Long-Term Quality of Life Outcomes After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass-a Comparative Study.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to improve metabolic comorbidities as well as quality of life (QoL) in the obese population. The vast majority of previous studies have investigated the metabolic effects of bariatric surgery and there is a dearth of studies examining long-term QoL outcomes post bariatric surgery. The outcomes of 43 patients who underwent bariatric surgery were prospectively assessed, using BAROS questionnaires to quantify QoL and metabolic status pre-operatively, at 1 year and at 8 years. Total weight loss and comorbidity resolution were similar between RYGB and SG. The RYGB cohort experienced greater QoL improvement from baseline and had higher BAROS scores at 8 years. RYGB may provide more substantial and durable long-term benefits as compared to SG.

Understanding Patient Acceptance of Risk with Treatment Options for Intermittent Claudication.

BACKGROUND: Intermittent claudication has a major impact on the quality of life and functional ability of the patient. However, when treating these patients, management is largely influenced by vascular surgeons' perceptions of risk. There is little information available regarding the level of risk that patients perceive to be acceptable, when considering complications of treatment. This study investigates patients' acceptance of risk associated with current management options for intermittent claudication and explores factors associated with greater risk acceptance. METHODS: Patients with confirmed intermittent claudication presenting to vascular clinic and supervised exercise classes were surveyed in a single-center prospective study. A standard gamble-type method was used to measure patients' acceptance of risk associated with medical treatment, angioplasty, and surgical bypass. Level of risk acceptance was correlated to patient factors. RESULTS: Fifty patients were surveyed; 74% were male, median age was 68 years (interquartile range [IQR] 59-74), maximal walking distance was 100 m (IQR 70-200), and ankle-brachial pressure index was 0.65 (IQR 0.60-0.78). Median risk acceptance for treatment failure was 70% for medical treatment, 50% for angioplasty, and 40% for surgical bypass. Median risk acceptance for major amputation and death was 0% for all 3 management options. Claudicants with maximal walking distance <100 m accepted higher risk of treatment failure (P = 0.0005 for medical treatment, P = 0.0038 for angioplasty), and death with medical treatment (P = 0.0009). There was no significance between claudication distance and risk acceptance of major amputation with any treatment modality or death with angioplasty or surgical bypass. There was no significant correlation among level of risk acceptance and age, gender, or diabetic status. CONCLUSIONS: Claudicants are prepared to accept significant risk of treatment failure, in order to gain benefit, but regardless of claudication distance, patients have low acceptance of the risk of amputation or death. Patient acceptance of risk should be considered when planning management.

Changing habitat associations of a thermally constrained species, the silver-spotted skipper butterfly, in response to climate warming.

1. The impact of climate change on the distribution, abundance, phenology and ecophysiology of species is already well documented, whereas the influence of climate change on habitat choice and utilization has received little attention. Here we report the changing habitat associations of a thermally constrained grassland butterfly, Hesperia comma, over 20 years. 2. Between 1982 and 2001-2, the optimum percentage of bare ground within habitat used for egg-laying shifted from 41% to 21%. 3. Egg-laying rates are temperature-dependent and females actively adjust microhabitat usage in response to temperature variations; relatively warmer host plants are chosen or oviposition at low ambient temperatures, and cooler host plants at high ambient temperatures. 4. Climate warming has increased the availability of thermally suitable habitat for H. comma at the cool, northern edge of the species' distribution, therefore increasing: (a) egg-laying rate and potentially the realized rate of population increase; (b) effective area of habitat patches as more microhabitats within a given vegetation fragment are now suitable for egg-laying; (c) buffering of populations against environmental variation as eggs are laid within a wider range of microhabitats; and (d) the number of habitat patches in the landscape that are currently available for colonization (including the use of more northerly facing aspects; Thomas et al., Nature, 2001, 411, 577-581). 5. Conservationists often assume the habitat requirements of a species to be constant, and manage habitats to maintain these conditions. For many species, these requirements are likely to change in response to climate warming, and care must be taken not to manage habitats based on outdated prescriptions.