Comparison of mean differences of pain, depressed mood, and sleep disturbance in women before and six weeks after total abdominal hysterectomy (TAH) and laparoscopic assisted vaginal hysterectomy (LAVH)
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He has over 25 years of experience in neuro-oncology and minimally invasive surgery techniques. He is a pioneer in many areas in neurosurgery (treatment of brain tumors, Chiari Malformation, and sacroiliac joint disorders).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"199099",title:"Ph.D.",name:"Vicente",middleName:null,surname:"Vanaclocha",slug:"vicente-vanaclocha",fullName:"Vicente Vanaclocha",profilePictureURL:"https://mts.intechopen.com/storage/users/199099/images/system/199099.jpeg",biography:"Vicente Vanaclocha is Chief of Neurosurgery. Doctor of Medicine from the University of Valencia, he has over 25 years experience in neuro-oncology, minimally invasive and minimally invasive surgery techniques. Specialist in neurosurgery both nationally and internationally (including the General Medical Register of England and stay at the Groote Schuur Hospital in Cape Town, South Africa) has been Chief of Neurosurgery at the University Hospital of Navarra and head of Neurosurgery Service of San Jaime Hospital in Torrevieja. He was also associate professor of neurosurgery at the Faculty of Medicine of the University of Navarra and is a professor of neuroanatomy at the Catholic University of Valencia also serving as an editorial board member of repute.\nCurrently he is Associate Professor at the University of Valencia.",institutionString:"University of Valencia",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Valencia",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"297737",firstName:"Mateo",lastName:"Pulko",middleName:null,title:"Mr.",imageUrl:"https://mts.intechopen.com/storage/users/297737/images/8492_n.png",email:"mateo.p@intechopen.com",biography:"As an Author Service Manager my responsibilities include monitoring and facilitating all publishing activities for authors and editors. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"878",title:"Phytochemicals",subtitle:"A Global Perspective of Their Role in Nutrition and Health",isOpenForSubmission:!1,hash:"ec77671f63975ef2d16192897deb6835",slug:"phytochemicals-a-global-perspective-of-their-role-in-nutrition-and-health",bookSignature:"Venketeshwer Rao",coverURL:"https://cdn.intechopen.com/books/images_new/878.jpg",editedByType:"Edited by",editors:[{id:"82663",title:"Dr.",name:"Venketeshwer",surname:"Rao",slug:"venketeshwer-rao",fullName:"Venketeshwer Rao"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"48586",title:"Comparative Analyses of Pain, Depressed Mood and Sleep Disturbance Symptoms in Women before and after Hysterectomy",doi:"10.5772/60424",slug:"comparative-analyses-of-pain-depressed-mood-and-sleep-disturbance-symptoms-in-women-before-and-after",body:'Hysterectomy relieves preoperative symptoms including heavy bleeding and pain; however it may carry a substantial risk of morbidity such as sleep disturbance and depressed mood. Current evidences indicate that after a hysterectomy, women experience further complications during the recovery period that might vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms such as pain, anxiety, and depressive symptoms might be influenced by various demographic and biopsychosocial factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined symptom outcomes in women after hysterectomy. This study investigated the pain, depressed mood, and sleep disturbance symptoms experienced by women before and after hysterectomy and compared their multidimensional biopsychosocial variables including surgical procedures related to the symptoms.
Hysterectomy was one of the most common gynecological surgeries in the United States [1-4]. According to the National Center of Health Statistics, approximately 600,000 hysterectomies were performed annually in the United States. It also was one of the most frequently performed surgeries among women all over the world with annual rates of 50,000 in Canada [5-6], 1.8/1000 in Denmark [1], 4.1/1000 in Finland [1], and 11,000 in Portugal [4]. The most common indications for a hysterectomy comprised of leiomyoma, endometriosis, prolapse of the uterus, cancer of the reproductive tract, adenomyosis, fibroids, and heavy bleeding [7-9]. Varying rates of surgical cases were reported in literature, however approximately 40% of hysterectomies were elective [10], and 90% were operated for a benign condition [11].
A hysterectomy could be done in various ways; such as vaginal hysterectomy, abdominal hysterectomy, laparoscopic assisted vaginal or total hysterectomy, and robotic assisted hysterectomy. The choice might depend on diagnoses and physicians’ ability to perform procedures on their patients. Total abdominal hysterectomy (TAH) was performed more commonly for myomas [12] and presence of malignancy [13] however it was associated with a worse patient experience relative to the other types of procedures [14]. In a study, 60% underwent TAH, and those women experienced higher levels of pain and depressed mood after TAH compared to laparoscopic assisted vaginal hysterectomy [15]. Li and colleagues [16] claimed that both procedures had similar efficacy and morbidity rates for women with cervical cancer. Susini and colleagues [17] argued that laparoscopic assisted vaginal hysterectomy (LAVH) had both advantages and disadvantages. An advantage of LAVH was the ability to inspect the tissue with laparoscopy once vaginal cuff closure was completed; however the complication rate did not exceed that of TAH when performed by well-trained physicians. Robotic assisted surgery for endometrial cancer has further been shown to reduce blood loss, while maintaining the benefits of laparoscopic techniques [18-19] however its lengthy preparation and operating time would contribute to an exorbitant price and cause cost inefficiency.
Although the research addressed the substantial numbers of positive effects such as relief of physical symptoms and improvements of social and psychological functioning, the appropriateness of using hysterectomy to treat non-malignant conditions remained controversial [10]. Research showed the possible reasons of negative physical and psychological outcomes after hysterectomy; such as depression [20-21], sleep disturbance and fatigue [22, 7], pelvic pain [23], sexual dysfunction [24-25, 11], and urinary incontinence or symptoms [26].
Sleep disturbance is one of the most prevalent symptoms following hysterectomy. Kim and Lee [7] reported that three weeks after surgery, women’s self-reported sleep disturbance was significantly higher than baseline. Similarly, after adjustment for factors such as current psychological, vasomotor, and somatic symptoms and waking frequently at night to use the toilet, a study on self-reported sleep difficulty during the menopausal transition demonstrated that women with hysterectomy remained at higher risk for moderate sleep difficulty [27]. Another study evaluated the sleep patterns before gynecologic surgery that indicated sleep quality was only impaired in the very last night before surgery [28]. Moreover, no significant association between the nature of the planned surgery and preoperative sleep characteristics was shown in the study. A study by researchers [29] compared two groups receiving treatments, one receiving the GnRH agonist and other receiving hysterectomy for treatment of dysfunctional uterine bleeding in premenopausal women and concluded that there was no significant differences existed between two treatment groups in sleep disorders after two-years of follow up.
