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In unilateral ureteral obstruction (UUO), the kidney is characterized by increased fibrosis and apoptosis. Both transforming growth factor-[beta] (TGF-[beta]) and ANG II have been implicated, and ANG II may mediate its effects through TGF-[beta]. Previous studies demonstrated amelioration of renal damage when either TGF-[beta] or ANG II has been individually targeted. In this study, we sought to determine whether combining 1D11 (monoclonal antibody to TGF-[beta]) and an ACE inhibitor, enalapril, would be more effective in UUO than either individual treatment, as has been shown in diabetic and glomerulonephritic models. Rats underwent UUO and were given either control monoclonal antibody, 1D11 or enalapril, or 1D11/enalapril combination, for 14 days. Kidneys were harvested and examined for fibrosis [trichrome; collagen (real-time PCR, Sircol assay) and fibroblast-specific protein expression (immunohistochemistry), apoptosis (TUNEL), macrophage infiltration (immunohistochemistry), and TGF-[beta] expression (real-time PCR and tubular localization with immunohistochemistry)]. UUO was found to induce fibrosis, apoptosis, macrophage infiltration, and TGF-[beta] expression in the obstructed kidney. Administration of either 1D11 or enalapril individually significantly decreased all these changes; when 1D11 and enalapril were combined, there was little additive effect, and the combination did not provide full protection against damage. The results demonstrate that, for the most part, combination therapy is not additive in UUO. This could be due to the continued presence of a physical obstruction or to biochemical differences between UUO and other renal disease models. Furthermore, it suggests that other targets may be amenable to pharmacological manipulation in UUO. fibrosis; apoptosis; transforming growth factor-[beta]; converting enzyme inhibitor

Progression of renal damage after relief of unilateral ureteral obstruction (UUO) has been demonstrated, especially in neonatal rats. We evaluated renal function and renal damage after relief of 3-day UUO in five groups of adult rats: group 1, no treatment; group 2, 3-day UUO; groups 3-5, 3-day UUO followed by relief; group 3, 7-day relief; group 4, 14-day relief; and group 5, 28-day relief. Glomerular filtration rate (GFR), renal blood flow (RBF), tissue transforming growth factor-[beta] (TGF-[beta]), interstitial fibrosis and fibroblast expression, tubular apoptosis, macrophage infiltration, expression of nitric oxide synthases (NOS), and urinary nitrate/nitrite (N[O.sub.2]/N[O.sub.3]) were evaluated. RBF and GFR were decreased to Sprague-Dawley rats; interstitial fibrosis; apoptosis; transforming growth factor-[beta]; FSP; nitric oxide

The use of robotic surgery in bariatric patients is controversial. To evaluate the outcome of robotic surgery in Roux-en-Y gastric bypass (RYGB) patients. Tertiary-care referral hospital. A total of 149,132 patients who underwent RYGB in the 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were included in our initial analysis. The propensity-matched analysis that was performed resulted in 21,736 patients, whose data were utilized to compare outcomes of the robotic (R) and laparoscopic (L) groups. Patients were also compared after dividing them into obese (body mass index [BMI] < 50 kg/m2) and super-obese categories (BMI ≥ 50 kg/m2). R-RYGB patients had a significantly lower 30-day incidence of serious adverse events (SAEs) and bleeding (2.0% and.7%, respectively, for R-RYGB versus 2.4% and 1.3%, respectively, for L-RYGB; P ≤.05) but a higher incidence of 30-day reoperation compared to L-RYGB patients (2.7% versus 2.3%, respectively; P ≤.05). The R-RYGB group also had a shorter length of hospital stay compared to the L-RYGB group (1.98 versus 2.02 days, respectively; P ≤.05), but higher readmission rates (7.1% versus 5.8%, respectively; P ≤.05). The robotic approach also resulted in lower mortality rates for those in the super-obese category. In that BMI category, 30-day mortality rates were.4% versus.2% for L-RYGB and R-RYGB patients, respectively (P ≤.05). The use of robotic surgery in bariatric patients is controversial. Our analysis, based on the MBSAQIP database for the years 2015 to 2018, demonstrated lower overall SAEs and bleeding rates, in addition to a shorter hospital stay, favoring robotic RYGB compared to laparoscopic RYGB. However, readmission and reoperation rates were higher in the robotic group. Randomized controlled trials are needed to further clarify the benefit of robotic surgery in bariatric patients. • We used the MBSAQIP database to compare outcomes of robotic and laparoscopic RYGB. • R-RYGB had lower incidence of adverse events, bleeding and hospital stay. • R-RYGB had lower mortality rates in the super-obese category. • R-RYGB had higher incidence of reoperation and readmission. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative.Objective: The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients' pain, satisfaction, and hospital length of stay.Methods: In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h. Group 2 (control) received IV normal saline plus IV/PO narcotics. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (SG). Primary outcomes included direct hospital costs, length of stay, postoperative pain, and patient satisfaction. Secondary outcomes included indirect costs, rescue narcotics dosage, and 30-day outcomes.Results: Mean direct hospital cost in the treatment group (n = 50) was $3089.18 versus $2991.62 for the control group (n = 50) (p > 0.05). Pain scores did not differ significantly (p = 0.61). After adjusting for surgery type, there was no significant difference in length of stay (p = 0.95). Significantly more control group patients incurred surgery-related indirect costs (10 versus 2%, p < 0.05), with greater presentation to the emergency department (ED) for abdominal pain (5/50 versus 1/50), yielding higher total indirect costs ($39,293 versus $13,185).Conclusions: Using IV acetaminophen for postoperative pain management produced notable indirect cost savings and reduced ED visits in the first 30 days postoperatively, with good safety and tolerance. Decreased statistical power may have accounted for certain non-significant findings. [ABSTRACT FROM AUTHOR]