You look stressed: A pilot study on facial action unit activity in the context of psychosocial stress.

Quality and quantity of the human stress response are highly individual. Not only are there differences in terms of psychological and physiological stress reactivity, but also with regard to facial muscle stress reactivity. In a first correlative pilot study to decipher the signature of stress as it presents in the physiognomy of a stressed individual, we investigated how stress-induced muscle movement activity in the face is associated with stress marker activation during a standardized laboratory stress test. Female and male participants (N = 62) completed the Trier Social Stress Test and provided multiple measurements of salivary cortisol, subjective experience, heart rate, and high-frequency heart rate variability. In addition, participants were filmed during stress induction to derive the activation of 13 individual muscles or muscle groups, also termed action units (AU). Mean AU intensity and occurrence rates were measured using the opensource software OpenDBM. We found that facial AU activity correlated with different aspects of the psychosocial stress response. Higher stress-induced cortisol release was associated with more frequent upper eyelid raiser (AU05) and upper lip raiser (AU10) occurrences, while more lip corner pulling (AU12) went along with lower cortisol reactivity. More frequent eyelid tightener (AU07) occurrences were linked to higher subjective stress reactivity but decreased heart rate and HF-HRV reactivity. Last, women showed greater stress-induced smiling intensity and occurrence rates than men. We conclude that psychosocial stress reactivity is systematically linked to facial muscle activity, with distinct facial stress profiles emerging for different stress markers. From all the AUs studied, eyelid tightening (AU07) seems to provide the strongest potential for future attempts of diagnosing phases of acute stress via facial activity.

Associations of social processing abilities with psychosocial stress sensitivity.

Through the long-term activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, chronic psychosocial stress can compromise mental and bodily health. Psychosocial stress is determined by the perception of social interactions as ego-threatening, and thus strongly influenced by individual social processing capacities. In the current study, we investigated whether three key components of social processing are linked to how individuals respond to the experience of acute psychosocial stress exposure. Empathy, compassion, and Theory of Mind (ToM) were assessed using a state-of-the-art paradigm, the EmpaToM. Participants (N = 118) also underwent the Trier Social Stress Test (TSST), a standardized psychosocial laboratory stress test. Stress responses were measured in terms of salivary cortisol and alpha-amylase, heart-rate, high-frequency heart-rate variability (HF-HRV), and subjective stress experience. ToM performance correlated with different aspects of the acute psychosocial stress response. More specifically, higher levels of ToM were linked to increased alpha-amylase and reduced HF-HRV sensitivity to stress. Empathy and compassion levels had no influence on stress sensitivity. We conclude that ToM performance has a stable albeit contradictory association with acute psychosocial stress, while empathy and compassion tendencies appear to be largely unrelated. Overall, the relationship between EmpaToM-derived empathy, compassion, and ToM characteristics with stress sensitivity in the TSST is relatively weak.

Resilience and personality as predictors of the biological stress load during the first wave of the Covid-19 pandemic in Germany.

Since the Covid-19 outbreak, pandemic-specific stressors have potentiated the-already severe-stress load across the world. However, stress is more than an adverse state, and chronic exposure is causally involved in the development of mental and physical disease. We ask the question whether resilience and the Big Five personality traits predict the biological stress response to the first lockdown in Germany. In a prospective, longitudinal, observational study, N = 80 adult volunteers completed an internet-based survey prior to the first Covid-19-related fatality in Germany (T0), during the first lockdown period (T1), and during the subsequent period of contact restrictions (T2). Hair strands for the assessment of systemic cortisol and cortisone levels were collected at T2. Higher neuroticism predicted higher hair cortisol, cortisone and subjective stress levels. Higher extraversion predicted higher hair cortisone levels. Resilience showed no effects on subjective or physiological stress markers. Our study provides longitudinal evidence that neuroticism and extraversion have predictive utility for the accumulation of biological stress over the course of the pandemic. While in pre-pandemic times individuals high in neuroticism are typically at risk for worse health outcomes, extraverted individuals tend to be protected. We conclude that, in the pandemic context, we cannot simply generalize from pre-pandemic knowledge. Neurotic individuals may currently suffer due to their general emotional lability. Extraverted individuals may primarily be socially stressed. Individualized stress management programs need to be developed, and offered in a lockdown-friendly format, to minimize the stress burden caused by Covid-19 or future pandemics and to protect the most severely affected individuals from the development of stress-associated disease.