Pain before and after hysterectomy has been discussed in the literature. Although Solnik and Munro [30] suggested that women experiencing chronic pelvic pain should be counseled against hysterectomy until a more clear etiology was identified, Tiwana and colleague [31] claimed that women with chronic pelvic pain must consider hysterectomy. It is quite common for women to experience chronic pain following hysterectomy. Brandsborg and colleagues [1] argued that chronic pain was prevalent in women with hysterectomy; on their study, 5-32% of women reported to experience pain. Chronic pelvic pain persisted after surgery in 22% of cases [32] and 19% of cases that needed a further intervention to cure this problem [12]. Furthermore, Darnall and Li [33] reported that 29% of the female sample (n = 323) aged between18 and 45 at a chronic pain clinic reported to experience pain: They suggested that hysterectomy might confer risk for pain-related dysfunction and opioid prescription in women 45 years of age and younger. Hysterectomy also was used to treat chronic pelvic pain in the past. In a comparative study of pre-hysterectomy cases, pelvic pain and abdominal pain were reduced five years post hysterectomy [34]. However, several studies demonstrated that in the absence of any obvious pathology, 21-40% of women undergoing hysterectomy to treat chronic pelvic pain might continue to experience pain after the surgery [23], no more than 60-70% might achieve significant pain relief, and 3-5% might suffer worsening of pain or had new onsets of pain [35]. Therefore, it was suggested that women with chronic pelvic pain could consider hysterectomy [31] if they had pelvic varices and were ruled out having non-reproductive causes of pain after a careful pre-operative assessment [23,35].
In regards to pain after hysterectomy, researchers examined whether the severity of acute postoperative pain differed between laparoscopic (LH) or laparoscopically assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy, and found LH was associated with reduced need of analgesics and lower acute pain scores than LAVH [36]. A study in Finland comparing hysterectomy with levonorgestrel-releasing intrauterine system (LNG-IUS) as a treatment for menorrhagia showed that both treatments reduced lower abdominal pain: However, only LNG-IUS use, not hysterectomy, had beneficial effects on back pain [37]. In a study on predictors of acute postsurgical pain in women undergoing hysterectomy due to benign disorders, Pinto and colleagues [4] found that younger age, pre-surgical pain, pain due to other causes, and pain catastrophizing appeared to be the main predictors of pain severity at 48 hours after the operation, while presurgical anxiety also predicted pain intensity after surgery. Their findings revealed the joint influence of demographic, clinical, and psychological factors on postsurgical pain intensity and severity.
In addition to the physical outcomes, much has been written about the possible psychological effects from hysterectomy. 50% of women had obvious abnormal emotions before hysterectomy, and the surgery could cause strong mental stress reactions [21]. Of the statistics, however, women with hysterectomy were not higher in negative affect or negative attitudes toward aging and menopause compared to those without hysterectomy [38]. In a study on 113 women during an eight-week post hysterectomy period, Cohen and colleagues [2] found the significant overall positive changes in anxiety, depression, and hostility: They indicated that the positive changes could be due to women’s high self-esteem, which might partially be attributed to the high educational level of the sample. The findings from the study by Farquhar et al. [34] also showed lower depression scores five years following hysterectomy. Nonetheless, Sehlo and Ramadani [20] found that the prevalence of major depressive episode (MDE) was significantly higher in women having hysterectomy compared with women having cholecystectomy. Moreover, the prevalence and severity of MDE was significantly higher in the nullipara group than the multipara group. They declared that hysterectomy increased the risk of MDE that should be diagnosed and treated promptly [20]. Ewalds-Kvist and associates [39] also found that married nullipara suffered from enhanced depression post-surgery.
When evaluating the relationship between hysterectomy and the psychological health afterwards, Cooper, Mishra, Hardy, & Kuh [40] emphasized the importance to take previous psychological status into account: Their findings suggested that women who underwent hysterectomy at a young age might require more support than those who maintained good psychological health in middle age. Similarly, Vandyk, Brenner, Tranmer, and Kerkhof [41] also found that young women with high levels of anxiety and pain that needed a hysterectomy were at high risk of experiencing psychological distress before and after their operation.
The association between hysterectomy and psychological outcomes has aroused the interest of the researcher not only in the United States but outside the US. Researchers in Japan demonstrated that depressed women had a higher incidence of hysterectomy and/or oophorectomy than non-depressed women [42]. By comparing mastectomy patients with hysterectomy patients in a study conducted in Turkey, Keskin & Gumus [25] found that mastectomy patients were more depressive while hysterectomy patients demonstrated more problems in expression of emotions as well as greater sexual problems and difficulties with spousal relationships. Wang, Lambert, & Lambert [43] demonstrated a study on 105 Chinese women with hysterectomy before their scheduled discharge: The findings showed that 4.8% experienced depression; and the best predictors of depression were self-blame and employment status. These results imply that besides physical and psychological factors, social and economic well-being of the post-hysterectomy women were affected.
Without complications, most women with a LAVH require a few weeks of recovery time, however those who undergo an abdominal hysterectomy may require six to eight weeks of longer recovery periods. This study aimed to examine symptoms experienced by women with hysterectomy; compared their perceived pain, depressed mood and sleep disturbance symptoms before and six weeks after hysterectomy; and examined the relationships between their symptoms and biopsychosocial variables including types of surgical procedures, TAH vs LAVH.
The pre and post measures study examined pain, depressed mood and sleep disturbance symptoms experienced by a sample of 26 culturally diverse women before and after hysterectomy and evaluated the relationship between their symptoms and biopsychosocial contextual variables. After describing the women’s experience of pain, depressed mood and disturbed sleep, the symptoms were compared to determine the differences in symptom severity between two surgical procedures; total abdominal vs. laparoscopic hysterectomy.
The Institutional Review Board on Human Research approved the study. The inclusion criteria included: (a) women above 30 years of age, (b) no history of pregnancy or surgery for the past one year, (c) no history of mental illnesses, and (d) no history taking psychotropic drugs in the past one year. Potential participants were accessed through the flyer provided by the investigator in the two women’s clinics at two to three weeks prior to surgery. Once women expressed an interest in participating in the study, they were asked to call the investigator who would provide the details of the study and obtain informed consent, their health history, and baseline data that included physiologic, psychological and social variables as well as sleep-wake patterns and symptoms. They were given information about instructions on how to manage a wrist actigraph although this instruction was repeated at the time of wearing the actigraph by the researcher as participants needed to wear a wrist actigraph for 48 hours, between three days to two weeks before their scheduled surgery. Once discharged from the hospital, women were asked to wear the wrist actigraph in their home to monitor activity continuously for 48 hours at six weeks after surgery. At each time point, they were also asked to complete standardized questionnaires that measure pain and depressed mood. Participants were informed to record their sleep and wake times on a diary. Standardized questionnaires used for this study took approximately 15 minutes to complete. After each 48-hour session, the investigator collected the wrist actigraph and diary from the participant’s home.
The women’s biopsychosocial and symptom variables were evaluated using standardized questionnaires completed by participants and objective actigraphy data for sleep efficiency and sleep-wake patterns. Physiologic factors included age at preoperative baseline as well as whether the surgery was a laparotomy approach to total abdominal hysterectomy (TAH) or laparoscopic assisted vaginal hysterectomy/vaginal hysterectomy (LAVH). Social factors included ethnicity (African/Black, Asian, Caucasian/European, or Hispanic), marital status (single, married, divorced, or widowed), education (graduates of high school, college, or post-graduate work), employment (full- or part-time, homemaker, or retired), and numbers of children. These data were collected as part of the health history baseline data.
