Postsurgical Phase Research Articles

Reverse RV remodeling after isolated tricuspid valve surgery

Abstract Background Impact of tricuspid regurgitation (TR) on right ventricular (RV) and atrial (RA) size and function is one of the main determinants of prognosis. However, there is scarce data about the recovery of right chambers after isolated tricuspid valve surgery (ITVS). Purpose Our aim is to evaluate postsurgical changes in right chamber morphofunctional parameters by echocardiography after ITVS. Methods We selected all the patients that underwent ITVS in our tertiary centre between 2009 and 2022 excluding those with congenital anomalies. Echocardiographic right ventricular classical parameters (RV diameters, RA area, TAPSE and fractional area change (CAF)) as well as myocardial deformation (free wall (FW)- and 4 chambers (4C)- global longitudinal strain (GLS)) were compared in baseline studies, early and late postsurgical periods. Results Among the 45 patients included (65 ± 2 years-old, 51% female, TRI-SCORE 2 [1-4]) surgical indication was functional TR in 51%, 29% underwent tricuspid valve repair and 71% replacement. The treatment was considered ineffective (postoperative TR ≥ moderate) in 9%. In the early postsurgical phase (1.9 [1.2 – 3] months) a significant reduction in basal (-17%, p<0.01), mid (-15%, p<0.01) and longitudinal (- 7%, p<0,01) RV diameters as well as RA area (-26%, p<0.01) was noted. These changes persist in the late postoperative period for basal (-16%, p<0.01) and mid (-20%, p<0.01) RV diameters and RA area (-19%, p=0.03). RV function parameters suffer significant reduction in the early phases: TAPSE (-39%, p<0.01), FAC (-24%, p<0.01), FW-GLS (-17.1%, p<0.01) and 4C-GLS (-16.3%, p<0.01). In later stages the major worsening in classical parameters persist: TAPSE (-28%, p=0.01) y FAC (-20%. P=0.01). However, strain variables recover to the baseline values. Postoperative RV reverse remodeling is reflected in Table and Figure. Conclusions Postoperative changes in echocardiographic right chambers features after ITVS suggest that myocardial deformation parameters should be the method of choice for follow-up of this surgical procedure. Table. Comparison of baseline and postsurgical echocardiographic parameters. Figure. Echocardiographic parameters evolution.TableFigure

P11.05.B LONGITUDINAL MODIFICATIONS OF GRADIENTS AND GRAPH-THEORY MEASURES OF FUNCTIONAL MRI CONNECTIVITY IN GLIOMA PATIENTS AS POTENTIAL MARKERS OF POST-SURGICAL LONG-TERM COGNITIVE OUTCOME

Abstract BACKGROUND Integrating connectomics and functional brain activity into the study of brain tumors is among neuro-oncology’s challenges. Functional MRI (fMRI) studies showed that gliomas are integrated with brain networks’ activity, exerting effects beyond their margins. We investigated longitudinal modifications of fMRI gradients and graph-theory parameters in glioma patients, assessing their role in cognitive prognostication. MATERIAL AND METHODS Diffuse non-enhancing glioma patients underwent fMRI and cognitive assessments (OCS-Bridge) before, within 72h after, 3 and 12 months after surgery. Cognitive data were normalized and averaged into a global score. Differences between the last and preoperative scores were computed (“cognitive difference”). fMRI data underwent preprocessing, cortical parcellation, computation of timeseries, connectivity matrices, gradients and graph-theory measures. To quantify gradient dispersion, we computed a circularity metric (“CM”) of the hull perimeter of the first two gradients’ distribution. T-tests, partial correlations (correcting for volume and surgery radicality) and linear regression (regressors: age, volume, preoperative cognition, surgery radicality) were used to investigate associations with cognitive difference. RESULTS 17 patients (22-56 years, 8 females) were included, 4 had long-term cognitive worsening. Postoperative circularity metric, especially of the healthy intra- and inter-hemispheric connectivity (“HIIHC”), was higher than the preoperative (0.43 vs 0.32, t=2.4, p=0.03). Month3-postoperative and month3-preoperative differences in HIIHC CM were higher in patients with compared to those without cognitive worsening (0.33 vs -0.06, t=6.9, p<0.0001 and 0.27 vs 0.009, t=4.3, p=0.001). Both were negative predictors of the cognitive difference (the first: R=-0.94 with p=0.0002; β=-1.1 with p=0.001 and regression model’s p=0.003; the second: R=-0.76 with p=0.006; β=-1.1 with p=0.02 and model’s p=0.05). Month3-preoperative network modularity difference correlated with the second metric (R=-0.72, p=0.01) and the cognitive difference (R=0.67, p=0.02), while the preoperative modularity with the first metric (R=0.77, p=0.014). Similar results were obtained using a predetermined number of modules (Yeo’s 7 networks). Month12-preoperative difference in healthy intra-hemispheric connectivity CM also correlated with cognitive difference (R=-0.91, p=0.002). CONCLUSION Functional gradients seem dispersed after glioma surgery. Their recovery or worsening at month 3 could predict opposite long-term cognitive outcomes, putatively due to connectivity changes mainly involving the healthy hemisphere. Low preoperative network modularity and its increase at month 3 are associated with such gradient dispersion. Cognitive rehabilitation might be beneficial in the early post-surgical phase.

