Postsurgical Week Research Articles

Comparative Evaluation of Postoperative Facial Swelling and Occlusion in Orthognathic Treatment with Clear Aligners versus Fixed Orthodontic Appliances: A Systematic Review

The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was “Is there a difference in postoperative FS and occlusion attained with CAT and fixed OT after OS?” Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion attained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was better in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS.

Comparison of the Efficacy of HYAFF11 Mesh with Collagen Membranes in Guided Bone Regeneration

This study aimed to evaluate the efficacy of HYAFF11-based meshes in guided bone regeneration (GBR). Two defects of 5-mm width were prepared in the calvaria of 36 rats. The rats were divided into the following groups: empty defect (group E); HYAFF11-based mesh (group HY), collagen membrane (group CM), xenograft (group X), xenograft+HYAFF11 mesh (group X+HY), and xenograft+collagen membrane (group X+CM). Sacrifications were performed at the third and sixth post-surgical weeks, followed by histological evaluation. The highest amount of new bone (NB) formation in the third week was observed in group X+CM (0.94±0.40 mm 2 ), followed by group X+HY (0.80±0.21 mm 2 ). The highest amount of NB formation in the sixth week was observed in group X+CM (1.57±0.66 mm 2 ), followed by groups X and X+HY (1.39±0.48 mm 2 and 1.34±0.44 mm 2 , respectively). There was no statistically significant difference in the amount of residual graft between groups X+HY, X+CM, and X at the third and sixth weeks. Considering the close values observed between the groups, it could be concluded that HYAFF11 may be an alternative biomaterial for use in GBR. Further studies using different graft materials and defect sizes are required to evaluate the effectiveness of HYAFF11 in GBR.

Whole body vibration, an alternative for exercise to improve recovery from surgery?

Although exercise is usually associated with beneficial effects on physical and mental health, patients recovering from surgery may be hampered to perform active exercise. Whole body vibration (WBV) is suggested a passive alternative for physical training. Aim of the present study was to explore the therapeutic potential of WBV compared to physical exercise during early post-surgery recovery.Male three months old Wistar rats underwent major abdominal surgery. Starting the day after surgery, rats were subjected to either daily WBV or exercise (treadmill running) for 15 consecutive days. Control rats underwent pseudo treatment. During the first week after surgery, effects of interventions were obtained from continuous recording of hemodynamic parameters, body temperature and activity (via an implanted transducer). Behavioral tests were performed during the second post-surgical week to evaluate anxiety-like behavior, short and long-term memory functions, cognitive flexibility and motor performance. Animals were sacrificed 15 days after surgery and brain tissue was collected for analysis of hippocampal neuroinflammation and neurogenesis.Surgery significantly impacted all parameters measured during the first post-surgery week, irrespective of the type of surgery. Effect on cognitive performance was limited to cognitive flexibility; both WBV and exercise prevented the surgery-induced decline. Exercise, but not WBV increased anxiety-like behavior and grip strength. WBV as well as exercise prevented the surgery-induced declined neurogenesis, but surgery-associated hippocampal neuroinflammation was not affected.Our results indicated that active exercise and WBV share similar therapeutic potentials in the prevention of surgery induced decline in cognitive flexibility and hippocampal neurogenesis. In contrast to exercise, WBV did not increase anxiety-like behavior. Since neither intervention affected hippocampal neuroinflammation, other mechanisms and/or brain areas may be involved in the behavioral effects. Taken together, we conclude that WBV may provide a relevant alternative to active exercise during the early stage of post-operative recovery.