Symptom measures included pain, depressed mood and sleep disturbance. Pain was measured at baseline and six weeks after surgery with the Wisconsin Brief Pain Inventory (BPI) to address multidimensional aspects of pain. Participants were asked to circle a number to describe the extent to which pain interfered with various activities from 0 (does not interfere) to 10 (completely interfere), during the past week. Internal consistency reliability of the severity and interference subscales on the BPI revealed Cronbach alpha coefficients of 0.89 and 0.90 in this sample.
Depressed mood was measured with the 21-item Beck Depression Inventory (BDI) pre-operatively and at six weeks after surgery by having the participant rate their perception of mood intensity from 0 (absence of depression) to 3 (the most severe depression). The BDI has established test-retest reliability ranges of 0.74 to 0.95 with elderly and depressive subjects. Internal consistency (Cronbach alpha coefficient) for this study was 0.93 preoperatively. The cutoffs scores were 0–13 (minimal depression); 14–19 (mild depression); 20–28 (moderate depression); and (29–63) severe depression. Higher total scores indicate more severe depressive symptoms.
Sleep history was assessed at baseline with the 19-item Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, latency, duration, and disturbances in the past month. A global sleep quality score could range from 0 to 21 and a higher score reflecting more severe sleep disturbance and poor sleep quality. Internal consistency reliability (Cronbach alpha coefficient) was 0.73 in this sample. Current sleep disturbance was assessed using the 21-item General Sleep Disturbance Scale (GSDS). Items on the GSDS assess sleep quality and quantity during the past week on a scale of 0 (not at all) to 7 (every day). Scores can range from 0 to 147 (Lee, 1992). Internal consistency reliability (Cronbach alpha coefficient) for this study was 0.87.
Objective sleep parameters were measured using wrist actigraphy (Ambulatory Monitoring, Inc., Ardsley, NY); a non-invasive watch-like tool that provided sleep-wake patterns via an accelerometer that detected wrist movements of participants over 48 hours at baseline and six weeks after surgery. The actigraph worn by participants’ non-dominant wrist detects motion and quantifies the number of movements over a preprogrammed interval (30-second epochs). It has been demonstrated to be reliable and valid with polysomnographic measures of sleep in clinical settings. In surgical patients including women with hysterectomy, in whom traditional sleep monitoring could be difficult, actigraphy would be indicated for characterizing sleep. Wrist actigraphy has accompanying software for an automatic sleep scoring algorithm to allow for quantifying activity and sleep time without bias by researchers, and objectively determines time spent asleep and awake during the night. Sleep parameters of interest included: (a) Total sleep time (TST) in minutes, from the time of ‘lights out’ to final awakening; (b) sleep efficiency in percentages, of time asleep while in bed; (c) sleep onset latency (SOL) in minutes, between bed time and the first block of inactivity after bed time; (d) awake after sleep onset (WASO) in minutes, awake between sleep onset and wake time; (e) number of awakenings lasting at least 3 minutes; and (f) day time sleep in minutes. A sleep diary was also used for self-monitoring of participant’s sleep and daytime activities. Actigraphy data were collected for an average of 3.5 days. Data for each variable was averaged over the recorded time. A sleep diary is useful in conjunction with actigraphy and provides an indication of type of daily activity, including time in bed, trips to the bathroom, or exercise.
Data were analyzed using descriptive and inferential statistics. Objective sleep data were first downloaded from the actigraph into a personal computer using an interface unit, and then analyzed using Action W4 (Ambulatory Monitoring, Inc., Ardsley, NY) automatic sleep analysis software. Because of a potential ‘first-night’ adaptation effect, only the second night of sleep data was used for analyses at each time. Pearson product moment correlation coefficients were used to establish significant relationships between the symptom outcome variables (pain, depressed mood and sleep disturbance) and biopsychosocial contextual variables. Multiple regression analyses were performed for those variables with high coefficients (r >.30). Repeated measures analysis of variance (RMANOVA) was used to test for within-subject changes in severity of symptom scores from baseline and to test between subjects by type of surgical procedure.
Participants ranged in age from 35 to 81 years, with a mean age of 50 (median age 48) ± 10 years. There were 12 Caucasians, 6 African/Black Americans, 4 Asian Americans, and 4 Hispanic women. Over two third of the participants (69%) were employed full-time outside the home, and 77% of them had more than a high school education. Fifteen women were married, six were single, and four were separated or divorced. The majority (73%) had children, and 69% reported a net family annual income of more than $62,000. Time since diagnosis of their disease processes ranged from 1.5 month to 15 years. Four women experienced complications after TAH that included infection, severe leg pain due to thrombosis, or chronic diarrhea.
Descriptive statistics at baseline and six weeks after surgery showed significant changes in their symptom experience. Pain interfered with general activities preoperatively (5.6 ± 1.6) however began to decrease and remain at the lower level by the sixth week (4.7 ± 3.15) after hysterectomy. Eighteen women scored higher means at baseline than postoperatively, indicating that pain had interfered with their general activities; walking, mood, work, sleep, and enjoyment of life before surgery. The Hispanic women perceived significantly higher postoperative pain interference than did the Caucasian women or Black women. The 15 women who had TAH perceived significantly higher pain scores than the 11 women who had LAVH, both before and after surgery (F = 14.48, p <.01). Women with TAH also scored high on depressed mood than women with LVH after surgery (F = 4.49, p = 0.05).
Although less than expected, the severity of depressed mood varied greatly in this sample, but averaged 8 ± 2.8 at baseline and decreased to 6 ± 1.71 at six weeks after surgery. Caucasian women (11 ± 3.6) perceived significantly higher depressed mood scores than Hispanic women (8 ± 2.8) pre-operatively (F = 4.65, p = 0.05). Their scores however reversed at six weeks after surgery, showing that Hispanic women perceived significantly higher depressed mood scores (9 ± 2.8) than Caucasians (5 ± 1.4) or Black Americans (6 ± 1.7). These scores could be arbitrary as they ranged within a minimal depression level that might not be concerns as indicated on BPI.
Furthermore, there was a significant difference in severity of depressed mood perceived by women with TAH and LAVH groups. Women with TAH rated significantly higher scores on a depressed mood inventory than women with LAVH (F = 4.49, p = 0.05) at six weeks after surgery. For example, although depressed mood scores did not change significantly in women with TAH from the baseline (7.1 ± 1.8) to six weeks after surgery (6.4 ± 2.0), the scores in women with LAVH significantly decreased from the baseline (6.3 ± 1.4) to six weeks after surgery (2.5 ± 0.5) [see TABLE1], showing less severity of depressed mood after surgery. There were no significant differences in symptom severity between women with children and women without children, or between married and single women.
Current sleep disturbance score measured by GSDS in women with TAH averaged 42.1 ± 5.1 at baseline and 38.7 ± 4.9 at six weeks after surgery; and women with LAVH averaged 35 ± 4.1 at baseline and 42.8 ± 5.1 at six weeks after surgery. Women with TAH scored higher on sleep disturbance than women with LAVH at baseline however the scores reversed at six weeks after surgery; women with LAVH scored high on GSDS, indicating that they experienced significantly increased levels of sleep disturbance after surgery.
