Effectiveness of micro-implant in vertical control during orthodontic extraction treatment in class II adults and adolescents after pubertal growth peak: a systematic review and meta-analysis.

OBJECTIVE: To compare the effectiveness of micro-implant (MI) and conventional anchorage (CA) in vertical control during orthodontic extraction treatment of class II adults and adolescents after pubertal growth peak. MATERIALS AND METHODS: Literature search was conducted through Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine (CBM), and other sources, from inception to December 2021. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Mean differences (MDs) with 95% confidence intervals (CIs) were conducted. A meta-analysis concerning change of mandibular plane, vertical change of upper and lower molar, change of occlusal plane, SNB, chin position, and profile was carried out. RESULTS: A total of 10,669 records were identified in the database search, and 19 studies (10 RCTs and 9 CCTs) were included in the final analysis. Compared with CA, MI significantly decreased mandibular plane angle and intruded upper molars. No significant difference was found in vertical change of lower molars, occlusal plane, SNB, chin position, and profile. CONCLUSION: MI seems to be more effective than CA in vertical control during orthodontic extraction treatment of class II adults and adolescents after pubertal growth peak. CLINICAL RELEVANCE: MI should be given priority when considering the vertical control of class II patients, which is beneficial to the counterclockwise rotation of mandible or at least prevention of deterioration of the profile.

Assessing Anti-Social and Aggressive Behavior in a Zebrafish (Danio rerio) Model of Parkinson's Disease Chronically Exposed to Rotenone.

Background: Rotenone (ROT) is currently being used in various research fields, especially neuroscience. Separated from other neurotoxins, ROT induces a Parkinson's disease (PD)-related phenotype that mimics the associated clinical spectrum by directly entering the central nervous system (CNS). It easily crosses through the blood−brain barrier (BBB) and accumulates in mitochondria. Unfortunately, most of the existing data focus on locomotion. This is why the present study aimed to bring novel evidence on how ROT alone or in combination with different potential ant(agonists) might influence the social and aggressive behavior using the counterclockwise rotation as a neurological pointer. Material and Methods: Thus, we exposed zebrafish to ROT­2.5 µg/L, valproic acid (VPA)­0.5 mg/mL, anti-parkinsonian drugs (LEV/CARB)­250 mg + 25 mg, and probiotics (PROBIO)­3 g for 32 days by assessing the anti-social profile and mirror tests and counterclockwise rotation every 4 days to avoid chronic stress. Results: We observed an abnormal pattern in the counterclockwise rotation only in the (a) CONTROL, (c) LEV/CARB, and (d) PROBIO groups, from both the top and side views, this indicating a reaction to medication and supplements administered or a normal intrinsic feature due to high levels of stress/anxiety (p < 0.05). Four out of eight studied groups­(b) VPA, (c) LEV/CARB, (e) ROT, and (f) ROT + VPA­displayed an impaired, often antithetical behavior demonstrated by long periods of time on distinct days spent on the right and the central arm (p < 0.05, 0.005, and 0.0005). Interestingly, groups (d) PROBIO, (g) ROT + LEV/CARB, and (h) ROT + PROBIO registered fluctuations but not significant ones in contrast with the above groups (p > 0.05). Except for groups (a) CONTROL and (d) PROBIO, where a normalized trend in terms of behavior was noted, the rest of the experimental groups exhibited exacerbated levels of aggression (p < 0.05, 0.005, and 0.001) not only near the mirror but as an overall reaction (p < 0.05, 0.005, and 0.001). Conclusions: The (d) PROBIO group showed a significant improvement compared with (b) VPA, (c) LEV/CARB, and ROT-treated zebrafish (e−h). Independently of the aggressive-like reactions and fluctuations among the testing day(s) and groups, ROT disrupted the social behavior, while VPA promoted a specific typology in contrast with LEV/CARB.

Association between electrocardiographic QRS transition zone and mortality from all causes and cardiovascular diseases: A systematic review and meta-analysis.