Antibiotics for surgical site infections in patients undergoing orthognathic surgery.

PubMed, Embase, Web of Science and Scopus. Randomized Controlled Trials (RCTs) for patients undergoing orthognathic surgery of any type, which evaluated surgical site infections (SSI) in either: long-term (at least 2 days) post-surgical antibiotic dosing versus short term (one day) post-surgical dosing for the same drug; or Orthognathic surgery patients administered a post-surgical single-day antibiotic versus a singular pre-operative dosing of any antibiotic in the post-surgical phase. Singe-arm studies, retrospective studies, unpublished data, studies which were not peer-reviewed, editorials and trials not dealing with patients undergoing orthognathic surgery specifically were not included. Data for the publication year, primary author name, location of the study, antibiotic type, antibiotic protocol with its type, dosing and timing, sample size, protocol of the control group, male gender, age, diagnosis and rates of SSIs were extracted from the included studies. Pooled rates of SSIs were utilized to produce risk ratio (RR). A total of eleven RCTs met the inclusion criteria. As per the meta-analysis, post-orthognathic surgery SSI risk was reduced significantly as a result of long-term prophylactic antibiotic usage when compared to short-term utilization. Further, the meta-analysis demonstrated that there was a significant reduction of SSI risk in patients on a single day prophylactic antibiotic regimen in comparison to those on a single preoperative antibiotic dose. The study observed that long-term (2-7 days) prophylactic antibiotics reduce SSI risk when compared to antibiotic administration over a single day. In turn, it was also found that the latter was of greater benefit over a pre-operative single antibiotic dosage.

Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings.

Evaluate the relationship between psychological distress, namely anxiety and depression, with urinary continence and recovery of erectile function in patients undergoing radical prostatectomy (RP). We retrospectively analyzed data from 33 consecutive patients who underwent RP in a single tertiary-referral academy between 01/2018 to 01/2019. We used the International Index of Erectile Function (IIEF-15), the Sexual Complaints Screener for Men (SCS-M), and the Hospital Anxiety and Depression Scale (HADS), validated questionnaires for the assessment of sexual function, anxiety, and depression experiences, respectively. These questionnaires were administered at the pre-surgical visit, after surgery, and at intermediate follow-ups (three, six, and twelve months). The analysis of the questionnaires completed during follow-up shows that erectile function is the most affected, with 90% erectile dysfunction (ED) at three months after surgery. In terms of emotional states, anxiety prevails in the first months following surgery and is statistically significantly associated with incontinence (p = 0.02). Depressive symptoms, on the other hand, appear later and prevail over anxiety at six months after surgery, although not statistically significant. In the early post-surgical phase anxiety and ED are the most frequently detected components, while depressive experiences and decreased desire, typical of later stages, have not yet fully emerged.

Evaluation of Plasma Glycosaminoglycan in monitoring the patients of Renal cell carcinoma after Nephrectomy

