Acta Academiae Medicinae Sinica

Bariatric surgery is one of the most effective treatment options for obesity. Compared with laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery has demonstrated more benefits and surgical risks. Bariatric surgery can result in the decreases in multiple gastrointestinal hormone levels, which can partially explain the mechanisms behind weight loss and resolution of diabetes after bariatric surgery. The management after bariatric surgery should be multidisciplinary and comprehensive, including dietary adjustment, physical exercise, behavioral intervention, and drug therapy.

The excess fatty tissues on the head, neck, thorax, and abdomen of morbid obese patients can impede the patency of the upper airway and impair lung functions. Meanwhile, these patients often have comorbidities such as obstructive sleep apnea, hypoventilation syndrome, chronic obstructive pulmonary disease, and asthma, which may result in difficult airway, intraoperative hypoventilation, and postoperative respiratory depression. Therefore, perioperative airway management for morbid obese patients may pose a big challenge to anesthesiologists. Anesthesiologists should know well about the pathophysiological features of respiratory system and grasp rational management principles, so as to improve the safety and effectiveness of perioperative airway management and optimize the clinical prognosis.

Bariatric surgery has increasingly been applied for patients with severe obesity. By dramati- cally reducing body weight and producing favorable effects on disorders in endocrine metabolism, bariatric surgery has shown to be able to lower the overall mortality. However, this intervention involves a profound change in digestive physiology and may cause nutrition and endocrinal metabolism-related severe complications, which mainly result from the deficiency or unbalance of macronutrients and micronutrients. Therefore, it is necessary to establish a fixed management procedure which includes routine perioperative nutritional consultation, regular monitoring, and early preventive nutritional support, so as to prevent metabolic complications and achieve better outcomes.

An increasing number of patients require body contouring procedures after massive weight loss. Body contouring can bring better quality of life and increase their satisfaction towards weight loss procedures. However, due to the special body status after massive weight loss, the complications of body contouring can be high. This article briefly describes body contouring procedures and summarizes their indications and complications.

Obesity, with an increasing prevalence,has become one of the most common metabolic diseases. Obesity is associated with many respiratory diseases, especially sleep-related breathing disorders including obstructive sleep apnea-hypopnea syndrome, obesity hypoventilation syndrome, and overlap syndrome. This article reviews the association between obesity and these sleep-related breathing disorders.

Medical nutritional therapy (MNT) is an effective approach for the long-term weight control in obese patients. This review describes the processes and principles of MNT, nutritional assessment Methods, types of diets, and nutrients allowance for obesity management, and also introduces the nutritional intervention for bariatric surgery.

Obesity has become a major health problem worldwide. The prevalence and morbidity of obesity-related diseases including diabetes, hypertension, cerebro-cardiovascular diseases, and tumors also have remarkably increased. Treatment of obesity poses a challenge for clinicians. Anti-obesity treatment is helpful to improve and even reverse obesity-related complications. Diet control and physical exercises remain the predominant interventions for obese patients. Anti-obesity drugs can be considered in those who respond poorly to behavioral intervention or those who have developed obesity-related complications. The commonly used anti-obesity drugs include gastrointestinal lipase inhibitors and appetite suppressants. Glucagon-like peptide 1 has also been found to be effective in reducing body weight. Some more drugs are under development, which include selective 5-HT 2c agonist, β3 receptor agonist, and melanocortin receptor 4 agonist, may also be promising.

Exercise training plays a critical role in the prevention and control of type 2 diabetes mellitus (T2DM). New guidelines on exercise training for T2DM patients was jointly published by American College of Sports Medicine and American Diabetes Association at the end of 2010. In the Guidelines on Prevention and Treatment of Type 2 Diabetes Mellitus in China issued by Chinese Diabetes Society, the role of exercise training is also clearly defined. The implementation of guidelines requires individualized exercise training prescription and program. In this article, we review the procedure of individualized aerobic exercise training prescription, resistant exercise, safety issues, and other relevant topics.

Nutritional therapy is the basis for all types of diabetes treatment, but has not been properly applied due to the lack of scientific criteria. In 2010, the China Medical Nutrition Therapy Guideline for Diabetes was successfully developed based on the up-to-dated scientific research evidences (especially those from China) using Oxford Centre for Evidence-Based Medicine grading system. These guidelines cover the nutrition-based prevention and treatment of diabetes and its complication as well as the parenteral and enteral nutritional supports, with an attempt to improve the quality of life and lower the burdens of diabetes and its complications.