AIMS: To investigate whether clockwise rotation (CWR) and counterclockwise rotation (CCWR) of electrocardiographic QRS transition zone is associated with mortality from all causes and cardiovascular diseases (CVD). METHODS: Studies were identified from searching of PubMed, EMBASE and the reference lists of relevant papers. Summary multivariate-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) and 95% prediction intervals (PIs) were computed through meta-analysis. RESULTS: A total of five observational cohort studies fulfilled the inclusion criteria, which included 47,252 participants from the general population (8.8% CWR; 44.1% CCWR). Pooling data revealed that CWR was significantly associated with the increased risk of all-cause mortality (HR, 1.18; 95% CI: 1.12-1.24; 95% PI: 1.03-1.37) and CVD mortality (HR, 1.18; 95% CI: 1.08-1.29; 95% PI: 0.98-1.42) compared to NR pattern, with low heterogeneity among studies (P = 0.29, I2 = 20%; P = 0.37; I2 = 7%; respectively). However, CCWR was inversely associated with the risk of all-cause mortality (HR, 0.92; 95% CI: 0.89-0.95; 95% PI: 0.80-1.05) with low heterogeneity (P = 0.14; I2 = 43%), while no significant association existed between CCWR and CVD mortality (HR, 0.89; 95% CI: 0.77-1.02; 95% PI: 0.53-1.48) with high heterogeneity (P < 0.01; I2 = 78%). CONCLUSION: Our meta-analysis demonstrated CWR was positively associated with higher risk of mortality from all-cause and CVD, while CCWR was negatively associated with the risk of all-cause mortality and no significant association with CVD mortality. These findings suggested that QRS transition zone carries important prognostic value, more attention should be paid in clinical practice.

QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study.

ECG screening can detect people at risk of developing atrial fibrillation (AF). Recent literature indicated that QRS transitional zone rotations could predict several cardiovascular events. Herein, we investigated the association between QRS transitional zone rotations and the future risk of AF. This prospective cohort study included 6794 participants (3178 men and 3616 women), aged 30-84 years, from the urban Japanese city of Suita. QRS transitional zone rotations were diagnosed by ECG during baseline, while AF was diagnosed by ECG, hospital records, and checkups during follow-up. The Cox regression was used to compute the sex-specified hazard ratios (HRs) and 95% confidence intervals (CIs) of incident AF for participants with counterclockwise and clockwise QRS transitional zone rotations compared to those with normal rotation. Within a median follow-up period of 14.6 years, 311 participants (206 men and 105 women) developed AF. Counterclockwise rotation was associated with the reduced risk of AF among men, but not women, in the age-adjusted model: HR (95% CI) = 0.66 (0.44, 0.98) and the multivariable-adjusted model: HR (95% CI) = 0.65 (0.43, 0.97). Clockwise rotation was not associated with AF risk in either sex. To the best of our knowledge, this is the first study to indicate that counterclockwise rotation could be associated with the reduced risk of AF in men. More studies are needed to confirm our findings and elucidate possible mechanisms.

Electrocardiographic QRS axis shift, rotation and COVID-19.

Background: In patients with coronavirus disease-2019 (COVID-19), severe dyspnea is the most dramatic complication. Severe respiratory difficulties may include electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr). Aim: This study investigated the predictability of advanced lung tomography findings with QRS axis shift and rotation. Patients and Methods: This was a retrospective analysis of 160 patients. Patients were divided into the following two groups: normal (n = 80) and low (n = 80) oxygen saturation. These groups were further divided into four groups according to the rightward and leftward axis shift (Lws) on the electrocardiographic follow-up findings. These groups were compared in terms of electrocardiographic rotation (Cwr, counterclockwise rotation, or normal transition), tomographic stage (CO-RADS5(advanced)/CO-RADS1-4), electrocardiographic intervals, and laboratory findings. Results: In patients with low oxygen saturation, the amount of QRS axis shift, Cwr, and tomographic stage were significantly higher in the Rws group than in the Lws group. There were no differences in the above parameters between the Rws and Lws groups in patients with normal oxygen saturation. Logistic regression analysis revealed that the presence of Cwr and Rws independently increased the risk of CO-RADS5 by 18.9 and 4.6 fold, respectively, in patients with low oxygen saturation. Conclusion: In COVID-19 patients who have dyspnea with low oxygen saturation, electrocardiographically clockwise rotation with a rightward axis shift demonstrated good sensitivity (80% [0.657-0.943]) and specificity (80% [0.552->1]) for predicting advanced lung tomographic findings. ClinicalTrialsgov Identifier: NCT04698083.

