Search results for: bilateral cleft

Authors: Mrudula Kudtarkar, Rajesh Mane

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Introduction: Cleft lip repair is one of the common surgeries performed in India and the usual method used for post-operative analgesia is perioperative opioids and NSAIDs. There has been an increase in use of regional techniques and Opioids are the common adjuvants but their efficacy and safety have not been studied extensively in children. Aim: A prospective, randomized, double-blind study was done to compare the efficacy, duration and safety of intraoral infraorbital nerve block on post-operative pain relief using bupivacaine alone or in combination with fentanyl or pethidine in paediatric cleft lip repair. Methodology: 45 children between the age group 5 – 60 months undergoing cleft lip surgery randomly allocated into 3 groups of 15 each received bilateral intraoral infraorbital nerve block with 0.75ml of solution. Group B received 0.25% bupivacaine; group P received 0.25% bupivacaine with 0.25mg/kg pethidine, group F received 0.25% bupivacaine with 0.25microgm/kg fentanyl. Sedation after recovery, post-operative pain intensity and duration of post-operative analgesia were assessed using Modified Hannallah Pain Score. Results: The mean duration of analgesia was 17.8 hrs in Group B, 23.53 hrs in Group F and 35.13 hrs in Group P. There was statistically significant difference between the means of the three groups- ANOVA (p < 0.05). Conclusion: Thus we conclude that addition of fentanyl or pethidine to bupivacaine for Bilateral Intraoral Infraorbital Nerve Block prolong the duration of analgesia with no complications and can be used safely in paediatric patients.

Keywords: cleft lip, infraorbital block, NSAIDS, Opiods

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Authors: Tomaz Oliveira, Rui Medeiros, André Lacerda

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Introduction: Cleft lip and/or palate are the most frequent forms of congenital craniofacial anomalies, affecting mainly the middle third of the face and manifesting by functional and aesthetic changes. Bilateral cleft lip represents a reconstructive surgical challenge, not only for the labial component but also for the associated nasal deformation. Recently, the paradigm of the approach to this pathology has changed, placing the focus on muscle reconstruction and anatomical repositioning of the nasal cartilages in order to obtain the best aesthetic and functional results. The aim of this study is to carry out a systematic review of the surgical approach to bilateral cleft lip, retrospectively analyzing the case series of Plastic Surgery Service at Hospital Santa Maria (Lisbon, Portugal) regarding this pathology, the global assessment of the characteristics of the operated patients and the study of the different surgical approaches and their complications in the last 20 years. Methods: The present work demonstrates a retrospective and descriptive study of patients who underwent at least one reconstructive surgery for cleft lip and/or palate, in the CPRE service of the HSM, in the period between January 1 of 1997 and December 31 of 2017, in which the data relating to 361 individuals were analyzed who, after applying the exclusion criteria, constituted a sample of 212 participants. The variables analyzed were the year of the first surgery, gender, age, type of orofacial cleft, surgical approach, and its complications. Results: There was a higher overall prevalence in males, with cleft lip and cleft palate occurring in greater proportion in males, with the cleft palate being more common in females. The most frequently recorded malformation was cleft lip and palate, which is complete in most cases. Regarding laterality, alterations with a unilateral labial component were the most commonly observed, with the left lip being described as the most affected. It was found that the vast majority of patients underwent primary intervention up to 12 months of age. The surgical techniques used in the approach to this pathology showed an important chronological variation over the years. Discussion: Cleft lip and/or palate is a medical condition associated with high aesthetic and functional morbidity, which requires early treatment in order to optimize the long-term outcome. The existence of a nasolabial component and its respective surgical correction plays a central role in the treatment of this pathology. The high rates of post-surgical complications and unconvincing aesthetic results have motivated an evolution of the surgical technique, increasingly evident in recent years, allowing today to achieve satisfactory aesthetic results, even in bilateral cleft lip with high deformation complexity. The introduction of techniques that favor nasolabial reconstruction based on anatomical principles has been producing increasingly convincing results. The analyzed sample shows that most of the results obtained in this study are, in general, compatible with the results published in the literature. Conclusion: This work showed that the existence of small variations in the surgical technique can bring significant improvements in the functional and aesthetic results in the treatment of bilateral cleft lip.

Keywords: cleft lip, palate lip, congenital abnormalities, cranofacial malformations

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Authors: Saidasanov Saidazal Shokhmurodovich, Topolnickiy Orest Zinovyevich, Afaunova Olga Arturovna

