Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey

BACKGROUND

Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known.

OBJECTIVES

Assess patient needs, goals, and preferences regarding WR treatment.

SETTING

Single MBSAQIP-accredited academic center, and online recruitment.

METHODS

An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations.

RESULTS

Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively.

CONCLUSIONS

Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.

Host, environment, and anthropogenic factors drive landscape dynamics of an environmentally transmitted pathogen: Sarcoptic mange in the bare-nosed wombat

Understanding the spatial dynamics and drivers of wildlife pathogens is constrained by sampling logistics, with implications for advancing the field of landscape epidemiology and targeted allocation of management resources. However, visually apparent wildlife diseases, when combined with remote-surveillance and distribution modelling technologies, present an opportunity to overcome this landscape-scale problem. Here, we investigated dynamics and drivers of landscape-scale wildlife disease, using clinical signs of sarcoptic mange (caused by Sarcoptes scabiei) in its bare-nosed wombat (BNW; Vombatus ursinus) host. We used 53,089 camera-trap observations from over 3261 locations across the 68,401 km2 area of Tasmania, Australia, combined with landscape data and ensemble species distribution modelling (SDM). We investigated: (1) landscape variables predicted to drive habitat suitability of the host; (2) host and landscape variables associated with clinical signs of disease in the host; and (3) predicted locations and environmental conditions at greatest risk of disease occurrence, including some Bass Strait islands where BNW translocations are proposed. We showed that the Tasmanian landscape, and ecosystems therein, are nearly ubiquitously suited to BNWs. Only high mean annual precipitation reduced habitat suitability for the host. In contrast, clinical signs of sarcoptic mange disease in BNWs were widespread, but heterogeneously distributed across the landscape. Mange (which is environmentally transmitted in BNWs) was most likely to be observed in areas of increased host habitat suitability, lower annual precipitation, near sources of freshwater and where topographic roughness was minimal (e.g. human modified landscapes, such as farmland and intensive land-use areas, shrub and grass lands). Thus, a confluence of host, environmental and anthropogenic variables appear to influence the risk of environmental transmission of S. scabiei. We identified that the Bass Strait Islands are highly suitable for BNWs and predicted a mix of high and low suitability for the pathogen. This study is the largest spatial assessment of sarcoptic mange in any host species, and advances understanding of the landscape epidemiology of environmentally transmitted S. scabiei. This research illustrates how host-pathogen co-suitability can be useful for allocating management resources in the landscape.

Iterative development and the scope for plasticity: contrasts among trait categories in an adaptive radiation

Phenotypic plasticity can influence evolutionary change in a lineage, ranging from facilitation of population persistence in a novel environment to directing the patterns of evolutionary change. As the specific nature of plasticity can impact evolutionary consequences, it is essential to consider how plasticity is manifested if we are to understand the contribution of plasticity to phenotypic evolution. Most morphological traits are developmentally plastic, irreversible, and generally considered to be costly, at least when the resultant phenotype is mis-matched to the environment. At the other extreme, behavioral phenotypes are typically activational (modifiable on very short time scales), and not immediately costly as they are produced by constitutive neural networks. Although patterns of morphological and behavioral plasticity are often compared, patterns of plasticity of life history phenotypes are rarely considered. Here we review patterns of plasticity in these trait categories within and among populations, comprising the adaptive radiation of the threespine stickleback fish Gasterosteus aculeatus. We immediately found it necessary to consider the possibility of iterated development, the concept that behavioral and life history trajectories can be repeatedly reset on activational (usually behavior) or developmental (usually life history) time frames, offering fine tuning of the response to environmental context. Morphology in stickleback is primarily reset only in that developmental trajectories can be altered as environments change over the course of development. As anticipated, the boundaries between the trait categories are not clear and are likely to be linked by shared, underlying physiological and genetic systems.