The treatment of type 2 diabetes mellitus (T2DM) is traditionally focused on glycemic control. In recent years, comprehensive treatment approaches including blood sugar control, blood pressure management, and use of antihyperlipidemic agents (e.g. statins) and aspirin play critical roles in improving the outcomes of T2DM. Some newly developed approaches such as stomach reduction surgery also have been applied.

Type 2 diabetes can be treated by gastrointestinal surgery, but the underlying mechanism is unclear. This review summarizes the possible mechanisms which include weight loss, gastrointestinal hormones, foregut hypothesis, hindgut hypothesis, adipocytokines, and inflammatory factors.

Objective To assess the safety and feasibility of laparoscopic adjustable gastric banding (LAGB) and a multi-disciplinary team (MDT) approach in the treatment of morbid obesity and its complications. Methods We retrospectively analyzed the clinical data of 16 patients who underwent LAGB and MDT approach in Peking Union Medical College Hespital from October 2009 to February 2011.Results Of these 16 patients, 15 patients completed the 3 month follow up; their body weight and body mass index (BMI) decreased significantly after treatment (both P=0.000), with an percentage of excess weight loss (%EWL) of (25.7±7.4)%. Thirteen patients completed 6 month follow up; their body weight and BMI were significantly lower than the preoperative levels (both P=0.001), while there were no significant difference between the third and sixth month measurements (P=0.103 and P=0.053, respectively); %EWL of 6 months after operation was significantly higher than that of 3 months after operation [(37.0±14.7)% vs. (29.1±6.8)%,P=0.042]. Six patients completed 12 month follow up; their body weight and BMI decreased significantly at the first 3 months after operation (P=0.007 and P=0.005,respectively) and at the second 6 postoperative months (P=0.007 and P=0.013,respectively); the BMI of 6 months after operation was significantly lower than that of 3 months after operation (P=0.045), but there was no significant difference of body weight between the third and sixth month after operation (P=0.065); meanwhile, the %EWL increased significantly within the second 3 postoperative months from (29.6±6.8）% to（42.4±14.0）%(P=0.028), and also within the second 6 postoperative months (60.4±12.6）%(P=0.001). In 9 patients with pre-operative obstructive sleep apnea hypopnea syndrome, the symptom was remarkably resolved in all these 9 patients 3 months after the treatment. Of 16 patients with preoperative metabolic syndrome, the condition was obviously improved after treatment in 10 patients. Of 9 patients with hypertension preoperatively, the blood pressure returned to normal level after the withdrawal of antihypertensive agents in 7 patients; in addition, one patient had his dose dcreased and one patient switched to a milder antihypertensive agent. Of 8 patients accompanied with type 2 diabetes, 7 had their antidiabetic drugs withdrawn after the blood sugar returned normal and one patient had his dose decreased. Conclusion LAGB combined with MDT approach is effective, safe, and feasible for treating morbid obesity and its complications.

ObjectiveTo evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) for achieving type 2 diabetes mellitus (T2DM) remission in patients with body mass index (BMI) in the range of 25-35 kg/m². MethodsTwenty-two non-morbidly obese (BMI: 25-35 kg/m²) patients with T2DM underwent LRYGB. The changes of BMI, fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA1c) levels were recorded, and the prognostic factors were analyzed. ResultsAll these 22 patients successfully underwent LRYGB and were followed up for twelve months. Two patients (9.1%) developed complications: one patient had an early hemorrhage at the gastrojejunostomy site, and the other had frequent loose stools that required revision surgery. At 12 months, 14 patients (63.6%) showed T2DM remission, 6 (27.3%) showed glycemic control, and 2(9.1%) showed improvement. Compared with the latter two groups, patients in the T2DM remission group had significantly higher BMI (P=0.001), younger age (P=0.002), and shorter duration of diabetes (P=0.001) before operation. ConclusionsLYRGB can efficiently and safely treat T2DM in non-morbidly obese patients. Early intervention in these patients may yield better outcomes.