A region on equine chromosome 13 is linked to recurrent airway obstruction in horses.

UNLABELLED: REASONS FOR STUDY: Equine recurrent airway obstruction (RAO) is probably dependent on a complex interaction of genetic and environmental factors and shares many characteristic features with human asthma. Interleukin 4 receptor a chain (IL4RA) is a candidate gene because of its role in the development of human asthma, confirmation of this association is therefore required. METHODS: The equine BAC clone containing the IL4RA gene was localised to ECA13q13 by the FISH method. Microsatellite markers in this region were investigated for possible association and linkage with RAO in 2 large Warmblood halfsib families. Based on a history of clinical signs (coughing, nasal discharge, abnormal breathing and poor performance), horses were classified in a horse owner assessed respiratory signs index (HOARSI 1-4: from healthy, mild, moderate to severe signs). Four microsatellite markers (AHT133, LEX041, VHL47, ASB037) were analysed in the offspring of Sire 1 (48 unaffected HOARSI 1 vs. 59 affected HOARSI 2-4) and Sire 2 (35 HOARSI 1 vs. 50 HOARSI 2-4), age 07 years. RESULTS: For both sires haplotypes could be established in the order AHT133-LEXO47-VHL47-ASB37. The distances in this order were estimated to be 2.9, 0.9 and 2.3 centiMorgans, respectively. Haplotype association with mild to severe clinical signs of chronic lower airway disease (HOARSI 2-4) was significant in the offspring of Sire 1 (P = 0.026) but not significant for the offspring of Sire 2 (P = 0.32). Linkage analysis showed the ECA13q13 region containing IL4RA to be linked to equine chronic lower airway disease in one family (P<0.01), but not in the second family. CONCLUSIONS: This supports a genetic background for equine RAO and indicates that IL4RA is a candidate gene with possible locus heterogeneity for this disease. POTENTIAL RELEVANCE: Identification of major genes for RAO may provide a basis for breeding and individual prevention for this important disease.

[Is the preoperative removal of dentures reasonable in every case?]. / Muss die Zahnprothese wirklich vor jeder Anästhesie entfernt werden?

Traditionally, dentures are removed prior to anaesthesia. Modern techniques in dentistry and the widespread use of regional anaesthesia should lead to a more individual approach to this problem. From a legal standpoint, the information about advantages and disadvantages concerning the removal of dentures can be explained without problems to the patient without medical background.

[Repeated improper intravenous injection of fentanyl from a transdermal system]. / Mehrfache missbräuchliche intravenöse Injektion von Fentanyl aus einem transdermalen System.

We report on a 30 year-old male who misused transdermal fentanyl. He injected the contents of transdermal patches intravenously. Suffering from chronic pain following total hip replacement, he had received a prescription for this drug formulation from his general practitioner. During his stay in a pain clinic he was able to obtain a total of 13 fentanyl patches from other patients or local pharmacies. He became seriously ill with multiple organ dysfunction in the course of an infection of his thigh. After surgical and intensive care treatment he recovered soon, but the hip prosthesis had to be explanted. There are some reports in the literature of misuse of fentanyl patches. The contents may be ingested orally, or they can be inhaled. Aspirated with a syringe the content of fentanyl patches can also be injected intravenously, sometimes resulting in exit-us. Prescribers must be aware of the potential for abuse of fentanyl patches which can be stolen, sold or even removed from dead bodies.

[Spinal anaesthesia in 50 patients with previous lumbar spinal surgery]. / Spinalanästhesien bei 50 Patienten mit Zustand nach lumbaler Laminektomie.

In anaesthesia textbooks, spinal anaesthesia is described as relatively contraindicated in patients with a history of lumbar spinal surgery. In order to assess the feasibility of spinal anaesthesia in these patients, we performed 56 spinal anaesthetics in 50 consecutive patients with previous lumbar spinal surgery. Our success rate of spinal anaesthesia was 100 %. Side effects were only minor and had a low incidence. We conclude that spinal anaesthesia is a viable technique in these patients.

[Complete brachial plexus paralysis caused by compartment syndrome in heroin intoxication]. / Kompletter Plexus-brachialis-Ausfall durch Kompartmentsyndrom bei Heroinintoxikation.

