Prosthetic management of a growing patient with Russell-Silver syndrome: a clinical report

Russell-Silver syndrome (RSS) is a congenital disease characterized by short stature due to growth hormone deficiency, physical asymmetry, inverted triangular face, micrognathia, prominent forehead, and hypodontia. This case report presents a prosthetic management of a 6-year-old patient with Russell-Silver syndrome treated with overdentures on the maxilla and the mandible using the remaining primary teeth. Subsequent and comprehensive dental management considering the growth and development of a young patient will be necessary.     

Vulvar epithelioid sarcoma: A case report with literature review

ObjectiveTo report a case of vulvar epithelioid sarcoma, a rare type of tumor that has been reported in 37 cases in the English literature to date.Case reportWe report three cases of vulvar epithelioid sarcoma, proximal type. Wide excisions of the mass were performed with margins free of tumor in all three cases.ConclusionDue to its low incidence, there are no evidence-based diagnostic algorithms or published recommendations for treatment. Locoregional lymph node involvement, vascular invasion, tumor size larger than 2 cm, deep localization, presence of necrosis, and a high mitotic index are known as poor prognostic factors. Adjuvant radiotherapy is advisable in the presence of a high-grade tumor or positive margins. The beneficial effect of adjuvant chemotherapy is not well established. Treatment decisions should be made based on the individual case presentation and pathology evaluation.     

Alterations in gene expression in vitamin D‐deficiency: Down‐regulation of liver Cyp7a1 and renal Oat3 in mice

The vitamin D‐deficient model, established in the C57BL/6 mouse after 8 weeks of feeding vitamin D‐deficient diets in the absence or presence of added calcium, was found associated with elevated levels of plasma parathyroid hormone (PTH) and plasma and liver cholesterol, and a reduction in cholesterol 7α‐hydroxylase (Cyp7a1, rate‐limiting enzyme for cholesterol metabolism) and renal Oat3 mRNA/protein expression levels. However, there was no change in plasma calcium and phosphate levels. Appraisal of the liver revealed an up‐regulation of mRNA expressions of the small heterodimer partner (Shp) and attenuation of Cyp7a1, which contributed to hypercholesterolemia in vitamin D‐deficiency. When vitamin D‐sufficient or D‐deficient mice were further rendered hypercholesterolemic with 3 weeks of feeding the respective, high fat/high cholesterol (HF/HC) diets, treatment with 1α,25‐dihydroxyvitamin D₃ [1,25(OH)₂D₃], active vitamin D receptor (VDR) ligand, or vitamin D (cholecalciferol) to HF/HC vitamin D‐deficient mice lowered the cholesterol back to baseline levels. Cholecalciferol treatment partially restored renal Oat3 mRNA/protein expression back to that of vitamin D‐sufficient mice. When the protein expression of protein kinase C (PKC), a known, negative regulator of Oat3, was examined in murine kidney, no difference in PKC expression was observed for any of the diets with/without 1,25(OH)₂D₃/cholecalciferol treatment, inferring that VDR regulation of renal Oat3 did not involve PKC in mice. As expected, plasma calcium levels were not elevated by cholecalciferol treatment of vitamin D‐deficient mice, while 1,25(OH)₂D₃ treatment led to hypercalcemia. In conclusion, vitamin D‐deficiency resulted in down‐regulation of liver Cyp7a1 and renal Oat3, conditions that are alleviated upon replenishment of cholecalciferol.     

Curing units' ability to cure restorative composites and dual-cured composite cements under composite overlay

