back to reference Sugaya N, Izawa S, Ogawa N, Shirotsuki K, Kobayashi H, Yamada KC, et al. Effect of day-to-day variations in adrenal cortex hormone levels on abdominal symptoms. BPS Med. 2010;4:1–7. Sugaya N, Izawa S, Ogawa N, Shirotsuki K, Kobayashi H, Yamada KC, et al. Effect of day-to-day variations in adrenal cortex hormone levels on abdominal symptoms. BPS Med. 2010;4:1–7.
29.
go back to reference Yanase T, Fukahori M, Taniguchi S, Nishi Y, Sakai Y, Takayanagi R, et al. Serum dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) in Alzheimer's disease and in cerebrovascular dementia. Endocr J. 1996;43:119–23.CrossRefPubMed Yanase T, Fukahori M, Taniguchi S, Nishi Y, Sakai Y, Takayanagi R, et al. Serum dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) in Alzheimer's disease and in cerebrovascular dementia. Endocr J. 1996;43:119–23.CrossRefPubMed
30.
go back to reference Orentreich N, Brind JL, Rizer RL, Vogelman JH. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab. 1984;59:551–5.CrossRefPubMed Orentreich N, Brind JL, Rizer RL, Vogelman JH. Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab. 1984;59:551–5.CrossRefPubMed
31.
go back to reference Drossman DA, Talley NJ, Whitehead WE, Corazziari E. Research diagnostic questions for functional gastrointestinal disorders: Rome II Modular Questionnaire: Investigations and respondent forms. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, editors. Rome II The functional gastrointestinal disorders. 2nd ed. McLean: Degnon Associates; 2000. p. 669–714. Drossman DA, Talley NJ, Whitehead WE, Corazziari E. Research diagnostic questions for functional gastrointestinal disorders: Rome II Modular Questionnaire: Investigations and respondent forms. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, editors. Rome II The functional gastrointestinal disorders. 2nd ed. McLean: Degnon Associates; 2000. p. 669–714.
32.
go back to reference Shinozaki M, Kanazawa M, Sagami Y, Endo Y, Hongo M, Drossman DA, et al. Validation of the Japanese version of the Rome II modular questionnaire and irritable bowel syndrome severity index. J Gastroenterol. 2006;41:491–4.CrossRefPubMed Shinozaki M, Kanazawa M, Sagami Y, Endo Y, Hongo M, Drossman DA, et al. Validation of the Japanese version of the Rome II modular questionnaire and irritable bowel syndrome severity index. J Gastroenterol. 2006;41:491–4.CrossRefPubMed
33.
go back to reference Cohen S, Kamarck T, Mermelstein E. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.CrossRefPubMed Cohen S, Kamarck T, Mermelstein E. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.CrossRefPubMed
34.
go back to reference Iwahashi D, Tanaka Y, Fukudo S, Hongo M. The development of the Japanese version of the perceived stress scale. Jpn J Psychosom Med. 2002;42:459–66. Iwahashi D, Tanaka Y, Fukudo S, Hongo M. The development of the Japanese version of the perceived stress scale. Jpn J Psychosom Med. 2002;42:459–66.
35.
go back to reference Granger DA, Kivlighan KT, Fortunato C, Harmon AG, Hibel LC, Schwartz EB, et al. Integration of salivary biomarkers into developmental and behaviorally-oriented research: problems and solutions for collecting specimens. Physiol Behav. 2007;92:583–90.CrossRefPubMed Granger DA, Kivlighan KT, Fortunato C, Harmon AG, Hibel LC, Schwartz EB, et al. Integration of salivary biomarkers into developmental and behaviorally-oriented research: problems and solutions for collecting specimens. Physiol Behav. 2007;92:583–90.CrossRefPubMed
36.
go back to reference Shirtcliff EA, Granger DA, Schwartz E, Curran MJ. Use of salivary biomarkers in biobehavioral research: cotton-based sample collection methods can interfere with salivary immunoassay results. Psychoneuroendocrinology. 2001;26:165–73.CrossRefPubMed Shirtcliff EA, Granger DA, Schwartz E, Curran MJ. Use of salivary biomarkers in biobehavioral research: cotton-based sample collection methods can interfere with salivary immunoassay results. Psychoneuroendocrinology. 2001;26:165–73.CrossRefPubMed
37.
