Abdominal wall hernia and mental health: patients lived experiences and implications for patient care.

BACKGROUND: Abdominal wall hernia (AWH) affects mental health and mental health questions are frequently included within Patient-Reported Outcome Measures (PROMS) for this patient population. However, these questions have not been informed by the subjective lived experiences of mental health in AWH patients. This study is the first to qualitatively examine how AWH affects patients' mental health. METHODS: Fifteen patients were interviewed from a purposive sample of AWH patients until no new themes emerged. Interviews explored patient thoughts and experiences of AWH and mental health. Data were examined using Interpretative Phenomenological Analysis (IPA). RESULTS: Three key themes pertaining to mental health were identified: "psychological and emotional distress", "identity disruption" and "coping mechanisms and support systems". CONCLUSION: Our findings illustrate that AWH is a pathology that can have a significant detrimental impact on people's mental health. This impact has implications for patient care and can be treated and managed through better psychological support. This support may positively affect AWH patient's experience and outcomes in terms of quality of life. This paper provides recommendations for improved AWH patient care in regard to mental health.

Health-related quality of life in abdominal wall hernia: let's ask patients what matters to them?

INTRODUCTION: Quality of Life (QoL) is an important consideration in patients with abdominal wall hernia (AWH). What matters to patients and their everyday experience living with AWH may depend on a variety of personal, psychological, social and environmental factors. At present, no study has addressed what is important to this particular group of patients by asking the patients themselves. This study aims to determine QoL from the patient's perspective by examining the lived experience in this patient population. METHODS: We interviewed 15 patients with AWH until thematic saturation. The patients were purposively sampled from AWH clinic between February 2020 and June 2020 using topic guides and interview schedules. Verbatim interview transcripts were coded and analysed using NVivo12 software and Interpretative Phenomenological Analysis (IPA). We adhered to consolidated criteria for reporting qualitative research (COREQ). RESULTS: Fifteen participants (8 men and 7 women) of age range 36-85 years, median 65 years, covering all Ventral Hernia Working Group (VHWG) grades. Five superordinate themes were identified each with several subordinate themes, as follows: (1) body image (subthemes-'changes to perceptions of self' and 'fears concerning perceptions of others'). (2) Mental health (subthemes-'emotional responses', 'disruptions to previously solid aspects of identity', 'developing coping strategies'). (3) Symptoms (subthemes-'managing pain', 'freedom of movement', 'restriction and adaptation of function'). (4) Interpersonal relationships (subthemes-'difficulties socially connecting' and 'changes in sexual relations'). (5) Employment (subthemes-'financial pressure', 'return to work issues' and 'costs to family'). CONCLUSION: This is the first phenomenological qualitative study in the field of AWH and presents a rich account of what is important to these patients in terms of QoL. Developed from the patients' own words, the themes are interrelated and should shape our understanding of patients with AWH. This study provides qualitative examples of each theme. This study has identified new themes (body image, interpersonal relationships and employment) that are not incorporated in existing AWH-specific QoL instruments. This is important for surgeons because the study suggests that we are currently not capturing all data relevant to QoL in this specific patient group with current tools. The wider impact of this would be to help counsel patients and support them more holistically through the disease process and it's management. Further research is needed to generate a standardised AWH QoL instrument which incorporates bio-psycho-emotional-social themes important to patients, as identified by patients.

Haemoglobin variants among voluntary blood donors in Jos, Nigeria: the implications on blood transfusion.

INTRODUCTION: The normal haemoglobin is an efficient transporter of oxygen to the tissues and carbondioxide from tissues to the lungs for elimination. Various abnormal haemoglobin variants including, the sickle cell diseases, have been described with varying sickling tendencies. AIMS: This study aimed to determine the haemoglobin variants among voluntary blood donors in Jos. METHOD: Records of the age, sex, Haemoglobin level, and the haemoglobin genotype of all voluntary blood donors who donated blood at the National Blood Transfusion Service Centre, Jos, Nigeria between January 2011 and April 2012; and their haemoglobin levels and protein electrophoresis determined, were reviewed. RESULTS: A total of 937 blood donors, 658 (70.23%) males and 279 (29.79%) females, mean age 32.4 years, donated blood voluntarily, their haemoglobin electrophoretic patterns determined by alkaline cellulose acetate electrophoresis. Donor blood haemoglobin levels were determined by automation. Haemoglobin protein electrophoretic patterns identified among our donors were 77.70% AA, 21.88% AS, 0.22% SC, 0.11% AC and 0.11% SS. Mean haemoglobin levels of the donors according to their haemoglobin proteins electrophoretic patterns were, 150.4 +/- 12.5 gms/l for AA, 151.9 +/- 13.8 gms/l for AS and 131.1 +/- 5.0 gms/l for haemoglobin SC. CONCLUSION: Determination of haemoglobin protein electrophoretic patterns of blood unit for transfusion could enhance selective blood issuing based on recipient's haemoglobin type.

