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For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. After a sufficient amount of flap is made available, it is gently introduced through the osteotomy gap until it reaches the palatal mucosa defect and is then sutured. In the patient case presented, the palatal mucosa healed fully within 18 days, and the patient reported no nasal regurgitation of food, defective speech, fetid odour, bad taste, or upper respiratory tract or ear infection during the postoperative period. This technique using a BFP flap should therefore be considered in the context of unexpected tearing of the palatal mucosa in patients undergoing a segmented Le Fort I osteotomy.

This paper aims to investigate the relationship between CO2 Emissions and GDP per capita of three East Asian countries (China, Japan, and South Korea). The Environmental Kuznets Curve hypothesis and its possible implications to the implementation of the Kyoto Protocol Agreement will be tested. The independent variables Employment and Energy consumption will be used as control variables. Multiple regression analysis and cointegration tests will be used on time series data of Japan, Korea, and China that is obtained from the World Bank database. GDP per capita is measured in constant 2010 US$, CO2 emission in kt, Employment in the ratio of total employment to total population aged 15 and above, and Energy Consumption in annual kWh per capita.

In this paper, we approach the phenomenon of criminal activity from an infectious perspective by using tailored compartmental agent-based models that include the social flavor of the mechanisms governing the evolution of crime in society. Specifically, we focus on addressing how the existence of competing gangs shapes the penetration of crime. The mean-field analysis of the model proves that the introduction of dynamical rules favoring the simultaneous survival of both gangs reduces the overall number of criminals across the population as a result of the competition between them. The implementation of the model in networked populations with homogeneous contact patterns reveals that the evolution of crime substantially differs from that predicted by the mean-field equations. We prove that the system evolves toward a segregated configuration where, depending on the features of the underlying network, both gangs can form spatially separated clusters. In this scenario, we show that the beneficial effect of the coexistence of two gangs is hindered, resulting in a higher penetration of crime in the population.

Background:Longitudinal evaluation of allograft diastolic function in paediatric heart transplant recipients is important for early detection of acute rejection, cardiac allograft vasculopathy, and graft dysfunction. Mean diastolic right atrial and pulmonary capillary wedge pressures obtained at catheterisation are the reference standards for assessment. Echocardiography is non-invasive and more suitable for serial surveillance, but individual parameters have lacked accuracy. This study aimed to identify covariates of post-transplant mean right atrial and pulmonary capillary wedge pressures, including B-type natriuretic peptide and certain echocardiographic parameters.Methods:A retrospective review of 143 scheduled cardiac catheterisations and echocardiograms from 56 paediatric recipients transplanted from 2007 to 2011 was performed. Samples with rejection were excluded. Univariate and multivariate linear regression models using backward selection were applied to a database consisting of B-type natriuretic peptide, haemodynamic, and echocardiographic data.Results:Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, mitral E/e’, and percent interventricular septal thickening in systole were independently associated with mean right atrial pressure. Ln B-type natriuretic peptide, heart rate z-score, left ventricular end-diastolic dimension z-score, left ventricular mass (observed/predicted), and mitral E/e’ were independently associated with mean pulmonary capillary wedge pressure. Covariates of B-type natriuretic peptide included mean pulmonary artery and pulmonary capillary wedge pressures, height, haemoglobin, fractional shortening, percent interventricular septal thickening in systole, and pulmonary vascular resistance index.Conclusions:B-type natriuretic peptide and echocardiographic indices of diastolic function were independently related to post-transplant mean right atrial and pulmonary capillary wedge pressures in paediatric heart transplant recipients without rejection.

Employing cutting fluids in machining processes, especially for difficult-to-cut materials, improves machinability through prolonged tool life, improves surface integrity and chip evacuation. However, like oil and water-based cutting fluids are hazardous to the environment and workers’ health, alternative solutions are required. Liquid Nitrogen (LN2) is a cryogenic fluid that can be an option due to its low boiling point (-197oC) and the fact it exists in the atmosphere at room conditions. Nevertheless, the feasibility of cryogenic cooling techniques in machining is not fully understood; this is why the Finite Element Method (FEM) could give an insight into the phenomena happening on the tool-chip/workpiece interface. This research aims to compare fundamental and industrial outputs when turning hardened steel 100Cr6 using Cubic Boron Nitride (CBN) inserts with wiper geometry in dry conditions and with cryogenic cooling. For this purpose, turning experimental tests were performed in both cooling conditions varying the cutting speed (150-550 m/min). Machining forces were measured during the tests, and then tool wear, microstructural damage, and residual stresses of the workpiece were characterised. A nose turning (3D) FEM model was also developed to understand the influence of cooling strategy on the outputs measured experimentally.

