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.     

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.     

Safety and tolerability of concurrent natalizumab treatment for patients with Crohn's disease not in remission while receiving infliximab

BACKGROUND: Natalizumab, a humanized monoclonal IgG(4) antibody to alpha4 integrin, was investigated as a treatment of active Crohn's disease (CD). The safety of natalizumab given in combination with infliximab has not previously been studied. METHODS: Seventy-nine adult patients with active CD (Crohn's Disease Activity Index [CDAI] score > or = 150) despite ongoing infliximab treatment were randomized 2:1 to receive 3 intravenous infusions of natalizumab (300 mg; n = 52) or placebo (n = 27) every 4 weeks. Patients received infliximab (5 mg/kg) every 8 weeks for at least 10 weeks before randomization and throughout the study. The primary objective was to assess the short-term safety and tolerability of natalizumab in patients concurrently receiving infliximab. Secondary and tertiary objectives included measures of efficacy, health-related quality of life (HRQoL), and effects on inflammatory markers. A subset of patients also participated in a pharmacokinetic/pharmacodynamic (PK/PD) analysis of the effects of concurrent treatment. RESULTS: Incidence of adverse events (AEs) was similar in the treatment groups. AEs frequently reported in both groups were headache, CD exacerbation, nausea, and nasopharyngitis. No patient had a hypersensitivity-like reaction to natalizumab, whereas 4 patients (5%) experienced reactions to infliximab. Two patients (4%) developed anti-natalizumab antibodies; 10 patients (14%) developed anti-infliximab antibodies. The mean CDAI score decreased with natalizumab plus infliximab but was unchanged with infliximab alone (-37.7 versus +3.5; P = 0.084). Patients in both groups showed small increases in HRQoL (P = 0.811). No drug-drug interactions were noted. CONCLUSIONS: The combination of natalizumab plus infliximab was well tolerated. Several positive trends suggested that treating patients not in remission with infliximab plus natalizumab had greater efficacy than treatment with infliximab alone.     

Awareness of illness and insight into obsessive-compulsive symptoms in schizophrenia patients with obsessive-compulsive disorder

Obsessive-compulsive symptoms (OCS) have been revealed in a substantial proportion of schizophrenia patients. We sought to evaluate insight into OCS in schizo-obsessive patients. We evaluated insight into OCS and awareness of schizophrenia, using the Brown Assessment of Beliefs Scale (BABS) and the Scale to Assess Unawareness of Mental Disorder (SUMD), respectively. Fifty-seven inpatients that met DSM-IV criteria for both schizophrenia and OCD were recruited. To determine a possible modifying effect of OCS on the awareness of schizophrenia, we included a comparison group of non-OCD schizophrenia patients (N = 80). Nine (15.8%) schizo-obsessive patients revealed lack of insight into OCS, whereas a majority (48 patients, 84.2%) exhibited good or fair insight. In the schizo-obsessive group, insight into OCS positively correlated with awareness of schizophrenia but not with awareness of delusions. Roughly 40% of the schizo-obsessive and non-OCD schizophrenia patients revealed unawareness of schizophrenia. Our findings indicate that OCS in schizophrenia represent an identifiable dimension of psychopathology independent of core schizophrenia symptoms.     

Fitness, fatness, and cardiovascular risk factors in type 2 diabetes: look ahead study