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Relevance: Bilateral congenital cleft is one of the most complex forms of all clefts, which makes it difficult to choose a surgical method of treatment. During primary operations to close the hard and soft palate, there is a shortage of soft tissues and their lack during standard uranoplasty, and these factors aggravate the period of rehabilitation of patients. Materials and methods: The results of surgical treatment of children with bilateral cleft, who underwent uranoplasty using a flap from the tongue, were analyzed. The study used methods: clinical and statistical, which allowed us to solve the tasks, based on the principles of evidence-based medicine. Results and discussion: in our study, 15 patients were studied, who underwent surgical treatment in the following volume: uranoplasty using a flap from the tongue in two stages. Of these, 9 boys and 6 girls aged 2.5 to 6 years. The first stage was surgical treatment in the volume: veloplasty. The second stage was a surgical intervention in volume: uranoplasty using a flap from the tongue. In all patients, the width of the cleft ranged from 1.6-2.8 cm. All patients in this group were orthodontically prepared. Using this method, the surgeon can achieve the following results: maximum narrowing of the palatopharyngeal ring, long soft palate, complete closure of the hard palate, alveolar process, and the mucous membrane of the nasal cavity is also sutured, which creates good conditions for the next stage of osteoplastic surgery. Based on the result obtained, patients have positive results of working with a speech therapist. In all patients, the dynamics were positive without complications. Conclusions: Based on our observation, tongue flap uranoplasty is one of the effective techniques for patients with wide clefts of the hard and soft palate. The use of a flap from the tongue makes it possible to reduce the number of repeated reoperations and improve the quality of social adaptation of this group of patients, which is one of the important stages of rehabilitation. Upon completion of the stages of rehabilitation, all patients had the maximum improvement in functional, anatomical and social indicators.

Keywords: congenital cleft lips and palate, bilateral cleft, child surgery, maxillofacial surgery

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Authors: Kusmayadi Ita Nursita, Sundoro Ali

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Cleft lip and palate are one of the most common congenital abnormalities in the face. It could happen to anyone, but mostly affect Asian population including Indonesia. Factors that influence the occurrence of cleft lip and palate vary from genetic to environmental factors. Children with cleft lip and palate will often have various problems such as airway disorders, eating disorders, speech and language developmental disorders, hearing disorders and psycho-social disorders, one of which is caused by appearance disorders. During his life, the child will experience multidisciplinary surgery and non-surgical treatment and can be accompanied by a psychological and financial burden on himself and his family. In Indonesia, there are no detailed scientific data on the prevalence and characteristic of cleft lip and palate patients. It was mainly caused by the absence of a national level organization, differences in geographical location, and the absence of national guidelines. This study aimed to describe the characteristic and prevalence of cleft lip and palate patients in Bandung Cleft Lip and Palate Center from 1 January 2016 to 31 December 2017. A total of 560 patients were included in the study. The highest percentage of cases are left unilateral cleft lip and palate with higher number of female patient and labioplasty as the most often surgical procedure to be conducted in Bandung Cleft Lip and Palate Center. In order to improve quality of life in patients with cleft lip and palate, early recognition and early treatment based on actual comprehensive data should be conducted. The data from Bandung Cleft Lip and Palate Center as one of the largest center of cleft lip and palate in West Java Indonesia hopefully could provide a big step of further comprehensive data collection in Indonesia and for the better overall management of cleft lip and palate in the future.

Keywords: cleft lip, cleft palate, characteristic, prevalence

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Authors: Diaa Othman, Muhammad Adil Khan, Muhammad Riaz

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Without an early intervention to correct the unilateral complete cleft lip and palate deformity, nasal architecture can progress to an exaggerated cleft nose deformity. We present the results of a modified unilateral cleft rhinoplasty procedure ‘the Gujrat technique’ to correct this deformity. Ninety pediatric and adult patients with non-syndromic unilateral cleft lip underwent primary and secondary composite cleft rhinoplasty using the Gujrat technique as a single stage operation over a 10-year period. The technique involved an open rhinoplasty with Tennison lip repair, and employed a combination of three autologous cartilage grafts, seven cartilage-molding sutures and a prolene mesh graft for alar base support. Post-operative evaluation of nasal symmetry was undertaken using the validated computer program ‘SymNose’. Functional outcome and patient satisfaction were assessed using the NOSE scale and ROE (rhinoplasty outcome evaluation) questionnaires. The single group study design used the non-parametric matching pairs Wilcoxon Sign test (p < 0.001), and showed overall good to excellent functional and aesthetic outcomes, including nasal projection and tip definition, and higher scores of the digital SymNose grading system. Objective assessment of the Gujrat cleft rhinoplasty technique demonstrates its aesthetic appeal and functional versatility. Overall it is a simple and reproducible technique, with no significant complications.

Keywords: cleft lip and palate, congenital rhinoplasty, nasal deformity, secondary rhinoplasty

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Authors: Mohammad Alqattan, Tala Alkhunani, Reema Al, Aldawish, Felwa Almurshard, Abdullah Alzahrani

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: Poland’s Syndrome is a congenital anomaly with two clinical features : unilateral agenesis of the pectoralis major and ipsilateral hand symbrachydactyly. Case presentation: We report a rare case of bilateral Poland’s syndrome with several unique features. Discussion: Poland’s syndrome is thought to be due to a vascular insult to the subclavian axis around the 6th week of gestation. Our patient has multiple rare and unique features of Poland’s syndrome. Conclusion: To our best knowledge, for the first time in the literature we associate Poland’s syndrome with cone-shaped epiphysis of the metacarpals of all fingers. Bilaterality, cleft hand deformity, and dextrocardia, were also rare features in our patient.