ObjectiveTo investigate the whole body fat distribution in severe obese patients with multi-slice spiral CT, and to explore the correlation between adipose volume parameters and anthropometric data. MethodsTotally 14 severe obese patients were enrolled and examined with multi-slice spiral CT. Total adipose tissue (TAT) volume and visceral adipose tissue (VAT) volume were measured using Volume software. The total, subcutaneous, and visceral adipose tissue volumes on umbilical level were also determined. The correlations between these parameters and anthropometric data including body weight, body mass index (BMI), and waist circumference were analyzed. ResultsAll scans were performed successfully. TAT was significantly correlated with body weight (r=0.7185，P =0.004), BMI (r=0.8079，P=0.004), and waist circumference (r=0.7627, P=0.002). VAT was mildly correlated with body weight (r=0.5727，P=0.032) and strongly correlated with waist circumference (r=0.6707，P =0.001). There was highly significant correlation between subcutaneous adipose tissue volume on umbilical level with TAT (r=0.8926，P=0.000), and mild correlation between visceral adipose tissue volume on umbilical level with VAT (r=0.5949，P=0.025). ConclusionsMulti-slice spiral CT can be applied to evaluate whole body fat distribution in severe obese patients. Waist circumference is highly relevant with VAT and therefore can be used as a simple parameter for evaluating adipose tissue inside the abdomen.

Objective To explore the effect of chlorogenic acid on disordered glucose and lipid metabolism in db/db mice and its mechanism. Methods Thirteen 5-6-week-old male db/db mice were randomly divided into db/db-CGA group (n=7) and db/db-CON group (n=6), and thirteen 5-6-week-old male db/m mice were randomly divided into db/m-CGA group (n=6) and db/m-CON group (n=7). Mice in the CGA groups were administrated with CGA 80 mg/(kg·d)by gavage, and mice in the CON groups were administrated with PBS in the same volume by gavage. Twelve weeks later, the level of biomedical parameters in plasma, liver, and skeletal muscle were determined, the concentrations of adiponectin and visfatin in visceral adipose, and the mRNA expression of glucose-6-phosphatase (G-6-Pase) and peroxisome proliferators-activated receptor-α (PPAR-α) as well as the protein level of PPAR-α in liver were detected. ResultsTwelve weeks after CGA administration, the levels of triglycerides in plasma, liver, and skeletal muscle and the fasting plasma glucose in db/db-CGA group were significantly lower than those in db/db-CON group(P<0.05). The muscle glycogen level was significantly higher than that in db/db-CON group (P<0.05), and the adiponectin concentration was significantly higher than that in db/db-CON group ( P<0.01) and lower than that in db/m-CGA group(P<0.05). The visfatin concentration in db/db-CGA group was significantly lower than that in db/db-CON group (P<0.01) and significantly higher than that in db/m-CGA group(P<0.05). The mRNA expression level of G-6-Pase was significantly down-regulated in db/db-CGA group when compared with db/db-CON group (P<0.05). Both the mRNA and the protein expression levels of PPAR-α were significantly up-regulated in db/db-CGA group(P<0.05) compared with in db/db-CON group. Conclusion CGA improves the disordered glucose/lipid metabolism in db/db mice, which is speculated to be related with its role in modulating the adipokines secretion, up-regulating hepatic PPAR-α, and inhibiting G-6-Pase expression.

Objective To screen for the differential protein peaks of renal cell carcinoma (RCC) using magnetic beads-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). MethodsSerum proteins were profiled by magnetic beads (WCX) from 62 RCC patients and 37 patients with benign renal space-occupying lesions. Protein peaks were identified by MALDI-TOF-MS. Data were analyzed with Biomarker Wizard 3.1 and Biomarker Patterns Software 5.0. Diagnostic model for RCC was constructed based on 47 RCC cases and 26 patients with benign renal space-occupying lesions. The remaining 26 cases were evaluated with blind method. ResultsSeven differential protein peaks related to RCC were identified (P<0.05). The diagnostic model for RCC constructed by the differential protein peaks (m/z 2945.35, 15340.8, 6984.51, and 5819.23) generated excellent separation between the RCC and control groups, with a sensitivity of 83.0% and the specificity of 84.6%. As validated by blind method, the model had a sensitivity of 80.0 % and a specificity of 81.8%. ConclusionDifferential protein peaks for RCC can be identified in serum by magnetic beads-based MALDI-TOF-MS, which is also valuable for the establishment of a RCC diagnostic model with a high sensitivity and specificity.