Endovascular repair of thoracoabdominal aortic aneurysm (TAAA): early experience

BACKGROUND

Repair of thoracoabdominal aortic aneurysms (TAAA) represents a considerable technical challenge. Since its first description in 1955, open repair of TAAA has been considered the gold standard of repair. Despite improvements in surgical techniques, spinal cord protection and post-operative critical care support, patients who undergo open repair are faced with a mortality rate of 5-35 %. We report the first Irish experience of endovascular management of TAAAs.

RESULTS

To date five patients have undergone endovascular repair; four had hybrid repair and one a fenestrated graft. The mean age of the patients was 66.8 ± 3.4 and the mean aneurysm diameter was 6.74 ± 0.6 cm. All patients were ASA III. Two-stage hybrid repair was associated with an increased risk of complications, prolonged intensive care unit and overall hospital stay. One patient died in the perioperative period due to rupture of their aneurysm between the two stages of their hybrid repair.

CONCLUSION

The role of endovascular techniques in the treatment of TAAA continues to evolve. Hybrid and complete endovascular repairs do not replace conventional repair, but provide an alternative for high-risk patients who might otherwise be denied treatment.

The relationship of retinal vessel diameter to changes in diabetic nephropathy structural variables in patients with type 1 diabetes

AIMS/HYPOTHESIS

We examined whether retinal vessel diameter in persons with type 1 diabetes mellitus is associated with changes in subclinical anatomical and functional indicators of diabetic nephropathy.

METHODS

Persons with type 1 diabetes mellitus had gradable fundus photographs and renal biopsy data at baseline and 5-year follow-up (n = 234). Retinal arteriolar and venular diameters were measured at baseline and follow-up. Central retinal arteriole equivalent (CRAE) and central retinal venule equivalent (CRVE) were computed. Baseline and 5-year follow-up renal structural variables were assessed by masked electron microscopic morphometric analyses from percutaneous renal biopsy specimens. Variables assessed included: mesangial fractional volume, glomerular basement membrane width, mesangial matrix fractional volume and glomerular basement membrane width composite glomerulopathy index.

RESULTS

While controlling for other covariates, baseline CRAE was positively associated with change in the glomerulopathy index over the 5-year period. Change in CRAE was inversely related to a change in mesangial matrix fractional volume and abnormal mesangial matrix fractional volume, while change in CRVE was directly related to change in the volume fraction of cortex that was interstitium [Vv((Int/cortex))] over the 5-year period. Baseline CRAE or CRVE or changes in these diameters were not related to changes in other anatomical or functional renal endpoints.

CONCLUSIONS/INTERPRETATION

Independently of other factors, baseline CRAE correlated with changes in glomerulopathy index, a composite measure of extracellular matrix accumulation in the mesangium and glomerular basement membrane. A narrowing of the CRAE was related to mesangial matrix accumulation. Changes in CRVE were related to changes in Vv((Int/cortex),) a measure of interstitial expansion in persons with type 1 diabetes mellitus.

Fluid balance, thermoregulation and sprint and passing skill performance in female soccer players

Ten females performed 90 min of the Loughborough Intermittent Shuttle Test (LIST) on two occasions separated by 7 days. Water [3 mL/kg body mass (BM)] was provided every 15 min during exercise (FL); no fluid was given in the other trial (NF). Participants performed the Loughborough Soccer Passing Test (LSPT) before and every 15 min during the LIST. Core temperature (T(c) ) was measured throughout using ingestible temperature sensors. Heart rate (HR), blood lactate ([La(-) ]) and ratings of perceived exertion (RPE) were collected at regular intervals during exercise. Participants experienced greater BM loss in NF (2.2 ± 0.4%) than FL (1.0 ± 0.4%; P<0.001). Sprint performance deteriorated by 2.7% during exercise (P<0.001) but there was no difference between trials (P=0.294). No significant differences in LSPT performance were detected between trials (P=0.31). T(c) was higher during exercise in NF and was 38.6 ± 0.3 °C (NF) and 38.3 ± 0.3 °C (FL; P<0.01) after 90 min. HR (P<0.001), [La(-) ] (P<0.01) and RPE (P=0.009) were higher during exercise in NF. Ingesting water during a 90-min match simulation reduces the mild dehydration seen in female soccer players when no fluid is consumed. However, there was no effect of fluid ingestion on soccer passing skill or sprint performance.

