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.     

HIV disclosure patterns, predictors, and psychosocial correlates among HIV positive women in Zimbabwe

Disclosure of positive HIV status in Sub-Saharan Africa has been associated with safer sexual practices and better antiretroviral therapy (ART) adherence, but associations with psychosocial function are unclear. We examined patterns and psychosocial correlates of disclosure in a Zimbabwean community. Two hundred HIV positive women at different stages of initiating ART participated in a cross-sectional study examining actual disclosures, disclosure beliefs, perceived stigma, self-esteem, depression, and quality of life. Ninety-seven percent of the women disclosed to at least one person, 78% disclosed to their current husband/partner, with an average disclosure of four persons per woman. The majority (85-98%) of disclosures occurred in a positive manner and 72-95% of the individuals reacted positively. Factors significantly correlated with HIV disclosure to partners included being married, later age at menses, longer duration of HIV since diagnosis, being on ART, being more symptomatic at baseline, ever having used condoms, and greater number of partners in the last year. In multivariate analysis, being married and age at menses predicted disclosure to partners. Positive disclosure beliefs, but not the total number of disclosures, significantly correlated with lower perceived stigma (ρ = 0.44 for personalized subscale and ρ = 0.51 for public subscale, both p<0.0001), higher self-esteem (ρ = 0.15, p=0.04), and fewer depressive symptoms (ρ = -0.14, p=0.05). In conclusion, disclosure of positive HIV status among Zimbabwean women is common and is frequently met with positive reactions. Moreover, positive disclosure beliefs correlate significantly with psychosocial measures, including lower perceived stigma, higher self-esteem, and lower depression.     

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.     

Pregnancy Outcomes after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Korean Patients

Laparoscopic sleeve gastrectomy (LSG) is an effective procedure for treating morbid obesity, and the majority of female patients who received LSG were at childbearing age. Female patients, who successfully lost weight following LSG and became pregnant, need to be evaluated carefully. Information was gathered, through prospectively maintained database and phone interview, on women who underwent LSG from May 2003 to July 2011. A total of 136 women underwent LSG in this period. There were 13 (9.6 %) pregnancies in 12 patients after LSG. The age before surgery was 28.3?±?4.0. The mean weight and body mass index (BMI) before LSG were 95.3?±?9.4 kg and 35.1?±?3.5 kg/m², respectively. The average time from LSG to the first live birth was 32.0?±?19.1 months. Mean BMI decreased significantly after LSG, from 35.1?±?3.5 to 24.9?±?2.3 kg/m² at conception. The mean percentage of excess body mass index loss was 85.8?±?16.7 % at conception and 42.7?±?25.1 % at delivery. Gained weight during pregnancy was 15.1?±?5.2 kg. The mean gestational age and birth weight were 39.0?±?1.6 weeks and 3,229.0?±?505.9 g. In two cases (15.4 %), cesarean section was performed. No cases of pregnancy-induced hypertension and diabetes developed. Major congenital anomalies and neonatal deaths were not recorded. Larger study with longer follow-up is needed to evaluate the effect of LSG in pregnancies. However, these findings show that LSG seems to be a safe option for morbidly obese women in their reproductive period.     

Bariatric Surgery Patients Exhibit Improved Memory Function 12 Months Postoperatively

Background

Previous work from our group demonstrated improved memory function in bariatric surgery patients at 12 weeks postoperatively relative to controls. However, no study has examined longer-term changes in cognitive functioning following bariatric surgery.

Methods

A total of 137 individuals (95 bariatric surgery patients and 42 obese controls) were followed prospectively to determine whether postsurgery cognitive improvements persist. Potential mechanisms of change were also examined. Bariatric surgery participants completed self-report measurements and a computerized cognitive test battery prior to surgery and at 12-week and 12-month follow-up; obese controls completed measures at equivalent time points.

Results

Bariatric surgery patients exhibited cognitive deficits relative to well-established standardized normative data prior to surgery, and obese controls demonstrated similar deficits. Analyses of longitudinal change indicated an interactive effect on memory indices, with bariatric surgery patients demonstrating better performance postoperatively than obese controls.

Conclusions

While memory performance was improved 12 months postbariatric surgery, the mechanisms underlying these improvements were unclear and did not appear attributable to obvious postsurgical changes, such as reductions in body mass index or comorbid medical conditions. Future studies employing neuroimaging, metabolic biomarkers, and more precise physiological measurements are needed to determine the mechanisms underlying memory improvements following bariatric surgery.     

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.     

肉桂子药材的薄层鉴别方法研究

目的建立肉桂子药材的薄层鉴别系统。方法以桂皮醛和β-谷甾醇为对照品,对维药肉桂子进行薄层鉴别,并考察不同展开系统、不同点样量、不同薄层板、不同检视方式、不同温度和不同湿度对肉桂子药材薄层色谱的影响。结果以桂皮醛和β-谷甾醇为对照品,正己烷–乙酸乙酯(6∶1)为展开系统,肉桂子药材薄层鉴别特征明显,专属性强。结论该薄层方法可行,重复性好,可作为肉桂子药材的薄层鉴别方法。