Pool-Based Surfboard Elicits Activation of Posterior Shoulder Muscles During a Surfing Stroke.

ABSTRACT: Pexa, BS, Johnston, CD, Elder, EE, Ford, KR, Patterson, MQ, and Myers, JB. Pool-based surfboard elicits activation of posterior shoulder muscles during a surfing stroke. J Strength Cond Res 38(7): 1300-1304, 2024-Surfboard paddling may activate posterior shoulder muscles, which are critical to baseball pitchers' injury risk and performance. The purpose of this study was to measure posterior shoulder muscle activation during different phases of the surf stroke (propulsion vs. recovery) on a pool-based surfboard. Twenty healthy active adult subjects completed a familiarization and testing session with the pool-based surfboard. During the testing session, electromyography (EMG) sensors were placed on 6 posterior shoulder muscles: latissimus dorsi, infraspinatus, posterior deltoid, upper trapezius, middle trapezius, and lower trapezius. Subjects completed 4 laps in a pool at 3 separate resistances (low, moderate, and heavy) in a randomized order. The peak EMG signal during each phase (propulsion and recovery) was recorded. A 2-way within subject ANOVA (resistance-by-phase) with post hoc Bonferroni's corrections was used to identify differences in EMG activation. There was a significant main effect of phase for the latissimus dorsi (F = 91.3, p < 0.001), upper trapezius (F = 36.5, p < 0.001), middle trapezius (F = 33.8, p < 0.001), and lower trapezius (F = 21.6, p < 0.001). The latissimus dorsi demonstrated higher activation during the propulsion phase (p < 0.001), and all trapezius muscles demonstrated higher activation during the recovery phase (p < 0.001). There was a significant main effect of resistance for the posterior deltoid (F = 3.4, p = 0.043), with higher muscle activation in the low resistance trials compared with the heavy resistance trials (p = 0.036). Recreationally active individuals demonstrate activation of the posterior shoulder when using a pool-based surfboard. This pool-based surfboard may be beneficial to activate the posterior musculature and may be more accessible than standard surfing to baseball athletes.

From Haphazard to a Sustainable Normothermic Regional Perfusion Service: A Blueprint for the Introduction of Novel Perfusion Technologies.

Normothermic Regional Perfusion (NRP) has shown encouraging clinical results. However, translation from an experimental to routine procedure poses several challenges. Herein we describe a model that led to the implementation of NRP into standard clinical practice in our centre following an iterative process of refinement incorporating training, staffing and operative techniques. Using this approach we achieved a four-fold increase in trained surgical staff and a 6-fold increase in competent senior organ preservation practitioners in 12 months, covering 93% of the retrieval calls. We now routinely provide NRP throughout the UK and attended 186 NRP retrievals from which 225 kidneys, 26 pancreases and 61 livers have been transplanted, including 5 that were initially declined by all UK transplant centres. The 61 DCD(NRP) liver transplants undertaken exhibited no primary non-function or ischaemic cholangiopathy with up to 8 years of follow-up. This approach also enabled successful implementation of ex situ normothermic liver perfusion which together with NRP contributed 37.5% of liver transplant activity in 2021. Perfusion technologies (in situ and ex situ) are now supported by a team of Advanced Perfusion and Organ Preservation Specialists. The introduction of novel perfusion technologies into routine clinical practice presents significant challenges but can be greatly facilitated by developing a specific role of Advanced Perfusion and Organ Preservation Specialist supported by a robust education, training and recruitment programme.

COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study.

OBJECTIVE: Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN: Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS: From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS: Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

The trials and tribulations of liver allocation.

Allocation policies are necessary to ensure a fair distribution of a scarce resource. The goal of any liver transplant allocation policy is to achieve the best possible outcomes for the waiting list population, irrespective of the indication for transplant, whilst maximizing organ utilization. Organ allocation for liver transplantation has evolved from simple centre-based approaches driven by local issues, to complex, evidence-based algorithm prioritizing according to need. Despite the rapid evolution of allocation policies, there remain a number of challenges and new approaches are required to ensure transparency and equity on the decision-making process and the best possible outcomes for patients on the waiting list. New ways of modelling, together with novel outcome criteria, will be required to enable a dynamic adaptability of the allocation policies to the ever changing demographics of the donor population and the changing landscape of indications for transplantation.

