Biopsychosocial complexity in patients scheduled for elective TKA surgery: A feasibility pilot study with the INTERMED self-assessment questionnaire

OBJECTIVE

Primary aim; to determine the feasibility of implementation of the INTERMED Self-Assessment (IM-SA) in adult patients scheduled for total knee arthroplasty (TKA). Secondary aim; to measure biopsychosocial complexity, referral to psychiatry or psychology in cases of complexity and to gain insight into the relation between biopsychosocial complexity and length of stay (LOS), method of discharge (MOD) and polypharmacy.

METHODS

A feasibility study was conducted with 76 participants in a general hospital in the Netherlands. Feasibility was determined by the number of completed questionnaires, time spent completing the questionnaire and the attitude of staff and patients towards the IM-SA. A cut off point ≥19 on the IM-SA was used to determine the prevalence of biopsychosocial complexity. A case file study was performed to check if referral to psychiatry or psychology had taken place. The Spearman's Rank Correlation Coefficient or Phi was used to determine if there was a relation between biopsychosocial complexity and LOS, MOD and polypharmacy.

RESULTS

All participants completed the IM-SA. The average time spent completing the questionnaire was 11.46 min (SD 5.74). The attitude towards the IM-SA was positive. The prevalence of biopsychosocial complexity was 11.84%. Referral to psychiatry or psychology did not take place. There was no relation between complexity and LOS (Spearman's rho (r) = 0.079, p = 0.499, MOD (Phi = 0.169, p = 0.173) and polypharmacy (Phi = 0.007, p = 0.953).

CONCLUSION

Biopsychosocial complexity can be identified in TKA patients during the pre-operative phase by using the IM-SA. Implementation of the IM-SA in a Dutch general hospital is feasible.

Improving mental health in U.S. Veterans using mHealth tools: A pilot study

Rates of PTSD remain elevated among U.S. Veterans, highlighting a need for innovative management tools. Previous studies have shown mobile apps to have positive effects on PTSD symptoms, but few apps have been examined systematically. This pilot study evaluated the perceived effectiveness and usability of Mindset, a novel mobile app that monitors user stress level via heart rate to encourage e-therapy use. The study sample included 30 community-residing Veterans who completed baseline assessments. They used the Mindset app and associated smartwatch until their approximate 1-month follow-up. Self-reported assessments included pre- and post-deployment experiences; experience with Mindset; and standard screeners for PTSD (PCL-M), anxiety (GAD-7), depression (PHQ-9), and alcohol use problems (AUDIT). Among the 24 participants who completed follow-up interviews, a significant decrease (p < 0.05) was found in PCL-M, PHQ-9, and modified AUDIT scores. Respondents reported moderate to high acceptance and satisfaction with Mindset features, though considerable frustration with the associated smartwatch. These findings highlight mHealth apps such as Mindset as potentially useful tools for PTSD and depression symptom management. These findings are also encouraging in the context of the current COVID-19 pandemic, which may accelerate further innovation and implementation of mHealth technologies to improve mental health self-care.

