{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:36:55Z","timestamp":1792517815188,"version":"4.5.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81974092"],"award-info":[{"award-number":["81974092"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mental stress and imbalance of its two neural stress systems, the autonomic nervous system (ANS) and the hypothalamic\u2013pituitary\u2013adrenal (HPA) axis, are associated with chronic prostatitis\/chronic pelvic pain syndrome (CP\/CPPS) and erectile dysfunction (ED). However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP\/CPPS patients complicated by lower urinary tract symptoms (LUTS) and ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Participants were 95 patients in CP\/CPPS+ED group, 290 patients in CP\/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS) were used for assessing the disease severity of CP\/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), Type A Personality Test (TAPT) and Symptom Checklist 90 (SCL-90) were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability (HRV) as marker of the ANS was measured using 24\u2009h electrocardiography, and time-and frequency-domain variables were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The BAI and SCL-90 scores were significantly higher in the CP\/CPPS+ED, CP\/CPPS and ED groups compared with the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). The PSS scores of both groups with ED were significantly higher than the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). Compared with the CP\/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP\/CPPS+ED patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). The IPSS scores were shown to have significantly positive correlations with BAI (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), PSS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01) and SCL-90 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01) in the CP\/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.17\uff0c\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), PSS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.25\uff0c\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), SCL-90 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.20\uff0c\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and quality of life score in NIH-CPSI (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.14\uff0c\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0075). Cortisol awakening response (CAR) parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency (LF) was significantly lower in ED patients when compared with CP\/CPPS+ED patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.044) and healthy controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), high frequency (HF) power was significantly higher in healthy controls compared to patients with ED (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), CP\/CPPS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and CP\/CPPS+ED (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), and the CP\/CPPS+ED group had significantly higher LF\/HF ratio than the control group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CP\/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP\/CPPS, whereas HPA axis activity is not.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2022.903250","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T12:16:18Z","timestamp":1667564178000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Evaluation of psychological stress, cortisol awakening response, and heart rate variability in patients with chronic prostatitis\/chronic pelvic pain syndrome complicated by lower urinary tract symptoms and erectile dysfunction"],"prefix":"10.3389","volume":"13","author":[{"given":"Jian","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longjie","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinwei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaming","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingchao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyuan","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shulin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaogang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1038\/s41443-018-0047-1","article-title":"Semen reactive oxygen species levels are correlated with erectile function among chronic prostatitis\/chronic pelvic pain syndrome patients","volume":"30","author":"Alkan","year":"2018","journal-title":"Int. J. Impot. Res."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.juro.2007.10.084","article-title":"Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis\/chronic pelvic pain syndrome","volume":"179","author":"Anderson","year":"2008","journal-title":"J. Urol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2319","DOI":"10.1016\/j.juro.2009.07.042","article-title":"Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis\/chronic pelvic pain syndrome","volume":"182","author":"Anderson","year":"2009","journal-title":"J. Urol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s40359-021-00546-1","article-title":"Assessing the measurement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV\/AIDS and healthy people","volume":"9","author":"Bagheri","year":"2021","journal-title":"BMC Psychol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/s0306-4530(02)00065-3","article-title":"Systemic apomorphine alters HPA axis responses to interleukin-1 beta administration but not sound stress","volume":"28","author":"Buller","year":"2003","journal-title":"Psychoneuroendocrinology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/1471-2490-14-53","article-title":"Chronic bacterial prostatitis: efficacy of short-lasting antibiotic therapy with prulifloxacin (Unidrox\u00ae) in association with saw palmetto extract, lactobacillus sporogens and arbutin (Lactorepens\u00ae)","volume":"14","author":"Busetto","year":"2014","journal-title":"BMC Urol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1080\/13685538.2018.1434772","article-title":"Epidemiology and risk factors of lower urinary tract symptoms\/benign prostatic hyperplasia and erectile dysfunction","volume":"22","author":"Calogero","year":"2019","journal-title":"Aging Male"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.clinph.2008.10.155","article-title":"Combined cardiac sympathetic excitation and vagal impairment in patients with non-organic erectile