We report the case of a young man with heroin intoxication. While deeply unconscious, he sustained a compartment syndrome of the arm and shoulder region leading to a lesion of the upper plexus. Immediate surgical decompression by fasciotomy incisions, intensive care treatment including hemofiltration to treat myoglobinemia, intense physical exercise, and mesh-grafting closure of the wounds soon led to unexpected recovery. The function of the arm was restored in such a way that the patient was able to intoxicate himself again. He needed intubation and ventilation but recovered uneventfully.

[Experience with G27 Whitacre needle in in-patient and out-patient settings--incidence of post dural puncture headaches and other side effects]. / Erfahrungen mit der G27 Whitacre Spinalnadel im stationären und ambulanten Bereich--Inzidenz von postpunktionellen Kopfschmerzen und anderen Nebenwirkungen.

OBJECTIVE: The aim of the study was to evaluate the incidence of side-effects in patients bearing a high risk of post dural puncture headache (PDPH) when a spinal anaesthesia was performed. This included outpatients, patients for sectio caesarea and patients younger than 40 years who were mobilized as soon as the surgeon agreed. METHODS: Quality control without randomization. Spinal anaesthesia for sectio caesarea was applied with a G27 Whitacre needle with the patient in the right lateral decubitus position. Hyperbaric Bupivacain 2-2.2 ml (10-12 mg) was injected when spontaneous flow of spinal fluid occurred through the needle. The preparations for the surgery then started immediately with the patient in a left lateral position. Intravenous Ephedrin (10-20 mg) was given simultaneously. All the other spinal anaesthesias were performed in a similar manner with the patient lying on the side of the scheduled surgery. For outpatients Articain was used instead of Bupivacain. In those outpatients older than 60 years a 26 G Quincke needle was used for spinal anaesthesia. Interviews: All in-hospital patients were visited once or more during the first 48 hours and asked about side-effects e.g. PDPH. Outpatients older than 60 years were interviewed by a telephone call on the third day after surgery. The younger ones were asked to send back a questionnaire free of charge. RESULTS: None of the 206 patients (mean age 30.7 years) who underwent caesarian sectio suffered from headache. Lower back pain was seldom [8] and moderate. They all had the bladder drained as a routine measure of the obstetrician. 547 of 600 in hospital patients were mobilized as soon as the block disappeared. 11 complained of headache. (1.8%) 2 females needed oral non-opioid analgesics, one 17-year-old woman an epidural blood patch (0.17%). 150 of the outpatients younger than 60 years sent back the questionnaire spontaneously. 75 had to be reminded by a telephone call. 10 of these 225 had PDPH but only 2 females needed oral non-opioids for one day. One 34-year-old woman needed conservative treatment with oral fluid intake more than 3 liters a day, analgesics and bed rest. None of the outpatients older than 60 years complained of headache. Two suffered from vomiting on the way home. Three males had disturbed bladder function, but did not need catheterism. CONCLUSIONS: The use of a thin pencil point needle (Whitacre G27) enables the application of a spinal anaesthesia to young people with a low risk of moderate PDPH. Pregnancy is not a contraindication. Early mobilisation does not increase the risk of PDPH even in young patients nor is this the case in outpatients. In outpatients older than 60 years a G26 Quinke needle, which is easier to handle and cheaper, is suitable for spinal anaesthesia without a risk of PDPH. Better post-operative vigilance may be a further benefit of the method. Young people especially appreciated the option to pursue their own video-endoscopic surgery. In a comparable group where an epidural was performed we found more side-effects.

[Quality assurance in a psychiatric day clinic. A catamnestic study with goal attainment scaling]. / Qualitätssicherung in einer psychiatrischen Tagesklinik. Eine katamnestische Untersuchung mit Zielerreichungsskalierung.

PURPOSE: For the second time after 1990, a community mental health service questioned the outcome quality of its day hospital in rehabilitating primarily psychotic patients. METHODS: In addition to the assessment of 66 persons at the beginning and at the end of an average of six months' treatment in the years 1990-95, a psychologist who had not been involved in the treatment interviewed 49 persons one year after discharge with the use of goal attainment scaling in five relevant fields. RESULTS: Due to the economic recession the goal attainment decreased with regard to the job situation in the sense that it was difficult to find unsheltered jobs. By defining the goals in accordance with the needs of the patients, an improvement in the lodging situation was observed. As a result of the first study, quality monitoring led to an improvement of the structures that promote spare time interests. Social contacts and coping with everyday life showed sustainable achievements. CONCLUSIONS: These achievements can be interpreted as a result of the comparably long time of exposure to social learning within the therapeutic milieu of the day hospital. This hypothesis of a positive correlation between the sustainability of the outcome and the length of treatment must be validated by another study.

