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BACKGROUND: Secondary bariatric surgery rates have increased, accounting for approximately 19% of the total bariatric cases in the last years, most commonly conversion of sleeve gastrectomy to gastric bypass. Using the MBSAQIP, we evaluate the outcomes of this procedure compared to the primary RYGB surgery. METHODS: The new variable, conversion of sleeve gastrectomy to RYGB in the 2020 and 2021 MBSAQIP database was analyzed. Patients who underwent primary laparoscopic RYGB and those who underwent laparoscopic sleeve gastrectomy to RYGB conversion were identified. Using Propensity Score Matching analysis, the cohorts were matched for 21 preoperative characteristics. We then compared 30-day outcomes and bariatric-specific complications between primary RYGB and conversion from sleeve gastrectomy to RYGB. RESULTS: There were 43,253 primary RYGB procedures performed and 6,833 conversions from sleeve gastrectomy to RYGB. The matched cohorts (n = 5912) for the two groups have similar pre-operative characteristics. Propensity-matched outcomes showed that conversion from sleeve gastrectomy to RYGB was associated with more readmissions (6.9% vs 5.0%, p < 0.001), interventions (2.6% vs 1.7%, p < 0.001), conversion to open (0.7% vs 0.2%, p < 0.001), length of stay (1.79 ± 1.77 days vs 1.62 ± 1.66 days, p < 0.001), and operative time (119.16 ± 56.82 min vs 138.27 ± 66.00, p < 0.001). There were no significant differences in mortality (0.1% vs 0.1%, p = 0.405), and bariatric-specific complications such as anastomotic leak (0.5% vs 0.4%, p = 0.585), intestinal obstruction (0.1% vs 0.2%, p = 0.808), internal hernia (0.2% vs 0.1%, p = 0.285) or anastomotic ulcer (0.3% vs 0.3%, p = 0.731) rates. CONCLUSION: Conversion from sleeve gastrectomy to RYGB is a safe and feasible operation with reasonable outcomes compared with primary RYGB.
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Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Humanos , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Puntaje de Propensión , Estudios Retrospectivos , Laparoscopía/métodos , Gastrectomía/efectos adversos , Gastrectomía/métodos , Resultado del TratamientoRESUMEN
Background: Empiric antimicrobial treatment selection for management of appendicitis is based on patient risk of infection with drug-resistant pathogens. Per Surgical Infection Society (SIS) guidelines, only high-risk patients should receive extended spectrum antibiotics. After observing substantial use of piperacillin-tazobactam at an academic medical center, a quality improvement initiative was developed targeting standardization of antibiotics for uncomplicated appendicitis. Patients and Methods: A project was performed to improve antibiotic stewardship in acute appendicitis treatment using plan-do-study-act methodology. We designed educational materials to guide risk-based empiric antimicrobial treatment selection for adult patients presenting with appendicitis. Implementation began January 1, 2020. High-risk criteria included presence of sepsis, presence of one or more comorbidities, and health-care-associated appendicitis. Retrospective chart review included adult patients admitted for appendectomy between January 1, 2019 and December 1, 2020. Pre-/post-implementation analysis and run chart analysis were performed. Primary outcome was the proportion of patients receiving the correct antibiotic. Secondary outcomes included antibiotic cost. Patients treated pre-/post-implementation were compared using univariable analysis, with statistical significance set at p < 0.05. Results: Of the 138 patients, 85 patients were in the pre-implementation group and 53 in the implementation group. The implementation group was 19.1% more likely to receive the correct antibiotic (pre = 31.8%; post = 50.9%; p = 0.03). Average cost per patient was reduced $13.25 (pre = $23.68 ± $18.76; post = $10.43 ± $8.45; p ≤ 0.0001). There were no differences in complications (pre = 2.4%; post = 0%; p = 0.26) or re-admissions (pre = 2.34%; post = 1.9%; p = 0.86). Conclusions: After an educational initiative to raise awareness about SIS guidelines for empiric antibiotic treatment for acute appendicitis, we observed an increase in the number of patients receiving the appropriate antibiotic. Prescribing habits were altered with no adverse impact on clinical outcomes. The next phase will address sustainability by incorporating an electronic medical record order set to integrate just-in-time education within the provider workflow.
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Programas de Optimización del Uso de los Antimicrobianos , Apendicitis , Adulto , Antibacterianos/uso terapéutico , Apendicectomía , Apendicitis/tratamiento farmacológico , Humanos , Combinación Piperacilina y Tazobactam/uso terapéutico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 56-year-old woman underwent abdominoplasty with no immediate complications. She had no known bleeding history nor any relevant past surgical history. Adequate preventive measures for venous thromboembolism were performed, including sequential compression devices, good hydration, and early ambulation. At 17 days post operation, the patient presented to the emergency room complaining of left leg swelling and sharp, shooting pain radiating down her left leg. Workup in the Emergency Room revealed significant venous thrombosis involving complete occlusion of the major veins of the left leg. There were no indications of cardiopulmonary compromise. Angiography revealed an anatomical variant consistent with May-Thurner Syndrome (MTS). This variant first described in 1957 may present in up to one-quarter of patients, more commonly in young women. This case appears to the first reported of MTS occurring in association with a postoperative complication of abdominoplasty. Diagnosis and management considerations are discussed.