An investigation into the prevalence of Renibacterium salmoninarum in farmed rainbow trout, Oncorhynchus mykiss (Walbaum), and wild fish populations in selected river catchments in England and Wales between 1998 and 2000

A cross-sectional survey of Renibacterium salmoninarum infection in farmed rainbow trout (RBT) and wild fish populations was carried out in 10 farms and six river catchments, respectively, in England and Wales. The majority of the wild fish were sampled in 1998 and the farmed fish in 2000. Grayling, Thymallus thymallus, and brown trout, Salmo trutta, were the main wild species sampled. Two fish, one grayling and one salmon, Salmo salar, were R. salmoninarum culture-positive, compared with 40 confirmed polymerase chain reaction-positive wild fish. The highest prevalence of R. salmoninarum infection was found in grayling in rivers with RBT farms with a history of R. salmoninarum infection. One hundred and fifty fish were sampled from each RBT farm, but none of the fish was found to be R. salmoninarum-positive. Evidence was found, for the first time, for the presence of R. salmoninarum in an eel, Anguilla anguilla.

Qualitative risk assessment of routes of transmission of the exotic fish parasite Gyrodactylus salaris between river catchments in England and Wales

Gyrodactylus salaris is a freshwater, monogenean ecto-parasite of Atlantic-salmon. Infection of its natural host, the Baltic strain of Atlantic-salmon, is inapparent. G. salaris also can infect rainbow-trout (Oncorhynchus mykiss) permanently, and cause infection of < or =50 days in several other species. It is only on Atlantic stocks of Atlantic-salmon (Salmo salar) that the parasite multiplies unchecked by an immune response, causes death in juveniles and dramatic reductions in wild populations. In Norway, the parasite has been introduced into 45 rivers, resulting in reductions in Atlantic-salmon stocks of up to 98%. It is probably the most-important exotic fish-disease threat to the UK. We used risk analysis to assess the most-important routes of spread for G. salaris between rivers in England and Wales. The movement of live rainbow-trout was identified as the most-important route of transmission; this route is likely to lead rapidly to the wide geographic spread of the parasite. The movement of other species of fish (especially from sites holding rainbow-trout) is also an important risk. Other routes of spread (including mechanical transmission on farm equipment and vehicles, angling equipment, canoes, etc.) might allow limited local spread (mainly to neighbouring rivers).

Isolation of a rhabdovirus during outbreaks of disease in cyprinid fish species at fishery sites in England

A virus was isolated during disease outbreaks in bream Abramis brama, tench Tinca tinca, roach Rutilis rutilis and crucian carp Carassius carassius populations at 6 fishery sites in England in 1999. Mortalities at the sites were primarily among recently introduced fish and the predominant fish species affected was bream. The bream stocked at 5 of the 6 English fishery sites were found to have originated from the River Bann, Northern Ireland. Most fish presented few consistent external signs of disease but some exhibited clinical signs similar to those of spring viraemia of carp (SVC), with extensive skin haemorrhages, ulceration on the flanks and internal signs including ascites and petechial haemorrhages. The most prominent histopathological changes were hepatocellular necrosis, interstitial nephritis and splenitis. The virus induced a cytopathic effect in tissue cultures (Epithelioma papulosum cyprini [EPC] cells) at 20 degrees C and produced moderate signals in an enzyme immunoassay (EIA) for the detection of SVC virus. The virus showed a close serological relationship to pike fry rhabdovirus in both EIA and serum neutralisation assays and to a rhabdovirus isolated during a disease outbreak in a bream population in the River Bann in 1998. A high degree of sequence similarity (> or = 99.5% nucleotide identity) was observed between the English isolates and those from the River Bann. Experimental infection of juvenile bream, tench and carp with EPC cell-grown rhabdovirus by bath and intraperitoneal injection resulted in a 40% mortality of bream in the injection group only. The virus was re-isolated from pooled kidney, liver and spleen tissue samples from moribund bream. The field observations together with the experimental results indicate that this rhabdovirus is of low virulence but may have the potential to cause significant mortality in fishes under stress.

