Knotless barbed suture versus conventional polydioxanone suture material for intraoral surgical incisions - A randomized controlled trial.

Purpose: To evaluate and compare the perioperative wound management and healing of intraoral surgical incisions between the conventional and knotless barbed Polydioxanone suture materials. Materials and methods: A Randomized Controlled Trial was conducted with well-constructed inclusion and exclusion criteria. 46 participants were allotted into the control and test groups based on a computer-generated randomization sequence. The materials used were 3-0 Stratafix™ knotless barbed PDS suture and conventional 3-0 Ethicon PDSTMII suture materials. Parameters assessed included intraoperative time taken for closure and assessment with Early Wound Healing Score (EHS) on postoperative day 1 and Landry, Turnbull, and Howley (LTH) Healing index on postoperative days 3 and 7. Statistical analyses were done using the Chi-square test and student's t-test with a p-value less than 0.05 indicating statistical significance. Results: 32 patients had surgical intervention for maxillofacial fracture management and 14 patient for orthognathic osteotomies. Surgical sites (n = 60) included maxillary and mandibular vestibules. Intraoperative closure time was better in the test group with statistical significance (p-value = 0.0472). The healing scores on the 3rd and 7th postoperative days were compared between the control and test groups exhibiting statistical significance favouring the test group. The p-values were 0.0479 and 0.0393 respectively. Conclusion: To conclude, our study concurred with the existing literature in terms of reduced operating time, and better wound healing observed with the knotless barbed suture. Along with statistical significance, all the variables exhibited clinical relevance and better wound management in the test group.

Comparison of Conventional Versus Right Angled Fixation Technique in Management of Mandibular Angle Fractures - A Prospective Randomized Clinical Study.

PURPOSE: The treatment of mandibular angle fractures ranges from observation to closed reduction with maxillomandibular fixation to open reduction and internal fixation. The study aims to compare the effectiveness of three different techniques (transoral, transbuccal, and right-angled fixation technique) for single adaptational monocortical upper border plating in mandibular angle fracture. METHODS: The study conducted at our center was a prospective randomized study. The study duration was from November 2019 to August 2021. The three groups included in our study were transoral, transbuccal, and transoral approach using the right-angled drill. Patients who required open reduction and internal fixation of mandibular angle fracture were included in the study. Computer-generated randomization method was used to assign the participants among the 3 groups, ie, transoral, transbuccal, or right-angled fixation technique. The primary outcome clinical variables were mouth opening (MO), occlusion stability, scar or laceration, facial nerve weakness, infection, and the radiological variables were gap between the fracture segments and displacement of the fracture segment. The secondary outcome of our study is a comparison of the perioperative complications including plate exposure during the entire fracture healing period. The covariates of the study were age, sex, etiology, and tooth in line of fracture. Statistical analysis was done using ANOVA, post hoc Tukey test, and Pearson χ2 test. A P value less than 0.05 was considered statistically significant. RESULTS: A total of 48 patients were included in our study. According to randomization, each group was allotted 16 patients. In the study, 66.7% of the study population were male and 33.3% were female; 75% of the study population were victims of road traffic accidents, and 25% were injured due to assault. The mean and standard deviation for MO at 1 month were 31.3 ± 2.9 for the transoral group, 35.8 ± 1.7 for the transbuccal group, and 35.5 ± 1.3 for the right-angled fixation group. On intergroup comparison, statistically significant results were seen at the 1-month postoperative MO clinical parameter. The P value here was 0.02 which was statistically significant. CONCLUSION: The comparison of the right-angled fixation technique to transoral and transbuccal fixation methods have not been documented. Our study is the first of its kind to compare the right-angled fixation technique to various other approaches. Our study showed that the MO was better postoperatively with the transbuccal approach. The other variables showed no difference among the three techniques.

B-cell lymphoma 6 expression is not associated with live birth in a normal responder in vitro fertilization population.

OBJECTIVE: To determine whether increased endometrial B-cell lymphoma 6 (BCL6) expression is associated with live birth in a normal responder in vitro fertilization (IVF) population. DESIGN: Case-control study. SETTING: University-affiliated infertility center. PATIENT(S): Two groups of women undergoing IVF with preimplantation genetic testing for aneuploidy followed by warmed, single, euploid embryo transfer. Group 1 consisted of women who failed to achieve live birth, and group 2 consisted of women who achieved live birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Endometrial BCL6 expression measured by immunohistochemistry in endometrial tissue samples. Overexpression was defined by mean HSCORE with a cutoff of positivity of >1.4, as previously described in the literature. RESULT(S): Twenty-seven patients who achieved live birth and 23 patients who failed to achieve live birth were included. B-cell lymphoma 6 expression/HSCORE and live birth rate were not associated (Odds ratio [OR], 0.78 [0.24-2.55]). Using a cutoff of >1.4 for positivity, 8 of 23 samples were positive for BCL6 in the no live birth group, whereas 7 of 27 were positive in the live birth group. There was no significant association between BCL6 positivity and live birth (OR, 0.66 [0.19-2.21]). CONCLUSION(S): The proportion of patients with BCL6 positivity did not significantly differ between those who achieved live birth and those who did not. In the population of patients at our center, who compromise of women who respond normally to IVF stimulation, BCL6 overexpression was not associated with IVF success. Physicians implementing BCL6 testing as a diagnostic tool for clinical decision making should counsel patients that results may have limited utility in predicting IVF outcomes in this population.