Keywords: Poland's syndrome, cleft hand deformity, bilaterality, dextrocardia, cone-shaped epiphysis

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Authors: Indira Kothalanka

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For individuals born with a cleft palate (CP), there is no separation between the nasal cavity and the oral cavity, due to which they cannot build up enough air pressure in the mouth for speech. Therefore, it is common for them to have speech problems. Common cleft type speech errors include abnormal articulation (compensatory or obligatory) and abnormal resonance (hyper, hypo and mixed nasality). These are generally resolved after palate repair. However, in some individuals, articulation problems do persist even after the palate repair. Such individuals develop variant articulations in an attempt to compensate for the inability to produce the target phonemes. A spectrographic analysis is used to investigate the compensatory articulatory behaviours of pressure consonants in the speech of 10 Telugu speaking individuals aged between 7-17 years with a history of cleft palate. Telugu is a Dravidian language which is spoken in Andhra Pradesh and Telangana states in India. It is a language with the third largest number of native speakers in India and the most spoken Dravidian language. The speech of the informants is analysed using single word list, sentences, passage and conversation. Spectrographic analysis is carried out using PRAAT, speech analysis software. The place and manner of articulation of consonant sounds is studied through spectrograms with the help of various acoustic cues. The types of compensatory articulation identified are glottal stops, palatal stops, uvular, velar stops and nasal fricatives which are non-native in Telugu.

Keywords: cleft palate, compensatory articulation, spectrographic analysis, PRAAT

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Authors: Ritesh Verma, Manisha Rathi, Chand Singh Dhull, Sumit Sachdeva, Jitender Phogat

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A Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the anterior pituitary gland. It occurs when the Rathke's pouch does not develop properly and ranges in size from 2 to 40mm in diameter. A 38-year-old male presented to the outpatient department with loss of vision in the inferior quadrant of the left eye since 15 days. Visual acuity was 6/6 in the right eye and 6/9 in the left eye. Visual field analysis by HFA-24-2 revealed an inferior field defect extending to the supero-temporal quadrant in the left eye. MRI brain and orbit was advised to the patient and it revealed a well defined cystic pituitary adenoma indenting left optic nerve near optic chiasm consistent with the diagnosis of Rathke’s cleft cyst (RCC). The patient was referred to neurosurgery department for further management. Symptoms vary greatly between individuals having RCCs. RCCs can be non-functioning, functioning, or both. Besides headaches, neurocognitive deficits are almost always present but have a high rate of immediate reversal if the cyst is properly treated or drained.

Keywords: pituitary tumors, rathke’s cleft cyst, visual field defects, vision loss

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Authors: Yu Zhang, Kohei Inoue, Kiichi Urahama

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We propose a simplified bilateral filter with binarized coefficients for accelerating it. Its computational cost is further decreased by sampling pixels. This computationally low cost filter is useful for smoothing or denoising images by using mobile devices with limited computational power.

Keywords: bilateral filter, binarized-weight bilateral filter, image smoothing, image denoising, pixel sampling

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Authors: Sadam Elayah, Yang Li, Bing Shi

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Background: The impact of relaxing incisions on maxillofacial growth during palatoplasty remains a topic of debate, and further research is needed to understand its effects fully. Thus, the current study is the first long-term study that aimed to assess the maxillofacial growth of patients with isolated cleft palate following the Sommerlad-Furlow modified (S.F) technique and to estimate the impact of relaxing incisions on maxillofacial growth following S.F technique in patients with isolated cleft palate. Methods: A total of 85 participants, 55 patients with non-syndromic isolated soft and hard cleft palate underwent primary palatoplasty with our technique (30 patients received the Sommerlad-Furlow modified technique without relaxing incision (S.F+RI group), and 25 received Sommerlad-Furlow modified technique without relaxing (S.F-RI group) with no significant difference found between them regarding the cleft type, cleft width, and age at repair. While the other 30 were normal participants with skeletal class I pattern (C group). The control group was matched with the study group in number, age, and sex. All the study variables were measured using stable landmarks, including 12 linear and 10 angular variants. Results: The mean ages at collection of cephalograms were 6.03±0.80 in the S.F+RI group, 5.96±0.76 in the S.F-RI group, and 5.91±0.87 in the C group. Regarding cranial base, the results showed no statistically significant differences between the three groups in S-N and S-N-Ba. The S.F+R.I group had a significantly shorter S-Ba than the S.F-R.I & C groups (P= 0.01). However, there was no statistically significant difference between the S.F-R.I & C groups (P=0.80). Regarding the skeletal maxilla, there was no significant difference between the S.F+R.I and S.F-R.I groups in all linear measurements (N-ANS, S- PM & SN-PP ) except Co-A, the S.F+R.I group had significantly shorter Co-A than the S.F-R.I & C groups (P= <0.01). While the angular measurement, S.F+R.I group had significantly less SNA angle than the S.F-R.I & C groups (P= <0.01). Regarding mandibular bone, there were no statistically significant differences in all linear and angular mandibular measurements between the S.F+R.I and S.F-R.I groups. Regarding intermaxillary relation, the S.F+R.I group had significant differences in Co-Gn - Co-A and ANB compared to the S.F-R.I & C groups (P= <0.01). There was no statistically significant difference in PP-MP among the three groups. Conclusion: As a preliminary report, the Sommerlad-Furlow modified technique without relaxing incisions was found to have good maxillary positioning in the face and a satisfactory intermaxillary relationship compared to the Sommerlad-Furlow modified technique with relaxing incisions.