Latent sleep disturbance scores measured by the Pittsburg sleep quality index (PSQI) in women with TAH and LAVH averaged 7.4 ± 1.1 and 7.6 ± 1.2 respectively at baseline. Compared to the baseline, the average sleep scores of women with TAH (7.5 ± 1.2) and LAVH (7.8 ± 1.3) increased at six weeks after surgery, indicating that their sleep patterns did not improve after surgery over time. Table 1 displays comparison charts of mean differences of pain, depressed mood and sleep disturbance in women with two types of surgical procedures before and six weeks after surgery.
Symptom lists at baseline and 6 weeks after surgery | \n\t\t\t\tTAH (n = 15) Mean (SE) | \n\t\t\t\tLAVH (n = 11) Mean (SE) | \n\t\t\t
Pain intensity (0-10) | \n\t\t\t\n\t\t\t | \n\t\t |
Baseline | \n\t\t\t5.6 (2.1) | \n\t\t\t3.4 (0) | \n\t\t
6 weeks after surgery | \n\t\t\t4.7 (3.6) | \n\t\t\t3.3 (1) | \n\t\t
Beck Depressed Mood (0-63) | \n\t\t\t\n\t\t\t | \n\t\t |
Baseline | \n\t\t\t7.1 (1.8) | \n\t\t\t6.3 (1.4) | \n\t\t
6 weeks after surgery | \n\t\t\t6.4 (2.0) | \n\t\t\t2.5 (0.5) | \n\t\t
PSQI-Sleep Disturbance in last week (0-21) | \n\t\t\t\n\t\t\t | \n\t\t |
Baseline | \n\t\t\t7.4 (1.1) | \n\t\t\t7.6 (1.2) | \n\t\t
6 weeks after surgery | \n\t\t\t7.5 (1.2) | \n\t\t\t7.8 (1.3) | \n\t\t
GSDS-Sleep Disturbance, current (0-147) | \n\t\t\t\n\t\t\t | \n\t\t |
Baseline | \n\t\t\t42.1 (5.1) | \n\t\t\t35 (4.2) | \n\t\t
6 weeks after surgery | \n\t\t\t38.7 (4.9) | \n\t\t\t42.8 (5.2) | \n\t\t
Comparison of mean differences of pain, depressed mood, and sleep disturbance in women before and six weeks after total abdominal hysterectomy (TAH) and laparoscopic assisted vaginal hysterectomy (LAVH)
Subjective sleep disturbance was evident at all-time points, with mean PSQI global scores greater than 5, the established cut point for severe sleep disturbance [see TABLE1]. Hispanic and Black women experienced significantly higher PSQI scores than Caucasian or Asian American women at baseline. Similarly, the Black women perceived significantly higher current sleep disturbance on the GSDS than did the Caucasian women at baseline (F = 8.1, p = 0.015). There were no significant differences in self-reported sleep quality between TAH and LAVH groups.
The sleep actigraphy data are reported on the Table 2 that displays means and standard deviations of sleep data at the baseline and six weeks after surgery. The total sleep time (TST) for the second night of sleep recording at baseline ranged from 301 minutes to 720 minutes with a mean of 392 ± 121 minutes, and number of awakenings ranged from 3 to 21, with a mean of 10 ± 6.0. At six weeks after surgery, the TST ranged from 180 minutes to 540 minutes with a mean of 402 ± 126 minutes. Sleep efficiency decreased from 89% (SD = 8) at the baseline to 82% (SD = 16) at six weeks after surgery. The mean wake after sleep-onset (WASO) increased from 8.48 ± 7.36 minutes to 14.69 ± 12.50 minutes, indicating increase in sleep disturbance. The numbers of awakenings significantly increased from 10 ± 6 at baseline to 20 ± 8 at six weeks after surgery (F = 2.0, p < 0.02). An additional finding, after surgery, was that the daytime sleep increased to compensate for lack of sleep at night. When actigraphy sleep data were compared by type of surgical procedure, there were no statistically significant differences between TAH and LAVH groups.
\n\t\t\t\t\tTime\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tTotal Sleep Time\n\t\t\t\t\t \n\t\t\t\t\t(minutes)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSleep Efficiency (%)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tWake After Sleep Onset\n\t\t\t\t\t \n\t\t\t\t\t(minutes)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tNumber of Awakenings\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tSleep Onset Latency (minutes)\n\t\t\t\t | \n\t\t\t\t\n\t\t\t\t\tDay\n\t\t\t\t\t \n\t\t\t\t\tSleep\n\t\t\t\t\t \n\t\t\t\t\t(minutes) \n\t\t\t\t | \n\t\t\t|
Baseline | \n\t\t\t\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t | |
\n\t\t\t | Mean Median SD | \n\t\t\t402 404 126 | \n\t\t\t89 91 8 | \n\t\t\t8.5 6.5 7.4 | \n\t\t\t10 8 6 | \n\t\t\t11.1 8.0 9.5 | \n\t\t\t3.7 3.1 2.9 | \n\t\t
6 weeks Post | \n\t\t\t\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t | |
\n\t\t\t | Mean Median SD | \n\t\t\t411 437 102 | \n\t\t\t82 87 16 | \n\t\t\t14.7 11.7 12.5 | \n\t\t\t20 18 8 | \n\t\t\t13.7 6.5 2.6 | \n\t\t\t4.0 2.7 4.1 | \n\t\t
Significance | \n\t\t\t\n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t\t | \n\t\t | |
\n\t\t\t | F (p) | \n\t\t\t1.5 (0.12) | \n\t\t\t0.9 (0.10) | \n\t\t\t2.1 (0.2) | \n\t\t\t2.0 (0.02) | \n\t\t\t\n\t\t\t | \n\t\t |
Mean Comparisons of sleep efficiency and numbers of awakenings of actigraphy recordings at baseline and six weeks after hysterectomy (n = 26)
Table 3 displays Pearson product moment correlation coefficients of pain, depressed mood, and sleep disturbance symptoms and biopsychosocial variables before and six weeks after surgery. Age was negatively related to current and latent sleep quality, indicating that younger women had more sleep disturbance by self-report. Age was also negatively correlated with pain and depressed mood however the relationship was not statistically significant in this sample.
Preoperative sleep efficiency recorded in wrist actigrpahs was negatively correlated with perceptions of current sleep disturbance of GSDS (r = -0.51, p <0.01) and latent sleep disturbance (PSQI) in the past month (r = -0.64, p < 0.01). Preoperative perception of depressed mood was related with current and latent sleep disturbances (r = 0.60, r = 0.44, p < 0.01). Current sleep disturbance was correlated with the latent sleep disturbance (r = 0.78, p < 0.05). Postoperative sleep disturbance (PSQI) was also negatively related to age (r = -0.47, p <.002), and positively correlated with depressed mood (r = 0.65, p <.01). There were no statistically significant relationships between the pain and other covariables over time in this sample.