Objective To observe the role of interleukin (IL) 21 alone, IL12 alone, and IL21 plus IL12 for inducing the antitumor activity of peripheral blood mononuclear cells (PBMCs) in patients with endometrial cancer. 
Methods PBMCs were isolated from peripheral blood in patients with endometrial cancer in vitro, and kept the culture with low-level IL2. IL2-stimulated PBMCs were cocultured under different conditions (with anti-IL21 antibody, IL21 alone, IL12 alone, or IL21 plus IL12) for 72 h. The cytotoxicity of PBMCs was then examined by lactate dehydrogenase(LDH) released assay. CD4⁺ CD25⁺ FOXP3⁺ regulatory (Treg) cell and CD4⁺ IL17A⁺ T-helper (Th17) cell proportion were determined with flow cytometry. Cell proliferation and apoptosis were measured by cell counting kit-8(CCK-8)assay and flow cytometry, respectively. 
Results In comparison to control group, both IL21 and IL12 significantly enhanced the cytotoxicity of PBMCs. The IL21 plus IL12 group had superior effect to IL21 alone and IL12 alone. IL21 and IL12 significantly decreased the percentages of Treg cells and the rate of PBMCs apoptosis. IL21 or IL12 had no significant effect on the differentiation of Th17 cells and the proliferation of PBMCs. 
Conclusions IL21 and IL12 can enhance the cytotoxicity of PBMCs in patients with endometrial cancer, which can be further strengthened with treatment of IL21 plus IL12. Such effects may be achieved by inhibiting the differentiation of Treg cells and the apoptosis of PBMCs, but not by the differentiation of Th17 cell.

Objective To explore the relationship between six-transmembrane epithelial antigen of prostate 4 (STEAP4) genetic polymorphisms and insulin resistance (IR) in Uygur Chinese general population. Methods In this cross-sectional study on the metabolic diseases (e.g. obesity) among Uygur Chinese in Hetian, Xinjiang, China,from January to February 2007, 2127 Uygur individuals were enrolled. The sample size for IR subjects ［homeostasis model assessment for insulin resistance (HOMA-IR) ≥2.3 ₆₅%］ was 669, whereas that for non-IR controls was 664 (HOMA-IR≤1.3₃₅%). STEAP4 gene was sequenced in 50 Uygur Chinese individuals with IR (HOMA-IR≥2.3). The representative variations were selected from the population based on a r² cutoff of 0.8 and a minor allele frequency of >5% for case-control study. Results Totally 16 variations including 10 novel variations (no reported in dbSNP) were identified in 50 Uygur individuals with IR. 7414 G/A (rs8122)(P/Pc=0.004/0.012)and 224A/G (rs1981529, Gly75Asp)(P/Pc=0.015/0.045)variations were significantly correlated with IR phenotype in Uygur subjects. As shown by multiple linear regression analysis, the mean values of waist circumference (WC) (P/Pc=0.032/0.256), body mass index (BMI) (P/Pc=0.004/0.032), HOMA-IR (P/Pc=0.010/0.08), and fasting insulin (P/Pc=0.023/0.184) among A (protection) allele carriers of rs8122 and the mean values of WC (P/Pc=0.005/0.040) and BMI (P/Pc=0.002/0.016) among G (protection) allele carriers of rs1981529 gradually declined. Haplotype 1 (rs8122 G- rs1981529 A- rs34741656 G) was significantly associated with a higher prevalence of IR (Permutation P=0.021). Conclusion STEAP4 genetic variations are likely to be associated with obesity-related insulin resistance in Uygur Chinese general population.