Cardiovascular responses in anticipation of changes in posture and locomotion.

Measurements were made in 29 adult baboons that were housed in social groups, allowing the occurrence of the full range of species-specific behavioral interactions. The cardiovascular variables measured included blood pressure, heart rate, renal blood flow, lower limb blood flow, and occasionally mesenteric blood flow. The data were telemetered from backpacks worn by the animals and were recorded in analogue form on a polygraph, digitally on a computer and were also recorded on the audio channels of videotape being made of the behavior and social interactions of the baboons. The video and the computer recordings were synchronized by a timing system that made it possible to relate the cardiovascular responses to the behavioral responses. A numerically based behavioral code was developed that allowed the categorization of the totality of the behavior, including postural and locomotor changes. Comparisons between baseline cardiovascular values and those occurring 1 s before the initiation of a movement or posture change gave no evidence of anticipatory cardiovascular responses unless the movement was associated with behavior that included emotional content. Hypothalamic perifornical lesions reduced or eliminated these anticipatory changes.

A remote-controlled device for long-term blood collection from freely moving, socially housed animals.

A remote-controlled device was developed for injection of fluids and collection of blood samples from freely moving, socially housed animals via an indwelling catheter. Samples are collected at times chosen by the investigator, and the animal is not aware that sampling is occurring. This technique allows measurement of plasma catecholamines and other substances that fluctuate rapidly, are affected by psychosocial stimuli, and are altered by capture and other stressful activities that often accompany sample collection. Rapid retrieval of samples is facilitated by remote-controlled injection of an anesthetic. The device has been used to collect blood from dominant and subordinate male baboons before and during events such as chases and presentation of food treats. Heart rate and blood pressure were measured via radio telemetry, and behavior was recorded on videotapes. This technique allowed construction of multifaceted physiological profiles of social roles and behaviors.

Integrating behavior and cardiovascular responses: posture and locomotion. I. Static analysis.

Heart rate, arterial blood pressure, and renal and mesenteric or femoral blood flow were telemetered from 11 Papio hamadryas in an untethered free-ranging situation. The animals' behavior was recorded on videotape, and the cardiovascular (CV) data were recorded on the audio channels of the tape. The behavior was coded, and the codes were linked to the CV data via a time-code generator and computer control. The CV data were digitized into 1-s intervals, and the static relations between CV measures and the postures/locomotions (P/Ls) associated with the behavior were analyzed. The total frequency distributions for heart rate, blood pressure, and renal conductance approximated Gaussian distributions, whereas femoral conductance was positively skewed. The distribution for renal conductance suggested that during normal waking conditions the kidney is not maximally dilated and may increase or decrease its blood flow. All distributions were highly influenced by the Sit category, which occupied 80% of the total time. The CV measures for all P/Ls had wide ranges, and the CV values associated with each P/L overlapped those for the other P/Ls. The heart rate and renal conductance associated with the various P/Ls showed the largest deviations from the grand means and therefore contributed the most to the ability to discriminate one P/L from another. Blood pressure varied little from one P/L to another. The patterns of CV variables served to distinguish particular P/Ls very effectively. The frequency distributions were separated best when they were parceled on the basis of the intensity of behavior associated with a particular P/L. These variations in intensity were the major cause of the overlaps in the frequency distributions associated with P/Ls.

A system to acquire and record physiological and behavioral data remotely from nonhuman primates.

We describe an integrated system to record physiological and behavioral variables from nonhuman primates in social groups. The system records data simultaneously from two animals in family groups of five. It synchronizes behavioral and physiological data within 16 ms, either on-line or from recordings. Behavioral data are entered by trained observers on-line or from videotape. Recordings of physiological data are produced on-line as stripchart records, tape recordings on the audio channels of video cassettes, and magnetic disk files. The physiological data include two arterial blood flows, arterial blood pressure and heart rate. The data are transmitted from freely behaving animals to a central site via radio telemetry. The infrared link controls the radio transmitter and physiological signal processing electronics, as well as two sources of drugs for each animal. All of the electronics are contained in a small, light backpack that can be worn by either male or female baboons.