Renal cell carcinoma is the thirteenth most widespread malignancy worldwide and is the leading cause of urogenital tract cancers. Worldwide, renal cell carcinoma is sixth most prevalent cancer in males and tenth most in females. Its diagnosis is based on histological findings and CT scans that were performed for isolated symptoms. Treatment options include chemotherapy, radiofrequency ablation, nephron-sparing surgery, and radical nephrectomy. Therefore, there is a need for an early non-invasive bio marker for diagnosis, disease surveillance, as well as for monitoring of RCC after therapy. Objective: To determine the role of plasma glycosaminoglycans levels for monitoring and prognosis of renal cell carcinoma patients after nephrectomy. Methods: A Cross sectional study was taken place at Armed forces institute of Pathology in collaboration with Armed forces institute of urology from July 2021 to Dec 2022. A total of 124 samples were included in study, out of which 62 samples were collected from pre-operated patients and another 62 from same RCC patients after operation. Plasma Glycosaminoglycans levels were analyzed through manual enzyme linked immunosorbent assay by non-competitive sandwich technique. Quantitative variables were calculated by means and standard deviation while qualitative variables were assessed as frequency and percentage. Paired t test was applied to check statistical significance of the difference between the means of pre-operative and post-operative cases. Results: Mean age of total population was 39.24±15.90 years. Taking in account age, gender and staging of pre- and post-operative patients, the results revealed significant post-Surgical decrease in plasma glycosaminoglycans levels (p value <0.05). In renal cell carcinoma patients 74(61.7%) were in T2NM0 stage while 31(25.8%) in T3NM0 stage and 15(12.5%) in T4NM0 stage. Majority of patients lied in T2NM0 stage while T3NM0 stage was common in males and T4NM0 stage in females. Conclusion: Plasma glycosaminoglycans levels is a potential biomarker in post-surgical phase of RCC patients. It can be utilised as a promising marker to monitor RCC patients after nephrectomy. The non-invasive nature of the test will help monitoring of such patients which will prove convenient for both patient and treating surgeon.

Comparative efficacy of three anesthetic protocols on cardiac parameters during ovary-hysterectomy in bitches

This study aimed to compare the general electrical heart activity, blood pressure, and heart rate when using three anesthetic protocols for ovariohysterectomy in bitches. In total, 33 healthy canines were selected, distributed in 3 groups of 11 animals each, aged between 1 and 3 years, and with a body weight of 8 to 15 kg from shelters in Bucaramanga, Colombia. Three anesthetic protocols in a completely randomized experimental designwere used. Protocol 1: Ketamine (7 mg/kg) + pentobarbital sodium (1 mg/kg); Protocol 2: Ketamine (7 mg/kg) + propofol (3 mg/kg); Protocol 3: Tiletamine + zolazepam (7 mg/kg). The individual outcomes were classified according to the American Society of Anesthesiologists (ASA I). The results showed that parameters evaluated in the surgical phase significantly increased in patients with Protocol 1 (p<0.05). Protocol 2 showed a better performance in the post-surgical phase (p<0.05) compared with others. Patients with Protocol 3 presented fewer alterations in the electrical conduction of cardiac activity than the other protocols, and quicker recovery after the surgery.

Immunonutrition in Radical Cystectomy: State of the Art and Perspectives.

Preoperative nutritional status is a pivotal aspect to consider in patients with cancer undergoing radical cystectomy (RC), as those at risk of malnutrition or already malnourished are more prone to post-surgical complications. The loss of muscle mass is a major consequence of cancer-related malnutrition. It is associated with increased risk of hospital readmission, longer hospitalization, and higher mortality. Nowadays, the close relationship between nutritional and immunological aspects under stressful conditions, such as surgery, represents an emerging scientific and clinical issue. Indeed, the synergistic action of reduced food intake and systemic inflammation generates metabolic derangements with tissue catabolism, including skeletal muscle breakdown, which is, in turn, associated with immune system dysfunction. In order to offer an additional immune-nutritional boost to the post-surgical phase, particularly in malnourished patients, nutritional support may include oral nutritional supplements and/or enteral formulas enriched with specific nutrients such as omega-3 fatty acids, arginine, glutamine, and nucleotides, with acknowledged immune-modulating effects. In the present narrative review, we addressed the state of the art of the available scientific literature on the benefit of immunonutrition in patients undergoing RC for cancer and suggest possible future perspectives to be explored. Although the role of immunonutrition was found to be little explored in the context of urologic oncology, the preliminary available data on radical cystectomy, summarized in the present paper, are promising and suggest that it may improve postoperative outcomes through immunomodulation, regardless of nutritional status before surgery.

Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases.

Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT in most cases. In many studies, the effectiveness of local RT of the resection cavity, either as single-fraction stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic RT (hFSRT), has been demonstrated to be effective and safe. However, whereas prospective high-level incidence is still lacking on which dose and fractionation scheme is the best choice for the patient, further ablative techniques have come into play. Neoadjuvant SRS (N-SRS) prior to resection combines straightforward target delineation with an accelerated post-surgical phase, allowing an earlier start of systemic treatment or rehabilitation as indicated. In addition, low-energy intraoperative RT (IORT) on the surgical bed has been introduced as another alternative to external beam RT, offering sterilization of the cavity surface with steep dose gradients towards the healthy brain. This consensus paper summarizes current local treatment strategies for resectable brain metastases regarding available data and patient-centered decision-making.

Imaging Features of Main Hepatic Resections: The Radiologist Challenging.

Liver resection is still the most effective treatment of primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and of metastatic disease, such as colorectal liver metastases. The type of liver resection (anatomic versus non anatomic resection) depends on different features, mainly on the type of malignancy (primary liver neoplasm versus metastatic lesion), size of tumor, its relation with blood and biliary vessels, and the volume of future liver remnant (FLT). Imaging plays a critical role in postoperative assessment, offering the possibility to recognize normal postoperative findings and potential complications. Ultrasonography (US) is the first-line diagnostic tool to use in post-surgical phase. However, computed tomography (CT), due to its comprehensive assessment, allows for a more accurate evaluation and more normal findings than the possible postoperative complications. Magnetic resonance imaging (MRI) with cholangiopancreatography (MRCP) and/or hepatospecific contrast agents remains the best tool for bile duct injuries diagnosis and for ischemic cholangitis evaluation. Consequently, radiologists should be familiar with the surgical approaches for a better comprehension of normal postoperative findings and of postoperative complications.

The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy.

Obesity is associated with a higher risk of cardiac arrhythmias. Sleeve gastrectomy (SG) is a common bariatric surgery with beneficial effects on weight loss and comorbidities. The study aimed to investigate the prevalence of arrhythmias during maximal exercise testing in patients with moderate-severe obesity and to evaluate the impact of SG on these arrhythmic events. All patients with moderate or severe obesity who were considered suitable candidates for SG between June 2015 and September 2020 were recruited. Each patient underwent three incremental, maximal, ECG-monitored cardiopulmonary exercise test 1 month before and 6 and 12 months after SG; the frequency and complexity of ventricular premature beats (VPBs) and atrial premature beats (APBs) have been evaluated during rest, exercise and recovery phases. Fifty patients with severe obesity (BMI 46.39 ± 7.89 kg/m2) were included in the study. After SG, patients presented a decreased BMI (34.15 ± 6.25 kg/m2 at 6 months post-SG and 31.87 ± 5.99 kg/m2 at 12 months post-SG). At 6 months post-SG, an increase in VPBs, mainly during the recovery phase, was observed. At 12 months post-SG, a reduction in VPBs compared with the 6 months evaluation was showed. Although in the early post-surgical phase the risk of exercise-induced arrhythmias may be higher, SG does not seem to increase the occurrence of arrhythmias in the long-term. No life-threating arrhythmias were found during post-SG evaluations.

Midterm postoperative outcomes of different types of surgical reconstruction of sinus venosus atrial septal defects with anomalous pulmonary venous connection: The Results of Prospective Cohort Study.

Sinus venosus atrial septal defects (SVASDs) constitute a substantial part of atrial septal defects and are usually characterized by anomalous pulmonary venous connection (APVC), causing complications like sinus node dysfunction and arrhythmias. Several surgical approaches are used for treating SVASDs in pediatric patients, including single- and two-patch techniques. The study aimed to prospectively evaluate and compare the safety and efficacy of these two methods with different follow-up periods. Ten patients aged 1-8 years with SVASDs and partial APVC were enrolled in the study at Bhanubhai and Madhuben Patel Cardiac Centre, Karamsad, India, between December 2018 and October2021. The single-patch (sandwich-patch) technique was used in two patients, whereas the two-patch (dual-patch) technique with autologous pericardium was used in seven. Safety was assessed as the absence of complications in the follow-up periods of 6 months, 1, and 2 years, whereas efficacy was estimated by the preserved sinus rhythm and the development of arrhythmias. Electrocardiographic and echocardiographic methods were used to evaluate both parameters. No deaths, reoperations, pulmonary vein, and superior vena cava (SVC) stenosis or phrenic nerve palsy were observed among the 10 patients in the three follow-up periods. Sinus rhythm was arrested in two of the seven patients who underwent two-patch repair, whereas no rhythm disturbances occurred in those who underwent single-patch repair. Both techniques used in SVASD repair with autologous pericardium proved to cause the smaller rate of complications in midterm postsurgical phase. However, there is a potentially great risk of the development of sinus node malfunction after the application of the two-patch technique. Therefore, methods avoiding sinus node interference are preferred in patients with partial APVC involving SVC.