Comparison of bicortical, miniplate and hybrid fixation techniques in mandibular advancement and counterclockwise rotation: A finite element analysis study.

OBJECTIVE: This study aims to evaluate biomechanical stability and stress distribution of five different fixation types with finite element analysis using 10-mm advancement with or without counterclockwise rotation of the mandible. MATERIALS AND METHODS: After sagittal split osteotomy, 10-mm advancement was performed in the first group and 10-mm advancement and 10-degree counterclockwise rotation were performed in the second group. One miniplate (M-1), two-miniplate (M-2), one miniplate and a bicortical screw (H), l-shaped bicortical screw (B-1), and inverted l-shaped bicortical screw (B-2) systems were placed. Totally, 120 N force was applied to the models at a 45-degree angle from the lower edge of the symphysis. RESULTS: The highest values on fixation were seen with miniplate, while the mean values were obtained with bicortical screw system. The highest values on bone were achieved using bicortical screws. One miniplate (M-1) showed both the highest and mean displacement. The highest values in counterclockwise-rotated models increased in all parameters, compared to non-rotated models. CONCLUSION: In cases in which passive alignment between segments and adequate bone contact are ensured, inverted l-shaped bicortical screw, two-miniplate, or hybrid systems are recommended.

Impact of counterclockwise rotation of the occlusal plane on the mandibular advancement, pharynx morphology, and polysomnography results in maxillomandibular advancement surgery for the treatment of obstructive sleep apnea patients.

PURPOSE: Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. METHODS: Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. RESULTS: The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. CONCLUSION: Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.

Management of Class II Hyperdivergent Mandible by Surgically Altering Occlusal Plane Pattern through Counterclockwise Rotation of Mandible.

AIM AND OBJECTIVE: To evaluate the facial esthetic of class II hyperdivergent mandible by altering the high mandibular plane angle into an orthognathic mandibular plane angle by counterclockwise (CCW) rotation of the mandible. MATERIALS AND METHODS: Five patients with class II hyperdivergent mandible were selected for this study. Initially, preorthodontics was done by aligning the teeth. Then, surgically, bilateral sagittal split osteotomy (BSSO) advancement with CCW rotation of mandible with a posterior open bite of 4 mm was done. Eleven linear and 11 angular measurements were taken. Pre- and postsurgical values were evaluated by composite cephalometric analysis, and the changes in the occlusal plane and facial height were statistically analyzed by using paired t-test. Jarabak ratio was calculated for facial height measurements. Further finishing will be done by postsurgical orthodontic procedures to get functional occlusion. RESULTS: Change in occlusion to class I is seen in values of Jarabak ratio and Go-Gn. Jarabak ratio shows an increase in posterior and decreases in anterior facial height. Go-Gn, which implies the CCW movement of the mandible, has reduced the anterior open bite and created a posterior open bite of 4 mm for the supraeruption of teeth. CONCLUSION: BSSO with CCW rotation of mandible with a posterior open bite has conservatively involved in single-jaw surgery, thereby improving the facial esthetics of all the patients taken this study. CLINICAL SIGNIFICANCE: This innovative method of CCW rotation of mandible with open bite mainly prevents the bi-jaw surgery, improves the stability, and gives an esthetically good appearance.

Large versus small mandibular counterclockwise rotation during bimaxillary surgical correction of class II deformities-a retrospective CBCT study on skeletal stability.