Association between shape of the mandibular condylar head and the occurrence of unilateral condylar fracture - A retrospective computed tomographic study.

This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography. Medical records of patients diagnosed with unilateral condylar fractures from the year 2012-2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines. 201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture. In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures.

Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study.

PURPOSE: The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. MATERIALS AND METHODS: A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. RESULTS: Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. CONCLUSIONS: Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.

New Landmarks for the Surgical Creation of Dimples Based on Facial Form.

Dimleplasty is the surgical creation of dimples. The demand for dimpleplasty has increased over the past few years. Despite this increasing demand, the most widely used reference point for determining where to place a surgically created dimple, the Khoo Boo Chai (KBC) point, dates back more than 60 years. The aim of our study was to assess the facial shape of a sample of men and women, all of whom had natural dimples, to determine if characteristic patterns in dimple size, location, and shape existed according to each specific facial shapes. For our study, 1,194 people were examined for dimples and of these, 216 individuals with a group total of 336 naturally occurring dimples were included in the study. Facial form was categorized as mesoprosopic, euryprosopic, or leptoprosopic. We found that 54.8 percent of the total dimples were not positioned on the KBC point. In mesoprosopic group, out of 204 dimples, 117 were not positioned on the KBC point (87 were); in leptoprosopic group, out of 66 dimples, 30 dimples were not positioned on the KBC point (36 were); and in the euryprosopic group, out of 66 dimples, 36 were not positioned on the KBC point (30 were). Most of the dimples in the mesoprosopic group were positioned 4mm anterior to the KBC point, and in the eryprosopic group, most dimples were positioned 3mm above and behind the KBC point. Most of the dimples in the leptoprosopic group were positioned on the KBC point. We also observed differing patterns in size and shape between the groups. Understanding these differences could help surgeons achieve optimal outcomes by creating more natural looking and thus more aesthetically pleasing dimples among their patients seeking dimpleplasty.

Increased hepatic stiffness as consequence of high hepatic afterload in the Fontan circulation: a vascular Doppler and elastography study.

UNLABELLED: Hepatic dysfunction is a recognized complication after Fontan palliation of congenital heart disease. We sought to quantitatively measure hepatic stiffness and vascular Doppler indices using ultrasound (US) and shear wave elastography (SWE) in a Fontan cohort. Subjects were prospectively recruited for echocardiography and real-time hepatic duplex US with SWE for hepatic stiffness (kPa). Doppler peak velocities, velocity time integral, resistive, pulsatility, acceleration indices (RI, PI, AI), and flow volume were measured in celiac artery, superior mesenteric artery, and main portal vein (MPV). A subset underwent cardiac catheterizations with liver biopsy. Correlations were explored between SWE, duplex, hemodynamic, and histopathologic data. In all, 106 subjects were studied including 41 patients with Fontan physiology (age 13.8 ± 6 years, weight 45.4 ± 23 kg) and 65 controls (age 15.0 ± 8.4 years, weight 47.9 ± 22 kg). Patients with Fontan physiology had significantly higher hepatic stiffness (15.6 versus 5.5 kPa, P < 0.0001), higher celiac RI (0.78 versus 0.73, P = 0.04) superior mesenteric artery RI (0.89 versus 0.84, P = 0.005), and celiac PI (1.87 versus 1.6, P = 0.034); while MPV flow volume (287 versus 420 mL/min in controls, P = 0.007) and SMA AI (829 versus 1100, P = 0.002) were lower. Significant correlation was seen for stiffness with ventricular end-diastolic pressure (P = 0.001) and pulmonary artery wedge pressure (P = 0.009). Greater stiffness correlated with greater degrees of histopathologic fibrosis. No significant change was seen in stiffness or other duplex indices with age, gender, time since Fontan, or ventricular morphology. CONCLUSION: Elevated hepatic afterload in Fontan, manifested by high ventricular end-diastolic pressures and pulmonary arterial wedge pressures, is associated with remarkably increased hepatic stiffness, abnormal vascular flow patterns, and fibrotic histologic changes. The MPV is dilated and carries decreased flow volume, while the celiac and superior mesenteric arterial RI is increased. SWE is feasible in this population and shows promise as a means for predicting disease severity on liver biopsy.

Forgiveness, physiological reactivity and health: the role of anger.

Research has revealed that forgiveness may have beneficial effects for the forgiver's health. The present research explored whether reductions in anger underlie such effects, or whether forgiveness has beneficial health effects above and beyond the effects of decreasing anger. State and trait forgiveness were examined, along with styles of anger expression, for their relationship to physiological responses during recalled betrayal, and to self-reported health indices. State and trait forgiveness were negatively associated with anger-out; however, with one exception, no other styles of anger expression were linked with forgiveness. Both forgiveness and anger-out were associated with systolic blood pressure, heart rate and rate-pressure product. Partial correlations revealed that trait forgiveness accounted for significant variance in mean systolic blood pressure and rate-pressure product, and state forgiveness predicted mean heart rate, even after gender and anger-out had been controlled. On the other hand, anger-out fully mediated the trait forgiveness-heart rate and state forgiveness-rate pressure product effects. Trait forgiveness was significantly associated with fewer medications and less alcohol use, lower blood pressure and rate pressure product; state forgiveness was significantly associated with lower heart rate and fewer physical symptoms. Neither of these sets of findings were the result of decreased levels of anger-out being associated with forgiveness. These findings have important theoretical implications regarding the forgiveness-health link, suggesting that the benefits of forgiveness extend beyond the dissipation of anger.