Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes

BackgroundSevere obesity is frequently a barrier to kidney transplantation, and kidney transplant recipients often have significant weight gain following transplantation.ObjectivesThe goals of this study were to evaluate the long-term risks and benefits of bariatric surgery before and after kidney transplantation.SettingUniversity Hospital, United States.MethodsWe performed a retrospective cohort study of 43 patients who had pretransplantation bariatric surgery and 21 patients who had posttransplantation bariatric surgery from 1994 to 2017 with propensity-score matching to identify matched controls using national registry data.ResultsBody mass index at the time of transplantation was similar in patients who underwent bariatric surgery before versus after transplantation (32 versus 34 kg/m², P = .172). There was no significant difference in body mass index in the 5 years after bariatric surgery among patients who underwent bariatric surgery before versus after kidney transplantation (36 versus 32 kg/m², P = 0.814). Compared with matched controls, bariatric surgery before (n = 38) and after (n = 18) kidney transplantation was associated with a decreased risk of allograft failure (hazard ratio .31 [95% confidence interval .29–0.33] and .85 [95% confidence interval .85–.86] for pre- and posttransplant, respectively) and mortality (hazard ratio .57 [95% confidence interval .53–.61] and .80 [95% confidence interval .79–.82] for pre- and posttransplant, respectively).ConclusionsBariatric surgery before and after kidney transplantation results in similar maintenance of weight loss and improved long-term allograft survival compared with matched controls. Bariatric surgery appears to be a safe and reasonable approach to weight loss both before and after transplantation.     

Locoregional recurrence and metastasis in the long-term follow-up of postmastectomy breast cancer patients with T1–T2 tumours and one to three positive lymph nodes

Introduction

In this work we want to know the long-term rates of locoregional recurrence and distant metastasis in a population of breast cancer patients with pT1–pT2 tumours and one to three positive lymph nodes who were treated with mastectomy and axillary lymphadenectomy, and to study the relationship of certain clinical and histopathological parameters to their development.

Material and methods

Ninety patients diagnosed with a breast tumour of less than 5 cm and one to three affected lymph node, and undergoing a modified radical mastectomy with axillary lymphadenectomy, were studied. The mean overall follow-up was 132 months, and the minimum follow-up for the living patients was 10 years. Locoregional recurrence and metastasis development rates were studied and clinical and pathological parameters were evaluated.

Results

We found locoregional recurrence in 22.5% of the patients, and systemic metastases in 30.3%. In the study of locoregional recurrences significant differences were found for tumour size (T2) (p=0.001) and metastasis were more frequent with extracapsular lymph node extension (p=0.02) and non-administration of chemotherapy (0.019).

Conclusions

The parameter related to the development of locoregional recurrence was tumour size (stage T2) and those related to the development of metastasis were extracapsular lymph node extension and non-administration of chemotherapy.     

Mutual exposure or close peer relationships do not seem to foster increased similarity in food, music or television program preferences

We know very little about either the mechanisms through which preferences are created in humans, or the contributions of particular developmental forces: e.g. genetics, parental influence, peer influence, the media. Prior work has indicated surprisingly low correlations (averaging about 0.15) between the food or music preferences of young adult and the mid-point of the biological and rearing parents preferences for the same items. A likely candidate for a substantial influence is peers. In one study, we show that freshman college roommates, randomly assigned, do not become significantly more similar in their food or music preferences over the course of about seven months of mutual exposure. In a second study, we show that in three suburban third grade classrooms, the preferences for food or TV programs in children is not more similar to those of their best friends in the school, than it is to randomly selected other children of the same gender, in their classes. Although our findings are negative (lack of influence), in light of very strong expectations for positive findings, we take them to be notable. These findings add further mystery and puzzlement to the question of: where do preferences come from? The focus in this study is on individual differences among peers and forces that lead to preference similarity. The study does not speak to the influence of general peer norms.     

GM-CSF and dendritic cells in allergic airway inflammation: basic mechanisms and prospects for therapeutic intervention

The interaction between dendritic cells (DC) and na?ve T cells is the first step in the evolution of an immune response, either tolerogenic or inflammatory. Therefore, the status of DC residing at mucosal sites, such as the airway, has a definitive impact on the character of the ensuing immune response. In the absence of pathogenic stimulation, DC serve to regulate immunological homeostasis in the lung; the generation of Th2-associated (allergic) inflammatory responses, which are directed at presumably innocuous antigens, represent a deviation from normal DC function. The dysregulation of DC phenotype leading to the development of allergy might be programmed by genetic pedigree, or might be induced by factors released in the airway. One potential candidate, GM-CSF, is abundant in the allergic airway and can condition DC to propagate Th2 responses. Moreover, that allergens, alone or in combination with other factors, can spontaneously induce GM-CSF production in the airway thus present a compelling etiological argument for the role of GM-CSF in allergic sensitization. The interplay between DC and mediators present in the allergic airway is likely critical to the establishment of allergic airway inflammation. Understanding these interactions may, therefore, afford insight into prospective therapeutic interventions to circumvent, and even reverse the allergic diathesis.