Cone-beam computed tomography-assisted evaluation of the bone regenerative potential of modulated sol–gel-synthesized 45S5 bioglass intended for alveolar bone regeneration

Objectives:The objective of the study was to evaluate the in vitro cell compatibility and in vivo regenerative potential of 45S5 Bioglass (45S5-BG)-based bone graft implanted in critical-size defects (CSD) created at rat calvaria using cone-beam computed tomography (CBCT).Materials and Methods:In vitro cell compatibility of 45S5-BG was assessed using 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) test. For in vivo experiments, CSD of diameter 6 mm was created in the parietal bone and was treated with 45S5-BG bone graft in the test group (Group B), while the control group (Group A) CSD remained empty. Rats were euthanized at the 4th and 8th postsurgical weeks, and CBCT analysis was done for samples. The grayscale value in VGi and the selected region of interest (ROI, in mm) of CSD diameter were calculated.Results:In vitro cytotoxicity analysis of 45S5-BG showed that cell viability of more than 70% as compared to the control confirmed cell compatibility. CBCT analysis of CSD confirmed a significant increase in VGi (P < 0.001) and reduction in ROI of CSD (P < 0.001) from the 4th and 8th weeks in the test group as compared to the control.Conclusions:In vitro cytotoxicity analysis confirmed cell compatibility of 45S5-BG bone graft and CBCT analysis revealed its bone regenerative potential.

Evaluation of Peri-implant Crevicular Fluid Matrix Metalloproteinase-8 levels of flapped vs. flapless dental implants: A prospective study

Objectives: The objective of this study was to compare the placement of flapped vs. flapless dental implants utilizing clinical and immunological parameters. Subjects and methods: A total of 10 patients were received 20 dental implants. One quadrant in each patient was randomly assigned to control group while other to test group with the help of coin flip. Control group with 10 flapped implants and test group with 10 flapless implants. Follow-up examinations were carried out after 1 week, 1, and 3 months. All treatments were performed under local anesthesia. Peri-implant sulcular fluid samples were collected as well as clinical parameters recorded at the follow up periods. Results: Peri-implant sulcus depth was significantly greater in flapped implants at both 4 and 12 postsurgical weeks (P < 0.005). Matrix metalloproteinase-8 values were higher to a statistically significant level in the control group at 1 (P = 0.003) and 4 weeks (P = 0.007) after placement. Conclusions: Matrix metalloproteinase 8 levels of peri implant crevicular fluid as well as pocket depth were decreased in flapless implants than conventional flap implant surgery.

Minimal effects from a single exposure to sevoflurane in adult male and female Sprague-Dawley rats

Many people undergo procedures requiring general anesthesia each day and adverse cognitive effects have been reported in response to that anesthesia. Postoperative Cognitive Dysfunction (POCD) may occur in as many as 80% of adults during the first post-surgical week and can have lasting effects. Here, the cognitive and motor effects of sevoflurane exposure in Sprague-Dawley rats was examined along with body weights, blood oxygen saturation, heart rate, and body temperature. Male and female rats were exposed to 2.5% sevoflurane or medical grade air for one hour at postnatal day 115. Beginning the following day, rats began a series of behavioral tests examining locomotor activity, motor coordination, novel object recognition, and spatial learning and memory in a water maze. Blood oxygen saturation, heart rate, and body temperature were not affected by the sevoflurane exposure. A slight effect on locomotor activity was detected, but no effects on motor coordination, novel object recognition, or spatial learning and memory were observed. Brain weights following behavioral testing did not differ. The results reported here along with existing literature suggest sevoflurane is largely without effects on later cognition in adult rodents when exposure is of a relatively short duration and at a relatively low concentration.

Evaluation of Postsurgical Hyperalgesia and Sensitization After Open Inguinal Hernia Repair: A Useful Model for Neuropathic Pain?

Cutaneous mechanical hyperalgesia can be induced in healthy volunteers in early phase analgesic studies to model central sensitization, a key mechanism of persistent pain. However, such hyperalgesia is short-lived (a matter of hours), and is used only for assessing only single drug doses. In contrast, postsurgical peri-incisional hyperalgesia may be more persistent and hence be a more useful model for the assessment of the efficacy of new analgesics. We undertook quantitative sensory testing in 18 patients at peri-incisional and nonoperated sites before open inguinal hernia repair and up to the 24th postsurgical week. The spatial extent of punctate hyperalgesia and brush allodynia at the peri-incisional site were greatest at weeks 2 and 4, but had resolved by week 24. Heat allodynia, suggestive of local inflammation or peripheral sensitization, was not observed; instead, there were deficits in cold and heat sensory detection that persisted until week 24. The findings suggest that central sensitization contributes significantly to mechanical hyperalgesia at the peri-incisional site. The prolonged duration of hyperalgesia would be advantageous as a pain model, but there was considerable variability of mechanical hyperalgesia in the cohort; the challenges of recruitment may limit its use to small, early phase analgesic studies. PerspectivePeri-incisional mechanical hyperalgesia persists for ≥4 weeks after open inguinal hernia repair and reflects central sensitization; this may have usefulness as a model of chronic pain to assess the potential of antineuropathic analgesics.

