Bariatric surgery targeting opioid prescribing: a national model for effectively reducing opioid use after bariatric surgery.

Background: Prescription opioids are responsible for a significant proportion of opioid-related deaths in the United States. Approximately 6% of opioid-naïve patients who receive opioid prescriptions after surgery become chronic opioid users. However, chronic opioid use after bariatric surgery may be twice as common.

Steam explosion pretreatment of separated dairy cattle manure: Mass balances and effect on biomethane potential.

Manure is a renewable feedstock, whose theoretical potential for biogas production is scarcely deployed due to modest methane yields that prevent economic feasible operation of anaerobic digestion plants. Steam explosion pretreatment has the potential to improve the digestibility of manure, however it is energy intensive, and the optimal conditions depend on the feedstock. In this work, the solid and the liquid fraction of separated dairy cattle manure were pretreated between 130 and 210 °C for 5 to 40 min by steam explosion to individually determine the optimal conditions for each fraction.

Obesity-associated microbiomes instigate visceral adipose tissue inflammation by recruitment of distinct neutrophils.

Neutrophils are increasingly implicated in chronic inflammation and metabolic disorders. Here, we show that visceral adipose tissue (VAT) from individuals with obesity contains more neutrophils than in those without obesity and is associated with a distinct bacterial community. Exploring the mechanism, we gavaged microbiome-depleted mice with stool from patients with and without obesity during high-fat or normal diet administration.

Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease.

Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD).

Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized.

Methods: Patients with obesity (body mass index ≥30 kg/m 2 ), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.

Novel multiparametric bulk and single EV pipeline for adipose cell-specific biomarker discovery in paired human biospecimens.

Obesity is a global health crisis that contributes to morbidity and mortality worldwide. Obesity's comorbid association with a variety of diseases, from metabolic syndrome to neurodegenerative disease, underscores the critical need to better understand the pathobiology of obesity. Adipose tissue, once seen as an inert storage depot, is now recognized as an active endocrine organ, regulating metabolic and systemic homeostasis.

Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months.

Purpose: Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months.

Materials And Methods: Seven hundred eighty-seven patients (81.

How Does the Sequence of the American Board of Surgery Examinations Impact Pass/Fail Outcomes?

Objective: Historically, the American Board of Surgery required surgeons to pass the qualifying examination (QE) before taking the certifying examination (CE). However, in the 2020-2021 academic year, with mitigating circumstances related to COVID-19, the ABS removed this sequencing requirement to facilitate the certification process for those candidates who were negatively impacted by a QE delivery failure. This decoupling of the traditional order of exam delivery has provided a natural comparator to the traditional route and an analysis of the impact of examination sequencing on candidate performance.

Social History of Bariatric Surgery: Relationship to Patient and Associations with Postoperative Outcomes.

Purpose: There is limited research about the prevalence of patients initiating metabolic and bariatric surgery (MBS) who also know someone who had MBS, referred to as having a social history of MBS. Evidence about the specific relationship of these individuals to the patient, how having a social history of MBS is associated with patients' choice of surgical procedure, and how having a social history of MBS is associated with patients' postoperative outcomes can be used to inform future preoperative assessments. The objective was to (a) define the number of people patients knew who had MBS and relationship to patient, (b) assess congruence between those who had MBS with patients' procedure selection, and (c) explore associations between social history of MBS and postoperative outcomes.

Toward optimal use of biomass as carbon source for chemical bioproduction.

Biomass is widely identified as a promising, renewable replacement for fossil feedstocks in the production of energy, fuels, and chemicals. However, the sustainable supply of biomass is limited. Economic and ecological criteria support prioritization of biomass as a carbon source for organic chemicals; however, utilization for energy currently dominates.

Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals.

Background: Commonly cited studies have reported substantial improvements (defined as >20%) in process measure compliance after implementation of colorectal enhanced recovery programs (ERPs). However, hospitals have anecdotally reported difficulties in achieving similar improvement gains. This study evaluates improvement uniformity among 151 hospitals exposed to an 18-month implementation protocol for 6 colorectal ERP process measures (oral antibiotics, mechanical bowel preparation, multimodal pain control, early mobilization, early liquid intake, and early solid intake).

Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months.

Purpose: Explorations into the neighborhood food environment have not adequately extended to adults with obesity who undergo bariatric surgery. The objective of this study is to determine how diversity of food selection at food retail stores within proximities of 5- and 10-min walks associate with patient postoperative weight loss over 24 months.

Materials And Methods: Eight hundred eleven patients (82.

The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record, census, and county data.

Background: While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss.

Objective: To integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio.

Setting: Seven hundred seventy-two patients (82.