OBJECTIVES: Postsurgical skeletal relapse is a concern for class II deformities corrected with counterclockwise rotation of the occlusal plane. Therefore, the aim of this study was to compare the skeletal stability between large and small counterclockwise rotational advancement of the mandible in patients with skeletal class II deformity. MATERIALS AND METHODS: This retrospective study included 50 adult patients with skeletal class II deformity corrected by Le Fort I setback and bilateral sagittal split osteotomy counterclockwise rotational advancement. Patients were divided into two groups, according to the amount of counterclockwise rotation: small rotation (n = 25) and large rotation (n = 25). Serial cone beam computed tomography scans were analyzed to identify skeletal and dental position from presurgery to at least 12 months postsurgery. Changes in the facial skeleton (maxilla and mandible) and teeth (central incisor and first molar) were determined for six skeletal and four dental landmarks by measures before treatment (T0) and 1 week postsurgery (T1), and from T1 to at least 12 months postsurgery (T2). RESULTS: A relapse was found both after large and small rotational advancement of the mandible (pogonion: 1.0 (2.4) mm and 1.4 (3.0) mm, respectively). The result was statistically significant (both p < 0.05) and was with less than 1.5 mm clinically acceptable. There were no between-group differences in the postsurgical horizontal and vertical mandibular stability. CONCLUSIONS: The results suggest that counterclockwise rotational advancement of the mandible using bilateral sagittal split osteotomy is a clinically stable procedure. The amount of rotation does not affect the postsurgical stability of the mandible. CLINICAL RELEVANCE: The findings help clinicians better understand the surgical and postsurgical changes of the skeleton and teeth after counterclockwise rotational advancement of the mandible for class II deformity.

Skeletal Stability After Mandibular Counterclockwise Rotational Advancement for Correction of Skeletal Class II Deformity-A Systematic Review and Meta-analysis.

OBJECTIVES: The aim of this systemic review was to compare surgical and postsurgical changes in the mandible after bilateral sagittal split osteotomy (BSSO) with counterclockwise (CCW) rotational advancement. A review of the current available dental literature regarding skeletal stability after mandibular CCW rotational advancement for skeletal Class II deformity was performed using a qualitative and quantitative analysis (meta-analysis). MATERIAL AND METHODS: Five databases were searched: PubMed, MEDLINE (Ovid), Science Direct, Scopus, and Web of Science. The systematic review and meta-analysis addressed the stability of BSSO CCW rotational advancement and the effect of the amount of CCW rotation on skeletal stability after BSSO advancement. Meta-analysis was performed only for studies reporting point B position in mm or mandibular plane angle in degrees before and after surgery and at follow-up. RESULTS: The database search resulted in 284 articles after removal of duplicates, and an additional 3 articles were included from hand searches of the bibliographies of the selected articles and relevant reviews. Eight studies were included in the systematic review; all were retrospective case series, and all used rigid fixation. Only 1 study was of medium quality; all other studies were of low quality. Meta-analysis of 3 studies revealed a mean forward movement of 7.6 mm at point B (95% confidence interval [CI], 4.07 to 11.4), a mean downward movement of 2.6 mm (95% CI, -0.66 to 5.84), and a mean CCW rotation of mandibular plane of 4.3° (95% CI, -6.34 to -2.19) during surgery. After surgery, point B showed a mean backward movement of -0.18 mm (95% CI, -1.30 to 1.14), a mean upward movement of -0.5 mm (95% CI, -3.00 to 1.98), and a mean clockwise rotation of 0.1° (95% CI, -1.76 to 1.91). CONCLUSIONS: Meta-analysis showed mandibular CCW rotational advancement is a stable procedure, both horizontally and vertically. However, the conclusions are far from robust due to the small sample size and poor quality of the reviewed studies.

Acute anterior myocardial infarction with pectus carinatum.

We presented a case of acute anterior myocardial infarction caused by left anterior descending artery occlusion in a patient with pectus carinatum. The electrocardiogram (ECG) on admission showed counterclockwise rotation and T wave inversion only in leads V1-V2. Computed tomography revealed that this patient with pectus carinatum had greater septal angle. Electrocardiographic counterclockwise rotation due to greater septal angle in pectus carinatum led to atypical ECG findings of acute myocardial infraction.

Maxillomandibular Advancement: Contemporary Approach at Stanford.

Maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) has remained a reliable and highly effective surgical intervention since its introduction in 1989. Modifications have been made to maximize skeletal movement and upper airway stability without compromising facial balance. Contemporary indications of recommending MMA prior to other soft tissue surgery are described. MMA poses unique challenges to surgeons. There are patient-related factors, including OSA, a chronic inflammatory condition with associated cardiovascular and metabolic comorbidity. Perioperative management is more complex than routine orthognathic patients. Key details are shared from a 3-decade experience at Stanford.

Adolescent internal condylar resorption (AICR) of the temporomandibular joint can be successfully treated by disc repositioning and orthognathic surgery, part 2: Treatment outcomes.

OBJECTIVE: To evaluate treatment outcomes for patients with TMJ adolescent internal condylar resorption (AICR) treated by a specific surgical protocol, including: (1) Removal of bilaminar tissue surrounding the condyle, (2) Articular disc repositioning with Mitek anchor technique, and (3) Concomitant orthognathic surgery. METHODS: This study evaluated 24 AICR patients treated by the specific surgical protocol with clinical subjective and objective examinations and lateral cephalogram assessments for surgical changes and long-term outcomes. RESULTS: Mean age at diagnosis was 16.5 years, and mean follow-up was 30.3 months. All 24 patients had significant reduction in TMJ pain, facial pain, and headaches, with improvement in jaw function, diet, and disability. Cephalometric analysis showed significant surgical changes but good long-term occlusal and skeletal stability. CONCLUSION: Patients with AICR treated with the specific surgical protocol demonstrated good skeletal and occlusal stability as well as improvement in TMJ pain, headaches, jaw function, diet, and disability.

Distribution and determinants of QRS rotation of black and white persons in the general population.

BACKGROUND: The prevalence and determinants of QRS transition zones are not well established. METHODS: We examined the distributions of Normal, clockwise (CW) and counterclockwise (CCW)) QRS transition zones and their relations to disease, body size and demographics in 4624 black and white men and women free of cardiovascular disease and major ECG abnormalities enrolled in the NHANES-III survey. RESULTS: CW transition zones were least observed (6.2%) and CCW were most prevalent (60.1%) with Normal in an intermediate position (33.7%). In multivariable logistic regression analysis, the adjusted, significant predictors for CCW compared to Normal were a greater proportion of blacks and women, fewer thin people (BMI<20, thin), a greater ratio of chest depth to chest width, and an LVMass index <80g. By contrast, CW persons were older, had larger QRS/T angles, smaller ratio of chest depth to chest width, had a greater proportion of subjects with low voltage QRS, more pulmonary disease, a greater proportion with high heart rates, shorter QRS duration and were more obese (BMI≥30). CONCLUSIONS: Normal rather than being the most prevalent transition zone was intermediate in frequency between the most frequently encountered CCW and the least frequently encountered transition zone CW. Differences in the predictors of CW and CCW exist. This requires further investigation to examine how far these differences explain the differences in the published prognostic differences between CW and CCW.

Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?

Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion.

Counterclockwise maxillomandibular advancement: a choice for Chinese patients with severe obstructive sleep apnea.

PURPOSE: Maxillomandibular advancement (MMA) is an effective alternative for treating severe obstructive sleep apnea (OSA). However, the promotion of MMA in China is limited by many Chinese patients having a convex facial profile. To achieve maximal upper airway enlargement without an esthetic disaster, we added counterclockwise rotation of the maxillomandibular complex (MMC) in the routine MMA. In this paper, we have evaluated the objective and subjective outcomes of this technology. METHODS: In total, 33 severe OSA patients who accepted counterclockwise maxillomandibular advancement (CMMA) were investigated in this study. Genioplasty, uvulopalatopharyngoplasty (UPPP), and turbinate reduction were also performed on selected patients. Polysomnography (PSG) and Epworth sleepiness scale (ESS) were chosen to evaluate the effectiveness of this technology in treating OSA. Patients' facial appearances were evaluated by cephalometric analysis and 5-point Likert scales. RESULTS: After CMMA, the apnea-hypopnea index (AHI) decreased from 59.3 ± 14.6 to 10.2 ± 6.7 (P < 0.001), minimum SpO2 (pulse oxygen saturation, %) increased from 74.0 ± 11.7 to 88.8 ± 4.4 (P < 0.001), and ESS decreased from 12.5 ± 2.3 to 7.3 ± 2.1. It is encouraging that soft-tissue cephalometric measurements such as facial convexity angle, nasolabial angle, and labiomental fold were not worsening after surgery. The Likert scales revealed that 28 patients (85%) were satisfied or very satisfied with their facial changes. In addition, no patient complained about dental function after surgery. CONCLUSIONS: These findings indicate that CMMA is an effective way to achieve a balance between airway enlargement and facial appearance for Chinese patients with severe OSA.

