Esthetic correction of gingival recession using a modified tunnel technique and an acellular dermal connective tissue allograft

Esthetic correction of gingival recession is an important goal of periodontal therapy. This article describes a surgical technique that combines a modified tunnel technique and an acellular dermal connective tissue allograft. With the aid of vertical incisions, a tunnel is created under the buccal mucosa of the affected tooth. These incisions enable easy access for graft placement and create mobility for gingival coronal positioning. The use of an acellular dermal connective tissue allograft eliminates the need for a surgical palatal donor site. This minimizes postsurgical complications.

CLINICAL SIGNIFICANCE

The combination of a modified tunnel technique and an acellular dermal connective tissue allograft permits esthetic root coverage in a manner that reduces postsurgical complications.     

Association between the Red Cell Distribution Width and Vasospastic Angina in Korean Patients

PurposeThe association between the red cell distribution width (RDW) and vasospastic angina (VSA) has not been elucidated. We investigated the association of the RDW with the incidence and angiographic subtypes of VSA in Korean patients.ResultsThe VSA group had a higher RDW than the non-VSA group (12.9±0.8% vs. 12.5±0.7%, p=0.013). The high RDW level demonstrated an independent association with the high incidence of VSA [second tertile: hazard ratio (HR) 1.96 (1.13–2.83), third tertile: HR 2.33 (1.22–3.47), all p<0.001]. Moreover, the highest RDW tertile level had a significant association with the prevalence of the mixed-type coronary spasm [HR 1.29 (1.03–1.59), p=0.037].ConclusionThe high level of RDW was significantly associated with the prevalence of VSA and the high-risk angiographic subtype of coronary spasm, suggesting that a proactive clinical investigation for VSA could be valuable in Korean patients with an elevated RDW.     

Die Divertikel des Verdauungskanals

Ohne Zusammenfassung     

Development of natural soft tissue architecture and interdental papillae between adjacent implants in the aesthetic zone.

A classification of predicted vertical height of the interdental papillae has been developed based on whether a papilla has a tooth, a pontic, or an implant on either side of it. Based on this classification, it may be prudent to avoid the placement of adjacent implants in multiple-unit restorations. To further enhance the aesthetics of multiple-unit restorations, endodontically retained roots may be submerged between implant sites. Some patients, however, require adjacent implants due to limited bone support. Others request them for personal reasons. In these cases, additional efforts must be made to create naturally appearing soft tissue architecture with full and symmetrical papillae.     

Importance of diffuse atherosclerosis in the functional evaluation of coronary stenosis in the proximal-mid segment of a coronary artery by myocardial fractional flow reserve measurements

The objective of this study was to evaluate the impact of diffuse coronary atherosclerosis on the functional evaluation of moderate coronary lesions in the proximal-mid segment of a coronary artery and its clinical implications. This was a prospective study including 100 consecutive patients with a moderate lesion (45 ± 9% diameter stenosis) in the proximal-mid coronary segment who were evaluated with fractional flow reserve (FFR) measurement. No patient had any other angiographic stenosis distal to the evaluated coronary stenosis. FFR measurements were obtained just distal (~2 to 3 cm) to the lesion (FFR proximal measurement [FFR-PM]) and as distally as possible in the artery (FFR distal measurement [FFR-DM]) after administration of the same dose of intracoronary adenosine. Thirty-nine patients underwent dipyridamole or exercise myocardial single-photon emission computed tomography within 3 months of the FFR study. Mean FFR-PM was significantly higher compared to FFR-DM (0.84 ± 0.08 vs 0.78 ± 0.09, median gradient 0.06, 25th to 75th interquartile range 0.02 to 0.10, p <0.0001). FFR-DM was <0.75 in 33% of patients with FFR-PM ≥0.75, leading to the decision of revascularization in these patients. Performing FFR measurement in the left main/left anterior descending artery predicted a higher gradient between FFR-DM and FFR-PM (odds ratio 4.58, 95% confidence interval 1.4 to 15.03, p = 0.007). FFR-DM exhibited a better correlation with results of myocardial single-photon emission computed tomography compared to FFR-PM (kappa 0.33 vs 0.22, p <0.0001). In conclusion, significant differences between FFR-DM and FFR-PM were observed in patients with moderate coronary stenosis in the proximal-mid segment of a coronary artery, with FFR-DM exhibiting a better correlation with results of noninvasive functional tests. These differences influenced the treatment decision in about 1/3 of patients and highlight the potential clinical relevance of coronary pressure wire positioning for functional evaluation of lesions in the proximal-mid segment of the coronary arteries.     