139 Heat stress has a deleterious effect on bull semen quality and subsequent embryo development

High ambient temperature induces an increase in bovine body temperature above the physiological homeothermic point, leading to impaired reproductive performance. Belgian Blue bulls are more susceptible to heat stress compared with most other cattle breeds. Therefore, the aim of this study was to investigate whether high ambient temperature affected bull semen quality and subsequent embryo development. For this purpose, semen samples were collected from six Belgian Blue bulls during August (14-28 days after three consecutive warm days with temperature-humidity index between 63.8 and 83.7) and March 2016 (temperature-humidity index between 35.9 and 47.4). After semen collection, volume, sperm concentration, and motility of fresh semen were assessed. Furthermore, frozen sperm samples were used to assess the motion parameters and morphological abnormalities using computer-assisted sperm analysis, viability and reactive oxygen species (hydrogen peroxide and superoxide) production using flow cytometry, and acrosome integrity and chromatin condensation using fluorescence microscopy. Afterward, blastocysts were produced (r=4) by conventional invitro methods for assessment of embryo development (Wydooghe et al. 2014 Reprod. Fertil. Dev. 26, 717-724; https://doi.org/10.1071/RD13043). Cleavage rate was determined 48h after fertilisation, and the blastocyst rates were determined on Days 7 and 8 postinsemination. Moreover, Day 8 blastocysts underwent differential staining in order to determine the numbers of the inner cell mass, trophectoderm, total cell number, and apoptotic cells ratio. The data set was analysed using the GLM procedure of SAS (SAS Institute Inc.). Normal distribution was checked using the UNIVARIATE procedure, and the Shapiro-Wilk test and arcsine square root transformation were used when required. Furthermore, Duncan's test was applied to determine the significant differences (P=0.05). In fresh semen, samples from the non-heat-stressed (NHS) group showed a higher sperm concentration compared with samples from the heat-stressed (HS) group (P=0.05), whereas semen volume and motility were not affected by heat stress (P&gt;0.05). In frozen-thawed semen, total and progressive motility and straight-line velocity were lower in the HS group compared with the NHS group (P=0.05), whereas the generation of H2O2, percentages of aberrant chromatin condensation, total morphological abnormality, spermatozoa with bent tails, and distal protoplasmic droplets were higher in the HS group compared with the NHS group (P=0.05). The cleavage rate and blastocyst rates on Days 7 and 8 were higher (P=0.05) in the NHS group (70.4±1.13, 25.4±1.84, and 40.3±1.15, respectively) compared with the HS group (62.8±1.49, 15.4±1.56, and 23.3±1.84, respectively). However, there were no significant differences in hatched or hatching rate of two treatments (P&gt;0.05). The total cell number and trophectoderm were higher in NHS-derived blastocysts than in HS-derived blastocysts (P=0.05), whereas the apoptotic cells ratio was lower (P&lt;0.001) in NHS blastocysts (2.16±0.48% vs. 5.21±0.52%). In conclusion, these findings show that elevated ambient temperature during summer as a consequence of climate change can lead to decreased quality of fresh and frozen-thawed bull spermatozoa and subsequent embryo development.

Patient-specific mobility assessment to monitor recovery after total hip arthroplasty

Total hip arthroplasty is a ubiquitously successful orthopedic surgical procedure, whose prevalence is rising worldwide. While many investigations focus on characterizing periprosthetic pathophysiology, the objective of our research is to develop and describe multi-metric assemblies as a first step toward creating a patient-specific mobility index that rehabilitators and orthopedic surgeons can utilize for prescribing their respective procedures. In total, 48 total hip arthroplasty patients (both cemented and uncemented) undergoing unilateral, primary surgery went through computed tomographic scans and gait analysis measurements both before and 1 year following their surgery. Altogether, the reported quantitative metrics include 11 spatial and temporal gait parameters, muscle density, and electromyography signals from the rectus femoris, vastus lateralis, and vastus medialis, and bone mineral density values from bioimage analysis around the implant stem. We found that measured parameters from a subgroup were sensitive to changes observed during patient recovery, implicating the predictive sensitivity of these patient conditions. Most post-operative gait parameters changed significantly, while electromyography data indicated few significant differences. Moreover, results from bioimage analyses indicate a general reduction of periprosthetic bone mineral density after 1 year, in association with increasing density of the quadriceps muscles. Furthermore, this work identifies which quantitative metrics undergo the greatest variation after total hip arthroplasty and demonstrates the clinical feasibility of a multimodal approach to mobility assessment that may ultimately support decision-making for post-surgical rehabilitation protocols.

Acceptance of insulin therapy: a long shot? Psychological insulin resistance in primary care

AIM

To explore which factors are associated with psychological insulin resistance in insulin-naive patients with Type 2 diabetes in primary care.

METHODS

A sample of 101 insulin-naive patients with Type 2 diabetes completed self-administered questionnaires including demographic and clinical characteristics, the Insulin Treatment Appraisal Scale and the Center for Epidemiological Studies Depression scale. Psychological insulin resistance was denoted by negative appraisal of insulin (Insulin Treatment Appraisal Scale).