Administration of procaine-based local anaesthetic prior to surgical castration influences post-operative behaviours of piglets

In an effort to mitigate piglet acute responses to surgical castration, the procedure can be preceded by injections of a local anaesthetic. Regardless of potential benefits at castration, the impact of local anaesthetics on piglet welfare following the procedure remains under-documented. The present paper is based on data collected in two separate castration studies investigating the impact of injection with procaine, using different injection methods, different volumes of injected drug and different timing of injection, on behavioural responses of 3–4 day old piglets, as measured by indicators of social motivation immediately after castration (Study 1 and 2), as well as behaviours recorded continuously for 10 min upon return to the home pen (Study 2 only). Study 1 involved 597 piglets, and 13 treatments: castration without anaesthesia (CC), local anaesthesia followed by castration involving all combinations of two methods of injection (intra-funicular and intra-testicular) and four intervals between injection and castration (2.5, 5, 10 and 30 min), and sham handling separated by the same four intervals (SH). Study 2 involved 290 piglets and 5 treatments: castration without anaesthesia (CC), castration after intra-testicular injections of 0.5 or 0.3 mL of procaine per testis, and sham handling with either one (SH1) or two stays in a castration bench (SH2). Across both studies, piglets injected with procaine showed signs of reduced motivation to approach their siblings in the social motivation test compared to controls castrated without anaesthesia or sham handled. The indicators of social motivation did not differ from the controls in case of castration 30 min after drug injection. In addition, responses shown in the social motivation test were less impacted after injection of 0.3 compared to 0.5 mL of procaine per testis. In Study 2, piglets injected with 0.5 mL of procaine appeared to be less active at the udder, and displayed more huddled up postures, immediately upon return to the home pen, as compared to piglets injected with 0.3 mL of procaine or the controls castrated without anaesthesia or sham handled. Altogether, the results suggest that injections with a procaine-based local anaesthetic negatively impact the responses of piglets in a test of social motivation as well as the home-pen behaviour of piglets in the early post-operative period. The present results call for attention towards the post-surgical phase, but understanding the potential welfare impacts as well as the motivational changes underlying these findings require further study.

Long-term three-dimensional condylar remodeling during presurgical orthodontics and after orthognathic surgery of mandibular retrognathia with high mandibular plane angle.

Patients with high mandibular plane facial morphology are the most dominant facial type who experience TMJ abnormalities with resultant condylar resorption, affecting the orthodontic and orthognathic treatment outcomes. The study aimed to quantitatively assess the three-dimensional condylar remodeling during the presurgical orthodontics and after orthognathic surgery of the retrognathic mandible with a high mandibular plane angle. The study also investigated the correlation between the resultant remodeling based on the hypothesis that condylar resorption following orthognathic surgery is a part of a progressive presurgical resorption process. The study included adults with mandibular retrognathism and high mandibular plane angle who have computed tomography scans (CT) obtained before any treatment (T0), after completion of presurgical treatment before surgery (T1), and at long-term follow-up after surgery (T2). DICOM of CT scan was gathered and processed using ITK-SNAP and 3D Slicer software. The interval between T0 and T1 was represented as a presurgical phase, while between T1 and T2 was defined as a postsurgical phase (T1-T2). Twenty-five patients (50 condyles) were included with a mean age of 23 ± 3.2years. The mean of the follow-up during the presurgical phase was 19.8 ± 7.1months and 15.5 ± 5.5months during the postsurgical phase. The condylar volume during the presurgical phase (T0-T1) was relatively stable (- 3.3 ± 37.2mm3). However, during the postsurgical phase (T1-T2), the volume was significantly reduced - 113.8 ± 98.3mm3 (P < 0.001). Localized condylar surface resorption during the postsurgical phase was significantly higher than during the presurgical phase (P < 0.05). No correlation was found between the localized condylar surface remodeling during the presurgical and postsurgical phases. However, a negative statistically significant correlation existed between the overall condylar volume changes during the presurgical and postsurgical phases (r = 0.502, P < 0.001). Significant condylar resorption following orthognathic surgery of the retrognathic mandible with a high mandibular plane angle might occur regardless of the presurgical status of the condyle. The study provided anevidence to be discussed with the patients and considered throughout the treatment of mandibular retrognathia with high mandibular plane angle.