Objective To explore the effect of N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide(W7) on the differentiation from human adipose-derived mesenchymal stem cells (hADSCs) to endothelial cells. Methods hADSCs were cultured with serum-free differential medium containing 40 ng/ml vascular endothelial growth factor (VEGF) and 10ng/ml basic fibroblast growth factor (bFGF). Cells were divided into control group (differential medium without W7), high-dose group (containing 30 μmol/L W7), medium-dose group (containing 20 μmol/L W7), and low-dose group ( containing 10 μmol/L W7). The hADSCs were cultured for 8 days, and then the changes in the phenotypes of von Willebrand factor (vWF) and vessel-selective cadherin (VE-Cadherin) were detected by flow cytometry (FCM). The intracellular Ca²⁺ labeled with Fluo-3 was detected by laser confocal microscopy. After hADSCs planting on Matrigel, their angiogenic potentials were observed under the inverted phase contrast microscope, and the expression of extracellular regulated kinase (ERK) and phosphorylated extracellular regulated kinase (p-ERK) were evaluated by Western blot. Results After the hADSCs were cultured for 8 days, compared with the control group, the expressions of vWF and VE-Cadherin significantly increased along with the decrease of W7 level and the intracellular Ca²⁺ also significantly increased (P＜0.01). Lumina-like vascular structure was formed in W7 treatment groups, but not in the blank control group. Compared with the blank control group, the expression of ERK showed no significant in W7 treatment groups (high-, medium-, and low-dose groups)(P>0.05); however, along with the decrease of W7 levels, the expression of p-ERK significantly increased(P<0.05). Conclusion W7 in proper levels can effectively induce the differentiation from hADSCs to endothelium by increasing the intracellular Ca²⁺ level and thus activating the ERK/MAPK pathway.

Objective To investigate the acceptability of male circumcision among male miners in Baise, Guangxi, China. Methods A questionnaire-based survey on the willingness to be circumcised (WTC) and its influential factors were conducted among Guangxi male miners recruited by random cluster sampling. Results Of 569 subjects who were surveyed, 143 (25.13%) expressed their willingness to be circumcised. Univariate analysis showed that marital status, education level, and the awareness of the hazards of phimosis and redundant prepuce and reasons for circumcision were significantly different between WTC group and the non-WTC group (all P<0.05). Furthermore, the incidence of phimosis or redundant prepuce also significantly differed between these two groups (P=0.0001). Logistic regression analysis found marital status (OR=0.498，95%CI=0.272-0.913), history of foreskin disease (OR=8.181, 95%CI=4.252-15.741), and awareness of the risk that a redundant prepuce may cause smegma (OR=1.713，95%CI=1.090-2.693) were significantly correlated with the male miners’ WTC. Conclusions Male miners in this area have low WTC. Education on the basic knowledge of acquired immunodeficiency syndrome and circumcision may help promote the application of circumcision.

Objective To explore the effectiveness of the traditional Chinese herbal medicine Lingzhi (Gonoderma lucidum) preparation in treating simian acquired immune deficiency syndrome (SAIDS). 
Methods Five female adult Chinese rhesus monkeys were inoculated rectally with SIVmac239, and were all diagnosed as SAIDS by laboratory and clinical examinations 17 months later. Of these 5 monkeys, 3 (#393, #374, and #381; treatment group) were orally administered with Gonoderma lucidum (2 spores powder capsules plus 2 spores oil capsules on a daily basis), and the remaining other two monkeys (#348 and #361) served as control and did not receive treatment. 
Results Animal #393 (treatment group), #361 (control group) and #348 (control group) died of SAIDS (opportunity infection) 3.5 months, 6 months, and 11 months later, respectively. Two animals (#374 and #381) survived. The necropsy revealed depletion and/or exhaustions of their lymphoid tissue. In the monkey #374, the peripheral CD4⁺ T lymphocyte increased by 30% in the 6^th month compared with the baseline level and then fluctuated. The plasma viral load gradually fell and reached about 1 log¹⁰ in the treatment group, but remained stable in the control group. As shown by pathological examinations, the lymph node and spleen of monkeys #374 (treatment group) and #381 (treatment group) showed rehabilitation and reconstruction in the lymphatic tissue, thymus, nerve tissue of gyrus hippocampi, pituitary gland, pineal body, thyroid gland, adrenal gland, and ovary. In the control group, however, animals experienced depletion of lymph nodes, atrophy of spleen, disappearance of thymus, and other disorders in endocrine organs. 
Conclusion Gonderma bucidum preparation may have certain protective effect on the immune system, nervous system, and endocrine system of monkeys with SAIDS.