\n\t\t\t\tTime 1:\n\t\t\t\t \n\t\t\t\tBaseline\n\t\t\t | \n\t\t\t\n\t\t\t\tPittsburg\n\t\t\t\t \n\t\t\t\tPain1\n\t\t\t | \n\t\t\t\n\t\t\t\tBeck Depression1\n\t\t\t | \n\t\t\t\n\t\t\t\tCurrent Sleep GSDS1\n\t\t\t | \n\t\t\t\n\t\t\t\tLatent Sleep Quality PSQI1\n\t\t\t | \n\t\t||
Age | \n\t\t\t-0.45 | \n\t\t\t-0.41 | \n\t\t\t-0.63** | \n\t\t\t-0.66** | \n\t\t||
Education level | \n\t\t\t-0.26 | \n\t\t\t0.10 | \n\t\t\t0.22 | \n\t\t\t0.04 | \n\t\t||
Sleep efficiency | \n\t\t\t-0.37 | \n\t\t\t-0.04 | \n\t\t\t-0.51* | \n\t\t\t-0.64** | \n\t\t||
Pain | \n\t\t\t1 | \n\t\t\t0.17 | \n\t\t\t0.20 | \n\t\t\t0.27 | \n\t\t||
Depressed mood | \n\t\t\t0.17 | \n\t\t\t1 | \n\t\t\t0.60* | \n\t\t\t0.44* | \n\t\t||
Current sleep disturbance | \n\t\t\t0.20 | \n\t\t\t0.60* | \n\t\t\t1 | \n\t\t\t0.78** | \n\t\t||
\n\t\t\t\tTime 2:\n\t\t\t\t \n\t\t\t\t6 weeks Post-op\n\t\t\t | \n\t\t\t\n\t\t\t\tPittsburg\n\t\t\t\t \n\t\t\t\tPain2\n\t\t\t | \n\t\t\t\n\t\t\t\tBeck\n\t\t\t\t \n\t\t\t\tDepression2\n\t\t\t | \n\t\t\t\n\t\t\t\tCurrent Sleep GSDS2\n\t\t\t | \n\t\t\t\n\t\t\t\tLatent Sleep Quality PSQI2\n\t\t\t | \n\t\t||
Age | \n\t\t\t-0.08 | \n\t\t\t-0.34 | \n\t\t\t-0.45 | \n\t\t\t-0.47* | \n\t\t||
Education level | \n\t\t\t-0.48 | \n\t\t\t0.14 | \n\t\t\t0.18 | \n\t\t\t0.24 | \n\t\t||
Sleep efficiency | \n\t\t\t-0.32 | \n\t\t\t-0.34 | \n\t\t\t-0.39 | \n\t\t\t-0.65** | \n\t\t||
Pain | \n\t\t\t1 | \n\t\t\t0.40 | \n\t\t\t0.13 | \n\t\t\t0.17 | \n\t\t||
Depressed Mood | \n\t\t\t0.40 | \n\t\t\t1 | \n\t\t\t0.65* | \n\t\t\t0.40 | \n\t\t||
Current sleep disturbance | \n\t\t\t0.13 | \n\t\t\t0.65* | \n\t\t\t1 | \n\t\t\t0.57* | \n\t\t
Correlation coefficients between symptom outcome and biopsychosocial variables at baseline (Time 1) and Six Weeks (Time 2) after Surgery
Note: * = Correlation is significant at the .05 level (2-tailed); and ** = Correlation is significant at the.01 level (2-tailed)
This study examines key symptoms of pain, depressed mood and disturbed sleep experienced by culturally diverse women who have undergone total abdominal hysterectomy (TAH) and laparoscopic assisted vaginal hysterectomy (LAVH); and evaluates their biopsychosocial variables in relation to the symptoms preoperatively and six weeks after surgery. Results indicate that women experience high levels of pain that interfere with their daily activities prior to surgery. Findings also suggest that women who undergo TAH perceive significantly higher pain scores than the women who receive LAVH postoperatively. Pain severity, however, is not correlated with any other variables.
The severity of depressed mood varies greatly in this sample. Women with TAH score higher on depressed mood than women with LAVH before and after surgery. In this study, women’s depressive symptoms improved after surgery, especially in women with LAVH. Although Caucasian women experienced worsen symptoms of depressed mood than Hispanic women at baseline, their scores reversed after surgery, with improved perception of depressed mood, while Hispanic women reported worsening mood. This outcome coincides with the study conducted by Gibson, Joffe, and Bromberger’s [45] in that the researchers found women who had a hysterectomy with or without bilateral oophorectomy in midlife did not experience more negative mood symptoms in the years after surgery; however they reported that women’s depressive and anxiety symptoms improved over the course of the menopausal transition. Similarly, in their review, Darwish, Atlantis, and Mohamed-Taysir [46] claimed that hysterectomy was associated with a decreased risk of clinically relevant depression and standardized depression outcomes. However Wang and colleagues [21] argued that their patients had obvious depression and anxiety symptoms before and after hysterectomy; and those who received psychological interventions decreased the depression scores significantly. Interestingly, Gómez-Campelo, Bragado-Álvarez, and Hernández-Lloreda [47] identified psychological distress of women that had undergone hysterectomy and mastectomy; and found both surgeries caused body image disturbance and depression for women. It appears that women might feel depressed when they have lost a part of their womanhood after hysterectomy, however understanding the need, risks, and benefits of surgery would help alleviate depressive feelings. Based on a current findings, hysterectomy alone does not have a physical basis for resulting in depression; therefore women can prevent this symptom by thoroughly understanding the surgical cases.
Women also report significant levels of subjective and objective sleep disturbances before and after surgery. Although the subjective sleep disturbance is significantly greater in Black and Hispanic women at baseline, there is no statistically significant ethnic difference in objective data measured by actigraphy recordings in this study.
Use of a wrist actigraph for measuring objective sleep data provides the changing pattern of sleep over time. Compared to the preoperative actigraphy data, women experience a progressive decrease in sleep efficiency and increase in day time sleep and numbers of awakenings during nights at six weeks after surgery. Sleep efficiency is negatively correlated with perceptions of current and latent sleep disturbance. This is a concern that healthcare providers should be aware as women might develop further risks and other complications if the sleep disturbance continues after surgery.
Preoperative and postoperative sleep disturbances are negatively related to age, indicating that younger women experience worse sleep disturbance; and positively correlated with depressed mood. It is worthy to note that certain correlations may exist between the physiological and psychological outcomes of hysterectomy. For instance, symptoms such as preoperative depressive moods may increase pain thresholds that may eventually cause poor sleep after hysterectomy. It is well known that signs of depressive mood may include insomnia and restlessness. Therefore, depressive mood may partially account for sleep disturbance after hysterectomy. Further research on the correlations between the physiological, psychological, demographic, and social factors would contribute in developing an integrated and comprehensive nursing care plan for women with hysterectomy.
This study examines symptoms of pain, depressed mood and sleep disturbance of women that have undergone abdominal and vaginal hysterectomy using subjective and objective measurements. Without complications, most women with a vaginal hysterectomy recover within a few weeks however those who undergo an abdominal hysterectomy may require six to eight weeks to recover and return to normal routines. Therefore, it is important for women to understand the possible risks involved with both types of surgery prior to having one.