Surgical management of congenital deformities with temporomandibular joint malformation.

This article discusses hemifacial microsomia and Treacher Collins syndrome relative to the nature of these congenital deformities as well as the clinical, radiographic, and diagnostic characteristics. These patients often have severe facial deformities with hypoplasia or aplasia of the temporomandibular joints (TMJs) and mandible. The surgical treatment options are presented, including the advantages and disadvantages of autogenous tissues versus patient-fitted total joint prostheses to reconstruct the TMJs and mandible as well as counterclockwise rotation of the maxillomandibular complex.

Abnormal electrocardiographic QRS transition zone and risk of mortality in individuals free of cardiovascular disease.

AIMS: We examined the prognostic significance of abnormal electrocardiographic QRS transition zone (clockwise and counterclockwise horizontal rotations) in individuals free of cardiovascular disease (CVD). METHODS AND RESULTS: A total of 5541 adults (age 53 ± 10.4 years, 54% women, 24% non-Hispanic black, 25% Hispanic) without CVD or any major electrocardiogram (ECG) abnormalities from the US Third National Health and Nutrition Examination Survey were included in this analysis. Clockwise and counterclockwise horizontal rotations were defined from standard 12-lead ECG using Minnesota ECG Classification. Mortality and cause of death were assessed through 2006. At baseline, 282 participants had clockwise rotation and 3500 had counterclockwise rotation. During a median follow of 14.6 years, 1229 deaths occurred of which 415 were due to CVD. In multivariable-adjusted Cox proportional hazard analysis and compared with normal rotation, clockwise rotation was significantly associated with increased risk of all-cause mortality {hazard ratio (HR) [95% confidence interval (CI)]: 1.43 (1.15-1.78); P = 0.002} and CVD mortality [HR (95% CI): 1.61 (1.09, 2.37) P = 0.016]. In contrast, counterclockwise rotation was associated with significantly lower risk of all-cause mortality [HR (95% CI): 0.86 (0.76, 0.97); P = 0.017] and non-significant association with CVD mortality [HR (95% CI): 1.07 (0.86, 1.33); P = 0.549]. These results were consistent in subgroup analysis stratified by age, sex, and race. CONCLUSION: In a diverse community-based population free of CVD and compared with normal rotation, clockwise rotation was associated with increased risk of all-cause and CVD mortality while counterclockwise rotation was associated with lower risk of all-cause mortality and non-significant association with CVD mortality. These findings call for attention to these often neglected ECG markers, and probably call for revising the current definition of normal rotation.

Osseous alterations in the condylar head after unilateral surgical directional change in rabbit mandibular condyles: preliminary study.

The purpose of this study was to investigate bony changes in the mandibular condyle when the surface not normally subjected to masticatory forces was subjected to functional loading using a unilateral surgical experiment. Fifteen male New Zealand white rabbits, divided into two groups, were used. Oblique vertical body osteotomies of the mandible and counterclockwise rotation (CCWR) of the proximal segment (PS) [six with 1 mm (group I), six with 3 mm (group II)] were performed on the right side. Osseous changes of condyles were analyzed using micro-computed tomography and histological evaluation four weeks postoperatively. The comparison was performed between condyles on the right and left sides. Since the left condyle (control) might be affected by the operation on the right side, the results were also compared with the healthy control (group III, n = 3, 6 condyles). CCWR of the PS led to osteoporotic changes of the condyle including significantly reduced bone volume and bone mineral density (p < 0.05), thin and small number of trabeculae (p < 0.05). In addition, thinning of condylar cartilage and reduced density of cartilaginous cells were observed. However, these changes were not affected by the amount of CCWR of the PS.