Objective To summarize our experiences in the diagnosis and treatment of early gastric cancer (EGC). Methods The clinicopathological data of the 166 EGC inpatients who were treated in our hospital from January 1999 to January 2009 were retrospectively analyzed and their treatment outcomes were followed up. Results Surgical treatment for ECG accounted for 9.04% (176/1946) among all the surgeries performed for gastric cancers. Among the analyzed 166 cases, 9 asymptomatic patients were diagnosed by routine examination, 29 (17.47%) had a history of gastric ulcer or chronic gastritis, and 20 (12.05%) had a family history of esophageal or gastric cancer. Of 64 patients who received double-contrast gastric X-ray examination, 57 patients (89.06%) were found to be with abnormalities. Endoscocpy revealed lesions in lower third, middle third, and upper third of the stomach in 115 patients (69.28%), 26 patients (15.66%), and 25 patients (15.06%), respectively. A total of 126 patients received D^₀ or D₁ operations and 40 patients received operations more than D+1 operation. As shown by post-operative pathological examinations, the mean diameter of the lesions was (2.52±1.62) cm; 75 patients (45.18%) had mucosal gastric cancer, 91 (54.82%) had submucosal gastric cancer, 20 patients with submucosal gastric cancer had lymph node metastasis, and 8 patients had lymphatic vessel involvement. The overall 5-year survival rate was 70.0% and 89.7% among patients with or without lymph node metastasis (P=0.002). Univariate analysis revealed that depth of tumor invasion (submucosa) and lymphatic vessel involvement were significantly correlated with lymph node metastasis (P=0.000, P=0.001). Multivariate analysis showed that lymphatic vessel involvement was significantly correlated with lymph node metastasis (odds ratio: 15.67; 95% confidence interval, 3.40-72.14). Conclusions The proportion of EGC patients undergoing gastrectomy is relatively low among all gastric cancer patients. Lymph node metastasis is a key prognostic factor for EGC. A proper staging of gastric cancer, a precise evaluation of the depth of infiltration, and appropriate and standardized treatment are important to improve the outcomes.

Objective To analyze the clinical symptoms of patients with hyperparathyroidism. Methods The clinical data of 455 patients with hyperparathyroidism who were treated in Peking Union Medical College Hospital from October 1974 to January 2009 were retrospectively analyzed. Results Out of these 455 patients, there were 156 men (34.3%) and 299 women (65.7%), and the male/female ratio was 1:1.92. The mean onset age was (40.33±16.61) years (range: 5-86 years). Most patients (n=372, 81.8%) with skeletal manifestations, of whom 283 patients (62.2%) presented with ostealgia. The second most common symptom (n=252, 55.4%) was in urinary system, of whom 162 patients (35.6%) had nephrolithiasis. There were 200 patients (44.0%) with digestive system symptoms and 54 patients (11.9%) with neuropsychological symptoms. Twenty-one patients (4.6%) had asymptomatic hyperparathyroidism. There were 133 patients (29.2%) with decreased body height, and the mean decrease was(6.23±5.02)cm. Forty-nine patients (10.8%) presented with hypercalcemia crisis. Conclusions Women are more susceptible to hyperparathyroidism, which is featured by symptoms in skeletal system，urinary system, and digestive system. The asymptomatic hyperparathyroidism is relatively rare, which should be carefully considered during clinical practice.

Objective To evaluate the value of valplast dentures in the temporary restoration of single missing anterior tooth.Methods Totally 76 patients who needed temporary restoration of single missing anterior tooth were involved and equally divided into two groups according to their own choices of procedures: group A, with valpast dentures as their temporary dentures and group B, with conventional removable partial dentures as their temporary dentures. Meanwhile,38 patients who had their single anterior teeth pulled out and did not need temporary dentures were enrolled as control group without any temporary restoration, and impressions were taken immediately before the temporary dentures were used (2 weeks after tooth extraction) and before the initiation of permanent restorations (97-100 days after tooth extraction).The heights of clinical crowns of the adjacent teeth were also recorded twice from plaster models made from the impressions.The height of labial gingiva recession was calculated as the difference between the two heights recorded. Results The height differences of clinical crowns of the adjacent teeth was 0.5mm (range: 0.0-1.2mm) in group A, which was significantly larger than those in group B [0.0mm;(range: 0.0-0.6mm)](P<0.05) and in group C[0.0mm;(range: 0.0-0.4mm)](P<0.05).However, the difference was not significant between group B and group C (P>0.05).Conclusion Application of valpast dentureas as temporary denture may cause labial gingival recession of the adjacent teeth, and therefore is not suitable for the restoration of single missing anterior tooth.