Re-conceiving the genotype as an environmental response repertoire rather than a fixed developmental programme leads to three critical insights, as illustrated by norm of response data from Polygonum plants. Plastic responses to specific conditions often consist of functionally appropriate characteristic modifications, leading to an individual-level, developmental setting of adaptive variance. Environmental replies can prolong across years via results on progeny development and fitness, a form of inherited yet non-genetic adaptation. Finally, because genotypes are expressed with respect to the environment differently, the genetic diversity open to natural selection is itself environmentally contingent.
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Edward E. Mason (Iowa City, Iowa): My great job to Dr. Nguyen and his colleagues for a perfect demonstration of the need for laparoscopic surgery for weight problems. I used pneumoperitoneum in 1953 to prepare patients with giant hernias for hernia repair. In 1954, I used intestinal bypass in two of these patients to attempt to control putting on weight that was leading to recurrence of herniation In 1966, the first gastric bypass was performed ina patient with a giant lower stomach hernia. A season later we used pneumoperitoneum and then repaired her hernia.
Later, she regained weight and the hernia recurred. Dr. Nguyen, you have shown the great advantage of avoiding long incisions in the severely obese. You have the correct sequence by starting with pneumoperitoneum and stopping hernias in the morbidly obese. My only question, have you contemplated utilizing a simpler procedure? Vertical-banded gastroplasty provides nearly as great weight control without disrupting the several million many years of evolutional development of the digestive tract.
Last month I observed Dr. Wei-Jei Lee in Taipei, Taiwan, perform a laparoscopic vertical-banded gastroplasty. He has performed over 400 of the. They have a little vertical pouch stapled in continuity with one coating of polypropylene mesh collar to regulate the outlet. The operation appeared to be easy and was accomplished in one hour relatively.
It avoids the anastomotic problems. It also avoids the late problems peculiar to gastric bypass operations. Presenter Dr. Ninh T. Nguyen (Sacramento, California): Many thanks, Dr. Mason, for your comment. We presently are carrying out only the Roux-en-Y gastric bypass (GBP) procedure for treatment of morbid obesity. This decision was predicated on randomized tests confirming better long-term weight loss after Roux-en-Y GBP than after vertical-banded gastroplasty. Dr. Michael M. Meguid (Syracuse, NY): Dr. Nguyen, I appreciate having acquired the chance to read your manuscript. The data you shown is reflected in the manuscript really.
I wish to confine my feedback to the very remarkable quality of life indices which were not in the abstract and that you have consequently presented today. These indices are mainly the standard return to work, the vitality, physical, sociable and mental functions of the patients randomized to the laparoscopic group.