Evaluation of myectomized partial-thickness ileum in experimental bladder augmentation

BACKGROUND

We undertook this study to examine the effects of 'stripping' with excision of serosa and muscularis propria (myectomy) from the antimesenteric aspect of ileum incorporated into the urinary tract.

METHODS

Two groups of five dogs were studied. In the first group studied, detubularizing was effected by incising the middle of the thinned antimesenteric aspect of the ileal wall longitudinally. Myectomized bowel was then anastomosed to bladder as a patch-type augmentation cystoplasty. Omentum was applied to denuded surfaces. In the second group of dogs, two isolated segments of ileum were anastomosed to bladder to form cornua with ureters implanted into the cranial ends. One of the two cornua was myectomized as above and, in three of the five dogs, the denuded surfaces were covered by omentum.

RESULTS

In the first group, no contraction waves were recorded during filing. In the second group, myectomized segments with adherent omentum were acontractile with low intraluminal pressures and were considerably more capacious compared with control segments and those not omentally wrapped. Ureteric thickening and dilatation were present in all upper tracts proximal to control cornua and myectomized segments not covered by omentum. None of the upper tracts in the first group or above the omentally applied segments in the second group was dilated. Adhesions and back-to-back scarring were seen in stripped bowel which had not been covered by omentum per-operatively.

CONCLUSIONS

These findings indicate that myectomy of the antimesenteric aspect of ileum provides a voluminous low-pressure urinary reservoir. Careful application and fixing of omentum to denuded surfaces appears important, it ensures these features by prevention of scarring and adhesion formation.

Bistratene A causes phosphorylation of talin and redistribution of actin microfilaments in fibroblasts: possible role for PKC-delta

Bistratene A is a marine toxin which induces phosphorylation of cellular proteins. Our current evidence indicates that this occurs through activation of protein kinase C-delta. In fibroblasts bistratene A causes rounding up of the cells and a rapid disappearance of vinculin staining and actin stress fibers as detected by fluorescence immunohistochemistry. Phosphorylation of the focal adhesion protein, talin, is increased after bistratene A treatment and this is inhibited by calphostin C, a specific inhibitor of PKC. No changes in the phosphorylation status of vinculin, tubulin, or vimentin were observed in the presence of the toxin. Treatment with bistratene A caused a redistribution of PKC-delta from cytosolic and membrane compartments to the nuclear fraction. There was no effect on the subcellular distribution of any other PKC isoform. These results demonstrate that phosphorylation of talin is implicated in the disruption of actin microfilaments in fibroblasts by bistratene A and that this is most likely mediated by PKC-delta.

Taperloc femoral component. A 2-6-year study of the first 100 consecutive cases

The first 100 consecutive patients who underwent insertion of the Taperloc (Biomet, Warsaw, IN) femoral stem were prospectively studied with a mean follow-up period of 3.8 years (range, 2-6 years). Two of the original 100 patients were lost, giving a 98% follow-up rate. The diagnoses included osteoarthritis (76 patients), avascular necrosis (19), rheumatoid arthritis (3), chrondrolysis (1), and post-traumatic arthritis (1). The mean age at surgery was 56 years (range, 25-79 years), mean weight was 78 kg (range, 45-127 kg), and the female to male ratio was 29:71. Charnley pain and function scores were 3.0 and 2.8 before surgery and 5.5 and 5.4 after surgery. Thigh pain was present in 2% of the patients at the final follow-up evaluation. There were no revisions. Radiographic signs of bone-ingrowth fixation (calcar atrophy, spot welds) were seen in 92 of 94 components (98%). No component had complete demarcation of the porous-coated zones. Fifty-two of 94 patients were able to be matched for age, sex, weight, diagnosis, and length of follow-up period with a series of patients who received a contemporary cemented total hip. In this matched subset, the Charnley pain and function scores were 5.6 and 5.5 for the cementless Taperloc stem and 5.7 and 5.5 for the cemented control group; this is not a significant difference. These data indicate a clinical performance equivalent to a matched group of contemporary cemented total hip arthroplasties.

