Genetic variants associated with weight loss and metabolic outcomes after bariatric surgery: A systematic review

The extent to which genetic variations contribute to interindividual differences in weight loss and metabolic outcomes after bariatric surgery is unknown. Identifying genetic variants that impact surgery outcomes may contribute to clinical decision making. This review evaluates current evidence addressing the association of genetic variants with weight loss and changes in metabolic parameters after bariatric surgery. A search was conducted using Medline, Embase, Scopus, Web of Science, and Cochrane Library. Fifty-two eligible studies were identified. Single nucleotide polymorphisms (SNPs) at ADIPOQ (rs226729, rs1501299, rs3774261, and rs17300539) showed a positive association with postoperative change in measures of glucose homeostasis and lipid profiles (n = 4), but not with weight loss after surgery (n = 6). SNPs at FTO (rs11075986, rs16952482, rs8050136, rs9939609, rs9930506, and rs16945088) (n = 10) and MC4R (rs11152213, rs476828, rs2229616, rs9947255, rs17773430, rs5282087, and rs17782313) (n = 9) were inconsistently associated with weight loss and metabolic improvement. Four studies examining the UCP2 SNP rs660339 reported associations with postsurgical weight loss. In summary, there is limited evidence supporting a role for specific genetic variants in surgical outcomes after bariatric surgery. Most studies have adopted a candidate gene approach, limiting the scope for discovery, suggesting that the absence of compelling evidence is not evidence of absence.     

Prevalence of hypertension in adults with intellectual disability in the Netherlands

Background   Literature on the prevalence of hypertension in people with intellectual disability (ID) is mostly based on file studies or on measurements limited to the age group below 50 years. We measured and calculated the prevalence of hypertension in adults with ID and studied the distribution of hypertension in relation to age, gender, diagnosis of Down's syndrome and level of ID.
Methods   In an observational cross-sectional study, standardized blood pressure measurements were obtained from 258 randomly selected adult clients of three Dutch care providers for people with ID. Hypertension was defined as a mean systolic blood pressure above 140 mm Hg on repeated measurements.
Results   The overall prevalence rate of hypertension was 17.4% (95% CI 12.28–22.46). This was comparable to the prevalence in the general Dutch population. No accurate blood pressure measurement could be performed in 28.4% of people with severe and profound ID owing to repetitive physical activity or resistance. Hypertension was significantly related to older age and absence of Down's syndrome; no correlation with gender or level of ID could be shown.
Recommendation   The risk factor hypertension should be detected and treated in the same manner as in the general population following national guidelines.     

Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

Objective To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care. Background Health care is becoming more user‐centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care. Methods Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus‐group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments. Results From 37 instruments identified, the Patients’ Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ‐18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ‐18 were highly internally consistent, but not the PSQ‐18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ‐18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ‐18, focus‐group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient. Conclusions Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care.     

Assessing dog fear: evaluating the psychometric properties of the Dog Phobia Questionnaire

Background and objectivesThe Dog Phobia Questionnaire (DPQ; Hong &; Zinbarg, 1999) is a 27-item self-report questionnaire designed to assess symptoms of dog phobia. The present study investigated the psychometric properties of the DPQ.MethodStudy 1 explored the factor structure, internal consistency, and convergent and discriminant validity of the DPQ using an undergraduate sample (N = 174). Study 2 assessed the extent to which DPQ scores correlated with subjective fear ratings and avoidance during a behavioral approach test (BAT) with a live dog using undergraduate and community participants (N = 91), and the extent to which DPQ scores differed for individuals with (n = 15) versus without (n = 66) a clinically significant specific phobia of dogs. Study 3 evaluated the test-retest reliability of the DPQ using an undergraduate sample (N = 31).ResultsA principal components exploratory factor analysis suggested a one-factor solution. Internal consistency was high. DPQ scores were more highly correlated with measures assessing dog fear than measures assessing other types of fears. Test-retest reliability was high. DPQ scores correlated with fear responding and avoidance during the BAT. Participants with a specific phobia of dogs reported higher DPQ scores than those without a specific phobia of dogs.LimitationsThe present study included undergraduate students and community participants; future research with a clinical sample is recommended.ConclusionsThe DPQ may be a useful tool for measuring the severity of fear in dog phobic individuals. Implications for the theoretical assumptions underlying the development of the DPQ are discussed.     