PURPOSE: Most studies comparing the effects of fitness and fatness on cardiovascular (CVD) risk have been done with young, healthy participants with low rates of obesity and high levels of fitness. The present study examined the association of cardiorespiratory fitness and obesity with CVD risk factors in an ethnically diverse sample of overweight/obese individuals with type 2 diabetes. METHOD: Baseline data from Look AHEAD, a study of 5145 overweight or obese individuals with type 2 diabetes, were used to examine the association of BMI categories (overweight, class I, II, or III obesity) and cardiorespiratory fitness (assessed with a maximal graded exercise test and categorized by age- and gender-specific quintiles) on cardiovascular risk factors and on the odds of having hypertension, hyperlipidemia, or HbA1c > or = 7%. RESULTS: BMI categories and fitness quintiles were highly associated with each other (P < 0.0001), with the heaviest participants being the least fit. Only 2-3% of participants had class III obesity and were in the two fittest quintiles or, conversely, were overweight and in the two least-fit quintiles. When fitness and BMI were included in the same model (adjusting for age, smoking, diabetes duration, and race), HbA1c, ankle/brachial index (ABI), and Framingham risk score were most strongly associated with fitness. Systolic blood pressure was most strongly associated with BMI category. Similar results occurred when waist circumference and fitness were considered together. CONCLUSION: In this large, ethnically diverse sample of overweight/obese individuals with type 2 diabetes, fitness and fatness were highly related to each other but seemed to have different impact on specific CVD risk factors.     

Morphological examination of impacted tooth in maxillary lateral incisor region using computed tomography for consideration of treatment modalities

A 10Y2M-old girl was referred to our clinic by a general practitioner for consultation regarding an impacted supernumerary tooth identified in the maxillary left incisor region. Our intraoral examination revealed a maxillary left lateral incisor with a tubercle morphology, with slight swelling identified in the labial gingival area between the lateral incisor and primary canine. The dental age of the patient was calculated to be 1 year behind her chronological age based on root formation observed in orthopantomographs. X-ray photographic examinations revealed an impacted tooth on the labial side, with the root apex presumably directed into the palatal side. Computed tomography (CT) was used to produce three-dimensional reconstruction images in order to obtain morphological information for the impacted tooth, which had a tuberculate shape and an appearance that differed from that of the tooth on the opposite side, which showed a typical morphology of a lateral incisor. Periodical examinations were performed thereafter, which confirmed the developmental progress of the root formation of the impacted tooth. At 11Y8M, the tooth had emerged into the oral cavity and was extracted under local anesthesia. Based on this case, we concluded that effective use of CT is beneficial for consideration of treatment modalities in patients with an impacted tooth.     

Skeletal Class III and open bite treated with bilateral sagittal split osteotomy and molar intrusion using titanium screws

Two-jaw surgery has been performed for the treatment of severe skeletal open bite cases to obtain stability of occlusion after treatment. If molar intrusion with titanium screws could be performed instead of surgical superior repositioning of the maxilla, the incidence of surgical invasion would be reduced. However, there have been few reports of such a therapy. This case report describes treatment for skeletal Class III and open bite with bilateral sagittal split osteotomy and intrusion of the molars using titanium screws. The patient had a concave profile, a long lower facial height, Class III malocclusion, and excessive anterior open bite following mandibular protrusion and a high mandibular plane angle. The mandible autorotated closed 3.5° following intrusion of the upper and lower molars using titanium screws during the presurgical orthodontic treatment phase. After the autorotation of the mandible, a mandibular setback with a bilateral sagittal split osteotomy was performed. The posttreatment records showed a good facial profile and occlusion. The mandible was stable 1 year after surgery. These results demonstrate that surgical orthodontic treatment combined with bilateral sagittal split osteotomy and intrusion of the molars using titanium screws can reduce the need for surgical invasion by avoidance of maxillary surgery and was effective for correcting the facial profile and occlusion in a skeletal Class III and open bite patient.     

Behavioral self-regulation for weight loss in young adults: a randomized controlled trial

Objective  

To determine the feasibility of recruiting and retaining young adults in a brief behavioral weight loss intervention tailored for this age group, and to assess the preliminary efficacy of an intervention that emphasizes daily self-weighing within the context of a self-regulation model.     

异甘草素的制备方法和药理作用研究进展

异甘草素是甘草中的黄酮类成分,属于羟基查耳酮类化合物。目前异甘草素主要从甘草中提取分离及人工合成方法制备。它具有较强的生物活性,如抗癌、抗艾滋病、抗糖尿病并发症等,因而成为富有研究开发潜力的化合物。笔者结合自己的部分研究结果,对异甘草素的制备方法和药理作用研究进展作简要介绍,并对异甘草素的研究开发前景进行探讨。