Enteric helminth-induced type I interferon signaling protects against pulmonary virus infection through interaction with the microbiota.

BACKGROUND: Helminth parasites have been reported to have beneficial immunomodulatory effects in patients with allergic and autoimmune conditions and detrimental consequences in patients with tuberculosis and some viral infections. Their role in coinfection with respiratory viruses is not clear. OBJECTIVE: Here we investigated the effects of strictly enteric helminth infection with Heligmosomoides polygyrus on respiratory syncytial virus (RSV) infection in a mouse model. METHODS: A murine helminth/RSV coinfection model was developed. Mice were infected by means of oral gavage with 200 stage 3 H polygyrus larvae. Ten days later, mice were infected intranasally with either RSV or UV-inactivated RSV. RESULTS: H polygyrus-infected mice showed significantly less disease and pulmonary inflammation after RSV infection associated with reduced viral load. Adaptive immune responses, including TH2 responses, were not essential because protection against RSV was maintained in Rag1-/- and Il4rα-/- mice. Importantly, H polygyrus infection upregulated expression of type I interferons and interferon-stimulated genes in both the duodenum and lung, and its protective effects were lost in both Ifnar1-/- and germ-free mice, revealing essential roles for type I interferon signaling and microbiota in H polygyrus-induced protection against RSV. CONCLUSION: These data demonstrate that a strictly enteric helminth infection can have remote protective antiviral effects in the lung through induction of a microbiota-dependent type I interferon response.

Exploratory study on modification of sludge-based activated carbon for nutrient removal from stormwater runoff.

Nutrients (P, N) in stormwater runoff are a major cause of eutrophication and algal blooms. A promising solution to this problem is to amend the rain garden growing medium (RGGM) with sewage sludge-based activated carbon (SBAC). To optimize the SBAC production process, different metals, pyrolysis conditions (temperature, heating time, carrier gas), and post-treatments were explored. When pyrolyzed at 400 °C for two hours, Zn-activated SBAC removed up to 41% of PO4-P (initial concentration of 1 mg/L) and 72% of NO3-N (initial concentration of 2 mg/L), at a dose of 1 g sorbent/L of nutrient-spiked distilled water. When the same dosage was applied to stormwater leachate made from RGGM and spiked with nutrients, the removal efficiencies were reduced to 20% for PO4-P and 38% for NO3-N. These reductions were probably caused by competition from other leachate components. Increasing the dosage to 3 g/L leachate improved PO4-P removal to 31% and NO3-N to 72%, while also resulting in the removal of 46% of total organic carbon. The major energy cost of producing such sorbents is estimated to be ∼$0.76 CAD/kg SBAC.

A role for helminth parasites in achieving immunological tolerance in transplantation.

BACKGROUND: Helminths infect more than a quarter of the world's population. Their success as parasites is the result of active immunomodulation of the host immune response, which can have benefits for the host, particularly in suppressing harmful allergic and autoimmune responses. Accordingly, we tested the hypothesis that helminth infection reduces the immune response to allograft transplantation. METHODS: C57BL/6 mice were implanted with a subcutaneous minipump that delivered a continuous infusion of secreted products from the model mouse intestinal parasite, Heligmosomoides polygyrus (equivalent to 7 µg of protein per day). Simultaneously, fully allogeneic skin grafts from BALB/c donors were performed. 7 days later, lymphocytes were isolated from allograft draining lymph nodes and analysed by flow cytometry. FINDINGS: Flow cytometric analysis showed a 41·7% increase in the mean percentage of CD4+CD25+Foxp3+ regulatory T cells (of total CD4 cells) from a baseline of 8·1% (95% CI 7·4-8·8) in untreated mice to 11·5% (8·8-14·2) in the treatment group (p=0·0085). Treatment with parasite products also increased mean expression of the regulatory cell surface receptor PD1 by 62·2% in the effector CD4 T-cell population from a baseline of 7·7% (5·7-9·6) to 12·5% (7·5-17·4) (p=0·03). INTERPRETATION: The results show that helminth-derived products can powerfully induce regulatory immunological mechanisms in the presence of a fully allogeneic transplant. Identification of the specific mechanisms involved in suppression of allograft rejection by helminth parasites could lead towards development of safe and effective novel therapeutic strategies. FUNDING: Wellcome Trust.