New insights into early recovery after robotic surgery for endometrial cancer

ObjectiveTo assess early recovery of physical health after robotic minimally invasive surgery (RMIS) for early-stage endometrial cancer using the European Organisation of Research and Treatment of Cancer Computer Adaptive Test Core questionnaire (EORTC CAT Core). The EORTC CAT Core provides individualised measurements while maintaining comparability. A hypothesis of individual complete recovery to baseline within three post-surgical weeks was evaluated. MethodsNinety-four women who underwent RMIS for early-stage endometrial cancer were included consecutively. The EORTC CAT Core was distributed before surgery and prospectively every week during the first post-operative month. Repeated measures models were fitted for each of the four domains (physical functioning, role function, fatigue, and pain) and tested for impact of age, ASA score, minor/major surgery, and the individual baseline scores (poorest, intermediate, best). ResultsWomen with the lowest physical functioning, lowest role function, highest fatigue level, and highest pain level at baseline all recovered within three weeks. Women with the highest physical functioning, highest role function, lowest level of fatigue, and lowest level of pain at baseline did not reach their individual baselines within the first post-operative month but had the most favourable domain-scores three weeks post-operatively. ConclusionThe individual woman's physical health baseline score is predictive for her postoperative recovery following RMIS for early-stage endometrial cancer. Women with the best physical health had the best postoperative functions and lowest level of symptoms; however their recovery to baseline was prolonged. Computer adaptive testing may be a valuable tool for individualised pre-operative information and supportive care during surveillance.

Early Healing Events after Periodontal Surgery: Observations on Soft Tissue Healing, Microcirculation, and Wound Fluid Cytokine Levels

Early wound healing after periodontal surgery with or without enamel matrix derivative/biphasic calcium phosphate (EMD/BCP) was characterized in terms of soft tissue closure, changes of microcirculation, and expression of pro- and anti-inflammatory cytokines in gingival crevicular fluid/wound fluid (GCF/WF). Periodontal surgery was carried out in 30 patients (18 patients: application of EMD/BCP for regeneration of bony defects; 12 patients: surgical crown lengthening (SCL)). Healthy sites were observed as untreated controls. GCF/WF samples were collected during two post-surgical weeks. Flap microcirculation was measured using laser Doppler flowmetry (LDF). Soft tissue healing was evaluated after two weeks. GCF/WF levels of interleukin 1β (IL-1β), tumour necrosis factor (TNF-α), IL-6, and IL-10 were determined using a multiplex immunoassay. Surgery caused similar reductions of flap microcirculation followed by recovery within two weeks in both EMD/BCP and SCL groups. GCF/WF and pro-inflammatory cytokine levels were immediately increased after surgery, and returned only partially to baseline levels within the two-week observation period. Levels of IL-10 were temporarily reduced in all surgical sites. Flap dehiscence caused prolonged elevated levels of GCF/WF, IL-1β, and TNF-α. These findings show that periodontal surgery triggers an immediate inflammatory reaction corresponding to the early inflammatory phase of wound healing, and these inflammation measures are temporary in case of maintained closure of the flap. However, flap dehiscence causes prolonged inflammatory exudation from the periodontal wound. If the biological pre-conditions for periodontal wound healing are considered important for the clinical outcome, care should be taken to maintain primary closure of the flap.

Collagen-conjugated tracheal prosthesis tested in dogs without omental wrapping and silicone stenting.