Keywords: relaxing incisions, cleft palate, palatoplasty, maxillofacial growth

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Authors: Chih-Hsien Chen, Yi-Hung Ho, Chih-Wei Wang, Chih-Wei Chang, Yen-Nien Chen, Chih-Han Chang, Chun-Ting Li

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Laminotomy is a spinal decompression surgery compatible with a minimally invasive approach. However, the unilateral laminotomy for bilateral side decompression leads to more perioperative complications than the bilateral laminotomy. Although the unilateral laminotomy removes the least bone tissue among the spinal decompression surgeries, the difference of spinal stability between unilateral and bilateral laminotomy and laminectomy is rarely investigated. This study aims to compare the biomechanical effects of unilateral and bilateral laminotomy and laminectomy on the lumbar spine by finite element (FE) simulation. A three-dimensional FE model of the lumbar spine (L1–L5) was constructed with the vertebral body, discs, and ligaments, as well as the sacrum was constructed. Three different surgical methods, namely unilateral laminotomy, bilateral laminotomy and laminectomy, at L3–L4 and L4–L5 were considered. Partial pedicle and entire ligamentum flavum were removed to simulate bilateral decompression in laminotomy. The entire lamina and spinal processes from the lower L3 to upper L5 were detached in the laminectomy model. Then, four kinds of loadings, namely flexion, extension, lateral bending and rotation, were applied on the lumbar with various decompression conditions. The results indicated that the bilateral and unilateral laminotomy both increased the range of motion (ROM) compared with intact lumbar, while the laminectomy increased more ROM than both laminotomy did. The difference of ROM between the bilateral and unilateral laminotomy was very minor. Furthermore, bilateral laminotomy demonstrated similar poster element stress with unilateral laminotomy. Unilateral and bilateral laminotomy are equally suggested to bilateral decompression of lumbar spine with minimally invasive technique because limited effect was aroused due to more bone remove in the bilateral laminotomy on the lumbar stability. Furthermore, laminectomy is the last option for lumbar decompression.

Keywords: minimally invasive technique, lumbar decompression, laminotomy, laminectomy, finite element method

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Authors: Suteera Pradubwong, Darawan Augsornwan, Pornpen Pathumwiwathana, Benjamas Prathanee, Bowornsilp Chowchuen

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Background: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team’s understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. Objectives: To examine the impact of the empowering volunteer project, established in the northeast Thailand. Materials and Methods: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family’s general information, treatment, the group brainstorming, and satisfaction with the project were analyzed. Results: Participants were 12 children with CLP, their families and five volunteers with CLP; the participating patients were predominantly females and the mean, age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding; instructions’ needs for care at birth; difficulty in access information and society impact; and needs in having a network of volunteers. Conclusions: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Keywords: self-help and family support group, community based model, volunteer, cleft lip-cleft palate

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Authors: Taimoor Hussain Alvi, Syed Toqueer Akhter

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The focus of this research is to identify Pak-India bilateral trade spillover effects upon Pakistan’s Growth rate. Cross-country spillover growth Effects have been linked with openness and access to markets. In this research, we intend to see the short run and long run effects of Pak-India Bilateral Trade Openness upon economic growth in Pakistan. Trade Openness has been measured as the sum of bilateral exports and imports between the two countries. Increased emphasis on the condition and environment of financial markets is laid in light of globalization and trade liberalization. This research paper makes use of the Univariate Autoregressive Distributed Lagged Model to analyze the effects of bilateral trade variables upon the growth pattern of Pakistan in the short run and long run. Key findings of the study empirically support the notion that increased bilateral trade will be beneficial for Pakistan in the short run because of cost advantage and knowledge spillover in terms of increased technical and managerial ability from multinational firms. However, contrary to extensive literature, increased bilateral trade measures will affect Pakistan’s growth rate negatively in the long run because of the industrial size differential and increased integration of Indian economy with the world.

Keywords: bilateral trade openness, spillover, comparative advantage, univariate

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Authors: Zihan Yu, Kohei Inoue, Kiichi Urahama

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We present a method for de-hazing images. A dark envelope image is derived with the bilateral minimum filter and a bright envelope is derived with the bilateral maximum filter. The ambient light and transmission of the scene are estimated from these two envelope images. An image without haze is reconstructed from the estimated ambient light and transmission.

Keywords: image dehazing, bilateral minimum filter, bilateral maximum filter, local contrast

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Authors: Mohamed Taher Eldesoky, Enas Elsayed Abutaleb

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Background: The changes in foot posture possibly generate changes in the pelvic alignment, although, there is lack of evidence about the effects of bilateral and unilateral flatfoot on possible changes in pelvic alignment. The purpose of this study was to investigate the effect of flatfoot on the sagittal and frontal planes of pelvic postures. Materials and Methods: 56 subjects, aged 18–40 years, were assigned into three groups. 20 healthy subjects, 19 subjects with bilateral flexible second-degree flat foot, and 17 subjects with unilateral flexible second-degree flat foot. 3D assessment of the pelvis using the formetric-II device was used to evaluate pelvic alignment in the frontal and sagittal planes by measuring pelvic inclination and pelvic tilt angles. Results: ANOVA test with LSD test were used for statistical analysis. Both Unilateral and bilateral second degree flatfoot produced significant (P < 0.05) pelvic anteversion in comparison to the healthy subjects (P < 0.05), but the bilateral flatfoot subjects seemed to have more anteversion than the unilateral subjects. Unilateral flatfoot caused a significant (P<0.05) lateral pelvic tilt in the direction of the affected side in comparison to the healthy and bilateral flatfoot subjects. Conclusion: The bilateral and unilateral second degree flatfoot changed pelvic alignment. Both of them led to increases of pelvic anteversion while the unilateral one caused lateral pelvic tilt toward the affected side. Thus, foot posture should be considered when assessing patients with pelvic misalignment and disorders.