Revision total hip arthroplasty using ultrasonically driven tools. A clinical evaluation

A three-center clinical evaluation of the use of ultrasonic instrumentation for cement removal during 90 revision total hip arthroplasties was undertaken. In conjunction with hand tools, cement removal was facilitated with ultrasonic tools. Superficial bone burns were seen in eight cases (9%). Bone perforations were created with ultrasonic tools in three cases (4%)--two followed perforations already created by hand tools in the proximal metaphyseal area. Only one perforation (1%) was made in the shaft of the femur. Ultrasonic instrumentation is a valuable adjunct for cement removal in revision total hip arthroplasty.

Techniques of bone grafting in total knee arthroplasty

Bone grafting of osseous defects in primary or secondary total knee arthroplasty remains a popular and often indispensable solution to reconstructive problems. Solutions to contained, uncontained, and massive defects of both the tibia and femur are presented, as well as several options for reconstruction of deficient or ruptured extensor mechanisms.

The bistratenes: new cytotoxic marine macrolides which induce some properties indicative of differentiation in HL-60 cells

The biological effects of cytotoxic macrolide polyethers, the bistratenes, isolated from the ascidian Lissoclinum bistratum, have been examined. Bistratene A was toxic to HL-60 human promyelocytic leukemia cells with an IC50 value of 424 nM. At lower concentrations (10-100 nM), bistratene A induced the incomplete differentiation of these cells along the monocyte/macrophage pathway. These effects were not due to inhibition of DNA synthesis. Bistratene B had similar effects to bistratene A. At micromolar concentrations these compounds enhance the phospholipid-dependent activity of type II protein kinase C from bovine spleen. The bistratenes provide new probes for studying the molecular mechanisms governing cell growth and differentiation.

Efficacy of postevacuation view after double-contrast barium enema

A single postevacuation view was obtained in each of 100 consecutive patients undergoing double-contrast barium enema to determine the efficacy of the routine use of this view. This view was unequivocally helpful only when complete appendiceal filling was desired (1% of our series). Otherwise, this view was either noncontributory (95%), of doubtful assistance (3%), or misleading (1%). Therefore, the postevacuation view should not be obtained routinely.

Reaction of nitric oxide with heme proteins and model compounds of hemoglobin

Rates for the reaction of nitric oxide with several ferric heme proteins and model compounds have been measured. The NO combination rates are markedly affected by the presence or absence of distal histidine. Elephant myoglobin in which the E7 distal histidine has been replaced by glutamine reacts with NO 500-1000 times faster than do the native hemoglobins or myoglobins. By contrast, there is no difference in the CO combination rate constants of sperm whale and elephant myoglobins. Studies on ferric model compounds for the R and T states of hemoglobin indicate that their NO combination rate constants are similar to those observed for the combination of CO with the corresponding ferro derivatives. The last observation suggests that the presence of an axial water molecule at the ligand binding site of ferric hemoglobin A prevents it from exhibiting significant cooperativity in its reactions with NO.

Infective enterocolitides

Enteric infections, which range from asymptomatic to severe illnesses, are caused by a wide variety of organisms. Radiologic studies, in correlation with clinical findings, may suggest the correct diagnosis, but laboratory examinations are usually required for definitive diagnosis. Radiologic studies can be of help in determining the extent and course of infective enterocolitides.

