TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty.

BACKGROUND: Tumor necrosis factor-alpha (TNF-α) helps regulate neuroinflammation and anxiety and could conceivable predict early post-operative pain and function after fast-track total knee arthroplasty (TKA). METHODS: In patients with severe osteoarthritic knees undergoing TKA, we assessed: the correlations between pre-operative concentrations of TNF-α in synovial fluid; pre- and six-week post-operative knee function and pain; pre- and post-operative anxiety; pre- and post-operative synovial fluid concentrations of cartilage oligomeric matrix protein (COMP); age and body mass index (BMI). RESULTS: Of 100 enrolled patients, 78 had evaluable TNF-α data, and 58 had evaluable COMP data. Pre-operative TNF-α concentrations were inversely correlated with post-operative pain scores during walking (rS=-0.26, P=0.03) and with change of pain at rest during six weeks after TKA (rs=-0.28, P=0.03) and were directly correlated with a higher post-operative Knee Society score (KSS) (rS=0.43, P<0.001) and with greater increases in this score during six weeks after TKA (rS=0.33, P=0.001). Mean TNF-α concentrations were higher in the 39 patients reporting any pre-operative pain at rest than in 36 patients reporting no pre-operative pain (P=0.015) and were the only independent predictor of pre-operative pain at rest (OR=13, P=0.02). Independent predictors of better post-operative knee function were higher log-transformed TNF-α concentrations (ß=0.38, P=0.002) and male sex (ß=0.28, P=0.02). CONCLUSIONS: High levels of pre-operative TNF-α concentrations could be used as an independent predictor of better knee function at six weeks of follow-up. In patients with lower pre-operative TNF-α concentrations, post-operative pain management may improve the early outcome of the operated joint.

[Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature]. / Lek u chorych poddawanych alloplastyce stawów kolanowych w trybie skróconej hospitalizacji w swietle wspólczesnego pismiennictwa.

The rapid progress in knee implants technology and operational techniques go together with more and more modem medical programs, designed to optimize the patients' care and shorten their stay in hospital. However, this does not guarantee any elimination ofperioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence thefinal result of the treatment of patients after big joints arthroplasties.

[A knee clinical stateaffects the preoperative level of anxiety in patients undergoing knee arthroplasty - preliminary report]. / Stan kliniczny kolana wplywa na poziom przedoperacyjnego leku u chorych poddanych alloplastyce kolana - doniesienie wstepne.

AIM: The aim of this study was to evaluate whether intensity of state anxiety before operation depends on knee function. MATERIAL AND METHOD: The study was conducted among 81 patients qualified to knee arthroplasty because of severe arthrosis. A knee function was evaluated with Knee Society score and Oxford questionnaires, and level of anxiety - with State-Trait Anxiety Inventory by C.D. Spielberger a day before the operation. RESULTS: Patients with higher intensity of trait anxiety had higher level of state anxiety before operation. To a group with higher intensity of trait anxiety belonged above all elderly persons. In addition, in these patients the knee function was worse. It was indicated that the better knee state and knee function were, the higher level of state anxiety before operation was. CONCLUSIONS: The knee clinical state prior to knee arthroplasty and trait anxiety are the predictors of the preoperative state anxiety. In the group of patients undergoing knee arthroplasty trait anxiety levels were found to be higher in older persons. Before the operation worse clinical knee state was found in patients with primary education as compared to patients with secondary education and university degree. No statistically significant correlation were found between preoperative anxiety and gender, patient's work status and marital status.

Association of genetic polymorphisms with personality profile in individuals without psychiatric disorders.

OBJECTIVE: Population-based twin studies demonstrate that approximately 40-50% of the variability in personality dimensions results from genetic factors. This study assessed selected polymorphisms in the COMT Val158Met, MAOA 3'VNTR, 5HTTLPR, 102T/C 5-HT2A, DAT 3'VNTR and DRD2 exon 8 genes and evaluated their association with personality profiles, anxiety levels, and depressiveness in healthy subjects. METHODS: This study included 406 unrelated (mean age 38.51 years), mentally and somatically healthy Caucasian subjects of Polish origin. The prevalence of the gene variants mentioned above and their association with personality profiles, anxiety levels, and depressiveness was assessed using the Temperament and Character Inventory, NEO Five-Factor Inventory, Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory. RESULTS: The effects of the 5HTTLPR gene on the s/s genotype and empathy (C2) were lowest in the entire group. The effects of gender, age and the HT2A gene for the T/T genotype and attachment (RD3) were highest in women. The effects of gender, age and the DAT gene on the 9/9 DAT genotype, compassion (C4) and cooperativeness (C) were lowest in women. The effects of gender, age and the COMT gene on the Met/Met genotype and neuroticism (NEU) NEO-FFI were also lowest in women. CONCLUSIONS: Our results suggest considerable influence of individual genes on the formation of personality traits.

Personality dimensions measured using the Temperament and Character Inventory (TCI) and NEO-FFI on a Polish sample.

UNLABELLED: The results of two self-administered, paper-and-pencil tests based on biosocial theory of personality have been compared simultaneously: the Temperament and Character Inventory (TCI) and NEO Five Factor Inventory (NEO-FFI). The stability of the personality dimensions was assessed across age, sex and education level samples in a group of 406 Polish adults with major mental diseases excluded by use of PRIME-MD questionnaire. Significant effects of age, sex, and education have been found while comparing personality dimensions in both temperamental (novelty seeking, NS; harm avoidance, HA; reward dependence, RD; persistence, P) and character scales (cooperativeness, C; self-transcendence, ST) in TCI. Among subscales of temperament only NS1, RD4 were stable according to concerning factors. All converted to their age and sex norms NEO-FFI dimensions were stable according to sex. Extraversion scale was changeable depending on age (p = 0.04). Neuroticism dimension was a little higher in lower educated group (p = 0.035).To sum up, it was concluded that sex- and age-specific norms for the dimensions of the Polish version of TCI are necessary considering the established significant differences. Particular personality genetic studies should account for age, sex and also educational differences in their methods of associative studies. CONCLUSIONS: In the exploration of personality dimensions on healthy volunteers the Polish version of NEO-FFI corresponds better than TCI to theory of stability and genetic determinants of human personality. As the study included persons with excluded major mental diseases, the sample is appropriate to provide a control group in the research of psychiatric patients using both TCI and NEO-FFI. SIGNIFICANT OUTCOMES: TCI scores for persons with excluded mental disease are highly changeable depending on age, sex and education. Adjusted to sex and age scores NEO-FFI corresponded better than TCI to stability and genetic determinants of human personality.