The magnitude and perceived reasons for childhood cancer treatment abandonment in Ethiopia: from health care providers’ perspective

BackgroundTreatment abandonment is one of major reasons for childhood cancer treatment failure and low survival rate in low- and middle-income countries. Ethiopia plans to reduce abandonment rate by 60% (2019–2023), but baseline data and information about the contextual risk factors that influence treatment abandonment are scarce.MethodsThis cross-sectional study was conducted from September 5 to 22, 2021, on the three major pediatric oncology centers in Ethiopia. Data on the incidence and reasons for treatment abandonment were obtained from healthcare professionals. We were unable to obtain data about the patients’ or guardians’ perspective because the information available in the cancer registry was incomplete to contact adequate number of respondents. We used a validated, semi-structured questionnaire developed by the International Society of Pediatric Oncology Abandonment Technical Working Group. We included all (N = 38) health care professionals (physicians, nurses, and social workers) working at these centers who had more than one year of experience in childhood cancer service provision (a universal sampling and 100% response rate).ResultsThe perceived mean abandonment rate in Ethiopia is 34% (SE 2.5%). The risk of treatment abandonment is dependent on the type of cancer (high for bone sarcoma and brain tumor), the phase of treatment and treatment outcome. The highest risk is during maintenance and treatment failure or relapse for acute lymphoblastic leukemia, and during pre- or post-surgical phase for Wilms tumor and bone sarcoma. The major influencing risk factors in Ethiopia includes high cost of care, low economic status, long travel time to treatment centers, long waiting time, belief in the incurability of cancer and poor public awareness about childhood cancer.ConclusionsThe perceived abandonment rate in Ethiopia is high, and the risk of abandonment varies according to the type of cancer, phase of treatment or treatment outcome. Therefore, mitigation strategies to reduce the abandonment rate should include identifying specific risk factors and prioritizing strategies based on their level of influence, effectiveness, feasibility, and affordability.

The incidence of cardiac arrhythmias during exercise stress testing among patients with obesity undergoing sleeve gastrectomy

Abstract Funding Acknowledgements Type of funding sources: None. Background Obesity is associated with higher rate of cardiovascular morbidity and mortality, anatomical and functional cardiac alteration.(1) In particular, several studies found an association between increased body weight and arrhythmic events.(2) Sleeve Gastrectomy (SG) is recognized as significant treatment option for obesity, with beneficial effect in both weight loss and comorbidities.(3) Moreover, this treatment results in positively decrease in some basal parameters currently associated with increased risk of arrhythmic events, even if little is known about real incidence of cardiac arrhythmias, especially during exercise, before and after bariatric surgery.(4) Purpose To investigate the prevalence of arrhythmic events during maximal exercise testing in patients with moderate-severe obesity and to evaluate how SG affects the number of arrhythmic events. Methods All patients with moderate or severe obesity who were considered suitable candidates for SG after multidisciplinary evaluations were consecutively included in this study. Each patient underwent an incremental, maximal, ECG-monitored cardiopulmonary exercise testing (CPET) before and 6-months after SG. Presence and complexity of atrial premature beats (APBs) and ventricular premature beats (VPBs) has been evaluated at rest, during exercise and during recovery phase. Results 318 patients with morbidly obesity (BMI 44.20±6.79 kg/m2, age 48.9±10.7 years) were included in the study. After SG, patients presented lower heart rate at rest (80.75±12.60 versus 64.84±9.89 bpm, p&amp;lt;0.001) and an increased exercise time (831.30±195.32 versus 941.13±222.16 s, p&amp;lt;0.001). The analysis of the arrhythmic events during the complete test showed a slight significant difference between pre-SG and post-SG, only regarding number of patients presenting APBs (p=0.038). However, the incidence of arrhythmic events was significantly increased during the recovery phase in post-SG evaluation, both by number of patients with at least one arrhythmic episode and by number of arrhythmic events per minute (Table I). Patients affected by severe obesity had a higher risk occurrence of arrhythmias during CPET, notably atrial premature beats (p=0.038), when compared to patients with moderate obesity. No differences were found among post-SG patients. Men presented more frequently VPBs compared to women, both in pre-SG (p=0.048) and post-SG evaluation (p&amp;lt;0.001). No gender differences were observed in APBs (Figure 1). Conclusion Patients affected by severe obesity show an increased prevalence of atrial premature beats, even if no episode of exercise-induce atrial fibrillation has been described. In the early post-surgical phase, the risk of exercise-induced arrhythmias may be higher during the recovery phase, although SG does not seem to increase the occurrence of life-threating arrhythmias.