TGF-ß in tolerance, development and regulation of immunity.

The TGF-ß superfamily is an ancient metazoan protein class which cuts across cell and tissue differentiation, developmental biology and immunology. Its many members are regulated at multiple levels from intricate control of gene transcription, post-translational processing and activation, and signaling through overlapping receptor structures and downstream intracellular messengers. We have been interested in TGF-ß homologues firstly as key players in the induction of immunological tolerance, the topic so closely associated with Ray Owen. Secondly, our interests in how parasites may manipulate the immune system of their host has also brought us to study the TGF-ß pathway in infections with longlived, essentially tolerogenic, helminth parasites. Finally, within the spectrum of mammalian TGF-ß proteins is an exquisitely tightly-regulated gene, anti-Müllerian hormone (AMH), whose role in sex determination underpins the phenotype of freemartin calves that formed the focus of Ray's seminal work on immunological tolerance.

Effect of recipient age on prioritisation for liver transplantation in the UK: a population-based modelling study.

BACKGROUND: Following the introduction of an algorithm aiming to maximise life-years gained from liver transplantation in the UK (the transplant benefit score [TBS]), donor livers were redirected from younger to older patients, mortality rate equalised across the age range and short-term waiting list mortality reduced. Understanding age-related prioritisation has been challenging, especially for younger patients and clinicians allocating non-TBS-directed livers. We aimed to assess age-related prioritisation within the TBS algorithm by modelling liver transplantation prioritisation based on data from a UK transplant unit and comparing these data with other regions. METHODS: In this population-based modelling study, serum parameters and age at liver transplantation assessment of patients attending the Scottish Liver Transplant Unit, Edinburgh, UK, between December, 2002, and November, 2023, were combined with representative synthetic data to model TBS survival predictions, which were compared according to age group (25-49 years vs ≥60 years), chronic liver disease severity, and disease cause. Models for end-stage liver disease (UKELD [UK], MELD [Eurotransplant region], and MELD 3.0 [USA]) were used as validated comparators of liver disease severity. FINDINGS: Of 2093 patients with chronic liver disease, 1808 (86%) had complete datasets and liver disease parameters consistent with eligibility for the liver transplant waiting list in the UK (UKELD ≥49). Disease severity as assessed by UKELD, MELD, and MELD 3.0 did not differ by age (median UKELD scores of 56 for patients aged ≥60 years vs 56 for patients aged 25-49 years; MELD scores of 16 vs 16; and MELD 3.0 scores of 18 vs 18). TBS increased with advancing age (R=0·45, p<0·0001). TBS predicted that transplantation in patients aged 60 years or older would provide a two-fold greater net benefit at 5 years than in patients aged 25-49 years (median TBS 1317 [IQR 1116-1436] in older patients vs 706 [411-1095] in younger patients; p<0·0001). Older patients were predicted to have shorter survival without transplantation than younger patients (263 days [IQR 144-473] in older patients vs 861 days [448-1164] in younger patients; p<0·0001) but similar survival after transplantation (1599 days [1563-1628] vs 1573 days [1525-1614]; p<0·0001). Older patients could reach a TBS for which a liver offer was likely below minimum criteria for transplantation (UKELD <49), whereas many younger patients were required to have high-urgent disease (UKELD >60). US and Eurotransplant programmes did not prioritise according to age. INTERPRETATION: The UK liver allocation algorithm prioritises older patients for transplantation by predicting that advancing age increases the benefit from liver transplantation. Restricted follow-up and biases in waiting list data might limit the accuracy of these benefit predictions. Measures beyond overall waiting list mortality are required to fully capture the benefits of liver transplantation. FUNDING: None.

The effect of biochar and acid activated biochar on ammonia emissions during manure storage.