Keywords: bilateral flatfoot, unilateral flatfoot, pelvic alignment, foot posture

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Authors: Anuj Kumar Vaksha

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In the post cold war era the foreign direct investments have come to be considered as one of the most critical factors for economic development of a country particularly for the capital scarce countries like the developing and the under developed countries. The rush for foreign direct investments have led to intense competition between the countries treaties to attract foreign investments by entering into alluring Bilateral Investment Treaties (BITs). The Bilateral Investment Treaties are the intergovernmental legal framework for the promotion of private investments from one country to other. With more than 3000 BITs, the web of such BITs are the most dominant development of International Law in the post cold war era. The essence of all these BITs are bilateral cooperation for economic development and thus it is actually the theme of economic development around which the International Law had developed most dominantly in the post cold war era. Within the framework of two generally accepted premises that foreign direct investments are critical for economic development and the bilateral investment treaties are critical for promotion of foreign direct investments, the research paper seeks to explore the perspectives and paradigms on economic development as embodied in various Bilateral Investment Treaties. It seeks to address how and in what manners the perspectives on economic development as embodied in bilateral investment varies between the developed, developing and underdeveloped countries. It goes without saying that economic development is a very broad, complex and operationally intricate concept. In the paradigm of International Law it becomes much more complex and intricate. Understanding the concept of economic development from the perspectives of Bilateral Investment Treaties is a novel idea with far reaching significance. Such a perspective on economic development would help in enriching the contemporary International Law perspectives and paradigms on economic development.

Keywords: bilateral investment treaties, economic development, international Law, perspectives

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Authors: Mengying Wang, Dongjing Liu, Holger Schwender, Ping Wang, Hongping Zhu, Tao Wu, Terri H Beaty

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Background: Maternal smoking is a recognized risk factor for nonsyndromic cleft lip with or without cleft palate (NSCL/P). It has been reported that the effect of maternal smoking on oral clefts is mediated through genes that influence nicotine dependence. The polymorphisms of cholinergic receptor nicotinic alpha (CHRNA) and beta (CHRNB) subunits genes have previously shown strong associations with nicotine dependence. Here, we attempted to investigate whether the above genes are associated with clefting risk through testing for potential gene-gene (G×G) and gene-environment (G×E) interaction. Methods: We selected 120 markers in 14 genes associated with nicotine dependence to conduct transmission disequilibrium tests among 806 Chinese NSCL/P case-parent trios ascertained in an international consortium which conducted a genome-wide association study (GWAS) of oral clefts. We applied Cordell’s method using “TRIO” package in R to explore G×G as well as G×E interaction involving environmental tobacco smoke (ETS) based on conditional logistic regression model. Results: while no SNP showed significant association with NSCL/P after Bonferroni correction, we found signals for G×G interaction between 10 pairs of SNPs in CHRNA3, CHRNA5, and CHRNB4 (p<10-8), among which the most significant interaction was found between RS3743077 (CHRNA3) and RS11636753 (CHRNB4, p<8.2×10-12). Linkage disequilibrium (LD) analysis revealed only low level of LD between these markers. However, there were no significant results for G×ETS interaction. Conclusion: This study fails to detect association between nicotine dependence genes and NSCL/P, but illustrates the importance of taking into account potential G×G interaction for genetic association analysis in NSCL/P. This study also suggests nicotine dependence genes should be considered as important candidate genes for NSCL/P in future studies.

Keywords: Gene-Gene Interaction, Maternal Smoking, Nicotine Dependence, Non-Syndromic Cleft Lip with or without Cleft Palate

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Authors: A. H. Dikko, D. N Tsado, M. S. T. Rita, D. S. Umar

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This study was conducted on eighteen (18) New Zealand and chinchilla breeds of rabbits were used. The rabbits were allotted to 3 treatments with each treatment having six (6) animals with two (2) replicates. T1 were castrated, which both testes was removed (Bilateral); T2 were castrated, which only one testes was removed (unilateral) and T3 were not castrated (control). In nutrient digestibility, T1 and T2 (p>0.05) has a higher rate than T3. There was no significant (p<0.05) difference in live weight and dressing weight among the treatment groups. There is a significant (p > 0.05) difference in visceral organs in the treatment groups.

Keywords: New Zealand, chinchilla, castration, bilateral, unilateral

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Authors: Bo Sun, Ni Zhong

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Bilateral investment treaties have played a role in the construction of the Belt and Road, providing institutional protection for Chinese companies' overseas investments. However, such treaties between China and countries along the Belt and Road were signed in the 1980s and 1990s, and their provisions are outdated and insufficiently detailed to provide adequate legal protection for Chinese investors when they initiate investment arbitration against host countries. By studying cases involving China in international investment arbitration, this paper suggests that China should pay attention to further clarifying the identity of "investors", the scope of disputes that can be submitted to arbitration, and the concept of "indirect expropriation" when updating bilateral investment treaties in the future, in order to reduce the risk of losing cases for Chinese investors.

