UNASSIGNED: Vancomycin dosing decisions are informed by factors such as body weight and renal function. It is important to understand the impact of obesity on vancomycin pharmacokinetics and how this may influence dosing decisions. Vancomycin dosing guidelines use varied descriptors of body weight and renal function. There is uncertainty whether current dosing guidelines result in attainment of therapeutic targets in obese individuals.
UNASSIGNED: Literature was explored using PubMed, Embase, and Google Scholar for articles from January 1980 to July 2021 regarding obesity-driven physiological changes, their influence on vancomycin pharmacokinetics and body size descriptors and renal function calculations in vancomycin dosing. Pharmacokinetic simulations reflective of international vancomycin dosing guidelines were conducted to evaluate the ability of using total, ideal, and adjusted body weight, as well as Cockcroft-Gault and CKD-EPI equations to attain an area-under-the-curve to minimum inhibitory concentration ratio (AUC24/MIC) target (400-650) in obese individuals.
UNASSIGNED: Vancomycin pharmacokinetics in obese individuals remains debated. Guidelines that determine loading doses using total body weight, and maintenance doses adjusted based on renal function and adjusted body weight, may be most appropriate for obese individuals. Use of ideal body weight leads to subtherapeutic vancomycin exposure and underestimation of renal function.

Food reinforcement, or the motivation to obtain food, can predict choice and consumption. Vegetable consumption is well below recommended amounts for adults, so understanding how to increase vegetable reinforcement could provide valuable insight into how to increase consumption.
We sought to determine whether daily consumption of the Dietary Guidelines for Americans (DGA) recommendations for vegetable intake induces sensitization of vegetable reinforcement in adults with overweight and obesity.
Healthy adults with a BMI ≥ 25 kg/m2 who consumed ≤1 cup-equivalent of vegetables/day were randomly assigned to a vegetable intervention (VI; n = 55) or an attention control (AC; n = 55) group. The VI consisted of the daily provision of vegetables in the amounts and types recommended by the DGA (∼270 g/day) for 8 weeks. Participants were followed for an additional 8 weeks to assess sustained consumption. Compliance was measured weekly by resonance Raman light-scattering spectroscopy (RRS). Vegetable reinforcement was tested at weeks 0, 8, 12, and 16 using a computer choice paradigm.
In the VI group, RRS intensity increased from week 0 to 8 (from 22,990 to 37,220), returning to baseline by week 16 (27,300). No change was observed in the AC group. There was no main effect of treatment (P = 0.974) or time (P = 0.14) and no treatment x time interaction (P = 0.44) on vegetable reinforcement. There was no moderating effect of sex (P = 0.07), age (P = 0.60), BMI (P = 0.46), delay discounting (P = 0.24), 6-n-propylthiouracil taster status (P = 0.15), or dietary disinhibition (P = 0.82) on the change in vegetable reinforcement.
These findings suggest no effects of the provision of a variety of vegetables to meet DGA recommendations for 8 weeks on vegetable reinforcement and highlight the difficulty in increasing vegetable consumption in adults. This trial was registered at clinicaltrials.gov as NCT02585102.

Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient\'s health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular \"high-risk\" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.

Obesity is significantly associated with uncontrolled blood pressure and resistant hypertension (RH). There are limited studies on the prevalence and determinants of RH in patients with higher body mass index (BMI) values. Since the hypertension guidelines changed in 2017, the prevalence of RH has become unknown and now is subject to be estimated by further studies. We conducted a cross-sectional study in an urban Federally Qualified Health Center in New York City aiming to estimate the prevalence of RH in high-risk overweight and obese patients based on the new hypertension definition, BP threshold ≥130/80 mm Hg, and also to describe the associated comorbid conditions in these patients. We identified 761 eligible high-risk overweight and obese subjects with hypertension between October 2017 and October 2018. Apparent treatment-RH was found in 13.6% among the entire study population. This represented 15.4% of those treated with BP-lowering agents. True RH confirmed with out-of-office elevated BP was found in 6.7% of the study population and 7.4% among patients treated with BP-lowering agents. Prevalence was higher with higher BMI values. Those with true RH were more likely to be black, to have diabetes mellitus requiring insulin, chronic kidney disease stage 3 or above and diastolic heart failure. In conclusion, obesity is significantly associated with RH and other significant metabolic comorbid conditions.