Gastric restrictive surgery for obesity: early radiologic evaluation

This study was undertaken to determine the optimal radiologic examination techniques for the period immediately following gastric restrictive surgery to control obesity. Review of 450 examinations performed on 275 patients who underwent varied gastric restrictive procedures indicates that accurate evaluation requires prompt filming of the first swallow of contrast material in a specific initial patient position with only minimal fluoroscopic monitoring. It was found that the optimal patient position can be predicted, before contrast material is administered, by the orientation of the staples on an abdominal radiograph. Right posterior oblique (RPO) is the optimal starting position when vertical staple lines follow gastroplasty with a lesser curvature channel. Left posterior oblique (LPO) is optimal when horizontal staple lines follow gastroplasty. LPO is usually optimal when complex or confusing staple patterns follow gastric bypass operations and revisions of previous procedures to control obesity. However, RPO is the optimal orientation when the revision procedure is a vertical gastroplasty.

The colitides

Diverse signs may be seen on barium enema in the various forms of colitis. Barium enema is only reasonably specific in the diagnosis of Crohn's disease and ulcerative colitis once the other possible diseases have been excluded from consideration by biopsy, microscopy, culture, or therapeutic trial. In particular, campylobacter colitis has proved to be such a common entity that many patients originally thought to have had one attack of ulcerative colitis, ischemic colitis, or Crohn's colitis may never have had these diseases. Many of the relatively specific signs can be seen in a variety of conditions. For example, aphthae in the colon may be seen in Crohn's disease, yersinia enterocolitis, Behçet's syndrome, amebiasis, ischemia, tuberculosis, and campylobacter colitis. Continuity of disease is characteristic in ulcerative colitis. Nevertheless, patches of healing may occur, so that a rare patient may be seen during a resolving attack of ulcerative colitis in whom only scattered patches of active disease can be seen on barium enema. In general, few radiologic signs on barium enema are truly specific for one disease, with penumatosis cystoides coli being an exception to this rule. However, the sensitivity of barium enema with currently available materials for double-contrast techniques is such that radiology continues to be useful at present in diagnosing the colitides and in managing patients.

Colorectal carcinoma missed on double contrast barium enema study: a problem in perception

A total of 31 cases of primary colorectal carcinoma missed on double contrast barium enema studies over a 5 year period (1976-1980) were collected from six institutions, and the causes of error reviewed. The errors were purely perceptive in 52%, due to a combination of perceptive and technical factors in 32%, and interpretative in 6%. The most common perceptive mistakes were failure to recognize a filling defect in the barium pool and failure to detect the tumor en face in double contrast study. Five cases were only detected at the time of the study as a result of double reading. Ten percent of the lesions could not be seen in retrospect, and therefore can be attributed to failure of the technique itself. At four of the institutions, the double contrast barium enema study missed 11 (6%) of 197 primary colorectal carcinomas. The lesion was invisible in retrospect in only two (1%) of these 197 studies, indicating that the double contrast examination is potentially highly sensitive for detecting colorectal carcinoma. The mainly perceptive nature of the errors indicates the need for more careful viewing of double contrast barium enemas. Familiarity with the different appearances of colorectal carcinoma on double contrast study, together with double-reading by the same or different observers, should reduce the incidence of missed lesions.

Ileovesical fistula: a rare complication of ileal diverticulitis

Small bowel diverticulitis is an unusual condition but the development of a secondary enterovesical fistula is extremely rare. This report describes the second documented case of ileovesical fistula secondary to ileal diverticulitis. Definitive diagnosis was made by double-contrast enema and small bowel fluoroscopic examinations. Management should consist of dissection of the fistula with either resection or primary repair.

The identification of the medical and social needs of the elderly in the community: a pilot survey

A pilot study, covering 237 old people over the age of 75 years, was carried out by two Health Visitors in a Group Practice. Medical and social needs were tabulated and the amount of health visiting time calculated for such a service in a Health Board area covering a total population of 330 000.