Artificial tracheas fabricated from collagen-conjugated mesh appear to overcome fatal postoperative complications, namely anastomotic dehiscence and prosthesis dislocation. Such prostheses are incorporated by host tissue, provided they are wrapped in omentum (necessitating an additional abdominal procedure) and a silicone tube is used as a stent (to be extracted several weeks postoperatively). To mitigate related host impact (i.e. injury, pain and distress), we investigated the feasibility of implanting this type of tracheal prosthesis (∼5 cm in length) alone, without omental wrapping and use of a silicone stent. Porous-type tracheal prostheses that were reinforced with a continuous polypropylene spiral and sealed by collagen sponge from porcine skin replaced segments of cervical trachea (∼5 cm long) in 10 dogs through the method of telescopic anastomosis. Omental wrapping and silicone stent placement were omitted. Postoperatively, bronchoscopic examination was performed periodically. When dogs died or were sacrificed, tracheal prostheses were harvested for haematoxylin and eosin staining and electron microscopic scanning of luminal surface conditions. With the exception of one death from an anaesthesia-related incident during fibre-optic bronchoscopy (postsurgical week 1), nine dogs survived uneventfully (until sacrifice), without prosthesis dislocation or anastomotic dehiscence. The longest observation period was 2 years and 8 months. Bronchoscopic examination revealed that no stenosis or local infection was evident in the prostheses of five dogs. Moderate (n = 2) and slight (n = 2) stenoses were observed in the other four animals. All four animals survived for a long time, without dyspnoea or stridor. Histological examination showed that partial inner surface of the artificial trachea was covered with the pseudostratified ciliated epithelium. Regeneration of ciliated epithelium was also confirmed by scanning electron microscopy. This pilot study revealed that implantation of a collagen-conjugated tracheal prosthesis (∼5 cm in length) is feasible without the need for omental wrapping and silicone stenting as ancillary measures. This approach considerably simplified the surgical procedures to minimize host intrusion, which indicated a possible clinical application.

The Stabilization Time of Ocular Measurements after Cataract Surgery

ABSTRACTPurpose: To determine the stabilization time of automated refraction, ocular biometric parameters, keratometry, and central corneal thickness (CCT) and to find the optimal time for glasses’ prescription after cataract surgery. Methods: This was a prospective, case series study of 62 consecutive eyes with senile cataracts. Patients undergoing uncomplicated phacoemulsification surgery were included in the study. Automated refraction, keratometry, ocular biometric parameters, and CCT were recorded at baseline before cataract surgery and at follow-up visits at one day, one week, two weeks, and four weeks after surgery. Results: The study was composed of 62 eyes of 62 patients with a mean age of 66±12.38 (range, 40 to 84 years). The automated refraction stabilized one week after surgery and changed minimally between the first week and the first month after cataract surgery. The stabilization of average keratometric corneal astigmatism in keratometry, average anterior chamber depth, and CCT was achieved after the second postsurgical week. Conclusion: It may be possible to prescribe glasses starting from two weeks after an uneventful phacoemulsification cataract surgery for most patients.

The repair of full-thickness articular cartilage defect using intra-articular administration of N-acetyl-D-glucosamine in the rabbit knee: randomized controlled trial.

