Surgical interventions represent an important stress for the organism. Metabolic parameters can exhibit important changes in a short period of time related to surgery. Differences might occur between normal weight and obese patients. Weight excess represents a risk factor for osteoarthritis.The aim of the study was to assess metabolic parameters before and after total hip and knee replacement in patients with osteoarthritis. The study was performed during 2016-2017 at the Clinic of Orthopedics and Traumatology of the Emergency County Hospital in Tirgu Mures. The study group was divided, based on body mass index values, in normal weight (43 patients) and obese individuals (52 patients). Plasma uric acid level, glycemia and lipid profile (triglycerides, total cholesterol) were determined for each patient before surgery and one day after the intervention, the values being compared. Differences between the metabolic parameters of the two subgroups were also determined. In case of obese individuals, all followed metabolic parameters were significantly different one day after the intervention compared to the values obtained before the surgery: plasma uric acid, cholesterol and triglyceride values decreased, glycemia increased. In the group of normal weight subjects the level of plasma lipids and uric acid differed significantly between the first and second sample, mean values being decreased in the second one. Comparing the two subgroups, significant difference occured regarding plasma glucose levels one day after the intervention, the mean value being higher in case of obese patients, also a higher percentage of hyperuricemia has been found in the group of obese patients. Dynamics of the followed metabolic parameters shows important changes on short term following surgical intervention. Hyperglycemia and hyperuricemia was most common in obese patients, plasma glucose showing increasing tendency after surgery.

Osteoarthritis is a common problem in overweight and obese individuals and may lead to severe forms located especially at the knee and hip joints. Arthroplasty in these cases represents the appropriate treatment to solve the pain and to improve joint mobility. This intervention influences the laboratory parameters in different ways. The aim of the study was to compare pre- and postoperative values of metabolic and inflammatory parameters related to joint replacement surgery in patients suffering from advanced stages of knee and hip osteoarthritis, and to assess the relationship between different laboratory findings, taking into consideration the main cardio-metabolic comorbidities. The study was conducted at the Clinic of Orthopaedics and Traumatology of the Clinical County Hospital Mures between 2016-2017 on 57 overweight patients having severe knee or hip osteoarthritis undergoing total knee or hip arthroplasty. Plasma metabolic tests (uricemia, glycemia, triglycerides, cholesterol) and inflammatory markers (fibrinogen, high sensitive C-reactive protein - hsCRP) were followed in the studied overweight patients in the morning just before arthroplasty and 24 h after surgery. Dynamics of the measured laboratory tests and the relationship between them were assessed. Body mass index, waist circumference and cardio-metabolic associated diseases have also been evaluated. Significant decrease of uricemia, cholesterolemia, plasma triglyceride concentration and significant increase of hsCRP could be observed after joint replacement surgery compared to the previous values measured before the intervention. Glycemia was slightly higher after the arthroplasty, but the difference is not quite significant. Negative correlation could be found between preoperative HDL-cholesterol and plasma triglyceride level, while triglyceride concentration showed positive correlation with LDL-cholesterol and uricemia. BMI showed positive correlation with postoperative fibrinogen values. Hypertension was the most frequent cardio-metabolic comorbidity in the studied group. Significant difference occured in the level of a sensitive inflammatory marker and several biochemical laboratory tests suffered notable changes before and after arthroplasty in the studied group. Metabolic status was deeply affected by such an intervention during the first day after surgery. Laboratory components of the metabolic syndrome were present in close relationship in several patients. Further studies need to be performed for the dynamic assessment of more complex metabolic and inflammatory parameters in patients with similar pathology in order to evaluate the postoperative evolution and to provide appropriate support for these patients in the recovery process.