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OBJECTIVE: The phenomenon of foot binding, also known as 'lotus feet', has an enduring and influential history in China. To achieve a man-made smaller foot size, lifelong foot binding may have had adverse effects on the skeleton. We investigated bone properties in postmenopausal women with bound feet, which may provide new information for developing countermeasures for prevention of fragility fractures. DESIGN: Population-based cohort study. PARTICIPANTS: This study involved 254 postmenopausal women aged 65-80, including 172 with bound feet and 82 age- and gender-matched control subjects, living in a remote region of China. OUTCOMES: Anthropometric, SF-36 Lifestyle Questionnaire and heel quantitative ultrasound (QUS) data were collected for the whole study population. A small subset of two cases was also invited for assessment of bone mineral density and microarchitecture at the distal tibia using high-resolution peripheral quantitative CT (HR-pQCT) and gait and balance tests. RESULTS: Women with bound feet had significantly lower QUS values than age-matched women with normal feet; this was supported by HR-pQCT data. However, SF-36 Questionnaire results did not reveal any statistically significant differences in any categorical responses, including physical functioning, general health vitality and physical component summary score, and number of previous fractures. No impairment of body balance was found in the small subset. CONCLUSIONS: The man-made changes caused by foot binding led to reduced physical activity, making the subjects prone to osteoporosis. Women with bound feet and osteoporosis did not have a higher incidence of fragility fractures than controls. This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures.
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Absorciometría de Fotón/métodos , Deformidades Adquiridas del Pie/fisiopatología , Pie/diagnóstico por imagen , Talón/diagnóstico por imagen , Osteoporosis/fisiopatología , Tibia/diagnóstico por imagen , Anciano , Densidad Ósea , China/epidemiología , Estudios de Cohortes , Cultura , Femenino , Pie/patología , Deformidades Adquiridas del Pie/complicaciones , Deformidades Adquiridas del Pie/diagnóstico por imagen , Talón/patología , Humanos , Osteoporosis/diagnóstico por imagen , Osteoporosis/etiología , Posmenopausia , Calidad de Vida , Encuestas y Cuestionarios , Tibia/patología , Ultrasonografía , Soporte de PesoRESUMEN
Gap junctions (GJs) are composed of tens to many thousands of double-membrane spanning GJ channels that cluster together to form densely packed channel arrays (termed GJ plaques) in apposing plasma membranes of neighboring cells. In addition to providing direct intercellular communication (GJIC, their hallmark function), GJs, based on their characteristic double-membrane-spanning configuration, likely also significantly contribute to physical cell-to-cell adhesion. Clearly, modulation (up-/down-regulation) of GJIC and of physical cell-to-cell adhesion is as vitally important as the basic ability of GJ formation itself. Others and we have previously described that GJs can be removed from the plasma membrane via the internalization of entire GJ plaques (or portions thereof) in a cellular process that resembles clathrin-mediated endocytosis. GJ endocytosis results in the formation of double-membrane vesicles [termed annular gap junctions (AGJs) or connexosomes] in the cytoplasm of one of the coupled cells. Four recent independent studies, consistent with earlier ultrastructural analyses, demonstrate the degradation of endocytosed AGJ vesicles via autophagy. However, in TPA-treated cells others report degradation of AGJs via the endo-/lysosomal degradation pathway. Here we summarize evidence that supports the concept that autophagy serves as the cellular default pathway for the degradation of internalized GJs. Furthermore, we highlight and discuss structural criteria that seem required for an alternate degradation via the endo-/lysosomal pathway.
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Autofagia/fisiología , Conexinas/metabolismo , Endocitosis/fisiología , Uniones Comunicantes/fisiología , Activación del Canal Iónico/fisiología , Lisosomas/metabolismo , Transducción de Señal/fisiología , Animales , Humanos , Modelos BiológicosAsunto(s)
Lesiones de Codo , Fracturas del Húmero/diagnóstico , Preescolar , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/cirugía , Masculino , RadiografíaRESUMEN
We describe for the first time a naturally occurring lysine modification that is converted to methyllysine by reduction with sodium borohydride. This modification is approximately 1.7 times as abundant in soluble proteins from human substantia nigra pars compacta as in proteins from other brain regions, possibly as a result of elevated oxidative stress in the nigra. Proteins from cultured PC12 cells exposed to oxidative stress conditions also contain elevated levels of this lysine modification. The abundance of the naturally occurring modification is roughly 0.08 nmoles/mg protein in either unstressed brain or PC12 cells. Modification levels remain stable in isolated proteins incubated for 2 h at 37 degrees C in pH 7 buffer. We propose that the endogenous modification is the lysine Schiff base, epsilon-N-methylenelysine, and that lysine modifications may result from a reaction with formaldehyde in vivo. Rat brain contains approximately 60 nmoles/g wet weight of formaldehyde, which probably includes both free and reversibly bound forms. Adding approximately 35 microm HCHO to PC12 cell growth medium introduces methylenelysine modifications in cell proteins and impairs cell viability. The existence of this post-translational modification suggests new mechanisms of oxidative stress that may contribute to tissue degeneration, including loss of nigral dopamine neurons during normal aging and in Parkinson's disease.