BackgroundAlthough various alterative models of therapy are used for cartilage repair, no definite conclusion has been reached. Glucosamine (GlcN) is widely used as a nutritional supplement. However, the clinical- evidence-based outcome of GlcN administration remains controversial. N-acetyl-d-glucosamine (GlcNAc), a derivative of GlcN, shows chondroprotective activity and mediates the activation of articular chondrocytes. Therefore, we investigated the effect of intra-articular administration of GlcNAc in rabbits’ knee joints with experimental full-thickness articular cartilage (FTAC) defects.MethodsTwelve male adult New Zealand white rabbits, providing 24 knees, were used in this study. FTAC defects were created in the high-weight-bearing area of the medial femoral condyles of bilateral knees. All rabbits were randomly allocated to analysis at postsurgical week 4 or postsurgical week 12. In the week 4 group, rabbits’ knees (six per group) were intra-articularly injected with normal saline or with GlcNAc twice per week for 3 weeks, beginning 1 week postoperatively. In the week 12 group, the rabbits’ knees (six in each group) were intra-articularly injected with normal saline or with GlcNAc twice per week for 4 weeks, beginning 1 week postoperatively. Rabbits were sacrificed at 4 or 12 weeks after surgery for macroscopic, histological and radiological examinations of the knee joints.ResultsAll rabbits had no systemic or local adverse effects. The saline and GlcNAc groups showed visible differences in healing of the FTAC defect at the end of testing. At week 4, the GlcNAc group had a higher level of collagen type II (COL II) and showed up-regulated production of transforming growth factor (TGF)-β2 and TGF-β3, suggesting the involvement of endogenous growth factors. At week 12, the GlcNAc group displayed formation of hyaline-like cartilage regeneration with mature chondrocytes (SOX9+), robust glycosaminoglycan (GAG) content, and positive COL II content in both the adjacent cartilage and reparative sites. However, the saline group demonstrated mainly fibrocartilage scar tissue, indicating COL I expression. Furthermore, the GlcNAc group had significantly higher bone volume per tissue volume and higher trabecular thickness than the saline group.ConclusionsIntra-articular GlcNAc may promote the repair of experimental FTAC defects in the rabbit knee joint model.

An evaluation of the effect of bone morphogenetic protein-2 in a hydroxyapatite carrier on the rate of cortical restoration of large bone defects using the dog ulna model

To evaluate the rate of establishment of cortical continuity and union of large bone defects with the use of recombinant bone morphogenetic protein (rh-BMP- 2)/hydroxyapatite implants. Six adult male dogs were used to evaluate the effect of bone morphogenetic proteins (BMP) in filling large cortical defects. A 1.5cm cortical ulnar defect was created in two groups of dogs. First group had 1.5cm BMP implant in a carrier of hydroxyapatite in the cortical defect; the control (group 2) defect was left intact. Evaluation was through serial radiographic determination of mean fracture gaps. There was progressive filling of osseous defects in group 1, which was total at the 16th week post-surgical (PS); group 2 dogs had radiographic non-union at the 16th PS week. It was concluded that BMP implanted with a hydroxyapatite carrier significantly enhanced the rate of cortical restoration of massive bone defects in dogs. Keywords : Bone healing, Bone morphogenetic protein-2, Cortical growth, Dogs, Segmental bone defects, Ulna

Is there a role for rehabilitation streaming following total knee arthroplasty? Preliminary insights from a randomized controlled trial.

To determine whether total knee arthroplasty recipients demonstrating comparatively poor mobility at entry to rehabilitation and who received supervised therapy, had better rehabilitation outcomes than those who received less supervision. Retrospective analysis of randomized trial data. Total knee arthroplasty participants randomized to supervised (n = 159) or home-based therapy (n = 74). Participants were dichotomized based on mean target 6-min walk test (6MWT) pre-therapy (second post-surgical week). Absolute and change in 6MWT and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscales amongst low performers in the supervised (n = 89) and unsupervised (n = 36) groups were compared, as were high performers in the supervised (n = 70) and unsupervised (n = 38) groups. Low performers in the unsupervised compared with the supervised group demonstrated significantly poorer 6MWT scores (absolute δ = 8.5%, p = 0.003; change δ = 8.1%, p = 0.007) when therapy ceased (10 weeks post-surgery). No differences in 6MWT were observed between the high performing subgroups or in the recovery of WOMAC subscales between any subgroups. Individuals manifesting comparatively poor mobility at the commencement of physiotherapy may recover their mobility, but not perceived function, more quickly if streamed to supervised therapy.