Keywords: belt and road, bilateral investment agreement, investment arbitration, indirect expropriation

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Authors: Mauricio Plaza, Willian Aperador

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Hip disarticulation is an amputation through the hip joint capsule, removing the entire lower extremity, with a closure of the remaining musculature over the exposed acetabulum. Tumors of the distal and proximal femur were treated by total femur resection; a hip disarticulation sometimes is a performance for massive trauma with crush injuries to the lower extremity. This article discusses the design a system for rehabilitation of a patient with bilateral hip disarticulations. The prosthetics designed allowed the patient to do natural gait suspended between parallel articulate crutches with the body weight support between the crutches. The care of this patient was a challenge due to bilateral amputations at such a high level and the special needs of a patient mobility.

Keywords: amputation, prosthesis, mobility, hemipelvectomy

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Authors: Yi-Hung Ho, Chih-Wei Wang, Chih-Hsien Chen, Chih-Han Chang

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Unilateral laminotomy and bilateral laminotomies were successful decompressions methods for managing spinal stenosis that numerous studies have reported. Thus, unilateral laminotomy was rated technically much more demanding than bilateral laminotomies, whereas the bilateral laminotomies were associated with a positive benefit to reduce more complications. There were including incidental durotomy, increased radicular deficit, and epidural hematoma. However, no relative biomechanical analysis for evaluating spinal instability treated with unilateral and bilateral laminotomies. Therefore, the purpose of this study was to compare the outcomes of different decompressions methods by experimental and finite element analysis. Three porcine lumbar spines were biomechanically evaluated for their range of motion, and the results were compared following unilateral or bilateral laminotomies. The experimental protocol included flexion and extension in the following procedures: intact, unilateral, and bilateral laminotomies (L2–L5). The specimens in this study were tested in flexion (8 Nm) and extension (6 Nm) of pure moment. Spinal segment kinematic data was captured by using the motion tracking system. A 3D finite element lumbar spine model (L1-S1) containing vertebral body, discs, and ligaments were constructed. This model was used to simulate the situation of treating unilateral and bilateral laminotomies at L3-L4 and L4-L5. The bottom surface of S1 vertebral body was fully geometrically constrained in this study. A 10 Nm pure moment also applied on the top surface of L1 vertebral body to drive lumbar doing different motion, such as flexion and extension. The experimental results showed that in the flexion, the ROMs (±standard deviation) of L3–L4 were 1.35±0.23, 1.34±0.67, and 1.66±0.07 degrees of the intact, unilateral, and bilateral laminotomies, respectively. The ROMs of L4–L5 were 4.35±0.29, 4.06±0.87, and 4.2±0.32 degrees, respectively. No statistical significance was observed in these three groups (P>0.05). In the extension, the ROMs of L3–L4 were 0.89±0.16, 1.69±0.08, and 1.73±0.13 degrees, respectively. In the L4-L5, the ROMs were 1.4±0.12, 2.44±0.26, and 2.5±0.29 degrees, respectively. Significant differences were observed among all trials, except between the unilateral and bilateral laminotomy groups. At the simulation results portion, the similar results were discovered with the experiment. No significant differences were found at L4-L5 both flexion and extension in each group. Only 0.02 and 0.04 degrees variation were observed during flexion and extension between the unilateral and bilateral laminotomy groups. In conclusions, the present results by finite element analysis and experimental reveal that no significant differences were observed during flexion and extension between unilateral and bilateral laminotomies in short-term follow-up. From a biomechanical point of view, bilateral laminotomies seem to exhibit a similar stability as unilateral laminotomy. In clinical practice, the bilateral laminotomies are likely to reduce technical difficulties and prevent perioperative complications; this study proved this benefit through biomechanical analysis. The results may provide some recommendations for surgeons to make the final decision.

Keywords: unilateral laminotomy, bilateral laminotomies, spinal stenosis, finite element analysis

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Authors: Mihai-Ionut Firescu, Mark A. P. Carson

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We present a case of inferior vena cava agenesis (IVCA) associated with bilateral deep venous thrombosis (DVT) in a patient with Beckwith-Wiedemann syndrome (BWS). In adult patients with BWS presenting with bilateral lower limb oedema, specific aetiological factors should be considered. These include cardiomyopathy and intraabdominal tumours. Congenital malformations of the IVC, through causing relative venous stasis, can lead to lower limb oedema either directly or indirectly by favouring lower limb venous thromboembolism; however, they are yet to be reported as an associated feature of BWS. Given its life-threatening potential, the prompt initiation of treatment for bilateral DVT is paramount. In BWS patients, however, this can prove more complicated. Due to overgrowth, the above-average birth weight can continue throughout childhood. In this case, the patient’s weight reached 170 kg, impacting on anticoagulation choice, as direct oral anticoagulants have a limited evidence base in patients with a body mass above 120 kg. Furthermore, the presence of IVCA leads to a long-term increased venous thrombosis risk. Therefore, patients with IVCA and bilateral DVT warrant specialist consideration and may benefit from multidisciplinary team management, with hematology and vascular surgery input. Conclusion: Here, we showcased a rare cause for bilateral lower limb oedema, respectively bilateral deep venous thrombosis complicating IVCA in a patient with Beckwith-Wiedemann syndrome. The importance of this case lies in its novelty, as the association between IVC agenesis and BWS has not yet been described. Furthermore, the treatment of DVT in such situations requires special consideration, taking into account the patient’s weight and the presence of a significant, predisposing vascular abnormality.

