Use of Tuberosity Connective Tissue for Root Coverage and Ridge Augmentation: Background and Technique.

Excess tissue often exists distal to the upper second molar, creating a pocket in the maxillary tuberosity. When removed from this location, this tissue can serve as an optimal piece of connective tissue (CT), helping to both prevent periodontal disease and treat periodontal recession while also aiding in restorative dentistry. This tissue is an ideal CT for root coverage and soft-tissue ridge-augmentation grafting.

Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group.

Ketogenic dietary therapies (KDTs) are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. In 2009, an expert consensus guideline for the management of children on KDT was published, focusing on topics of patient selection, pre-KDT counseling and evaluation, diet choice and attributes, implementation, supplementation, follow-up, side events, and KDT discontinuation.

Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry.

Background: Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma.

Methods: Registry data from March 2013 to December 2016 were reviewed.

Safe Plastic Surgery of the Breast II: Saving Nipple Sensation.

Since its inception, reduction mammoplasty has matured considerably. Primary evolution in clinical research and practice initially focused on developing techniques to preserve tissue viability; breast parenchyma, skin, and nipple tissue that has expanded to include sensation and erectile function play a large role in the physical intimacy of women. Studies regarding primary innervation to the nipple are few and often contradictory.

Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy.

Objective: To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).

Methods: The trial was designed as a single-blinded cross-sectional study. Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.

Resting MAPK expression in chronically trained endurance runners.

Purpose: There is a paucity of research investigating the expression of mitogen-activated protein kinases (MAPK) in chronically trained (CT) athletes. Thus, it is unclear how MAPK may contribute to performance and muscle adaptation in CT subjects. The purpose of this study was to determine MAPK total protein, and phosphorylated expression of extracellular signal-regulated kinases 1 and 2 (ERK1/2), c-Jun N-terminal kinase (JNK), and p38-MAPK (p38) between untrained, and chronically trained runners.

First Report of Coexistence of Two Ectopic Pituitary Tumors: Rathke Cleft Cyst and Silent Adrenocorticotropic Hormone Adenoma.

Background: Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry; however, PAs with a concomitant RCC inside the sella turcica are rarely observed. Ectopic pituitary tumors are also rare.

Case Description: We present the case of a 65-year-old woman with an ectopic RCC in the sphenoid sinus and outside the sella turcica concomitant with an adrenocorticotropic hormone (ACTH)-staining, clinically silent PA.

Changes in resting mitogen-activated protein kinases following resistance exercise overreaching and overtraining.

Purpose: Many physiological maladaptations persist after overreaching and overtraining resistance exercise (RE). However, no studies have investigated changes in mitogen-activated protein kinases (MAPK) after overtraining in humans, despite their critical role regulating exercise-induced muscular adaptations. The purpose of this study was to describe the changes in total and resting phosphorylation status of extracellular signal-regulated kinase 1/2 (ERK1/2), c-Jun NH-terminal kinase (JNK) and p38-MAPK following a period of RE overreaching or overtraining.

Resting extracellular signal-regulated protein kinase 1/2 expression following a continuum of chronic resistance exercise training paradigms.

Extracellular signal-regulated protein kinase 1/2 (ERK1/2) moderates skeletal muscle growth; however, chronic responses of this protein to unique resistance exercise (RE) paradigms are yet to be explored. The purpose of this investigation was to describe the long-term response of ERK1/2 following circuit weight training (CWT), recreationally weight training (WT), powerlifting (PL) and weightlifting (WL). Independent t-tests were used to determine differences in trained groups compared to sedentary controls.

Diabetes Incidence and Glucose Tolerance after Termination of Pioglitazone Therapy: Results from ACT NOW.

Context: Thiazolidinediones have proven efficacy in preventing diabetes in high-risk individuals. However, the effect of thiazolidinediones on glucose tolerance after cessation of therapy is unclear.

Objective: To examine the effect of pioglitazone (PIO) on incidence of diabetes after discontinuing therapy in ACT NOW.

Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries.

This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers.

Complete heart block and asystole following blunt cardiac trauma.

Cardiac contusion is a well-recognized complication of blunt chest trauma. Various conduction system disorders have been reported in association with this condition, the most common being right bundle branch block. Complete heart block (CHB) is seen rarely.

Intravenous Recombinant Tissue Plasminogen Activator Does Not Impact Mortality in Acute Ischemic Stroke at Any Time Point up to 6 Months: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials.

Background And Objective: Concerns about the harms of intravenous alteplase (recombinant tissue plasminogen activator) continue to deter physicians from treating patients with acute ischemic stroke with the only drug proven to positively impact outcomes and reduce disability. Recent literature indicates an increase in mortality with alteplase within 7 days, an effect that does not persist from 3 months onwards. The objective of this meta-analysis was to pool mortality estimates from randomized controlled clinical trials (RCTs) at 7 days, 30 days, 90 days, and 6 months after stroke onset.

A cross-species genetic analysis identifies candidate genes for mouse anxiety and human bipolar disorder.

Bipolar disorder (BD) is a significant neuropsychiatric disorder with a lifetime prevalence of ~1%. To identify genetic variants underlying BD genome-wide association studies (GWAS) have been carried out. While many variants of small effect associated with BD have been identified few have yet been confirmed, partly because of the low power of GWAS due to multiple comparisons being made.

Variability in self-reported normal sleep across the adult age span.

Objectives: Illustrate the importance of examining within- and between-person differences in sleep across the adult age span.

Method: Two weeks of sleep diary data were analyzed for 592 normal sleepers ranging in age from 20 to 96 years. Variability in total sleep time (TST), number of nighttime awakenings (NWAK), sleep-onset latency (SOL), and wake-time after sleep onset (WASO) were examined overall and by age, sex, and race utilizing multilevel models and multiple regression.

Options for treatment of spontaneous mesenteric artery dissection.

Objective: Mesenteric artery dissection was once thought to be rare but has been identified more frequently with increasing use of computerized tomographic angiographic imaging. Multiple reports advocate a wide range of treatment including medical therapy, endovascular, and surgical intervention, with no clear guidelines for the application of each treatment.

Methods: A systematic review of the literature was analyzed and used to create a treatment algorithm that was applied to nine patients in our institution.

Bisphosphonates and osteonecrosis of the jaw.

Bisphosphonates are used worldwide as a successful treatment for people with osteoporosis, which is the major underlying cause of fractures in postmenopausal women and older adults. These agents are successful at increasing bone mass and bone trabecular thickness, decreasing the risk of fracture, and decreasing bone pain, enabling individuals to have better quality of life. Bisphosphonates are also used to treat multiple myeloma, bone metastasis, and Paget's disease; however, bisphosphonate treatment may result in negative side effects, including osteonecrosis of the jaw (ONJ).

Carotid endarterectomy for treatment of in-stent restenosis.

In-stent restenosis (ISR) after carotid angioplasty and stenting is becoming evident as more patients undergo carotid stenting and duplex scan surveillance. While redo endovascular therapy has been immediately successful, recurrent stenosis remains a problem. The ideal management of ISR has not been determined.

Optimal caloric intake for critically ill patients: first, do no harm.

Despite considerable efforts to define energy requirements for critically ill patients, no single method has been found to be precise and unbiased for all patients. As a result, clinicians have used various methods that may overestimate energy requirements for some patients. Provision of target caloric intake without regard to the complications of overfeeding, such as hyperglycemia, hypercapnia, or gastric feeding intolerance, could result in overall detrimental clinical outcome.