go back to reference Isowa T, Ohira H, Murashima S. Immune, endocrine and cardiovascular responses to controllable and uncontrollable acute stress. Biol Psychol. 2006;71:202–13.CrossRefPubMed Isowa T, Ohira H, Murashima S. Immune, endocrine and cardiovascular responses to controllable and uncontrollable acute stress. Biol Psychol. 2006;71:202–13.CrossRefPubMed
38.
go back to reference Miller WL, Chrousos GP. The adrenal cortex. In: Felig P, Frohman LA, editors. Endocrinology and Metabolism. 4th ed. New York: McGraw-Hill; 2001. p. 387–524. Miller WL, Chrousos GP. The adrenal cortex. In: Felig P, Frohman LA, editors. Endocrinology and Metabolism. 4th ed. New York: McGraw-Hill; 2001. p. 387–524.
39.
go back to reference Nawata H, Yanas T, Goto K, Okabe T, Ashida K. Mechanism of action of anti-aging DHEA-S and the replacement of DHEA-S. Mech Ageing Dev. 2002;123:1101–6.CrossRefPubMed Nawata H, Yanas T, Goto K, Okabe T, Ashida K. Mechanism of action of anti-aging DHEA-S and the replacement of DHEA-S. Mech Ageing Dev. 2002;123:1101–6.CrossRefPubMed
40.
go back to reference Suárez-Hitz KA, Otto B, Bidlingmaier M, Schwizer W, Fried M, Ehlert U. Altered psychobiological responsiveness in women with irritable bowel syndrome. Psychosom Med. 2012;74:221–31.CrossRefPubMed Suárez-Hitz KA, Otto B, Bidlingmaier M, Schwizer W, Fried M, Ehlert U. Altered psychobiological responsiveness in women with irritable bowel syndrome. Psychosom Med. 2012;74:221–31.CrossRefPubMed
41.
go back to reference Trickett PK, Noll JG, Susman EJ, Shenk CE, Putnam FW. Attenuation of cortisol across development for victims of sexual abuse. Dev Psychopathol. 2010;22:165–75.CrossRefPubMedPubMedCentral Trickett PK, Noll JG, Susman EJ, Shenk CE, Putnam FW. Attenuation of cortisol across development for victims of sexual abuse. Dev Psychopathol. 2010;22:165–75.CrossRefPubMedPubMedCentral
42.
go back to reference Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med. 1995;123:782–94.CrossRefPubMed Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med. 1995;123:782–94.CrossRefPubMed
43.
go back to reference Heitkemper M, Jarrett M, Taylor P, Walker E, Landenburger K, Bond EF. Effect of sexual and physical abuse on symptom experiences in women with irritable bowel syndrome. Nurs Res. 2001;50:15–23.CrossRefPubMed Heitkemper M, Jarrett M, Taylor P, Walker E, Landenburger K, Bond EF. Effect of sexual and physical abuse on symptom experiences in women with irritable bowel syndrome. Nurs Res. 2001;50:15–23.CrossRefPubMed
44.
go back to reference Weekes NY, Lewis RS, Goto SG, Garrison-Jakel J, Patel F, Lupien S. The effect of an environmental stressor on gender differences on the awakening cortisol response. Psychoneuroendocrinology. 2008;33:766–72.CrossRefPubMed Weekes NY, Lewis RS, Goto SG, Garrison-Jakel J, Patel F, Lupien S. The effect of an environmental stressor on gender differences on the awakening cortisol response. Psychoneuroendocrinology. 2008;33:766–72.CrossRefPubMed
45.
go back to reference Tang YR, Yang WW, Wang YL, Lin L. Sex differences in the symptoms and psychological factors that influence quality of life in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2012;24:702–7.CrossRefPubMed Tang YR, Yang WW, Wang YL, Lin L. Sex differences in the symptoms and psychological factors that influence quality of life in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2012;24:702–7.CrossRefPubMed
46.
go back to reference Kudielka BM, Kirschbaum C. Awakening cortisol responses are influenced by health status and awakening time but not by menstrual cycle phase. Psychoneuroendocrinology. 2003;28:35–47.CrossRefPubMed Kudielka BM, Kirschbaum C. Awakening cortisol responses are influenced by health status and awakening time but not by menstrual cycle phase. Psychoneuroendocrinology. 2003;28:35–47.CrossRefPubMed
Metadata
Title
Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome
Authors
Nagisa Sugaya
Shuhei Izawa
Keisuke Saito
Kentaro Shirotsuki
Shinobu Nomura
Hironori Shimada
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2015
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/s13030-015-0031-7

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Reviewer acknowledgement 2014