A Unique Spectrum of Care Tool Provides a Self-Regulated Learning Opportunity and Facilitates Client Communication.

Providing only the most state-of-the-art, intensive, and expensive level of treatment available does not meet the needs of every pet owner and pet. To overcome this barrier, veterinarians are working to provide spectrum of care (SOC) options to pet owners. This teaching tip describes the creation of a Spectrum of Care Options Presentation and Explanation (SCOPE), a tool which can serve a variety of educational purposes and improve delivery of care across the spectrum of care.

Outcomes of same-day discharge in bariatric surgery.

Background: Restrictions during the COVID-19 pandemic influenced a shift to same-day discharge in bariatric surgery. Current studies show conflicting findings regarding morbidity and mortality. We aim to compare outcomes for same-day discharge versus admission after bariatric surgery.

Carbon nanotube heterogenization improves cobalt pyridyldiimine complex CO reduction activity in aqueous carbonate buffer.

We present two novel cobalt pyridyldiimine complexes functionalized with pyrene. Initially modest in homogeneous acetonitrile solution, their electrocatalytic CO reduction performance significantly improves upon immobilization on MWCNTs in an aqueous carbonate buffer. The complexes exhibit outstanding stability, with CO selectivity exceeding 97%, and TON and TOF values reaching up to 10 and above 1.

Lessons learned from the metabolic and bariatric surgery accreditation and quality improvement program site surveys: common deficiencies and corrective actions.

Background: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a joint program between the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). On-site surveys of the applicant programs to determine adherence to the MBSAQIP standards are a hallmark of the accreditation process.

Objectives: A retrospective review of 619 site surveys completed over 2 years was performed to include analysis of reviewer decisions, tabulation and cross-reference of identified deficiencies to the MBSAQIP standards and determine final disposition of corrective actions and overall accreditation rates.

Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass.

As the prevalence of morbid obesity continues to climb in America, so does the popularity of the Roux-en-Y gastric bypass (RYGB) to achieve weight loss goals; however, a long-term risk of RYGB is marginal ulceration, which requires urgent surgery if perforated. We sought to identify characteristics associated with elective vs urgent presentation for marginal ulcer following RYGB. Retrospective data for consecutive cases with marginal ulcers that required surgical intervention from May 2016 to February 2021 were queried from our institution's bariatric database, and differences in patient characteristics and clinical course were assessed according to presentation.

Updated panel report: best practices for the surgical treatment of obesity.

Background: During the 2004 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on best practices in bariatric surgery. The rapid evolution of endoluminal technologies, surgical indications, and training in bariatric surgery since 2004 has led to new questions and concerns about optimal treatment algorithms, patient selection, and the preparation of our current and future bariatric workforce.

Methods: An expert panel was convened at the SAGES 2017 annual meeting to provide a summative update on current practice patterns, techniques, and training in bariatric surgery in order to review and establish best practices.

Tris-bipyridine based dinuclear ruthenium(ii)-osmium(iii) complex dyads grafted onto TiO nanoparticles for mimicking the artificial photosynthetic Z-scheme.

The Z-Scheme function within molecular systems has been rarely reported for solar energy conversion although it offers the possibility to achieve higher efficiency than single photon absorber photosystems due to the use of a wider range of visible light. In this study, we synthesized and investigated the electrochemical and spectroscopic properties of two new dyads based on ruthenium and osmium tris-bipyridine complexes covalently linked via a butane bridge to explore their ability to realize the Z-scheme function once immobilized on TiO. These dyads can be grafted onto a nanocrystalline TiO film via the osmium complex bearing two dicarboxylic acid bipyridine ligands, while the ruthenium complex contains either two unsubstituted bipyridine ancillary ligands (RuH-Os) or two (4,4'-bis-trifluoromethyl-bipyridine) ancillary ligands (RuCF3-Os).

Regioselectivity in C-H activation: reagent control in cyclometallation of 2-(1-naphthyl)-pyridine.

2-(1-Naphthyl)-pyridine () possesses sp(2) C-H bonds in both the γ- and δ-positions and is therefore a suitable substrate for studying the cyclometallation selectivity with different reagents and conditions. Such selectivity studies are reported. Based on deuterium-exchange experiments it is concluded that cycloruthenation with RuCl2(p-cymene) dimer is reversible with kinetic and thermodynamic preference for γ-substitution.

Effect of staple height on gastrojejunostomy during laparoscopic gastric bypass: a multicenter prospective randomized trial.

Background: Gastrointestinal (GI) bleeding and anastomotic stricture are frequent complications associated with the construction of the gastrojejunostomy during laparoscopic gastric bypass. Staplers with shorter staple height can reduce the rate of postoperative GI hemorrhage. The aim of the present study was to assess the outcomes of patients who had undergone gastric bypass with construction of the gastrojejunostomy using a 25-mm circular stapler with a 3.

Management of transmesenteric tunnel jejunal strictures with endoscopic dilation by using achalasia balloons (with videos).

Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Transmesenteric tunnel (TMT) or mesocolic jejunal stricture is an unusual postoperative complication that requires another operation. We hypothesize that endoscopic dilation by using achalasia dilatation balloons can be used to treat some TMT jejunal strictures.