The study provides important findings that women experience before and after hysterectomy and documents symptom severity and related biopsychosocial variables. Although the severity of pain and depressed mood decreased, women continue to experience poor sleep six weeks after surgery. With a small sample, results are difficult to generalize to the large population of women before and after hysterectomy. However, significant findings of the study allow for healthcare professionals in developing and implementing potential interventions that may benefit women considering the procedures.
This research was supported by grants from the American Nurses’ Foundation and National Institute of Nursing Research (T32NR07088).
Several methods have been developed to produce metal nanoparticles. Two synthesis approaches have been identified that is top-down and bottom-up approach. Top-down methods comprise of milling, lithography, and repeated quenching. This approach does not have good control of the particle size and structure. Bottom-up method is the approach that is mostly used by scientists in the synthesis of nanoparticles as it involves building up a material from bottom: atom-by-atom, molecule-by-molecule, and cluster-by-cluster [1, 2]. Several chemical routes have been identified to synthesize the colloidal metal nanoparticles from different precursors using chemical reductants in solvents (aqueous and nonaqueous). The chemical routes that have been studied for various applications include electrochemical method [3], sonochemical method [4], radiolytic [5] and photochemical [6] method.
The Polyol method is a chemical method for the synthesis of nanoparticles.
This method uses nonaqueous liquid (polyol) as a solvent and reducing agent. The nonaqueous solvents that are used in this method have an advantage of minimizing surface oxidation and agglomeration. This method allows flexibility on controlling of size, texture, and shape of nanoparticles. Polyol method can also be used in producing nanoparticles in large scale [7].
The polyol process can be taken as a sol-gel method in the synthesis of oxide, if the synthesis is conducted at moderately increased temperature with accurate particle growth control [8]. There are several reports that have studied the synthesis of oxide sub-micrometer particles and these include Y2O3, VxOy,Mn3O4, ZnO, CoTiO3, SnO2, PbO, and TiO2 [9, 10, 11, 12, 13, 14, 15, 16].
The solvent that is mostly used in polyol method in metal oxide nanoparticles synthesis is ethylene glycol because of its strong reducing capability, high dielectric constant, and high boiling point. Ethylene glycol is also used as a crosslinking reagent to link with metal ion to form metal glycolate leading to oligomerization [17]. It has been reported that as-synthesized glycolate precursors can be converted to their more common metal oxide derivatives when calcined in air, while maintaining the original precursor morphology [8].
The polyol synthesis process has also been used for the synthesis of bimetallic alloys and core-shell nanoparticles [18, 19, 20]. Yang and co-workers used polyol method to produce icosahedral and cubic gold particles on the order of 100–300 nm by careful regulation of the growth rate for each crystallographic direction [21]. Xia and co-workers reported the production of controlled morphologies such as nanocubes and nanowires by controlling the molar ratio between silver nitrate and PVP [22].
An emulsion is a liquid in liquid dispersion. A solution of polymers can produce emulsions as it is liquid. Emulsions are divided according to the size of droplet, i.e., macro-emulsions, mini-emulsions, and micro-emulsions [23].
Micro-emulsion synthesis method is widely used for the production of inorganic nanoparticles [24]. When oil and water are mixed, they separate into two phases as they are immiscible [25]. The energy input is required to mix the two phases to create water-oil.
An attempt to combine the two phases requires energy input that would establish water-oil connection replacing the water-water/oil-oil contacts. The interfacial tension between bulk oil and water can be as high as 30–50 dynes/cm and this can be avoided by using surfactants (surface-active molecules). Surfactants contain hydrophilic (water-loving) and lipophilic (oil-loving) groups [26]. The interface can be aligned and established between oil and water by reducing the interfacial tension if there are enough surfactant molecules.
The preparation procedure of metallic nanoparticles in water in oil microemulsion commonly consists of mixing of two microemulsions containing metal salt and a reducing agent, respectively as shown in Figure 1.
Schematic illustration of nanoparticles preparation using microemulsion techniques: Particle formation steps. Kchem is the rate constant for chemical reaction, kex is the rate constant for intermicellar exchange dynamics, kn is the rate constant for nucleation, and kg is the rate constant for particle growth [27].
Brownian motion is formed after the exchange of reactants (collision) between micelles that happens after mixing two microemulsions. Good collisions result into coalescence, fusion, and mixing well of the reactants. Metal nuclei are formed from the reaction between solubilizates. Bönnemann et al. reported the formation of zerovalent metal atoms at nucleation stage from reducing a metal salt, which can collide with additional metal ions, metal atoms, or clusters to form an irreversible seed of stable metal nuclei [28].
The growth stage happens around the nucleation point, where successful collision occurs between a reverse micelle moving a nucleus and another one moving the product monomers with the arrival of more reactants due to intermicellar exchange. The morphology and size of nanoparticles are based on the size and shape of the nanodroplets and the type of the surfactant. The surfactant is usually used to stabilize the particle and protect them from proceeding to grow [28].
Wongwailikhit et al. reported the formation of iron (III) oxide, Fe2O3 using water in oil microemulsion by combining the required amount of H2O in a stock solution of Sodium Bis (2-Ethylhexyl) Sulfosuccinate (AOT) in n-heptane. The solution was left overnight, then the concentrated Hydroxylamine (NH2OH) and FeCl3 were mixed into the water in oil microemulsion. Suspension of Fe2O3 was filtered and washed with 95% ethanol and dried at 300°C for 3 h. The product was spherical, monodisperse nanoparticles with diameter of about 50 nm. The size of particles depended on the water content in microemulsion system. The increase of particles size was achieved with increasing the water fraction in water in oil microemulsion [29].
Sarkar et al. reported the formation of pure monodispersed zinc oxide nanoparticles of different shapes. Microemulsion was composed of cyclohexane, Triton X-100 as surfactant, hexanol as cosurfactant and aqueous solution of zinc nitrate or ammonium hydroxide/sodium hydroxide complex. The molar ratio of TX-100 to hexanol was maintained at 1:4. The microemulsion containing ammonium hydroxide/sodium hydroxide was added to microemulsion containing zinc nitrate and stirred. The nanoparticles were then separated by centrifuging at 15,000 rpm for 1 h. The particles were washed with distilled water and alcohol and dried at 50°C for 12 h [30].
Maitra was the first to establish Chitosan nanoparticles by microemulsion technique. Chitosan nanoparticles were prepared in the aqueous core of reverse micellar droplets and crosslinked through glutaraldehyde. Surfactant dissolved in N-hexane was also used with chitosan in acetic acid and glutaraldehyde was added in the surfactant at room temperature. The mixture was stirred continuously and nanoparticles were produced [31].
Thermal decomposition also known as thermolysis is a chemical decomposition that is caused by heat. In this method, the heat is required to break chemical bonds in the compound undergoing decomposition and the reaction is endothermic. If decomposition is sufficiently exothermic, a positive feedback loop is created producing thermal runaway [32].