Integrating behavior and cardiovascular responses: the code.

The next revolution in biology is predicted to be in the integrative domain, and the need to involve physiologists in this kind of research has been recognized. This paper represents an approach to providing some of the tools required for dealing with integrative physiology at the behavioral level. Video tape recordings are made of the activities of a group of five baboons (Papio hamadryas) while simultaneous recordings of arterial blood pressure, heart rate, renal blood flow, and mesenteric or iliac blood flow are telemetered from two of the members of the group. The telemetered cardiovascular information is recorded on the two audio channels of the videotape. Subsequently the videotape is viewed, and a two-dimensional code is used to record the behavior of the two animals with the telemetry equipment. The first dimension of the code categorizes the behavior changes precisely regarding those aspects of behavior that are related to cardiovascular dynamics and does so with an accuracy of 16 ms. The second dimension codes relevant environmental changes. The paper describes the code and presents illustrations of how the code reflects the cardiovascular dynamics associated with the behavioral changes.

Neurons controlling cardiovascular responses to emotion are located in lateral hypothalamus-perifornical region.

We did four experiments to determine whether the lateral hypothalamus-perifornical (LH/PF) region is the source of neuronal cell bodies responsible for producing the cardiovascular (CV) responses associated with emotion or the defense reaction. Of particular concern was whether the paraventricular nucleus (PVN) plays a role in the generation of these CV responses. Mapping the hypothalamus with electrical stimulation showed that the CV pattern of responses was never produced by stimulating the PVN and was invariably produced by stimulating the LH/PF region. Complete electrolytic destruction of the PVN and subsequent axonal degeneration did not change the CV pattern of responses elicited by LH/PF stimulation, whereas any encroachment of the lesion on the LH/PF region decreased the magnitude of the CV responses. Injection of the neuroexcitotoxin ibotenic acid (Ibo) into the PVN did not affect responses to LH/PF stimulation, whereas Ibo injection into the LH/PF region eliminated or severely attenuated the CV responses. Retrograde labeling of cells from the thoracic cord and the ventrolateral reticular formation revealed a scattered group of cells in the LH/PF region that may be the cells controlling the CV responses. These results point directly to the LH/PF region as the source of the cell bodies responsible for the autonomic responses associated with emotion or defense reactions.

Spontaneous hypertension and its sequelae in woolly monkeys (Lagothrix lagotricha).

Arteriolar nephrosclerosis was observed at necropsy in 26 of 38 woolly monkeys (Lagothrix lagotricha). This lesion is the earliest histologic change associated with hypertension in humans. Seventeen of the monkeys had died of congestive heart failure, renal failure or acute cardiovascular accident, complications similar to those seen in human hypertension. All monkeys known to be over 4 years of age were affected. Direct blood pressure measurements in nine otherwise healthy woolly monkeys revealed systolic pressures of 194 +/- 20 mmHg. Our physiologic, clinical and pathologic studies suggest that woolly monkeys develop hypertension spontaneously and could be a useful model for the study of human hypertension.

Differential effect of behavior on cardiac and vasomotor baroreflex responses.

Bilateral carotid occlusion was performed in seven baboons during dynamic leg exercise, static arm exercise, feeding, rest, and sleep. The baroreceptor reflex effects on blood pressure, heart rate and interval, renal blood flow, and terminal aortic blood flow were determined during each behavior. The carotid sinus baroreflex increase in blood pressure and heart rate was greatest during sleep and least during exercise. The hindlimb and renal vasomotor responses followed different patterns. The baroreceptor reflex sensitivity for renal vasoconstriction was greatest during rest and least during sleep. The reflex sensitivity in the hindlimb was unaltered by behavior. Thus behavior modifies baroreceptor reflex responses in the heart and peripheral circulation in different patterns.

Organization of central nervous system pathways influencing blood pressure responses during emotional behavior.

A series of studies has demonstrated that the perifornical area of the hypothalamus ("acro-named" HACER, for Hypothalamic Area Controlling Emotional Responses) is responsible for producing the elevated blood pressure and other cardiovascular responses that accompany emotional behavior. The central neural structures providing afferents to the HACER are detailed, and the efferent outflow is analyzed to demonstrate how the HACER produces cardiovascular responses.