Variations of weight loss following gastric bypass and gastric band.

Objective: To compare and describe the weight loss outcomes from gastric bypass and gastric band so as to define the variation of excess weight loss (EWL) among individual patients, the time to onset of effect, and the durability of weight loss in severely obese adults.

Summary Background Data: Gastric bypass and gastric band are the most common operations for obesity performed in the United States, but few reports have compared these 2 procedures.

Methods: Patients (N = 1733, aged 18-65 years) met National Institutes of Health criteria for obesity surgery and underwent either gastric bypass or gastric band between March 1997 and November 2006.

Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos).

Background: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction.

Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables.

Background: Dexmedetomidine (Dex), an alpha(2) agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, double-blind, and placebo-controlled dose-ranging study to evaluate the effect of Dex on both early and late recovery after laparoscopic bariatric surgery.

Methods: Eighty consenting ASA II-III morbidly obese patients were randomly assigned to 1 of 4 treatment groups: (1) control group received a saline infusion during surgery, (2) Dex 0.

Metabolic syndrome phenotype in very obese women.

Severe obesity is increasingly common in the United States. Very obese persons are at increased risk for the metabolic consequences of obesity. A common multidimensional risk condition associated with obesity is the metabolic syndrome.

Endotherapy in unusual bariatric surgical complications (with videos).

Roux-en-Y gastric bypass (RYGBP) is the most commonly performed bariatric operation in the USA. We hypothesize that therapeutic endoscopy can be used to treat some unusual post-operative complications. We report two cases of early post-operative complications: (1) gastrogastrotomy (GG) stricture and (2) "trans-mesenteric tunnel" or "mesocolic" jejunal stricture.

Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome.

Background: Morbid obesity is now an epidemic with considerable associated morbidity for which bariatric surgery has been the only effective treatment. Despite its success, occasional patients require revision because of weight regain or mechanical complications. The impact of multiple prior bariatric operations on complications and weight loss after revision to Roux-en-Y gastric bypass (RYGBP) was evaluated.

Fascial ultrasound for evaluation of anterior abdominal stab wound injury.

Background: Local stab wound (SW) exploration to assess abdominal fascial integrity is a highly invasive procedure frequently performed under demanding circumstances in the Emergency Department (ED). We hypothesized ultrasound (U/S) may be useful in the detection of fascial defects resulting from anterior abdominal stab injury, eliminating the need for local wound exploration

Methods: Thirty-five hemodynamically normal patients evaluated at a Level I trauma center for anterior abdominal stab wounds were examined by U/S (8 mHz probe) for evidence of fascial violation. All patients were subsequently evaluated by local wound exploration

Results: Fascial U/S had an overall sensitivity of 59% and specificity of 100%, (PPV 100%, NPV 59%) for detection of fascial SW defects compared with local wound exploration.

Laparoscopic adjustable gastric banding: an attractive option.

Bariatric surgery is the only effective treatment producing sustained weight loss and reduction in comorbidities in the morbidly obese. Laparoscopic adjustable gastric banding (LAGB) has evolved considerably in techniques of insertion and band management since the initial descriptions in the early 1990s. Major advantages of LAGB include lower perioperative morbidity and mortality, adjust-ability, and reversibility.

Heated and humidified insufflation during laparoscopic gastric bypass surgery: effect on temperature, postoperative pain, and recovery outcomes.

Background: Controversy exists regarding the efficacy of heated and humidified intraperitoneal gases in maintaining core body temperature. We performed a sham-controlled study to test the hypothesis that active warming and humidification of the insufflation gas reduces intraoperative heat loss and improves recovery outcomes.

Patients And Methods: Fifty morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass procedures using a standardized anesthetic technique were randomly assigned to either a control (sham) group receiving room temperature insufflation gases with an inactive Insuflow (Lexion Medical, St.

Use of fibrin sealant in laparoscopic gastric bypass for the morbidly obese.

Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the USA. Anastomotic leak is one of the devastating complications in this operation. By using fibrin sealant around the anastomosis, surgeons can achieve better hemostasis around the suture-line and prevent or decrease the incidence of anastomotic leaks.

Abdominal wall neurofibroma presenting as an inguinal hernia.

Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions.

Is routine cholecystectomy required during laparoscopic gastric bypass?

Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP).

Methods: 289 LRYGBP were performed between November 1999 and May 2002.

Acute post-gastric reduction surgery (APGARS) neuropathy.

Background: A variety of neurologic complications have been reported after weight loss surgery. Recently, a new term was introduced to describe cases of postoperative polyneuropathy - acute post-gastric reduction surgery (APGARS) neuropathy, a polynutritional, multisystem disorder characterized by protracted postoperative vomiting, hyporeflexia, and muscular weakness. The incidence, associations, and prognosis of this disorder have not been precisely defined.

Gastro-clip gastroplasty: a very long-term complication.

For most surgeons, the gastro-clip gastroplasty is an unfamiliar operation. It was performed during the mid 1980s as an alternative to more complex bariatric operations. However, the device had problems.