Tylerdickinson9555

BACKGROUND Opioid consumption in North America has risen to alarming levels and represents a potentially modifiable risk factor in perioperative management. Chronic pain and obesity are commonly associated and bariatric surgery remains the most effective intervention for weight loss in morbidly obese patients. OBJECTIVES To understand how preoperative opioid use impacts surgical outcomes in patients undergoing bariatric surgery. SETTING The Ontario Bariatric Registry. METHODS Data collected in the Ontario Bariatric Registry between 2010 and 2018 were used for this retrospective study. Preoperative opioid use was retrospectively retrieved from the medication review during preoperative assessment. Primary outcomes were complications and readmissions at 30 and 90 days of surgery. Secondary outcomes included hospital length of stay and complication types at 30 and 90 days. Analyses were risk-adjusted for procedure type and patient-specific risk factors, such as age, sex, race, body mass index, and co-morbid conditions. RESULTS Overall, 5357 patients were included in the study. Among those, 12% (n = 643) used opioids preoperatively. Risk-adjusted analyses demonstrated that opioid users, compared with opioid-naïve patients, had a longer length of stay (odds ratio 2.50, 95% confidence interval 1.05-6.00, P less then .05) and higher rates of complications at 30 days (odds ratio 1.40, 95% confidence interval 1.02-2.18, P less then .05). Subgroup analyses revealed that within preoperative opioid users, patients who underwent Roux-en-Y gastric bypass had poorer outcomes than those who underwent sleeve gastrectomy. CONCLUSION Opioid use is common before bariatric surgery and is independently associated with prolonged length of stay and complication rates at 30 days. Preoperative opioid use represents a potentially modifiable risk factor and a unique target to improving the quality of surgical care. BACKGROUND Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences. OBJECTIVE To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences. SETTING Online survey. METHODS A discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations. RESULTS Respondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients. CONCLUSIONS Results show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs. (Surg Obes Relat Dis 2020;XXXX-XXX.) © 2020 American Society for Metabolic and Bariatric Surgery. All rights reserved. PURPOSES Recently, Methylcrotonoyl-CoA carboxylase 2 (MCCC2) is reported to be involved in tumor formation and progression. However, MCCC2 has nerve been reported in colorectal cancer. In this study, we aimed to investigate the role of MCCC2 in colorectal cancer. METHODS 118 colorectal cancer and matched adjacent normal tissues were enrolled in this study. The expression level of MCCC2 was measured by quantificational real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC). The clinical significance of MCCC2 and its influence on cell proliferation was further analyzed. Epibrassinolide RESULTS Results shown that the mRNA levels of MCCC2 in colorectal cancer tissues were significantly increased compared with those in normal tissues (P  less then  .0001). MCCC2 high-expression was observed in 56.8% colorectal cancer tissues, which was significantly higher than those in normal controls (9.3%, P  less then  .0001). MCCC2 high-expression correlated with tumor size, T stage, lymph node metastasis, distant metastasis, clinical stage and differentiation in colorectal cancer (P  less then  .05). Moreover, MCCC2 high-expression predicted poorer prognosis and could be as an independent prognostic factor. In addition, MCCC2 knockdown significantly inhibited cell proliferation compared with these controls, while MCCC2 overexpression could reverse the effect. CONCLUSION These data indicate MCCC2 overexpression promotes cell proliferation and predicts poorer prognosis in colorectal cancer. Low density lipoprotein-cholesterol (LDL-C) serves as the primary target of therapy for preventing atherosclerotic cardiovascular disease (ASCVD). Recently released European and American guidelines on lipid management recommend attaining very low LDL-C levels ( less then 1.8 mmol/L or even lower) in high and very-high risk patients. Therefore, utilizing an accurate means for determining LDL-C, especially at such low values, is of paramount importance to inform the best clinical decisions and use of effective therapies. This review compares the different methods of determining LDL-C, including the various forms of direct measurement and most commonly used calculations. This review discusses the evidence behind these methods in different populations of patients and in the fasting versus non-fasting state. The Martin/Hopkins method is the preferred method for determining LDL-C as it is the most accurate and widely applicable method. It is especially useful in patients with low LDL-C levels  less then  1.8 mmol/L ( less then 70 mg/dL) and high triglyceride levels between 1.