Left atrial volume index over late diastolic mitral annulus velocity (LAVi/A') is a useful echo index to identify advanced diastolic dysfunction and predict clinical outcomes

Background

Combined interpretation of late diastolic mitral annulus velocity (A′) with left atrial volume index (LAVi) may have additional benefits in the assessment of diastolic dysfunction.

Hypothesis

The LAVi/A′ ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea.

Methods

We enrolled 395 consecutive patients hospitalized with dyspnea (New York Heart Association class II–IV) and performed transthoracic Doppler echocardiography and B‐type natriuretic peptide (BNP) measurement. LAVi/A′ values were evaluated in terms of diagnosing ADD and predicting clinical outcome.

Results

On the receiver operation characteristic curve analysis for the determination of ADD, the area under the curves of LAVi/A′ in the entire population was comparable to those of BNP (0.94 vs 0.93, P = 0.845) and mitral E/E′ (0.94 vs 0.93, P = 0.614) and higher than that of LAVi (0.94 vs 0.87; P = 0.014). A LAVi/A′ of 4.0 was the best cut‐off value to identify ADD. During a median follow‐up of 31.9 months (range, 0.3 to 45.7 months), the group with LAVi/A′ ≥4.0 had a higher incidence of primary composite outcomes (cardiac death and/or rehospitalization for heart failure) than the group with LAVi/A′<4.0 (25.0% vs 3.3%, P < 0.001). LAVi/A′ ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386–7.598; P = 0.007).

Conclusions

As a new echo index, LAVi/A′ is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea. Copyright © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

Expression profiles of miRNAs in human embryonic stem cells during hepatocyte differentiation

Aim: Human embryonic stem cells (hESCs) are able to self‐renew and differentiate into a variety of cell types. Although miRNAs have emerged as key regulators in the cellular process, a few studies have been reported about behaviors of miRNAs during differentiation of hESCs into a specialized cell type. Here, we demonstrate that different kinds of miRNAs may function in a lineage‐specific manner during the differentiation of human embryonic stem cells (hESCs). Methods: hESCs were induced to definitive endoderm (DE) cells and further differentiated to hepatocytes. The expression levels of miRNAs were examined in hESCs, DE cells, and hepatocytes by miRNA array using 799 human miRNA probes. Results: Among 387 miRNAs significantly detected, 13 and 56 miRNAs were downregulated and upregulated during transition of hESCs to DE cells, respectively, while 30 and 92 miRNAs were downregulated and upregulated during differentiation of DE cells to hepatocytes, respectively. In particular, 5, 4, and 86 miRNAs were enriched in hESCs, DE cells, and hepatocytes, respectively. Quantitative RT‐PCR represented that miR‐512‐3p, miR‐512‐5p and miR‐520c‐3p were enriched in hESCs, miR‐9*, miR‐205 and miR‐375 in hESC‐derived DE cells, and miR‐10a, miR‐122 and miR‐21 in hESC‐derived hepatocytes. Expression patterns of lineage‐specific miRNAs in the liver tissue were similar to those of hESC‐derived hepatocytes. Conclusion: The results indicate that different kinds of miRNAs may function in a lineage‐specific manner during differentiation of hESCs into a specialized cell type.