Arshad et al. reported on thermal decomposition of metal complexes of type MLX2 [M = Co (II), Cu (II), Zn (II), and Cd (II);L = DIE; X = NO31−] by TG-DTA-DTG techniques in air atmosphere. They synthesized nitrate complexes of transition metals with 1,2-diimidazoloethane (DIE) of the general formula M(DIE)(NO3)2. The study was conducted by thermoanalytical techniques in static air atmosphere to study the thermal behavior of these complexes and to determine their mode of decomposition. The complexes and ligands decomposed in a two-step process when heated to 740°. Above 740°, the residue was found to correspond with metal oxide. The thermal stability of the complexes increases in the following series: Co(II) < Cu(II) < Zn(II) < Cd(II) [33].
Patil et al. studied infrared spectra and thermal decompositions of metal acetates and dicarboxylates. The study was done to determine the metal-acetate bonding and the thermal decomposition of lead, copper, and rare earth acetates was studied by means of thermogravimetric analysis and differential thermal analysis. The investigations on decomposition products yielded good results [34].
George et al. reported on the mechanism of thermal decomposition of n-Buty l (tri-n-butylphosphine) copper (I). This study provided the first easily interpretable example in which succeeding reaction of a metal hydride and its parent metal alkyl was found to be vital in determining the products of a thermal decomposition [35].
Thermal decomposition of bismuth and silver carboxylates was investigated by means of TG, DSC, mass spectrometry, X-ray analysis, and electron microscopy Logvinenko et al. [36]. Non-isothermal thermogravimetric data were used for kinetic studies. All decomposition processes had multi-step character [36].
Ewell et al. investigated nearly pure talc both unheated and after heating at various temperatures ranging up to 1,435°C. The research included the measurement of heat effects, weight losses, and changes in true specific gravity occurring on heating talc. There was no change in the crystal structure of the talc heated up to 800°C. At the temperature between 800 and 8400°C, the talc decomposed to enstatite, amorphous silica, and water vapor. At the temperature approximately 1,200°C, the enstatite steadily changed to clinoenstatite and the amorphous silica changed to cristobalite approximately 1,300°C, giving clinoenstatite and cristobalite as end products [37].
Electrochemical synthesis is the synthesis of chemical compounds in an electrochemical cell. The main advantage of electrochemical synthesis over an ordinary chemical reaction is rejection of the potential wasteful alternative half-reaction and the ability to accurately tune the preferred potential [38].
Electrochemical synthesis of silver nanoparticles has been extensively studied in the previous years. The method of electrochemical that was used was based on the dissolution of a metallic anode in an aprotic solvent. The silver nanoparticles that were produced by electroreduction of anodically solved silver ions in acetonitrile containing tetrabutylammonium ranged from 2 to 7 nm. The particle size was obtained by varying the current density. Different types of counter electrodes were used to study the effect of the different electrochemical parameters on the end particle size. The UV-Vis spectra showed the presence of two different silver clusters [39].
Dobre et al. also reported on the electrochemical synthesis of colloidal silver solutions using “sacrificial anode” technique conducted with a home-built current pulse generator with alternating polarity and a stirrer. Poly (N-vinyl-2-pyrrolidone) (PVP) and sodium lauryl sulfate (Na-LS) were used as a stabilizer and co-stabilizer, correspondingly. Spherical Ag particles with the size approximately 10–55 nm were synthesized. The UV/Vis spectra showed the absorption band at 420 nm, which is the evidence of the presence of Ag nanoparticles. The zeta potential values between −17 and −35 mV suggested a presence of particles covered by stabilizer with a slight agglomeration [40].
More research was done on the electrochemical synthesis of silver nanoparticles in aqueous poly (vinyl alcohol) solution (PVA). PVA is a low price widely used synthetic polymer with properties such as nontoxicity, water solubility, biocompatibility, biodegradability, and excellent mechanical properties. The experiment was conducted at a constant current density of 25 mA cm−2 for a synthesis time of 10 min. Silver nanoparticles with an average diameter of 15 ± 9 nm were obtained [41].
The electrochemical synthesis of red fluorescent Silicon (Si) nanoparticles stabilized with styrene. Si nanoparticles emit fluorescence under UV excitation, which is great for optics applications, etc. It was found that the liberated silicon particles in ethanol solution interact with styrene, which resulted in the substitution of Si-H bonds with those of Si-C. The developed styrene-coated Si nanoparticles exhibited a stable, bright, red fluorescence under excitation with a 365 nm UV light, and resulted into approximately 100 mg per Si wafer with a synthesis time of 2 h [42].
More investigations were done on the preparation of long-lived silver nanoparticles in aqueous solutions and silver powders using electrochemical method. The produced silver nanoparticles had a size distribution ranging from 2 to 20 nm and the nanoparticles remained stable for more than 7 years. Silver crystals containing agglomerated silver nanoparticles with sizes below 40 nm was found growing on the surface of the cathode [43].
The research was conducted on using electrochemical method to synthesize highly pure silver nanoparticles. This method was used as it is one-step less expensive procedure and easy to control at room temperature and it does not use dangerous chemicals. The experimental setup brought up the oxidation of the anode and reduction of the cathode. The silver nanoparticles synthesized were spherical and had a particle size below 50 nm [44].
Islam et al. explored on the synthesis of platinum nanoparticles by electrochemical deposition method. The particle size was controlled by varying electrolysis parameters and homogeneity of platinum particles was improved by varying the composition of electrolytic solutions. Platinum nanoparticles were deposited on electrode surfaces and the particle sizes were found to be larger than 10 nm and had wide particle size distribution [45].
Plasma method is another method that is used to produce nanoparticles. The plasma is generated by radio frequency (RF) heating coils. The initial metal is enclosed in a pestle and the pestle is enclosed in an evacuated chamber. The metal is then heated above its evaporation point by high voltage RF coils wrapped around the evacuated chamber. The gas that is used in the procedure is Helium (He), which forms a high-temperature plasma in the region of the coils after flowing into the system. The metal vapor nucleates on the helium gas atoms and diffuses up to a cold collector rod, this is where nanoparticles are collected and they are passivated by oxygen gas (Figures 2 and 3) [46].
Flow diagram for production plant based on plasma burners. The recirculation system is of special importance in the case of expensive reaction or carrier gases.
Different plasma classification.
Classification of plasma methods based on the feeding materials to reactor and also the heating source (electrodeless/ electrode containing), see (Figures 2 and 3).
The chemical vapor deposition method (CVD) involves a chemical reaction. CVD procedure is mostly used in semiconductor manufacturing for depositing thin films of different materials. The method involves one or more volatile precursors, the substrate is exposed to those precursors that decompose on it and form the desired deposit. The vaporized precursors are inserted into a CVD reactor and adsorb onto a substance being placed at high temperature. The molecules that get adsorbed react with other molecules or decompose to form crystals. The three steps in CVD method are:
Reactants are transported on the growth surface by a boundary layer.
Chemical reactions occur on the growth surface.
By products produced by the gas-phase reaction has to be removed from the surface. Homogeneous nucleation occurs in gas phase and heterogeneous nucleation happens in a substrate.