dysfunction","volume":"120","author":"Chen","year":"2009","journal-title":"Clin. Neurophysiol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e0141447","DOI":"10.1371\/journal.pone.0141447","article-title":"The effect of chronic prostatitis\/chronic pelvic pain syndrome (CP\/CPPS) on erectile function: a systematic review and meta-analysis","volume":"10","author":"Chen","year":"2015","journal-title":"PLoS One"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1016\/j.urology.2011.07.1379","article-title":"Heart rate variability in assessment of autonomic dysfunction in patients with chronic prostatitis\/chronic pelvic pain syndrome","volume":"78","author":"Cho","year":"2011","journal-title":"Urology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.urology.2009.08.018","article-title":"Characteristics of autonomic nervous system activity in men with lower urinary tract symptoms (LUTS): analysis of heart rate variability in men with LUTS","volume":"75","author":"Choi","year":"2010","journal-title":"Urology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1111\/j.1464-410X.2011.10807.x","article-title":"A case-control study on the association between chronic prostatitis\/chronic pelvic pain syndrome and erectile dysfunction","volume":"110","author":"Chung","year":"2012","journal-title":"BJU Int."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s10484-020-09499-4","article-title":"Heart rate variability and erectile function in younger men: a pilot study","volume":"46","author":"Costa","year":"2021","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.bbi.2020.11.005","article-title":"Cancer and stress: NextGen strategies","volume":"93","author":"Cui","year":"2021","journal-title":"Brain Behav. Immun."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"524395","DOI":"10.3389\/fpsyt.2020.524395","article-title":"Study of the SCL-90 scale and changes in the Chinese norms","volume":"11","author":"Dang","year":"2021","journal-title":"Front. Psych."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/s11934-018-0817-9","article-title":"Erectile dysfunction and lower urinary tract symptoms","volume":"19","author":"De Nunzio","year":"2018","journal-title":"Curr. Urol. Rep."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1097\/01.psy.0000024232.11538.54","article-title":"Chronic pain and psychopathology: research findings and theoretical considerations","volume":"64","author":"Dersh","year":"2002","journal-title":"Psychosom. Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.21037\/apm-20-985","article-title":"Study on the relationship between sex hormone changes and erectile dysfunction in patients with chronic prostatitis\/chronic pelvic pain syndrome","volume":"10","author":"Fan","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1080\/10253890.2019.1584178","article-title":"Salivary cortisol profiles of on-call from home fire and emergency service personnel","volume":"22","author":"Hall","year":"2019","journal-title":"Stress"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"496","DOI":"10.2164\/jandrol.110.012138","article-title":"The prevalence of erectile dysfunction and its relation to chronic prostatitis in Chinese men","volume":"32","author":"Hao","year":"2011","journal-title":"J. Androl."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1111\/andr.12273","article-title":"Chronic prostatitis\/chronic pelvic pain syndrome impairs erectile function through increased endothelial dysfunction, oxidative stress, apoptosis, and corporal fibrosis in a rat model","volume":"4","author":"Hu","year":"2016","journal-title":"Andrology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"485","DOI":"10.21037\/tau.2020.01.25","article-title":"Psychological factors and pain catastrophizing in men with chronic prostatitis\/chronic pelvic pain syndrome (CP\/CPPS): a meta-analysis","volume":"9","author":"Huang","year":"2020","journal-title":"Transl Androl Urol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"807","DOI":"10.2147\/PPA.S99544","article-title":"Association of psychological factors, patients\u2019 knowledge, and management among patients with erectile dysfunction","volume":"10","author":"Huri","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1097\/JU.0000000000001149","article-title":"Grading severity and bother using the international prostate symptom score and international consultation on incontinence questionnaire male lower urinary tract symptoms score in men seeking lower urinary tract symptoms therapy","volume":"204","author":"Ito","year":"2020","journal-title":"J. Urol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1080\/02701367.2020.1774486","article-title":"Cortisol awakening response and heart rate variability in the menstrual cycle of sportswomen","volume":"92","author":"Kayacan","year":"2021","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1111\/bju.14813","article-title":"The global prevalence of erectile dysfunction: a review","volume":"124","author":"Kessler","year":"2019","journal-title":"BJU Int."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.2147\/IJWH.S279245","article-title":"Perceived stress scale among adolescents with polycystic ovary syndrome","volume":"12","author":"Khafagy","year":"2020","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jpsychores.2013.11.004","article-title":"The association of personality trait on treatment outcomes in patients with chronic prostatitis\/chronic pelvic pain syndrome: an exploratory study","volume":"76","author":"Koh","year":"2014","journal-title":"J. Psychosom. Res."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1001\/jama.282.3.236","article-title":"NIH consensus definition and classification of prostatitis","volume":"282","author":"Krieger","year":"1999","journal-title":"JAMA"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"87","DOI":"10.5213\/inj.2011.15.2.87","article-title":"Heart rate variability in men with erectile dysfunction","volume":"15","author":"Lee","year":"2011","journal-title":"Int. Neurourol. J."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.jgr.2017.01.010","article-title":"Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis","volume":"41","author":"Lee","year":"2017","journal-title":"J. Ginseng Res."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"319","DOI":"10.4103\/aja.aja_71_20","article-title":"Is mild erectile dysfunction associated with severe psychological symptoms in Chinese patients with moderate-to-severe chronic prostatitis\/chronic pelvic pain syndrome?","volume":"23","author":"Li","year":"2021","journal-title":"Asian J. Androl."