Malabsorption plays a major role in the effects of the biliopancreatic diversion with duodenal switch on energy metabolism in rats

BackgroundThe mechanisms underlying the metabolic benefits of the biliopancreatic diversion with duodenal switch (BPD/DS) have not been clarified. The objective of this study was to investigate the metabolic roles of sleeve gastrectomy (SG) and duodenal switch (DS) as main surgical components of BPD/DS. MethodsBPD/DS, SG, and DS surgeries were performed on chow-fed nonobese Wistar rats. Weight and energy intake were recorded during 8 postsurgical weeks. Glucagon-like peptide 1 (GLP-1), peptide tyrosine-tyrosine (PYY), glucose-dependent insulinotropic peptide, and ghrelin were measured pre- and postprandially at weeks 3 and 8, after surgery. Body composition, muscle, liver, and adipose tissue weights were measured. Gut morphometry and the presence and distribution of GLP-1 and PYY (L-cells) in the gut were determined using histochemical techniques. ResultsCompared with sham, BPD/DS and DS led to significant reductions in weight gain, percentage of fat, and adipose tissue weight. These effects were accompanied by a reduction in digestible energy intake associated with fecal energy loss due to DS. BPD/DS and DS produced intestinal hypertrophy, as well as higher plasma GLP-1 and PYY in both fasted and refed states. It is noteworthy that none of those alterations were observed after SG, which nonetheless led to transient postoperative reduction in gross energy intake and weight. Similar to BPD/DS, SG alone produced a reduced meal size and an enhanced postprandial depression of plasma ghrelin. ConclusionBPD/DS results in metabolic benefits, which appear largely caused by food malabsorption due to DS. The elevation of anorectic GLP-1 and PYY are additional consequences of DS, which, together with malabsorption, could promote the metabolic benefits of BPD/DS.

Impact of surgical excision of lesions on pain in a rat model of endometriosis.

Chronic pain is the most common and disabling feature of endometriosis. Surgical excision of endometriosis lesions provides relief but pain relapse is common. Studies in a preclinical model of endometriosis might help to unravel the role of the ectopic lesions as the source of pain. Thus, we evaluated the impact of lesion excision on mechanical hyperalgesia in a preclinical model of endometriosis pain. Endometriosis was induced by implanting autologous uterine tissue onto the gastrocnemius muscle. Surgical excision or aspiration drainage of the cystic lesion was performed at different times post-implant and mechanical nociceptive thresholds were assessed at the site of the lesion. Lesions at 2, 8 and 16 weeks post-implant produced mechanical hyperalgesia of similar magnitude (n = 6/group). Excision of lesions (n = 6/group) produced a longer inhibition, with a magnitude and time course depending upon the timing of excision. Excision at 2 and 8 weeks produced a rapid onset marked attenuation of hyperalgesia, which returned to pre-excision values by post-surgical week 3. In contrast, excision of the lesion at 16 weeks produced a peak of inhibition of hyperalgesia 2 weeks post-excision, but then the inhibition was sustained. Aspiration of fluid from cysts in the lesions briefly attenuated mechanical hyperalgesia (n = 6/group). In this preclinical model, we demonstrate that endometriosis pain is alleviated by surgical excision of the ectopic lesion or drainage of its cysts, providing support for the clinical observation that endometriosis pain is dependent upon the ongoing presence of the lesions.

Acute and chronic MRI changes in the spine and spinal cord after surgical stem cell grafting in patients with definite amyotrophic lateral sclerosis: Post-infusion injuries are unrelated with clinical impairment

ObjectiveTo report MRI spinal changes after surgical infusion of bone marrow stem cells (BMSc) in ALS patients and assess their correlation with clinical events and functional performance. MethodsBMSc were surgically injected in the thoracic spinal cord of 11 ALS patients (6/5 male/female; median age 46years). We performed first-week and third, sixth, ninth and twelfth post-surgical months spinal MRIs. The spinal changes in the postsurgical week and follow-up MRIs, as well as clinical events, functional scales and respiratory and electromyography data, were longitudinally monitored. Correlations between the imaging and clinical data were evaluated with the Spearman's test. ResultsTransient extradural fluid collections (100%), transient spinal cord T2 hyperintensity (81.8%), and chronic spinal cord deformities (63.6%) were the dominating MRI changes. Spinal cord hemorrhages (27.3%) and cystic myelomalacia (1/11 patients) were important although unusual findings. During the follow-up, minor adverse events of mild to moderate intensity eventually improved. Initial and follow-up imaging scores showed a strongly positive correlation (r 0.879, P<0.001). The initial and delayed clinical scores did not correlate. There was no significant correlation between any of the imaging scores and clinical data. ConclusionsInfusion of BMSc produces a variety of spinal changes apparently unrelated with clinical events and disease worsening.

