The inferocentral whorl region and its directional patterns in the corneal sub-basal nerve plexus: A review.

There has been a growing application of in vivo confocal microscopy (IVCM) in the examination of corneal microstructure, including different corneal layers and corneal nerve fibers in health and in pathological conditions. Corneal nerves forming the sub-basal nerve plexus (SBNP) beneath the corneal basal epithelial cell layer in particular have been intensively researched in health and disease as a marker for corneal neurophysioanatomical and degenerative changes. One intriguing feature in the SBNP that is found inferior to the corneal apex, is a whorl-like pattern (or vortex) of nerves, which represents an anatomical landmark. Evidence has indicated that the architecture of this 'whorl region' is dynamic, changing with time in healthy individuals but also in disease conditions such as in diabetic neuropathy and keratoconus. This review summarizes the known information regarding the characteristics and significance of the whorl region of nerves in the corneal SBNP, as a potential area of high relevance for future disease monitoring and diagnostics.

Comparison of the skeletal stability after mandibular counter-clockwise rotation in three surgical procedures.

The treatment of mandibular deformities with an anterior open bite is challenging. In this study, skeletal stability after mandibular osteotomies was evaluated to determine the best treatment for mandibular prognathism with an anterior open bite in three procedures: intraoral vertical ramus osteotomy (IVRO), conventional sagittal split ramus osteotomy (conv-SSRO), and SSRO without bone fixation (nonfix-SSRO). Patients who underwent mandibular osteotomy to correct skeletal mandibular protrusion were included. Changes in skeletal and soft tissues were assessed using lateral cephalograms taken before (T1), 3 ± 2 days (T2), and 12 ± 3 months (T3) after surgery. Thirty-nine patients were included: nine in the IVRO group and 11 and 19 in the conv- and nonfix-SSRO groups, respectively. The mandibular plane angles (MPAs) of the T2-T1 were - 2.7 ± 2.0 (p = 0.0040), - 3.7 ± 1.7 (p < 0.0001), and - 2.3 ± 0.7 (p < 0.0001) in the IVRO, conv-SSRO, and nonfix-SSRO groups, respectively. The skeletal relapse of the MPAs was not related to the MPA at T2-T1, and it was approximately 1.3° in the conv-SSRO group. The skeletal relapse of the MAPs was significantly correlated with the MPA of T2-T1 in the IVRO (p = 0.0402) and non-fix-SSRO (p = 0.0173) groups. When the relapse of the MPAs was less than 1.3°, the MPA of T2-T1 was calculated as 2.5° in the nonfix-SSRO group. When the MPA of T2-T1 is less than 2.5°, non-fix SSRO may produce a reliable outcome, and when it is more than 2.5°, conv-SSRO may produce better outcomes.

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.

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.

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.

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 clockwise and counterclockwise right atrial flutter using high-resolution mapping and automated velocity measurements.

BACKGROUND: Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. OBJECTIVES: We sought to compare CW and CCW CTI-dependent AFL in pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. METHODS AND RESULTS: Thirty-three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p = .7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p = .9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p = .9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p = .2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p = .6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. CONCLUSION: The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions.

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.

Counterclockwise Drilling with Different Tapered Drills Condenses the Implant Bed-An Optical Coherence Tomography In Vitro Study.

Background and Objectives: To evaluate the condensation and the microarchitecture of implant bed walls of sites prepared with counterclockwise drilling with tapered implant drills using optical coherence tomography. Materials and Methods: Four drill designs with different wall and tip angles were used. Polyurethane laminas resembling type IV bone microarchitecture were superimposed and clamped with a vice to simulate the coronal, middle, and apical aspects of the implant site. Twenty implant beds were prepared at 1200 rpm in clockwise (control) and counterclockwise (test) directions (N = 160). Optical coherence tomography (OCT) was used to evaluate the condensation and microarchitecture characteristics of the implant bed walls. The relative condensation was calculated using the Image J software Bone application. The microarchitecture was evaluated in reconstructed 3D volumes in XY, XZ, and YZ sections. Statistical analysis was performed using one-way ANOVA. Dunnet test was applied to determine differences between groups. Significance was set as p < 0.05. Results: Counterclockwise drilling (Test) condensed and changed the microarchitecture of the apical regions for all the implant beds in all of the groups when compared to clockwise drilling (control). The apical region of test groups showed the highest relative bone condensation (p = 0.026) when compared to controls. Conclusions: The direction of rotation (counterclockwise drilling) and not the design of tapered drills (tip and wall angles) is responsible for the condensation at the apical area observed in polyurethane blocks. The OCT method can be used for the evaluation of changes in density and microstructure of polyurethane blocks.

