When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery?

BackgroundMany comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment. However, it is unknown whether these interventions are best delivered pre- or postoperatively. The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention, before or after surgery.MethodsA total of 32 pre- and postoperative patients were referred to a 10-week intervention designed to reduce eating behaviors associated with postoperative weight gain (e.g., loss of control while eating, grazing). The sample was 78.1% female and 84.4% white, with an average age of 49.43 ± 9.13 years and a body mass index of 44.22 ± 6.48 kg/m². Of the 32 patients, 21 were referred preoperatively and 11 were referred postoperatively (5.63 ± 2.91 months after surgery). These patients were tracked prospectively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention.ResultsCompared with the preoperative patients, the postoperative patients were more likely to follow-up with their referral and initiate treatment [χ²(1) = 10.06, P = .002]. Of the postoperative patients, 100% attended the first intervention session compared with only 43% of preoperative patients. The postoperative patients also attended more intervention sessions [t(18) = 2.51, P = .02] and were more likely to complete the intervention [χ²(1) = 7.21, P = .007]. Only 14% of the preoperative referral patients completed the program compared with 91% of the postoperative patients.ConclusionComprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery.     

Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery

BackgroundSexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery.MethodsThe FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2–36). A FSFI total cutoff score of ≤26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls.ResultsOf the 102 women, 61 (59.8%) had FSFI total scores of ≤26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar.ConclusionWomen seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.     

HPLC法测定新疆鼠尾草三萜有效部位中熊果酸的含量

目的:建立新疆鼠尾草以三萜为有效部位的熊果酸含量的高效液相色谱检测方法。方法:采用高效液相色谱法(HPLC法)检测浸膏中熊果酸的含量,色谱柱为Waters Symmetry C18柱(4.6mm×250mm,5μm),流动相为甲醇—水—冰乙酸—三乙胺(85:15:0.03:0.06):甲醇=70:30,流速0.8ml/min,检测波长210nm,柱温30℃。结果:HPLC法测得熊果酸的线性范围为Y=447684X-7680(r=0.9999),平均回收率为98.84%,RSD=1.69%(n=6)。结论:HPLC法测定熊果酸含量,操作简便,灵敏度高,重现性好,可为新疆鼠尾草以三萜为有效部位的质量控制提供一定的依据。     

Risk Adjustment and the Assessment of Disparities in Dialysis Mortality Outcomes

Standardized mortality ratios (SMRs) reported by Medicare compare mortality at individual dialysis facilities with the national average, and are currently adjusted for race. However, whether the adjustment for race obscures or clarifies disparities in quality of care for minority groups is unknown. Cox model-based SMRs were computed with and without adjustment for patient race for 5920 facilities in the United States during 2010. The study population included virtually all patients treated with dialysis during this period. Without race adjustment, facilities with higher proportions of black patients had better survival outcomes; facilities with the highest percentage of black patients (top 10%) had overall mortality rates approximately 7% lower than expected. After adjusting for within-facility racial differences, facilities with higher proportions of black patients had poorer survival outcomes among black and non-black patients; facilities with the highest percentage of black patients (top 10%) had mortality rates approximately 6% worse than expected. In conclusion, accounting for within-facility racial differences in the computation of SMR helps to clarify disparities in quality of health care among patients with ESRD. The adjustment that accommodates within-facility comparisons is key, because it could also clarify relationships between patient characteristics and health care provider outcomes in other settings.     

Horizontal impaction of primary mandibular bilateral central incisors identified in 2-year-8-month-old girl

A girl aged 2 years and 8 months came to our clinic for consultation with regard to unerupted primary mandibular bilateral central incisors. An intraoral examination revealed that the teeth had not emerged into the oral cavity and showed a tooth crown morphology similar to that of the primary mandibular incisors, which appeared in the lingual submucosal area outside of the mandibular dental arch. Periapical radiographs demonstrated that the tooth crowns of both affected teeth were severely displaced to the lingual side. Computed tomography examinations were performed to clarify the three-dimensional positions of the affected teeth and their permanent successors, which revealed that the affected teeth were located in their estimated positions and had a standard root morphology. In addition, the permanent successors, which had not initiated root formation, were located close to the affected teeth. We decided to postpone extraction of the affected teeth and perform periodical examinations until the roots of the permanent successors are sufficiently formed. At the age of 2 years and 10 months, the edge of the tooth crown of the primary mandibular left central incisor was found emerged into the oral cavity. According to her parents, the patient did not complain of the emerging edge and no abnormal conditions were observed around the tooth.     

Pericardial Patch Ring Roux-en-Y Gastric Bypass: A Preliminary Report

Background

Laparoscopic Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. Failure of weight loss has been reported in 10 to 30 % of RYGB patients. Silastic ring RYGB was introduced to minimize failure rate, however, with higher complication rate. The aim of our study is to evaluate the safety of utilizing pericardial patch as a ring on RYGB patients.

Methods

Between March 2010 and June 2011, a total of 189 patients underwent pericardial patch ring RYGB at the Bariatric and Laparoscopy Center. A retrospective review of a prospectively collected database was performed for all pericardial patch ring RYGB patients, noting the outcomes and complications of the procedure.

Results

Pericardial patch ring RYGB patients demonstrated a mean percentage of excess weight loss of 57.4 % at a mean follow-up of 11 months. Out of 164 patients with follow-up, five (3.0 %) patients required endoscopic balloon dilation due to dysphagia, abdominal pain, and/or gastric outlet obstruction. All patients did well after the procedure. Three (1.8 %) patients underwent diagnostic laparoscopy for abdominal pain. Of these patients, one (0.6 %) had dilated and enlarged blind limb, and two (1.2 %) patients had partial small bowel obstruction. No patient was readmitted or reoperated due to pericardial patch ring.

Conclusions

Longer follow-up is needed to prove the true efficacy of this procedure in reducing weight gain. Pericardial patch ring RYGB seems to be a safe alternative for banded RYGB of other materials.     

Adult patients' adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™

This prospective study examined the adult patient's perception of recovery after insertion of three types of orthodontic appliances: Buccal, Lingual and Invisalign. The sample consisted of sixty-eight adult patients (45 females and 23 males) who comprised three groups: 28 Buccal, 19 Lingual, and 21 Invisalign patients. After appliance insertion, patients completed a Health-Related Quality of Life questionnaire daily for the first week and again on day 14, in order to assess patients' perception of pain and analgesic consumption. In addition, four areas of dysfunction were assessed: oral dysfunction, eating disturbances, general activity parameters, and oral symptoms. Lingual appliance was associated with more severe pain and analgesic consumption, the greatest oral and general dysfunction, and the most difficult and longest recovery. The Invisalign patients complained of relatively high levels of pain in the first days after insertion; however this group was characterized by the lowest level of oral symptoms and by a similar level of general activity disturbances and oral dysfunction compared to the Buccal appliance. Many Lingual and some Buccal patients did not reach a full recovery from their eating difficulties by the end of the study period. The present study provides information to adult patients and clinicians assisting them in choosing the most appropriate treatment modality in relation to Health-Related Quality of Life parameters.