Suppression of Neuroinflammation Attenuates Persistent Cognitive and Neurogenic Deficits in a Rat Model of Cardiopulmonary Bypass.

Post-operative cognitive dysfunction (POCD) can be a serious surgical complication, and patients undergoing cardiac procedures are at particular risk for POCD. This study examined the effect of blocking neuroinflammation on behavioral and neurogenic deficits produced in a rat model of cardiopulmonary bypass (CPB). Minocycline, a drug with established anti-inflammatory activity, or saline was administered daily for 30 days post-CPB. Treatment with minocycline reduced the number of activated microglia/macrophages observed in the dentate gyrus of the hippocampus at 6 months post-CPB, consistent with an anti-inflammatory action in this CPB model. Behavioral testing was conducted at 6 months post-CPB utilizing a win-shift task on an 8-arm radial maze. Minocycline-treated animals performed significantly better than saline-treated animals on this task after CPB. In addition, the CPB-induced reduction in adult neurogenesis was attenuated in the minocycline-treated animals. Together, these findings indicate that suppressing neuroinflammation during the early post-surgical phase can limit long-term deficits in both behavioral and neurogenic outcomes after CPB.

Toward Evidence-Based Severity Assessment in Mouse Models with Repeated Seizures: (II.) Impact of Surgery and Intrahippocampal Kainate

Introduction: Chronic epilepsy models require neurosurgical procedures including depth electrode implants. The intrahippocampal kainate model is a frequently used chronic paradigm, which is based on chemoconvulsant administration and status epilepticus induction during the surgical procedure. This experimental approach raises the question of the extent to which this approach affects postsurgical recovery. In addition to the short- and long-term impact of the surgical intervention, a potential impact of highly frequent electrographic seizure events needs to be considered in the context of severity assessment. Methods: Various behavioral, biochemical, and telemetric parameters were analyzed in four experimental groups of mice: 1st naive, 2nd with transmitter implants, 3rd with transmitter and electrode implants, and 4th with transmitter implants, electrode implants, and kainate-induced status epilepticus. Results: During the early postsurgical phase, transmitter implants caused a transient impact on Mouse Grimace scores and intragroup increase of fecal corticosterone metabolites. Additional craniotomy was associated with an influence on total heart rate variability and fecal corticosterone metabolites. Heart rate and Irwin score increases as well as a prolonged increase in Mouse Grimace scores pointed to an added burden related to the induction of a nonconvulsive status epilepticus. Data from the chronic phase argued against a relevant influence of frequent electrographic seizures on behavioral patterns, fecal corticosterone metabolites, heart rate, and its variability. However, Irwin scores indicated long-term changes in some animals with increased reactivity, body tone, and Straub tail. Interestingly, selected behavioral and telemetric data from the early post-status epilepticus phase correlated with the frequency of electrographic seizure events in the chronic phase. Conclusion: In conclusion, our findings argue against the pronounced impact of highly frequent electrographic seizures on the well-being of mice. However, an increased level of nervousness in a subgroup of animals should be considered for handling procedures and refinement measures. In the early postsurgical phase, several parameters indicate an influence of the interventions with evidence that the nonconvulsive status epilepticus can negatively affect the recovery. Thus, the development and validation of refinement efforts should focus on this experimental phase. Finally, the datasets suggest that simple readout parameters may predict the long-term consequences of the epileptogenic insult. Respective biomarker candidates require further validation in the follow-up studies in models with subgroups of animals with or without epilepsy development.