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.

A combined orthodontic / orthognathic approach in the management of obstructive sleep apnoea: Balancing treatment efficacy and facial aesthetics.

Obstructive sleep apnoea (OSA) is a prevalent condition and has been extensively managed with orthognathic surgery using a variety of surgical techniques. This case report describes the successful management of a 56-year-old Caucasian woman with a bimaxillary retrusive profile and macroglossia complicated by OSA and the combined use of orthodontics and orthognathic surgery to improve Apnoea-Hypopnoea Index while maintaining facial aesthetics. The non-extraction treatment plan included: (1) pre-surgical orthodontic treatment to maximise aesthetics and functional occlusion after surgery; (2) maxillomandibular advancement using down fracture of the maxilla (Le Fort 1 osteotomy) with counter-clockwise rotation as well as bilateral sagittal split osteotomy with septoplasty to aid increase in airway function; and (3) post-surgical orthodontic finishing and alignment with self-ligating fixed appliances. Optimum aesthetic and functional results as well as an increase in the airway volume were achieved, without compromising facial aesthetics, with the cooperation of two specialties and the use of state-of-the-art technology during the surgical planning stages.

Surgical Orthodontic Treatment in Case of Severe High Angle Skeletal Class II Malocclusion and Mandibular Retrusion.

This report describes a patient with severe high angle class II malocclusion and mandibular retrusion in whom surgical orthodontic treatment to prevent an increase in ramus height resulted in a significant improvement in esthetics and long-term stability. The patient was a woman aged 30 years 5 months who presented with the chief complaint of maxillary protrusion. She had a convex facial type, a chin button on lip sealing, and a gummy smile. Cephalometric analysis revealed a normal maxilla anterior-posterior position, but significant mandibular retrusion with pronounced clockwise rotation. The anterior maxillary tooth axis was standard, but labially inclined in the mandible. Based on these findings, the diagnosis was skeletal class II high angle malocclusion and mandibular retrusion. The proposed treatment plan comprised 2-jaw surgery with premolar extraction. Le Fort I osteotomy, in particular, was planned in the maxilla to move the ANS upward by 3.0 mm and the PNS downward by 3.0 mm. Sagittal split ramus osteotomy (SSRO) was planned to adjust the mandible and move the mandible forward by 10.0 mm. To prevent postoperative relapse, the short lingual split method was used in performing the SSRO. The mandible was split to minimize stretching of the median pterygoid muscle. Postoperatively, the ANS, PNS, and pogonion showed movement of 2.0 mm upward, 3.0 mm downward, and 8.0 mm forward, respectively. Additionally, lip closure was now natural, and the gummy smile had markedly improved. At 6 years postoperatively, there has been no change skeletally or dentally. Follow-up is being continued to monitor further progress.

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.

Which nostril should be used for nasotracheal intubation with Airtraq NT®: the right or left? A randomized clinical trial

Background/aim: Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methods: After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Results: Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion: Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90° counterclockwise rotation, external laryngeal pressure, and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand, cuff inflation maneuver must also be kept in mind.

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.

Persistent One-Way Walking in a Circular Arena in Drosophila melanogaster Canton-S Strain.

We describe persistent one-way walking of Drosophila melanogaster in a circular arena. Wild-type Canton-S adult flies walked in one direction, counter-clockwise or clockwise, for minutes, whereas white-eyed mutant [Formula: see text] changed directions frequently. Locomotion in the circular arena could be classified into four components: counter-clockwise walking, clockwise walking, nondirectional walking and pausing. Genetic analysis revealed that while wild-type genetic background was associated with reduced directional change and reduced numbers of one-way (including counter-clockwise and clockwise) and nondirectional walks, the white ([Formula: see text]) locus promoted persistent one-way walking by increasing the maximal duration of one-way episodes. The promoting effect of [Formula: see text] was further supported by the observations that (1) [Formula: see text] duplicated to the Y chromosome, (2) four genomic copies of mini-white inserted on the autosomes, and (3) pan-neuronal overexpression of the White protein increased the maximal duration of one-way episodes, and that RNAi knockdown of [Formula: see text] in the neurons decreased the maximal duration of one-way episodes. These results suggested a pleiotropic function of [Formula: see text] in promoting persistent one-way walking in the circular arena.

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.

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.