This study compared the efficacy of using conventional low-power density QTH (LQTH) units, high-power density QTH (HQTH) units, argon (Ar) laser and Plasma arc curing (PAC) units for curing dual-cured resin cements and restorative resin composites under a pre-cured resin composite overlay. The microhardness of the two types of restorative resins (Z100 and Tetric Ceram) and a dual-cured resin cement (Variolink II) were measured after they were light cured for 60 seconds in a 2 mm Teflon mold. The recorded microhardness was determined to be the optimum microhard-ness (OM). Either one of the two types of restorative resins (Z100, Tetric Ceram) or the dual cured resin cement (Variolink II) were placed under a 1.5-mm thick and 8 mm diameter pre-cured Targis (Vivadent/Ivoclar AG, Schaan, Liechtenstein) overlay. The specimens that were prepared for each material were divided into four groups depending upon the curing units used (HQTH, PAC, Laser or LQTH) and were further subdi-vided into subgroups according to light curing time. The curing times used were 30, 60, 90 and 120 seconds for HQTH; 12, 24, 36 and 48 seconds for the PAC unit; 15, 30, 45 and 60 for the Laser and 60, 120 or 180 seconds for the LQTH unit. Fifteen specimens were assigned to each sub- group. The microhardness of the upper and and lower composite surfaces under the Targis overlay were measured using an Optidur Vickers hardness-measuring instrument (G?ttfert Feinwerktechnik GmbH, Buchen, Germany). In each material, for each group, a three-way ANOVA with Tukey was used at the 0.05 level of significance to compare the microhardnesses of the upper and lower composite surfaces and the previously measured OM of the material. From the OM of each material, 80% OM was calculated and the time required for the microhardness of the upper and lower surface of the specimen to reach 100% and 80% of OM was determined. In Z100 and Tetric Ceram, when the composites were light cured for 120 seconds using the HQTH lamp, microhardnesses of the upper and lower surfaces reached OM. When they were cured with the PAC unit, only 48 seconds was needed for the upper and lower surfaces to reach OM. When they were cured using the laser, the lower surface did not reach OM in any of the groups. When the specimens were cured using the LQTH lamp, 180 seconds of curing was needed for Z100 to reach OM, whereas Tetric Ceram did not reach OM. In Z100, 60, 12, 30 and 60 seconds were needed in HQTH, PAC, Laser and LQTH, respectively, for the specimens to reach 80% OM. Tetric Ceram was needed 60,24,45 and 180 seconds to reach 80% OM. In the Variolink II specimen, microhardness of the upper and lower surfaces did not reach OM even though they were light cured with the HQTH lamp for 120 seconds. When they were cured with the PAC unit, 48 seconds was insufficient for them to reach OM. When they were cured with laser for 45 and 60 seconds, microhardness reached OM on the upper surface but not on the lower surface. However, when they were cured using the LQTH lamp, microhardness did not reach OM on the upper and lower surfaces even though the curing time was extended to three minutes. In Variolink II, 120, 36, 45 and >180 seconds were needed in HQTH, PAC, Laser and LQTH, respectively, for the specimens to reach 80% OM. In conclusion, the PAC system is the most effective curing system to cure the restorative composite and dual cured resin cement under the 1.5 mm Targis overlay, followed by the laser, HQTH and LQTH units. In addition, the restorative composites cured more efficiently than the dual-cured resin cements.     

Gender Differences in Factors Associated with Perceived Need and Use of Korean Adolescents Mental Health Services

This study investigated the socio-demographic characteristics and emotional and behavioral factors associated with the perceived need and actual use of adolescent mental health services according to genders in Korea. We assessed 1,857 middle school students aged 14–16 years. We administered a self-reported questionnaire including questions on their socio-demographic data, Korean Youth Self Report, and self perceived need and actual use of mental health services. Overall, 11.6 % of the adolescents demonstrated a self perceived need for mental health services regarding their emotional or behavioral problems, while 2.1 % had sought mental health services. There were discrepancies between the perceived need and actual use. Most adolescents (81.6 %) used mental health services without self-perceived need, and only 3.3 % of adolescents with self-perceived need utilized mental health services. The perceived need of mental health services is positively influenced by the adolescent’s anxious/depressed problems in both genders. The use of them is negatively influenced by the withdrawn problem in adolescent boys, while positively influenced by the aggressive behavior in adolescent girls. To increase the actual use of mental health services more attention needs to be focused on their internalizing problems, such as anxious/depressed and withdrawn problems, in addition to externalizing problems in both genders.     

Risk Factors for Suicidal Ideation among Patients with Complex Regional Pain Syndrome

Objective

Chronic pain frequently coexists with psychiatric symptoms in patients diagnosed with complex regional pain syndrome (CRPS). Previous studies have shown a relationship between CRPS and the risk of suicide. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS.

Methods

Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD), and symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I, SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI).

Results

Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p=0.002), severity of pain (p=0.024), and low scores on the GAF (p=0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep.

Conclusion

Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.