Gingival Recession Treatment with the Use of Xenogeneic Matrix: Optimization of Patient-Centered Outcomes by the Digital Soft Tissue Design

Objective: To evaluate the impact of the originally-developed approach aimed at pre-treatment graphical modelling of soft-tissue changes (digital soft tissue design) for the optimization of patient-centered outcomes after Class I and Class II single gingival recessions treatment with the use of a xenogeneic dermal matrix. Material and Methods: Patients enrolled in the study group received single gingival recession treatment via CAF+XDM method supported by pre-treatment graphical modelling of potential soft-tissue changes (digital soft tissue design), while patients enrolled in the control group received single gingival recession treatment via CAF+CTG method with no pre-treatment graphical modeling of gingival level changes. Patient-centered outcomes were measured by visual analogue scale, OHIP-14, and Mahajan's scales. Results: Realization of pre-treatment graphical modelling of soft-tissue changes supported the achievement of better patient-centered outcomes, such as root coverage (p<0.05), surgical phase (p<0.05), post-surgical phase (p<0.05), cost-effectiveness (p<0.05) and diagnostics and patient-orientation (p<0.05) based on patient's personal perception grades. Conclusion: Patient-centered results were found to be more successful within the group using the xenogeneic type of graft accompanied with the implementation of pre-treatment graphical modeling of soft tissue changes, which helped to balance patients' pre-operative expectations and post-operative satisfaction with the received results, reduce post-operative morbidity and improve oral health-related quality of life.

Synergistic anti-inflammatory effect of NSAIDs plus B vitamins administered pre and postoperatively in third molar surgery: randomized clinical trial

Objective: The aim of the present study was to evaluate the synergistic anti-inflammatory effect of Non-steroidalanti-inflammatory drugs (NSAIDs) plus B vitamins administered pre and postoperatively in surgeries of impactedmandibular third molars. Material and Methods: Double-blind randomized clinical trial, sixty-six patients participatedand were randomized into 2 groups. The control group was administered meloxicam 15 mg intramuscularly plusplacebo orally and to the experimental group, meloxicam 15 mg intramuscularly plus vitamins B [B1, B6, andB12] orally; both treatments were administered preoperatively. The anti-inflammatory effect was evaluated bypain intensity, facial swelling (facial contour measurements), and mouth opening (distance between the upperand lower incisors) during the post-surgical phase. Student’s t-test was performed for independent samples.Results: In all the evaluated times (1 hour, 6 hours, 12 hours, 24 hours, 2 days, and 3 days after the end of thesurgery) the experimental group presented a significantly lower intensity of pain compared to the control group(p&lt;0.05). The highest pain intensity was recorded at 6 hours (17.7 ± 9.1 mm in the experimental group and34.5 ± 21.3 mm in the control group). Swelling and mouth opening were similar in both groups, at all timesevaluated (p&gt;0.05). Conclusion: In the present study, the administration of NSAIDs plus B vitamins (B1, B6,B12) produced lower intensity of pain compared to the administration of only NSAIDs. Nevertheless, swellingand mouth opening were similar in all evaluations for both study groups. KEYWORDSVitamin B complex; Inflammation; Meloxicam; Molar, third; Pain.

EVALUATION OF PALATAL VOLUME IN CHILDREN WITH CLEFT LIP AND PALATE: A COMPARISON OF TWO SURGICAL PROTOCOL

Objective: Compare the palatal volume in children with unilateral cleft lip and palate before and after two surgicalprotocols. Material and Methods: Retrospective data collection was performed in a specialized hospital. Thesample comprised 120 digitized dental models divided into, Group 1 (G1) – participants submitted to cheiloplastyat 3 months (Millard technique) and one-step palatoplasty at 12 months (von Langenbeck technique); Group 2(G2) – participants submitted to cheiloplasty (Millard technique) and hard palate closure (Hans Pichler technique)at 3 months and soft palate closure at 12 months (Sommerlad technique). The dental models were evaluatedat Time 1 (T1): before primary plastic surgeries, Time 2 (T2): 1st post-surgical phase, and Time 3 (T3): 2ndpost-surgical phase. The volume was measured through stereophotogrammetry system software. Parametric andnon-parametric statistical tests were applied (alpha = 5%). Results: The intragroup analysis revealed that G1 had astatistically significant increase in volume at T2 followed by a reduction at T3 (p=0.003); G2 showed a statisticallysignificant increase of dental arch volume between T1 and T2 (p=0.001). There was no statistically significantdifference in the intergroup and gender analyses (p&gt;0.05). Conclusion: The surgical protocol influenced thepalatal volume of children with unilateral cleft lip and palate. This study suggested that two-step palatoplastyprotocol has a tendency to be more appropriate.KEYWORDSCleft lip; Cleft palate; Dental arch; Imaging; Three-dimensional.