Objectives The objective of this study was to test the hypothesis that gastric bypass surgery (GBS) would favorably impact cardiac remodeling and function. Background GBS is increasingly used to treat severe obesity, but there are limited outcome data. Methods We prospectively studied 423 severely obese patients undergoing GBS and a reference group of severely obese subjects that did not have surgery (n = 733). Results At a 2-year follow up, GBS subjects had a large reduction in body mass index compared with the reference group (−15.4 ± 7.2 kg/m2 vs. −0.03 ± 4.0 kg/m2; p < 0.0001), as well as significant reductions in waist circumference, systolic blood pressure, heart rate, triglycerides, low-density lipoprotein cholesterol, and insulin resistance. High-density lipoprotein cholesterol increased. The GBS group had reductions in left ventricular (LV) mass index and right ventricular (RV) cavity area. Left atrial volume did not change in GBS but increased in reference subjects. In conjunction with reduced chamber sizes, GBS subjects also had increased LV midwall fractional shortening and RV fractional area change. In multivariable analysis, age, change in body mass index, severity of nocturnal hypoxemia, E/E', and sex were independently associated with LV mass index, whereas surgical status, change in waist circumference, and change in insulin resistance were not. Conclusions Marked weight loss in patients undergoing GBS was associated with reverse cardiac remodeling and improved LV and RV function. These data support the use of bariatric surgery to prevent cardiovascular complications in severe obesity.

Vibrio spp. are ubiquitous members of aquatic microbial food webs that can be pathogenic to humans and a range of other organisms. Previously published predictive models for Vibrio spp. concentrations in estuarine and coastal waters, based only on salinity and temperature, are 70 to 75% accurate during 'normal' conditions (e.g. not during storms or drought). We have conducted a preliminary comparison of the output from this type of model to the natural concentrations of both total Vibrio spp. and the potentially pathogenic Vibrio vulnificus when measured during tropical storms. Water samples were collected in situ from a deployed platform in the Neuse River Estuary (NRE), North Carolina, USA, during 2 storm events: Hurricane Ophelia and Tropical Storm Ernesto. Total Vibrio spp. concentrations were measured using culture-based methods and V. vulnificus levels were determined using a newly developed, rapid quantitative polymerase chain reaction (QPCR) assay. Results were analyzed in relation to environmental parameters and to concentrations of the fecal indicator bacteria Escherichia coli (EC) and Enterococcus spp. (ENT). Total concentrations of Vibrio spp. in the NRE were often orders of magnitude higher than those predicted by a previously published model. These large deviations from model predictions may indicate contributions from storm forcing (e.g. resuspension, surges) that are missing from the calm weather observations used to build these models.

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Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.