Interferon gamma mediates the reduction of adipose tissue regulatory T cells in human obesity.

Decreased adipose tissue regulatory T cells contribute to insulin resistance in obese mice, however, little is known about the mechanisms regulating adipose tissue regulatory T cells numbers in humans. Here we obtain adipose tissue from obese and lean volunteers. Regulatory T cell abundance is lower in obese vs.

An analysis of readmission trends by urgency and race/ethnicity in the MBSAQIP registry, 2015-2018.

Background: Large-scale analyses stratifying bariatric surgery readmissions by urgency are lacking.

Objectives: Identify predictors of urgent/nonurgent readmission among "ideal" bariatric candidates, using a national registry.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database.

Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis.

Importance: No therapy has been shown to reduce the risk of serious adverse outcomes in patients with nonalcoholic steatohepatitis (NASH).

Objective: To investigate the long-term relationship between bariatric surgery and incident major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and biopsy-proven fibrotic NASH without cirrhosis.

Design, Setting, And Participants: In the SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study, of 25 828 liver biopsies performed at a US health system between 2004 and 2016, 1158 adult patients with obesity were identified who fulfilled enrollment criteria, including confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3).

The Impact of Bariatric Surgery on Diverticulitis Outcomes and Risk of Recurrent Hospitalizations in Adults with Clinically Severe Obesity.

Purpose: Clinically severe obesity (SO) is a known risk factor for worsened outcomes and recurrence of acute diverticulitis. Paucity of data exist on outcomes of diverticulitis after bariatric surgery.

Methods: The Nationwide Readmissions Database was queried for diverticulitis hospitalizations between the years 2010 and 2014.

Towards Net Zero Greenhouse Gas Emissions in the Energy and Chemical Sectors in Switzerland and Beyond - A Review.

In today's societies, climate-damaging and finite fossil resources such as oil and natural gas serve a dual purpose as energy source and as carbon source for chemicals and plastics. To respond to the finite availability and to meet international climate goals, a change to a renewable energy and raw material basis is inevitable and represents a highly complex task. In this review, we assess possible technology paths for Switzerland to reach these goals.

Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy, and Usual Care.

Objective: To determine which one of the two most common metabolic surgical procedures is associated with greater reduction in risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and obesity.

Research Design And Methods: A total of 13,490 patients including 1,362 Roux-en-Y gastric bypass (RYGB), 693 sleeve gastrectomy (SG), and 11,435 matched nonsurgical patients with T2DM and obesity who received their care at the Cleveland Clinic (1998-2017) were analyzed, with follow-up through December 2018. With multivariable Cox regression analysis we estimated time to incident extended MACE, defined as first occurrence of coronary artery events, cerebrovascular events, heart failure, nephropathy, atrial fibrillation, and all-cause mortality.

Patient-reported Outcomes After Metabolic Surgery Versus Medical Therapy for Diabetes: Insights From the STAMPEDE Randomized Trial.

Objective: The aim of this study was to investigate the long-term effects of medical and surgical treatments of type 2 diabetes mellitus (T2DM) on patient-reported outcomes (PROs).

Background: Robust data on PROs from randomized trials comparing medical and surgical treatments for T2DM are lacking.

Methods: The Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial showed that 5 years after randomization, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were superior to intensive medical therapy (IMT) alone in achieving glycemic control in patients with T2DM and obesity.

Foregut Exclusion Enhances Incretin and Insulin Secretion After Roux-en-Y Gastric Bypass in Adults With Type 2 Diabetes.

Introduction: Patients with type 2 diabetes experience resolution of hyperglycemia within days after Roux-en-Y gastric bypass (RYGB) surgery. This is attributed, in part, to enhanced secretion of hindgut factors following exclusion of the gastric remnant and proximal intestine during surgery. However, evidence of the mechanisms of remission remain limited due to the challenges of metabolic evaluation during the early postoperative period.

Roux-en-Y gastric bypass restores islet function and morphology independent of body weight in ZDF rats.

Reductions in β-cell number and function contribute to the onset type 2 diabetes (T2D). Roux-en-Y gastric bypass (RYGB) surgery can resolve T2D within days of operation, indicating a weight-independent mechanism of glycemic control. We hypothesized that RYGB normalizes glucose homeostasis by restoring β-cell structure and function.

Quality in Endoscopy.

Quality improvement is a dynamic process that requires continuously monitoring quality indicators and benchmarking these with national and professional standards. Endoscopists have formed societal task forces to propose quality indicators and performance goals. Institutions are now incentivized by payers and value-based reimbursement agreements to have processes in place to measure, report, and act on these quality metrics.