RESULTS

Thirty-nine per cent of the sample were unwilling to accept insulin therapy. Unwilling participants perceived taking insulin more often as a failure to control their diabetes with tablets or lifestyle compared with willing participants (59 vs. 33%), unwilling participants were more reluctant to accept the responsibilities of everyday management of insulin therapy (49 vs. 24%). Multiple linear regression analysis revealed that depression and objection to lifelong insulin therapy were independently associated with psychological insulin resistance.

CONCLUSIONS

In this study in primary care, depression and objection to lifelong insulin therapy are associated with psychological insulin resistance. Analysis of the objection to the indefiniteness of insulin therapy showed a sense of limitation of daily life and loss of independence that should not be underestimated. Insulin should be offered as a means to improve health as this might facilitate the acceptance of insulin therapy.

Molecular characteristics of cocaine-induced cardiomyopathy in rats

Cocaine abuse induces severe cardiomyopathy. To investigate the molecular effects of acute and prolonged administration of cocaine, mRNAs encoding markers of either mechanical overload, as atrial natriuretic factor (ANF) and alpha- and beta-myosin heavy chains, or fibrosis as type I and III procollagens, were quantitated in the left ventricle of rats 4 h after one injection of cocaine (40 mg/kg, n = 7), or 14 (n = 15) and 28 days (n = 10) after chronic infusion of cocaine (40 mg/kg per day). Plasma cocaine and benzylecgonine concentrations were both significantly augmented during the infusion while plasma levels of triiodothyronine and thyroxine were lowered. Acute injection of cocaine induced ANF gene expression. Cocaine treatment during 28 days resulted in left ventricular hypertrophy (+ 20% after 24 days, P < 0.05) with normal blood pressure, associated with an accumulation of mRNAs encoding ANF and type I and III collagens (+66% and +55%, P < 0.05). Such a chronic treatment also induced a shift from the alpha- to the beta-myosin heavy chain gene expression (-40% and +50%, P < 0.05). In conclusion, cocaine activates markers of both hemodynamic overload and fibrosis. Such an activation may result from direct and/or indirect effects of the drug such as myocardial ischemia, mechanical overload and/or hypothyroidism.

Effects of antidotes to cocaine on the deregulation of the baroreflex by the alkaloid

Cocaine exerts in the rat an inhibitory effect on the baroreflex induced by bilateral clamping of the carotid arteries. The present series of experiments were designed to test the effectiveness of cocaine antidotes on this deregulation of the baroreflex. Sprague-Dawley rats were fitted under pentobarbital anesthesia with a catheter in the caudal artery, and their carotid arteries were exposed. The pressure signal from the caudal artery was treated on line by a microcomputer for continuous display of blood pressure and heart rate measurements. The animals were administered intraperitoneally either 50 mg cocaine or an equal volume of saline. Five minutes later, they were administered either saline or proven antidotes to cocaine (diltiazem, nicardipine, enzyme converting inhibitor [ECI], enalaprilat associated with diazepam). After 2 min, stimulation of the baroreceptor was performed by bilateral clamping of the two carotids for a period of 2 min. The measures of the maximal variation in systolic pressure before and after clamping indicated a significant difference between saline and cocaine treated animals (P < 0.05), with the former displaying a much greater increment in blood pressure after clamping. The cocaine-treated animals, administered diltiazem, nicardipine, and ECI associated with diazepam, presented after clamping of the carotid arteries a normal baroreflex with increments in blood pressure not significantly different from those occurring in the animals receiving saline, but significantly different from those administered cocaine only (P < 0.05). Baroreflex deregulation by cocaine may also be restored by an angiotensin II receptor antagonist. The possible role of this peptide in mediating in part baroreflex activity is discussed.