Refractive Stabilization and Corneal Swelling After Cataract Surgery

To determine the earliest time after cataract surgery when corneal swelling and automated refraction are stabilized sufficiently to allow reliable refractive prescription. This was a prospective, nonrandomized, case series study of 124 consecutive eyes undergoing uneventful cataract surgery. Automated refraction and central corneal thickness (CCT) measurements were made at baseline before cataract surgery and on follow-up visits 1 day and weekly for 4 weeks afterward. Corneal swelling was determined as the percentage change in CCT after surgery. To determine the validity of automated refraction, it was compared with subjective refraction at the final visit. Corneal swelling decreased between the first postsurgical day and the first week and again between postsurgical weeks 1 and 2 (p < 0.01 each). Although thinning continued through the fourth postsurgical week, the changes were not significant. Both spherical and cylindrical refraction were stable 1 week after surgery, with the greatest change between the first postsurgical day and 1 week (p < 0.01). In replicate measurements of automated spherical refraction taken on the last visit, the intraclass correlation coefficient was 0.93. For automated cylindrical refraction, it was 0.81. Automated refraction is highly repeatable and can be used to monitor postsurgical refractive changes. Whereas corneal swelling becomes stable 2 weeks after cataract surgery, automated refraction becomes stable after 1 week and can be used to accurately prescribe corrective lenses at that time.

Clinical, radiographic, microbiological, and immunological outcomes of flapped vs. flapless dental implants: a prospective randomized controlled clinical trial

The objective of this study was to compare the placement of flapped vs. flapless dental implants utilizing clinical, radiographic, microbiological, and immunological parameters. A total of 20 patients received 30 dental implants following a one-stage protocol. The patients were randomly assigned into two study groups: control group with 15 flapped implants and test group with 15 flapless implants. Follow-up examinations were carried out after 1, 2, 6, and 12weeks. Clinical recordings, sulcular fluid sampling, microbiological analysis, and digital subtraction radiography were utilized to compare the two surgical approaches. Peri-implant sulcus depth was significantly greater in flapped implants at both 6 and 12 postsurgical weeks (P<0.001). Flapped implants showed crestal bone loss (0.29±0.06mm), whereas no bone resorption was detected around flapless implants. Matrix metalloproteinase-8 values were higher to a statistically significant level in the control group at 1 (P=0.003) and 6weeks (P=0.007) after placement. In the test group, the presence of Porphyromonas gingivalis was significantly higher at the 2nd postoperative week (P=0.005), whereas the counts of Tannerella forsythia were significantly elevated at the 1st (P=0.005), 2nd (P=0.001), and 12th (P=0.002) postoperative weeks, possibly indicating an earlier formation and maturation of the peri-implant sulcus. Patients reported more pain after flapped implant placement. Flapless implant placement yielded improved clinical, radiographic, and immunological outcomes compared with flapped implantation. In addition, patients seem to better withstand flapless implant placement.

Morphologic Study of the Drainage Pathway Using a Tracer After a Bypass Filtering Procedure in Rabbit Eyes

To study the drainage pathway using a tracer after a modified filtering surgery in rabbit eyes. The authors performed trabeculectomy combined with deep sclerectomy on one eye (TS group) and trabeculectomy on the other eye (T group) of 20 rabbits. Cationic ferritin was injected intracamerally just before killing the rabbits at postsurgical week 2, 4, 8, 12, or 24. The opposite side of the surgical site was used as the control. Histologic study was conducted under light microscopy. In both groups, significantly more intrascleral and episcleral drainage vessels were observed than in the paired controls (P < .001). Intrascleral drainage canals were more often manifested in the TS group than in the T group (P < .05), especially after week 12. Intrascleral and episcleral outflow were the main drainage routes after filtering surgeries in this model. Compared with trabeculectomy, the modified surgery was superior for forming an intrascleral "bleb" and seemed to be better maintained at a later stage.