Animal manure contains valuable plant nutrients which need to be stored until field application. A significant proportion of slurry nitrogen is volatilized in the form of ammonia (NH3) during storage. This impacts human health, biodiversity, air and water quality and thus urgent action is needed to reduce NH3 emissions. In this experiment, we evaluated the NH3 emission mitigation potential of biochars derived from miscanthus (MB) and solid separated anaerobic digestate (DB), and orthophosphoric acid activated MB (AMB) and DB (ADB) as well as lightweight expanded clay aggregate (LECA) during four months of liquid manure storage. A slurry without amendment was included as a control (Ctrl). Acid activated and non-activated biochars were applied on top of the slurry maintaining a 7 mm thick surface layer, while LECA was applied in a 2 cm thick layer. NH3 emissions were measured by photoacoustic analyzer. In comparison to Ctrl, acid activated biochar decreased (p < 0.05) NH3 emissions during the slurry storage. Activated biochar reduced the emissions by 37-51% within the first month of slurry storage and achieved a 25-28% emissions reduction efficiency throughout the four month period due to the reduction in emission mitigation efficiency as the storage period progressed. LECA reduced NH3 emissions by 21% during storage. Losses of NH3 as a percentage of total ammoniacal N were 29-31% for activated biochars, 35-39% for non-activated biochars and 33% for LECA. In conclusion, acid activated biochars and LECA could be good floating-covers to mitigate NH3 emissions during manure storage, but activated biochars may have better mitigation potential than LECA.

Phosphorus Removal from Dirty Farmyard Water by Activated Anaerobic-Digestion-Derived Biochar.

The management of anaerobic digestate is important to realize the value of the waste and enhance the whole system sustainability of anaerobic digestion. In this study, the phosphorus treatment of dirty irrigation water by biochar samples derived from digestate of anaerobic digestion were investigated. The biochars were further activated by steam activation with different duration time and KOH activation with different introducing ratios; the textural properties of biochars were optimized after activation from the aspect of biochar characterization. Notably, AD-N2 demonstrates a remarkable adsorption effect of phosphorus, with an adsorption efficiency of 8.99 mg g-1. Besides the effect of biochar dosage on phosphorus removal, adsorption kinetics and thermodynamic isotherms are studied. According to the adsorption kinetics, the adsorption of phosphorus from dirty water fits the Elovich equation (R2 = 0.95). Furthermore, the thermodynamic isotherm results illustrate the process of phosphorus removal by biochar is endothermic (ΔH0 = 17.93 kJ mol-1) and spontaneous (ΔS = 96.24 J mol-1 K-1). Therefore, this work suggests a promising solution to phosphorus-related environmental challenges in industry and agriculture.

Delivering teaching in dentistry at Queen's University, Belfast for 100 years.

Dental education has been delivered in Queen's University for just over 100 years, with the Dental School celebrating its centenary in 2020. During that time, the undergraduate curriculum has evolved greatly, through innovations in the delivery of teaching and assessment driven by changes in educational practice, developing technologies and, most recently, the COVID-19 pandemic. Throughout all of these changes, our focus remains on our students, their wellbeing, and their development as lifelong learners for a career in the dental profession.

Endoscopic management of Bouveret syndrome with electrohydraulic lithotripsy.

Video 1Endoscopic management of Bouveret syndrome with electrohydraulic lithotripsy.

A comparative life-cycle assessment and cost analysis of biofilters amended with sludge-based activated carbon and commercial activated carbon for stormwater treatment.

Environmental and economic issues resulting from the unsustainable management of sewage sludge from wastewater have necessitated the development of eco-friendly sewage sludge disposal methods, whereas stormwater effluent contains tremendous amounts of pollutants. This study compares the feasibility and environmental impacts associated with incorporating biofilters with sludge-based activated carbon (SBAC) versus commercial activated carbon (CAC) for stormwater treatment. The results demonstrate that the construction and disposal life-cycle stages are the dominant contributors to several environmental impact categories, including resource scarcity, carcinogenic toxicity, terrestrial ecotoxicity, and ozone formation indicators. Across multiple impact categories, the incorporation of biofilters with SBAC can reduce the negative environmental impacts associated with biofilter construction and disposal by 40% over a 50-year analysis period. In contrast, the most significant improvement is on construction-dominant indicators, where the decreased need for biofilter reconstruction results in a higher reduction in environmental impacts. Economically, amending the biofilter with SBAC can increase profits by up to 66% due to extending its lifespan. This study shows that SBAC has similar performance as CAC for lowering the negative environmental impacts resulting from biofilter construction, while increasing the overall net profits of the system. However, converting sewage sludge to an effective sorbent (SBAC) and incorporating SBAC into a biofilter to capture pollutants from stormwater is an economically and environmentally sustainable solution available to practitioners to manage sewage sludge and stormwater effluent. This solution protects the environment in a cost efficient, sustainable manner.

