Levels in neurotransmitter precursor amino acids correlate with mental health in patients with breast cancer.

Breast cancer is the most common cancer among females. Approximately 30% of cancer patients develop depression or depressive adaptation disorder within 5 years post diagnosis. Low grade inflammation and subsequent changes in neurotransmitter levels could be the pathophysiological link. In the current study we investigated the association of neurotransmitter precursor amino acids with a diagnosis of depression or state anxiety in 154 subjects suffering from breast cancer (BCA(+)), depression (DPR(+)), both or neither. Sociodemographic parameters, severity of depressive symptoms, and state anxiety (ANX) were recorded. Neopterin, kynurenine/tryptophan and phenylalanine/tyrosine were analysed by HPLC or ELISA. Significantly higher serum neopterin values were found in DPR(+) patients (p = 0.034) and in ANX(+) subjects (p = 0.008), as a marker of Th1-related inflammation. The phenylalanine/tyrosine ratio (index of the catecholamine pathway) was associated with the factors "breast cancer" and "depression" and their interaction (all p < 0.001); it was highest in the DPR(+)BCA(+) group. The kynurenine/tryptophan ratio (index of the serotonin pathway) was significantly associated with the factors "breast cancer" and "state anxiety" and their interaction (p < 0.001, p = 0.026, p = 0.02, respectively); it was highest in the ANX(+)BCA(+) group. In BCA(+) patients kynurenine/tryptophan ratios correlated with severity of state anxiety (r = 0.226, p = 0.048, uncorrected) and phenylalanine/tyrosine ratios with severity of depressive symptoms (r = 0.376, p < 0.05, corrected). In conclusion, levels of neurotransmitter precursor amino acids correlate with mental health, an effect which was much more pronounced in BCA(+) patients than in BCA(-) subjects. Aside from identifying underlying pathophysiological mechanisms, these results could be the basis for future treatment studies: in BCA(+) patients with depression the use of serotonin-noradrenaline reuptake inhibitors might be recommended while in those with predominant anxiety selective serotonin reuptake inhibitors might be the treatment of choice.

Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer.

INTRODUCTION: Patient-reported outcome (PRO) assessment is becoming increasingly important after joint replacement surgery. However, PRO data collection, questionnaire handling, and data processing are time consuming and costly process. The aim of our study was to evaluate the efficiency of PRO assessment using tablet computers compared with traditional paper questionnaires in a total hip or knee arthroplasty (THR or TKR) population. MATERIALS AND METHODS: We recruited 100 patients from outpatient clinics attending for routine follow-up 2 months, 1 year, or 5 years after THR or TKR. Fifty patients completed the Western Ontario and McMaster Universities (WOMAC) osteoarthritis score and Forgotten Joint Score-12 (FJS-12) questionnaires on paper, and 50 patients completed these on a tablet computer. Questionnaire completion was timed for each PRO assessment and for manual data entry of the paper questionnaires into the database. The t test, Mann-Whitney U test, Fisher's exact test, and Wilcoxon test were used for statistical analysis. RESULTS: The mean age of the patients was 67.0 years (standard deviation 10.3 years), with no significant difference between the two groups. Median time for WOMAC questionnaire completion (including data entry for the paper questionnaires) was 197 s for the paper version and 117 s for the tablet version (p < 0.001). Median times for completion of FJS-12 were comparable for paper and tablet versions (32 vs. 37 s). We did not find a significant correlation between age and time for questionnaire completion. CONCLUSION: Electronic PRO data collection can substantially decrease time, logistics, and effort associated with questionnaire completion in daily clinical practice. It is also acceptable for use in an older arthroplasty population.