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"129","DOI":"10.13263\/j.cnki.nja.2014.02.006","article-title":"Erectile dysfunction in men with lower urinary tract symptoms","volume":"20","author":"Liang","year":"2014","journal-title":"Zhonghua Nan Ke Xue"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1210\/jc.2009-2801","article-title":"Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities","volume":"95","author":"Licht","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e13157","DOI":"10.1111\/and.13157","article-title":"Psychological impact of different primary treatments for prostate cancer: a critical analysis","volume":"51","author":"Maggi","year":"2019","journal-title":"Andrologia"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1159\/000258725","article-title":"Evaluation of stress systems by applying noninvasive methodologies: measurements of neuroimmune biomarkers in the sweat, heart rate variability and salivary cortisol","volume":"17","author":"Marques","year":"2010","journal-title":"Neuroimmunomodulation"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"173","DOI":"10.5937\/jomb0-26045","article-title":"Association of salivary steroid hormones and their ratios with time-domain heart rate variability indices in healthy individuals","volume":"40","author":"Mazgelyt\u0117","year":"2021","journal-title":"J. Med. Biochem."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"469","DOI":"10.5694\/mja2.50167","article-title":"Current diagnosis and management of erectile dysfunction","volume":"210","author":"McMahon","year":"2019","journal-title":"Med. J. Aust."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1007\/s10508-016-0757-8","article-title":"Prevalence and associated factors of erectile dysfunction in patients with moderate to severe psoriasis and healthy population: a comparative study considering physical and psychological factors","volume":"45","author":"Molina-Leyva","year":"2016","journal-title":"Arch. Sex. Behav."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1080\/00981389.2017.1326074","article-title":"Psychosocial and environmental factors in the prognosis of individuals with chronic pain and comorbid mental health","volume":"56","author":"Msw","year":"2017","journal-title":"Soc. Work Health Care"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"266","DOI":"10.3109\/15622975.2016.1163419","article-title":"Salivary alpha-amylase, secretory IgA and free cortisol as neurobiological components of the stress response in the acute phase of anorexia nervosa","volume":"17","author":"Paszynska","year":"2016","journal-title":"World J. Biol. Psychiatry"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1016\/s0306-4530(02)00108-7","article-title":"Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change","volume":"28","author":"Pruessner","year":"2003","journal-title":"Psychoneuroendocrinology"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"4367","DOI":"10.3390\/ijms22094367","article-title":"Biomarkers in prostate cancer diagnosis: from current knowledge to the role of metabolomics and exosomes","volume":"22","author":"Salciccia","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"49","DOI":"10.4111\/icu.2018.59.1.49","article-title":"Changes in autonomic nervous system activity after treatment with alpha-blocker in men with lower urinary tract symptoms","volume":"59","author":"Shim","year":"2018","journal-title":"Investig. Clin. Urol."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"20140040","DOI":"10.1098\/rsfs.2014.0040","article-title":"Biological mechanisms underlying the role of physical fitness in health and resilience","volume":"4","author":"Silverman","year":"2014","journal-title":"Interface Focus."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.psyneuen.2015.10.010","article-title":"Assessment of the cortisol awakening response: expert consensus guidelines","volume":"63","author":"Stalder","year":"2016","journal-title":"Psychoneuroendocrinology"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00345-013-1076-5","article-title":"Sexual dysfunction in chronic prostatitis\/chronic pelvic pain syndrome","volume":"31","author":"Tran","year":"2013","journal-title":"World J. Urol."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1002\/smi.3025","article-title":"Effects of late-night eating of easily-or slowly-digestible meals on sleep, hypothalamo-pituitary-adrenal axis, and autonomic nervous system in healthy young males","volume":"37","author":"U\u00e7ar","year":"2021","journal-title":"Stress. Health"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"101245","DOI":"10.1016\/j.diabet.2021.101245","article-title":"Fewer type a personality traits in type 2 diabetes patients with diabetic foot ulcer","volume":"47","author":"Verg\u00e8s","year":"2021","journal-title":"Diabetes Metab."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"126750","DOI":"10.1016\/j.jhazmat.2021.126750","article-title":"Impact of ozone exposure on heart rate variability and stress hormones: a randomized-crossover study","volume":"421","author":"Wang","year":"2022","journal-title":"J. Hazard. Mater."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1111\/and.12437","article-title":"Changes in erectile organ structure and function in a rat model of chronic prostatitis\/chronic pelvic pain syndrome","volume":"48","author":"Wang","year":"2016","journal-title":"Andrologia"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e0153054","DOI":"10.1371\/journal.pone.0153054","article-title":"Erectile dysfunction in chronic prostatitis\/chronic pelvic pain syndrome: outcomes from a multi-center study and risk factor analysis in a single center","volume":"11","author":"Zhang","year":"2016","journal-title":"PLoS One"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s11934-019-0930-4","article-title":"The complex relationship between lower urinary tract symptoms and sexual health","volume":"20","author":"Zhao","year":"2019","journal-title":"Curr. Urol. Rep."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.903250\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T12:16:23Z","timestamp":1667564183000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.903250\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":53,"alternative-id":["10.3389\/fpsyg.2022.903250"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2022.903250","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,4]]},"article-number":"903250"}}