[Propofol and postoperative nausea and/or vomiting]. / Propofol und postoperative Ubelkeit und/oder Erbrechen.

UNLABELLED: The objective of this prospective, randomised study was to investigate the incidence of postoperative nausea and/or vomiting (PONV) during the first 24 h postoperatively. For a quality assurance study on PONV, we compared two established general anaesthetic procedures in 239 patients undergoing four different types of surgery (subtotal thyroidectomy, laparotomy for gynaecological procedures, laparoscopy, and surgery for extra-abdominal procedures). METHODS: All eligible patients provided informed consent. For premedication temazepam 10-20 mg was administered orally. We used propofol (1.5-2 mg/kg) for induction of anaesthesia in all patients, followed by 0.1-0.3 mg fentanyl, 2.5-5 mg droperidol, and for muscular relaxation atracurium or pancuronium according to body weight. Maintenance of general anaesthesia in group A was by administration of isoflurane in a maximum concentration of 0.6 vol.% in 70% nitrous oxide and 30% oxygen and in group B by continuous infusion of propofol (5-8 mg/kg.h) and normoventilation with oxygen in air (Fi02 = 0.3). In both groups additional analgesia was provided intraoperatively by equal dosages of fentanyl up to a maximum of 0.6 mg and clonidine up to 200 micrograms. Episodes of PONV were registered following extubation, during the first 4 h postoperatively, during the period 4-24 h postoperatively, and after the first mobilisation. Pain scores were recorded with the aid of a visual analogues scale. The statistical evaluation was performed using the chi-square or Wilcoxon test. RESULTS AND DISCUSSION: In patients undergoing thyroidectomy or laparotomy, continuous infusion of propofol drastically reduced the incidence of PONV in the first 24 h postoperatively, particularly during the first 4 h (25/41 vs 10/41, resp. 20/32 vs 11/31). The overall incidence of PONV was higher in the first half of the menstrual cycles decreased with patient age, increased with the duration of anaesthesia, and was higher in patients with a history of motion sickness. With the same level of analgesia in both groups, the differences disappeared in the further postoperative course. The use of similar dosages of opioids for pain control in these groups might explain this observation. PONV occurred extremely rarely in patients undergoing laparoscopy (1 resp. 2 of 34), and in those undergoing surgery for extra-abdominal procedures did not occur at all. The explanation may be that the induction of anaesthesia with propofol was followed only by a relatively short duration of general anaesthesia for these surgical procedures, and postoperative pain control was performed solely with non-opioids. CONCLUSIONS: We found that the antiemetic effect of propofol was considerable in the early postoperative period. The higher cost of propofol as compared to other induction agents can be covered by not using nitrous oxide for maintenance of anaesthesia and by the decreased need for antiemetic drugs postoperatively. According to the calculations of our clinical pharmacy, the costs of the propofol infusion regimen exceeded those of balanced anaesthesia by 8.50 DM/h; the need for antiemetics was one-half that of the non-propofol group. Considering a cost of 16 DM for cleaning the bed after vomiting, improvement of the patient's condition during the postoperative period can be achieved without additional expense.

Conversion from cyclosporin to FK 506 after liver transplantation.

Thirty-seven liver-grafted patients with steroid-resistant acute or chronic graft rejection or with cyclosporin-related complications were converted from CyA to FK 506. The clinical outcome of the patients primarily depended on the degree of liver dysfunction present at initiation of FK 506 treatment. In patients switched to FK 506 for treatment of acute or early chronic graft rejection, CyA nephrotoxicity, or CyA malabsorption, the FK 506 therapy was associated with a clear improvement in the clinical course. In contrast, in patients with advanced chronic graft rejection, a lower response rate to the conversion in immunosuppression was observed. The lower response rate was associated with a higher patient mortality. These studies demonstrate that FK 506 represents a valuable alternative immunosuppressant for liver-grafted patients. The conversion from CyA to FK 506 should take place before serious--and potentially irreversible--disturbances in liver function are observed.