The CVD method can synthesize ultrafine particles of less than 1 μm by the chemical reaction taking place in the gaseous phase. The reaction can be controlled to produce nanoparticles of size ranging from 10 to 100 nm [46, 47].
Microwave irradiation is a synthesis method that has been widely used in the synthesis of organic, inorganic, and inorganic–organic hybrid materials because of its well-known advantages over conventional synthetic routes [48].
A research was conducted on a rapid and efficient oxidation of organic compounds in microwave condition with new phase transfer oxidative agent: CTAMABC. CTMABC (1 mmole) was suspended in acetonitrile (2 ml) and an alcohol (l mmole in 0.5–1.5 ml of acetonitrile) was quickly added at room temperature and the resulting mixture was stirred vigorously. The mixture was then irradiated by microwave radiation (3.67 GHz, 300 W). The solution became homogeneous for a short time before the black-brown reduced reagent precipitated. Thin layer chromatography (TLC) and UV/VIS spectrophotometer (at 352 nm) were used to monitor the progress of reactions [49].
In another experiment conducted by Sahoo Biswa Mohan et al., o-Phenylenediamine (1.08 g, 0.01 mole) and anthranillic acid (1.37 g, 0.01mole) were dissolved in ethanol (15 ml). And K2CO3 was added to a mixture and the reaction mixture was put in microwave oven and refluxed at power (140 Watt) for 10 min. TLC was used to monitor the reaction. After the reaction was complete, ethanol was removed by distillation process and the residue was poured into crushed ice. Then the reaction was made alkaline by using 10% NaOH to get the solid product. The product was filtered, dried, and recrystallized from ethanol [50].
Sahoo Biswa Mohan et al. conducted another experiment where N-(2-(1H-benzo[d]imidazol-2-yl) phenyl) acetamide (2.51 g, 0.01 mole) was dissolved in ethanol (30 ml) and various aromatic aldehydes (0.01 mole) were taken and then an aqueous solution of KOH (2%, 5 ml) added to it. The reaction was then put in a microwave oven and refluxed at power (210 Watt) for 10–20 min. The excess solvent was removed by vacuum distillation and then poured into crushed ice and acidified with dilute HCl. The product was filtered, dried, and recrystallized from ethanol [51].
Microwave-assisted organic synthesis has been widely used due to enhanced reaction rates, higher yields, improved purity, ease of work up after the reaction and eco-friendly reaction conditions compared to the conventional methods. In above experiments, microwave irradiated synthesis of chalcone was carried out to get higher yield with less reaction time period as compared to conventional method.
The synthesized benzimidazolyl chalcone produces yield around 60% (conventional) and 80% (microwave) [52].
Another study was conducted to synthesize silver nanoparticles (AgNPs) in aqueous medium by a simple, efficient, and economic microwave-assisted synthetic route using hexamine as the reducing agent and the biopolymer pectin as stabilizer. The synthesized AgNPs were characterized by UV-VIS, Spectroscopy, Energy dispersive X-ray (EDX), X-ray diffraction (XRD), and Transmission electron microscopy (TEM) techniques. The nanoparticles were found to be spherical shape with an average diameter of 18.84 nm. The rate of reaction was found to increase with increasing temperature and the activation energy was found to be 47.3 kJ mol−1 [53].
ZnS nanoparticles were synthesized by microwave-assisted irradiation method. The produced ZnS nanoparticles were characterized by XRD, SEM, and UV-Vis spectroscopy. The average size of the nanocrystallites was measured by Debye-Scherrer formula as per the XRD spectrum, and there were found to be approximately 6 nm [54].
Pulsed laser method is a method that is mostly used in the synthesis of silver nanoparticles, at a high rate of production of 3 gm/min. Silver nitrate solution and a reducing agent are poured into a blender-like device. The device is composed of a solid disc that rotates with the solution. The disc is exposed to pulses from a laser beam to create hot spots on the surface of the disc. Hot spots are where the silver nitrate reacts with reducing agent to produce silver particles that can be separated by centrifuge. The particle size is controlled by the energy of the laser and angular velocity of the disc [46] (Figures 4 and 5).
Synthesis of nanoparticles using a pulsed laser method [46].
Apparatus to produce silver nanoparticles using a pulsed laser beam that makes hot spots on the surface of a rotating disk [54].
Sonochemical method has been studied in the synthesis of metal nanoparticles. The synthesis of different types of metal nanoparticles has been studied by use of the sonochemical reduction of the corresponding metal ions. The sonochemical reduction of MnO4−, Au3+, Au+, and Pd2+ in the absence and presence of organic additives were investigated in relation to the synthesis of size and shape controlled metal nanoparticles. The rates of reduction were controlled to control the size and shape of metal nanoparticles. The size of the Au nanoparticles formed from the sonochemical reduction of Au3+ was controlled in the presence of an organic stabilizer citric acid [55].
Obreja et al. conducted a study on alcoholic reduction platinum nanoparticles synthesis by sonochemical reduction. H2PtCl6 was reduced with methanol, ethanol, and propanol working as solvents and reducing agents, in the presence of capping polymers such as chitosan, polyethylene glycol, and poly (amidehydroxyurethane). The produced nanoparticles size was found to be approximately 3 nm [56].
Gamma radiation is the preferred method for metallic nanoparticles synthesis because it is reproducible, may control the shape of the particles yields monodisperse metallic nanoparticles, is easy, cheap, and use less toxins precursors: in water or solvents such as ethanol, it uses the least number of reagents, it uses a reaction temperature close to room temperature with as few synthetic steps as possible (one-pot reaction) and minimizing the quantities of generated by-products and waste [57].
The radiolytic reduction has been proven to be a powerful tool to fabricate monosized and highly dispersed metallic clusters [58]. The primary effects of the interaction of high-energy gamma photons with a solution of metal ions are the excitation and the ionization of the solvent [59]. The different reactions that are observed are well explained in the paper by Abidi and Remita. In particular, water can be produce upon irradiation of a series of reducing and oxidizing agents as shown in the following equation.
For the production of metallic nanoparticles from metallic salt solutions, the reducing agents e−aq and H• are the cornerstones of the process. Unfortunately, the production of hydroxyl radicals OH• hampers the efficiency unless some specific hydroxyl scavengers are used. Among them, isopropanol is frequently used [60].
This technique has been widely used so far to produce solutions of MNP primarily gold and silver that were further investigated by UV-Visible spectroscopy with the aim to analyze their plasmonic absorption band. A wealth of literature can be found on this topic [61, 62]. Additionally, γ rays irradiation was also used to trap MNP inside polymers or inside porous frameworks like mesoporous silica for instance [63, 64, 65].
Nanoparticles have gained significant interest due to their unique chemical and physical properties and are applicable to diverse areas. Various methods of preparation of nanoparticles have been developed and they are suitable for synthesis of nanoparticles in different sizes and shapes. The methods that were discussed include gamma irradiation, chemical reduction photochemical method, thermal decomposition, and microwave irradiation among others.
The author is particularly grateful to National Research Foundation, University of South Africa, iThemba LABS and L’Oreal For Women in Science for their support and funding.
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