Keywords: Beckwith-Wiedemann syndrome, bilateral deep venous thrombosis, inferior vena cava agenesis, venous thromboembolism

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Authors: Rusmawati Said, N. Kar Yee, Asmaddy Haris

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This study employs a panel data set of ASEAN member states, 17 European Union (EU) countries, 7 American countries and 11 other Asia Pacific countries (China Mainland and Hong Kong SAR are treated as two separated countries) to investigate the role of labour standards in explaining the pattern of bilateral migration flows in ASEAN. Using pooled Ordinary Least Square (OLS) this study found mixed results. The result varies on how indicators were used to measure the level of labour standards in the empirical analysis. In one side, better labour standards (represented by number of strikes and weekly average working hours) promote bilateral migration among the selected countries. On the other side, increase in cases of occupational injuries lead to an increase in bilateral migration, reflecting that worsen in working conditions do not influence the workers’ decision from moving. The finding from this study become important to policy maker as the issues of massive low skilled workers have a significant impact to the role of labour standard in shaping the migration flows.

Keywords: labour standard, migration, ASEAN, economics and financial engineering

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Authors: Rashmi Yadawad, Disha Narayanan, Ravi Gautam

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Through Wall Radar Imaging is gaining increasing importance now a days in the field of Defense and one of the most important criteria that forms the basis for the image quality obtained is the Cross-Range resolution of the image. In this research paper, the Bilateral Back projection algorithm has been implemented for Through Wall Radar Imaging. The sole purpose is to enhance the resolution in the cross range direction of the obtained Back projection image. Synthetic Data is generated for two targets which are placed at various locations in a room of dimensions 8 m by 6m. Two algorithms namely, simple back projection and Bilateral Back projection have been implemented, images are obtained and the obtained images are compared. Numerical simulations have been coded in MATLAB and experimental results of the two algorithms have been shown. Based on the comparison between the two images, it can be clearly seen that the ringing effect and chess board effect have been heavily reduced in the bilaterally back projected image and hence promising results are obtained giving a relatively sharper image with relatively well defined edges.

Keywords: through wall radar imaging, bilateral back projection, cross range resolution, synthetic data

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Authors: Aamir Shahzad, Hubert Roth

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This paper is presenting the bilateral telecontrol of AutoMerlin Mobile Robot having communication delay. Passivity Observers has been designed to monitor the net energy at both ports of a two port network and if any or both ports become active making net energy negative, then the passivity controllers dissipate the proper energy to make the overall system passive in the presence of time delay. The environment force is modeled and sent back to human operator so that s/he can feel it and has additional information about the environment in the vicinity of mobile robot. The experimental results have been presented to show the performance and stability of bilateral controller. The results show the whenever the passivity observers observe active behavior then the passivity controller come into action to neutralize the active behavior to make overall system passive.

Keywords: bilateral control, human operator, haptic device, communication network, time domain passivity control, passivity observer, passivity controller, time delay, mobile robot, environment force

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Authors: Mehmet Yildiz, Mehmet Kale

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The primary aim of the present study was to identify the bilateral balance asymmetries when comparing the dominant (DL) vs. the non-dominant leg (NDL) in the collegian soccer players. The secondary aim was to compare the inter-limb asymmetry index (ASI) when differentiating by kicking preference (right-dominant vs. left-dominant). 34 right-dominant leg (RightDL) (age:21.12±1.85, height:174.50±5.18, weight:69.42±6.86) and 23 left-dominant leg (LeftDL), (age:21.70±2.03, height:176.2±6.27, weight:68.73±5.96) collegian football players were tested for bilateral static and dynamic balance. Balance ability was assessed by measuring centre of pressure deviation on a single leg. Single leg static and dynamic balance scores and inter-limb asymmetry index (ASI) were determined. Student t tests were used for the comparison of dominant and nondominant leg balance scores and RightDL and LeftDL football players’ inter-limb asymmetry index of the balance scores. The results showed that there were significant differences in the dynamic balance scores in favour of the nondominant leg, (DL:738±211 vs. NDL:606±226, p < 0.01). Also, it has been seen that LeftDL players have significantly higher inter-limb asymmetry index when compared with rightDL players for both static (rightDL:-7.07±94.91 vs. leftDL:-183.19±354.05, p < 0.01) and dynamic (rightDL: 1.73±49.65 vs. leftDL:27.08±23.34, p < 0.05) balance scores. In conclusion, bilateral dynamic balance asymmetries may be affected using single leg predominantly in the mobilization workouts. Because of having higher inter-limb asymmetry index, left-dominant leg players may be screened and trained to minimize balance asymmetry.