Inhibition by cocaine of the baroreflex in the rat

Sprague-Dawley rats were fitted under pentobarbital anesthesia with a catheter in the caudal artery and their carotid arteries were exposed. The pressure signal from the caudal artery was treated on line by a microcomputer for continuous display of blood pressure and heart rate measurements. The animals were administered intraperitoneally either 50 mg/kg of cocaine or an equal volume of saline. Five minutes later, stimulation of the baroreflex was performed by bilateral clamping of the two carotids for a period of 2 min. The same maneuver was repeated at 12, 24, and 31 min. Analysis of variance for repeated measures indicated that before carotid artery clamping, there was no significant difference between blood pressure measurements of the saline- and cocaine-treated groups. A two-factor analysis of variance of the repeated measures of the maximal variation in systolic pressure after each clamping showed a significant difference between control and cocaine-administered groups (P < 0.001), with the former displaying a much greater increment in blood pressure after carotid clamping. Cocaine exerts an inhibitory effect on the baroreflex that may be mediated through the increased angiotension II caused by the alkaloid.

The human toxicity of marijuana

The pathophysiological effects of marijuana smoke and its constituent cannabinoids were reported first from in-vitro and in-vivo experimental studies. Marijuana smoke is mutagenic in the Ames test and in tissue culture and cannabinoids inhibit biosynthesis of macromolecules. In animals, marijuana or delta 9-tetrahydrocannabinol (THC), the intoxicating material it contains, produces symptoms of neurobehavioural toxicity, disrupts all phases of gonadal or reproductive function, and is fetotoxic. Smoking marijuana can lead to symptoms of airway obstruction as well as squamous metaplasia. Clinical manifestations of pathophysiology due to marijuana smoking are now being reported. These include: long-term impairment of memory in adolescents; prolonged impairment of psychomotor performance; a sixfold increase in the incidence of schizophrenia; cancer of mouth, jaw, tongue and lung in 19-30 year olds; fetotoxicity; and non-lymphoblastic leukemia in children of marijuana-smoking mothers.

[Potentiation of the acute toxic effects of cocaine by ethyl alcohol]

Ethyl alcohol increases significantly the lethality of cocaine intoxication in the rat. This lethality is not modified by nicardipine or flunarizine, antidotes to cocaine, and might be due to the formation of a newly identified active metabolite cocaethylene. In addition alcohol like cocaine inhibits the baro receptor reflex.

[Calcium channel modulators as antidotes in fatal imipramine poisoning]

Calcium entry modulators were tested as antidotes to imipramine lethal toxicity. 42 rats were administered intraperitoneally 85 mg/kg of imipramine. In 6 control rats, hypotension and bradycardia were observed. Survival time was 15' +/- 5'. Survival time of rats treated with intraarterial nitrendipine was 21' +/- 11'. Survival time of 5 out of 6 rats treated by intraarterial verapamil or diltiazem was respectively 19'00" +/- 14'30" and 40'30" +/- 32'00". 5 out of 6 rats treated by intraarterial nimodipine, as well as all of the rats treated by flunarizine or nicardipine survived and were alive and active 48 hours later. Intoxication with imipramine may induce life threatening complications for which there are no specific medication. Nicardipine might be considered in the treatment of acute poisoning by imipramine and related tricyclic compounds.

In vivo inhibition of enterocyte metabolism by delta 9-tetrahydrocannabinol

Mice were given 10 to 100 mg/kg by stomach tube of delta 9-tetrahydrocannabinol (THC) in a single dose or for 4 consecutive days. [3H]Thymidine or [3H]glucosamine was given 3 or 24 hr before sacrifice. Enterocytes were isolated, and the incorporation of radioactivity into the acid insoluble fraction was measured. THC significantly inhibits in a dose-related fashion (from 10 to 90%) in vivo enterocyte metabolism. This inhibition is found in all enterocytes whatever their position in the intestinal tract; it is also independent of the state of differentiation of enterocytes. After a single ingestion of THC, crypt cells which synthesize DNA incorporate 37 to 45% less thymidine, and villus cells, which synthesize important amounts of glycoproteins, incorporate 15 to 39% less glucosamine. After 4 days of THC administration, the inhibition of thymidine incorporation is even more significant (up to 88%).