Regional distribution of blood flow during mild dynamic leg exercise in the baboon.

Five chair-restrained baboons were trained with operant techniques and a food reward to perform dynamic leg exercise. Cardiac output and blood flows to most tissues were determined by radioactive microsphere distribution. After 2 min of exercise mean arterial blood pressure had increased by 11 +/- 3% (SE), heart rate by 34 +/- 7%, cardiac output by 50 +/- 12%, and O2 consumption by 157 +/- 17%. The blood flow to exercising leg muscle increased by 585 +/- 338% and to the myocardium by 35 +/- 19%. Blood flow to torso and limb skin fell by 38 +/- 4 and 38 +/- 6%, respectively, and similar reductions occurred in adipose tissue blood flow. Nonworking skeletal muscle blood flow decreased by 30 +/- 10%. Renal blood flow was lowered by 16 +/-2%. The lower visceral organs had more variable responses, but when grouped together total splanchnic blood flow fell by 21 +/- 9%. Blood flow to the brain was unchanged with exercise, whereas spinal cord perfusion increased 23 +/- 3%. Thus during short dynamic exercise baboons redistributed blood flow away from skin, fat, nonworking muscles, and visceral organs to supply the needs of exercising muscles. Our data suggest the baboon is a useful animal model for investigating vascular responses of tissues, such as torso skin, adipose, individual visceral organs, and the spinal cord, that cannot be examined in humans.

Nerve conduction velocity, microscopic, and electron microscopy studies comparing repaired adult and baby monkey median nerves.

Three to three and a half years after repair of monkey nerves, comparison of total myelinated nerves, electron microscopic sections, and nerve conduction velocities delineated no significant difference between nerves sutured in adult life and those sutured in infancy. Extrapolating these results to the human clinical situation, central nervous system adaption in young patients could explain the better clinical results.

Afferent projections to the hypothalamic area controlling emotional responses (HACER).

The Mesulam technique for horseradish peroxidase was used to study the subcortical afferent projections to a location in the hypothalamus that has been shown to control the complete cardiovascular (CV) response accompanying a specific emotional behavior. Major projections common to all baboons injected included the lateral septal nucleus; medial, cortical and basal amygdala; the anteroventral third ventricle area; the preoptic areas; the subiculum; the paraventricular nucleus of the thalamus; periventricular gray and the central gray of the midbrain; the midbrain tegmentum; locus ceruleus, parabrachial and raphe cells in the pons; and in the medulla, raphe nuclei, the nucleus of the solitary tract, in and around the dorsal motor nucleus of the vagus, and in the region of the nucleus ambiguus. Other projections in some but not all baboons included the subfornical organ and the midline and dorsomedial nuclei of the thalamus. The nucleus of the diagonal band of Broca was labeled to some degree with all injections but was most heavily labeled with the injection extending more laterally in the hypothalamus. These results fit well with physiological and behavioral studies dealing with neural control of emotional and CV responses and support the concept of an integrative area in the hypothalamus concerned specifically with the control of CV response accompanying emotion.

[Role of the lateral hypothalamus in the genesis of somato-autonomic responses]. / Rol' lateral'nogo gipotalamusa v geneze somato-vegetativnykh reaktsii.

Coagulation of medial and lateral parts of the lateral hypothalamic area increases latency of responses and decreases respiration, arterial blood pressure and heart rate responses to stimulation of the hypothalamic ventromedial nucleus. Coagulation of the perifornical region of the lateral hypothalamus completely eliminates the above autonomic responses. A new rigid integration which is characterized with the increased number of correlated relations between separate components of somato-autonomic responses, was postulated after correlation analysis of somato-autonomic parameters during stimulation of hypothalamic ventromedial nucleus in animals with lateral hypothalamic lesions. The data suggest that somato-autonomic responses to stimulation of negative emotion sites of the hypothalamus are mediated by those brain structures which are under ascending excitatory influences of the lateral hypothalamus.

131I isotope placentography: simple counting equipment in obstetric practice.

Simple counting equipment and radioiodinated human serum albumin (131IHSA) were used to perform placental localization on 48 pregnant women with antepartum hemorrhage. The level of diagnostic accuracy of 85% compares favorably with more expensive methods. The false-negative diagnosis rate for the whole group was 4% and the false-positive diagnosis rate was 8%. The authors recommend this method of isotope placentography for developing countries because the cost of the equipment, including maintenance, and the isotopes is relatively small, and the radiation hazards are negligible.