Keywords: bilateral balance, asymmetries, dominant leg, leg preference

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Authors: Laura V. Gonzalez, Juan B. Duarte, Luis A. Palacio

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Decision making can be conditioned by factors such as the environments, circumstances, behavioral biases, emotions, beliefs and preferences of the participants. The objective of this paper is to analyze the effect ‘amount of information’ and ‘number of options’, on the behavior of competitors under a bilateral negotiation context. For the above, it has been designed an experiment as a classroom game where they negotiate goods, under the condition that none of the players knows exactly the real value of the asset. The game is designed under the concept of zero-sum (non-cooperative game) and focuses on the fact that agents must anticipate the strategies of their opponent to improve their chances of winning in the negotiation. The empirical results show that, contrary to the traditional view of expected utility theory, players prefer to obtain low profits and losses, when faced with a higher expectation of losses, using sub-optimal strategies not in accordance with game theory.

Keywords: bilateral negotiation, classroom game, decision making, game theory

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Authors: Samson Munn, Virginia H. Kim, Huija Chen, Sean Maldonado, Michelle Kim, Paul Koscheski, Babak N. Kalantari, Gregory Eckel, Albert Lee

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In terms of screening mammography quality, neither the portion of reports that advise call-back imaging that should be bilateral versus unilateral nor how much the unilateral call-backs may appropriately diverge from 50–50 (left versus right) is known. Many factors may affect detection laterality: display arrangement, reflections preferentially striking one display location, hanging protocols, seating positions with respect to others and displays, visual field cuts, health, etc. The call-back bilateral fraction may reflect radiologist experience (not in our data) or confidence level. Thus, laterality and bilaterality of call-backs advised in screening mammography reports could be worthy quality metrics. Here, laterality data did not reveal a concern until drilling down to individuals. Bilateral screening mammogram report recommendations by five breast imaging, attending radiologists at Harbor-UCLA Medical Center (Torrance, California) 9/1/15--8/31/16 and 9/1/16--8/31/17 were retrospectively reviewed. Recommended call-backs for bilateral versus unilateral, and for left versus right, findings were counted. Chi-square (χ²) statistic was applied. Year 1: of 2,665 bilateral screening mammograms, reports of 556 (20.9%) recommended call-back, of which 99 (17.8% of the 556) were for bilateral findings. Of the 457 unilateral recommendations, 222 (48.6%) regarded the left breast. Year 2: of 2,106 bilateral screening mammograms, reports of 439 (20.8%) recommended call-back, of which 65 (14.8% of the 439) were for bilateral findings. Of the 374 unilateral recommendations, 182 (48.7%) regarded the left breast. Individual ranges of call-backs that were bilateral were 13.2–23.3%, 10.2–22.5%, and 13.6–17.9%, by year(s) 1, 2, and 1+2, respectively; these ranges were unrelated to experience level; the two-year mean was 15.8% (SD=1.9%). The lowest χ² p value of the group's sidedness disparities years 1, 2, and 1+2 was > 0.4. Regarding four individual radiologists, the lowest p value was 0.42. However, the fifth radiologist disfavored the left, with p values of 0.21, 0.19, and 0.07, respectively; that radiologist had the greatest number of years of experience. There was a concerning, 93% likelihood that bias against left breast findings evidenced by one of our radiologists was not random. Notably, very soon after the period under review, he retired, presented with leukemia, and died. We call for research to be done, particularly by large departments with many radiologists, of two possible, new, quality metrics in screening mammography: laterality and bilaterality. (Images, patient outcomes, report validity, and radiologist psychological confidence levels were not assessed. No intervention nor subsequent data collection was conducted. This uncomplicated collection of data and simple appraisal were not designed, nor had there been any intention to develop or contribute, to generalizable knowledge (per U.S. DHHS 45 CFR, part 46)).

Keywords: mammography, screening mammography, quality, quality metrics, laterality

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Authors: Suteera Pradubwong, Pattama Surit, Sumalee Pongpagatip, Tharinee Pethchara, Bowornsilp Chowchuen

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Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup’s model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions, and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech-language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Keywords: evidence-triggers, cleft lip, cleft palate, problems of care

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Authors: Javad Vaezi, Ashraf Mohammadzadeh, Behjatalomoluk Ajami, Azin Vaezi, Aradokht Vaezi

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Introduction: Neonatal period is the first developing phase after birth, followed by different developmental processes up to the age of puberty. A neonate may be born with different oral lesions. The aim of this study was to evaluate oral lesions in newborns at Mashhad Imam Reza Hospital, which belongs to Mashhad University of Medical Sciences. Materials and Methods: In this cross–sectional descriptive study, 600 newborns were observed during 2.5 months in 2001. The total oral cavity, including the soft palate, hard palate, tongue, alveolar ridge, and oral cavity floor, was examined with a tongue blade and light. Results: Results showed that 52.6% of newborns (316 cases) had oral lesions. 0.66% cases had natal and neonatal teeth, 0.5% cases had congenital epulis, 1.8% cases were with ankyloglossia, 41.5% cases with Epstein’s pearls, 22.3% cases with Bohn nodules and 0.16% case with exostosis. There were no cases of cleft lip or cleft palate. The most frequent oral lesion observed was Epstein’s pearls. Conclusion: Our study showed that the prevalence of natal teeth in the city of Mashhad was more than in other countries except for Bohn nodule and Epstein’s pearls, which occurred less frequently than in other countries.

Keywords: newborn, oral lesion, epidemiology, frequency

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