Objective: Ambulatory blood pressure monitoring (ABPM) parameters are more accurately linked to target organ damage than office or home blood pressure values. Few studies focus on the relationship between ABPM parameters and cognitive aging. We aimed to investigate the relationship between ABPM parameters and prevalence of cognitive impairment and dementia among hypertensive patients. Design and method: In the present paper, we included 294 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 50–91years (mean age: 68.6 ± 8.8 years; 50.3% female; 49.7% male). After routine clinical assessment all participants had an ABPM recording (on antihypertensive medical treatment), completed the Montreal Cognitive Assessment (MoCA) test used for the detection of cognitive impairment, and the Mini Mental State Examination (MMSE) test for detection of dementia. We divided patients in two groups acording to cognitive status based on these cutoff values: 26 points for MOCA score, respectively 24 points for MMSE score – and compared ABPM parameters of the two groups. Statistical analysis was performed with the IBM SPSS v.20 program. Results: In patients with cognitive impairment (MOCA <26) we found significantly lower mean diastolic (69.9 vs. 72.4 mmHg, p = 0.023), daytime diastolic (72.0 vs. 75.1 mmHg, p = 0.012), nighttime diastolic (64.5 vs. 66.9 mmHg, p = 0.039), and higher pulse pressure values (average pulse pressure 61.5 vs. 55.5 mmHg, p = 0.002, daytime pulse pressure 61.7 vs. 56.6 mmHg, p = 0.003, nighttime pulse pressure (59.8 vs. 55.1 mmHg, p = 0.004). In patients with dementia (MMSE<24) we found significant differences between nighttime systolic values (129.7 vs. 124.5 mmHg, p = 0.04), average pulse pressure (63.5 vs. 58.9 mmHg, p = 0.038), and nighttime pulse pressure (63.5 vs. 57.4 mmHg, p = 0.003), values compared to patients with normal cognitive function. Conclusions: The presence of cognitive impairment was related to lower diastolic values, and higher pulse pressure values, while dementia was associated with higher nighttime systolic values in the studied patient population. Lowering too much diastolic blood pressure leading to higher pulse pressure and insufficient control of systolic blood pressure over night could have deleterious effect on neurocognitive abilities of treated hypertensive patients.

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Funding Acknowledgements Type of funding sources: None. Introduction  From the view of the heart-brain axis, several biomarkers have been suggested for the assessment, eventually for the prevention of cognitive impairment. Remodeling of the left ventricular (LV) structure could be such a marker. Purpose: This study aimed to investigate the relationship between cognitive functions and left ventricular geometrical structure. Methods: We enrolled 512 consecutive hypertensive patients (mean age 68 ±9.5 years, females: 51%, males 49%), the mean blood pressure was 135/81 mmHg (±19/11 mmHg). Cognitive abilities were measured with two questionnaires the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), considering cognitive impairment under 24 and 26 points respectively. Measures of the left ventricular structure were performed with transthoracic echocardiography using left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT). Cut off value for LV geometrical changes were: LVMI 115 g/m2 in males and 95 g/m2 in females and RWT 0.42 mm. IBM SPSS v20. was used for statistical analyses. Results: Normal geometry of LV was present in 7.4% and remodeling of LV in the studied group was: concentric remodeling in 16.8%, concentric hypertrophy in 61.9% and eccentric hypertrophy in 13.9%. Lower MoCA scores were observed in LV hypertrophy (22.6 vs. 23.4, p = 0.08). Patients with LV concentric hypertrophy had significantly lower cognitive scores compared to eccentric hypertrophy (mean MoCA 22.4 vs. 23.8 p = 0.02; mean MMSE 26.1 vs. 27.0 p = 0.02). Increased RWT alone were associated with poorer cognition (mean MoCA 22.58 vs. 23.89 p = 0.009; mean MMSE 26.17 vs. 26.99 p = 0.02).  Higher LVMI negatively correlated with MoCA scores (p = 0.018, r=-0.105), but not with MMSE scores (p = 0.216, r=-0.006). Conclusions: Left ventricular hypertrophy and even changes in relative wall thickness may cause cognitive impairment. Preventing LV geometrical changes may prevent the deterioration of cognitive abilities.