Protection from T cell-dependent colitis by the helminth-derived immunomodulatory mimic of transforming growth factor-ß, Hp-TGM.

In animal models of inflammatory colitis, pathology can be ameliorated by several intestinal helminth parasites, including the mouse nematode Heligmosomoides polygyrus. To identify parasite products that may exert anti-inflammatory effects in vivo, we tested H. polygyrus excretory-secretory (HES) products, as well as a recombinantly expressed parasite protein, transforming growth factor mimic (TGM), that functionally mimics the mammalian immunomodulatory cytokine TGF-ß. HES and TGM showed a degree of protection in dextran sodium sulphate-induced colitis, with a reduction in inflammatory cytokines, but did not fully block the development of pathology. HES also showed little benefit in a similar acute trinitrobenzene sulphonic acid-induced model. However, in a T cell transfer-mediated model with recombination activation gene (RAG)-deficient mice, HES-reduced disease scores if administered throughout the first 2 or 4 weeks following transfer but was less effective if treatment was delayed until 14 days after T cell transfer. Recombinant TGM similarly dampened colitis in RAG-deficient recipients of effector T cells, and was effective even if introduced only once symptoms had begun to be manifest. These results are a promising indication that TGM may replicate, and even surpass, the modulatory properties of native parasite HES.

Long-term occlusal and soft-tissue profile outcomes after treatment of Class II Division 1 malocclusion with fixed appliances.

INTRODUCTION: Our objective was to determine which factors were predictive of good long-term outcomes after fixed appliance treatment of Class II Division 1 malocclusion. METHODS: Two hundred seven patients with Class II Division 1 malocclusion were examined in early adulthood at a mean of 4.6 years after treatment with fixed appliances. The peer assessment rating index was used to evaluate dental alignment and occlusal relationships. The soft-tissue profile was assessed with the Holdaway angle. RESULTS: Logistic regression identified 3 pretreatment variables that were predictive of a good facial profile (Holdaway angle) at recall: the lower lip to E-plane distance (P <0.001; smaller distance behind the E-plane means a better outcome), ANB angle (P = 0.001; smaller ANB means a better outcome), and extraction pattern (P = 0.026). Linear regression analysis showed that 2 pretreatment variables were predictive of a favorable PAR score at recall: SNB angle (P = 0.001; larger SNB means a better outcome) and extraction pattern (P = 0.034). CONCLUSIONS: Three pretreatment cephalometric measures (lower lip to E-plane distance, ANB angle, and SNB angle) were predictive of the outcome in the treatment of Class II Division 1 malocclusion. The extraction pattern was also found to be a predictor of outcome.

Modelling and experimental investigation of small-scale gasification CHP units for enhancing the use of local biowaste.

Small-scale gasification Combined Heat and Power systems, fed by biowaste resources, have the potential to enhance local renewable energy production, reduce carbon emissions and address the challenges of waste disposal. However, there is a lack of understanding on the influence of challenging feedstocks, such as, for example, digestate, poultry litter and municipal solid waste, on the syngas quality and the incidence of the drying stage in the overall process. This paper addresses this gap by analysing and comparing 40 samples of the most common biowaste feedstocks. We developed a stoichiometric-thermodynamic one stage equilibrium model that was experimentally validated and calibrated by laboratory results, with a maximum error of 15% between real and predicted values. Simulation results show that the low heating value of the syngas produced from biowaste resources analysed ranges from 3.1 to 5.4 MJ/Nm3 on a dry basis. Working at the optimal equivalence ratio increases the electricity and thermal output by up to 20%. To achieve a feedstock moisture content of 10%, the drying process may require up to 60% of the heat produced. Furthermore, results show that downdraft gasification based combined heat and power, is a feasible and interesting option to deal with biowaste resources which can potentially avoid the cost, risk and externalities of landfilling while it contributes to the increase of local electricity and heat production from renewable energy sources, both for grid and off-grid applications.