Dynamics of the pool of infected resting CD4 HLA-DR- T lymphocytes in patients who started a triple class five-drug antiretroviral regimen during primary HIV-1 infection

Starting standard antiretroviral therapy within 10 days after the onset of a primary HIV-1 infection cannot prevent the establishment of a reservoir of HIV-1-infected memory CD4 T cells. Here we studied the reservoir of HIV-1-infected memory CD4 T cells in four patients who started a triple class, five-drug regimen during primary HIV-1 infection. There was a strong correlation between the proportion of productively infected CD4 HLA-DR- T lymphocytes and plasma HIV-1 RNA levels (r=0.852; P<0.001) during the first 24 weeks of therapy. Within 45 weeks of treatment, in three of the four patients the proportion of productively infected CD4 HLA-DR- T lymphocytes was reduced below the level of quantification. In the fourth patient the cellular reservoir remained quantifiable. In two patients who stopped therapy 44 weeks after initiation an immediate rebound of the plasma HIV-1 RNA level and the proportion of productively infected CD4 HLA-DR- T lymphocytes occurred. In conclusion, initiation of a potent five-drug, triple class regimen during primary HIV-1 infection does not result in virus-specific immune control upon discontinuation of therapy after 44 weeks. Therefore, longer or even stronger suppression of viral replication might be necessary to achieve this goal in primary HIV-1 infection.     

Disclosure of funding source and conflict of interest: exposure of biases affecting evidence and clinical utility of plastic surgery publications

The objective of the study is to investigate associations between research topics, level of evidence, conflict of interest, and declared sources of funding in articles published in major plastic surgery journals. All articles published in four major plastic surgery journals from September 2008 to September 2010 (Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Aesthetic Surgery) were reviewed. Published articles were assessed with regards to funding sources, level of evidence (I–V), research topics, and conflicts of interest. The association between these variables was described using contingency tables and compared using chi-square tests. The 1,706 articles were reviewed from four major plastic surgery journals. Level III studies comprised the majority of studies (634, 37%). The level of evidence least frequently observed in the plastic surgery journals was level I (25, 1.4%). Studies not reporting funding sources were significantly associated with a lower level of evidence (p?=?0.002). There was no significant association between source of funding and level of evidence (p?=?0.219) or between the source of funding and the type of study (p?=?0.075). Finally, the source of funding is significantly associated with the presence of a conflict of interest (p?<?0.005). While the level of evidence was related to publication of funding, further analysis of public and private funding revealed that the level of evidence of the research conducted is independent of the source of funding. Privately funded studies are more likely to present a conflict of interest.     

Characterization of four conventional dendritic cell subsets in human skin-draining lymph nodes in relation to T-cell activation

To increase (tumor) vaccine efficacy, there is an urgent need for phenotypic and functional characterization of human dendritic cell (DC) subsets residing in lymphoid tissues. In this study we identified and functionally tested 4 human conventional DC (cDC) subsets within skin-draining sentinel lymph nodes (SLNs) from early-stage melanoma patients. These SLNs were all tumor negative and were removed on average 44 days after excision of the primary melanoma. As such, they were considered representative of steady-state conditions. On comparison with skin-migrated cDC, 2 CD1a(+) subsets were identified as most likely skin-derived CD11c(int) Langerhans cells (LC) with intracellular langerin and E-cadherin expression or as CD11c(hi) dermal DCs with variable expression of langerin. Two other CD1a(-) LN-residing cDC subsets were characterized as CD14(-)BDCA3(hi)CD103(-) and CD14(+)BDCA3(lo)CD103(+), respectively. Whereas the CD1a(+) skin-derived subsets displayed greater levels of phenotypic maturation, they were associated with lower levels of inflammatory cytokine release and were inferior in terms of allogeneic T-cell priming and IFNγ induction. Thus, despite their higher maturation state, skin-derived cDCs (and LCs in particular) proved inferior T-cell activators compared with the CD1a(-) cDC subsets residing in melanoma-draining LNs. These observations should be considered in the design of DC-targeting immunotherapies.