Vibration improves gait biomechanics linked to posttraumatic knee osteoarthritis following anterior cruciate ligament injury.

Anterior cruciate ligament reconstruction (ACLR) incurs a high risk of posttraumatic knee osteoarthritis (PTOA). Aberrant gait biomechanics contribute to PTOA and are attributable in part to quadriceps dysfunction. Vibration improves quadriceps function following ACLR, but its effects on gait biomechanics are unknown. The purpose of this study was to evaluate the effects of whole-body vibration (WBV) and local muscle vibration (LMV) on gait biomechanics in individuals with ACLR. Seventy-five volunteers (time since ACLR 27 ± 16 months) were randomized to WBV, LMV, or Control interventions. Walking biomechanics were assessed prior to and following a single exposure to the interventions. Outcomes included pre-post change scores in the ACLR limb for the peak vertical ground reaction force (vGRF) and its loading rate, peak internal knee extension (KEM) and abduction moments, and peak knee flexion and varus angles. LMV produced a significant decrease in the vGRF loading rate (-3.6 BW/s) that was greater than the changes in the WBV (-0.3 BW/s) and Control (0.5 BW/s) groups. Additionally, WBV produced an increase in the peak KEM (0.27% BW × Ht) that was greater than the change in the Control group (-0.17% BW × Ht) but not the LMV group (0.01% BW × Ht). Lower KEM and greater loading rates have been linked to declines in joint health following ACLR. WBV acutely increased the peak KEM and LMV decreased loading rates. These data suggest that vibration has the potential to mitigate aberrant gait biomechanics, and may represent an effective approach for reducing PTOA risk following ACLR.

Self-perception of dentofacial attractiveness among patients requiring orthognathic surgery.

OBJECTIVE: To test the hypothesis that the self-perception of dental and facial attractiveness among patients requiring orthognathic surgery is no different from that of control patients. MATERIALS AND METHODS: Happiness with dental and facial appearance was assessed using questionnaires completed by 162 patients who required orthognathic treatment and 157 control subjects. Visual analog scale, binary, and open response data were collected. Analysis was carried out using a general linear model, logistic regression, and chi-square tests. RESULTS: Orthognathic patients were less happy with their dental appearance than were controls. Class II patients and women had lower happiness scores for their dental appearance. Among orthognathic patients, the "shape" and "prominence" of their teeth were the most frequent causes of concern. Older subjects, women, and orthognathic patients were less happy with their facial appearance. Class III orthognathic patients, older subjects, and women were more likely to have looked at their own face in profile. A greater proportion of Class II subjects than Class III subjects wished to change their appearance. CONCLUSIONS: The hypothesis is rejected. The findings indicate that women and patients requiring orthognathic surgery had lower levels of happiness with their dentofacial appearance. Although Class II patients exhibited the lowest levels of happiness with their dental appearance, there was some evidence that concerns and awareness about their facial profile were more pronounced among the Class III patients.

Psychological status of patients referred for orthognathic correction of skeletal II and III discrepancies.

OBJECTIVE: To establish the extent of psychological problems among patients who require orthognathic treatment. MATERIALS AND METHODS: Five aspects of psychological functioning were assessed for 162 patients who required orthognathic treatment and compared with 157 control subjects. RESULTS: Analysis of variance did not detect any significant difference in the five psychological scores recorded for the skeletal II, skeletal III, and control groups. The proportion of subjects with one or more psychological measure beyond the normal range was 27% for skeletal II subjects, 25% for skeletal III subjects, and 26% for control subjects. One skeletal II subject (1.5%), three skeletal III subjects (3%), and five control subjects (3%) required referral for psychological counseling. CONCLUSIONS: The orthognathic patients did not differ significantly from the control subjects in their psychological status.