Background Longitudinal clinical surveillance by transthoracic echocardiography (TTE) is an established practice in children with repaired tetralogy of Fallot (TOF). Non-Invasive Imaging Guidelines recommends a list of reporting elements that should be addressed during routine TTE in this population. In this study, we assessed the adherence to these recommendations. Methods This was a multi-center (n = 8) retrospective review of TTE reports in children ≤11 years of age who have had complete TOF repair. We included 10 patients from each participating center (n = 80) and scored 2 outpatient follow-up TTE reports on each patient. The adherence rate was based on completeness of TTE reporting elements derived from the guidelines. Results We reviewed 160 TTE reports on 80 patients. Median age was 4.4 months (IQR 1.5-6.6) and 3.6 years (IQR 1.3-6.4) at the time of complete surgical repair and first TTE report, respectively. The median adherence rate to recommended reporting elements was 61% (IQR 53–70). Of the 160 reports, 9 (7%) were ≥80% adherent and 40 (25%) were ≥70% adherent. Quantitative measurements of right ventricular outflow tract (RVOT), right ventricular (RV) size and function, and branch pulmonary arteries were least likely to be reported. Conclusions Overall adherence to the most recent published imaging guidelines for surveillance of children with repaired TOF patients was suboptimal, especially for reporting of RVOT, RV size and function, and branch pulmonary arteries. Further studies are needed to explore the barriers to adherence to guidelines and most importantly, whether adherence is associated with clinical outcomes.

International audience; Surface integrity directly affects the mechanical behavior of the workpiece, which is especially relevant on fatigue behavior. To characterize the quality of the machined surface, aspects such as material damage, roughness or residual stress are considered. Measurement of the material damage of the surface is characterized in some cases as surface drag, depth of the affected machining zone, a phenomenon which takes place due to plastic strain in the surface layer caused by machining stress which could have an influence on residual stress. Surface drag measurement done with optical microscopes has relevant uncertainty. In this paper, a methodology to measure the surface drag with lower uncertainty is proposed. The method consists of measuring the deformation of a grid as a result of the machining process. The grid was created with micromilling. The method was applied to analyze the effect of feed on the surface integrity after orthogonal cutting of Ti-6Al-4V. The depth of the affected layer was measured using a 3D optical measuring device (Alicona Infinite Focus IFG4) and compared with numerical simulations and a good agreement was achieved. In comparison with optical microscope results, it can be concluded that traditional method underestimates surface drag

Replacement of pollutant fluids with eco-friendly strategies in machining operations significantly contributes to protecting the environment, diminishing global warming, and ensuring a healthier workplace for employees. This study compares cryogenic coolants with conventional coolants in cylindrical plunge grinding using a Cubic Boron Nitride (CBN) wheel. Samples of 27MnCr5 steel used in the manufacture of automotive transmission components were ground using (i) Liquid Nitrogen (LN2), (ii) a combination of LN2 + Minimum Quantity Lubrication (MQL), and (iii) a conventional coolant. The effects of the different cooling methods on the surface integrity of the ground surfaces were examined in terms of surface roughness, microstructural defects, microhardness profiles, and residual stresses. In general, surface roughness was similar for the tested cooling systems, even after grinding three subsequent surfaces in which the process stability was analyzed. Interestingly, the use of eco-friendly cryogenic systems induced fewer microstructural defects than conventional systems, and particularly, LN2+MQL lead to more compressive surface residual stresses that would improve the in-service performance of components. These results show opportunities for replacing conventional pollutant systems with eco-friendly cryogenic strategies for refrigerating/lubricating grinding processes to reduce harmful effects on the environment and pose health risks to operators.

Background:Ventriculo-ventricular interactions are known to exist, though not well quantified. We hypothesised that the ventricular–vascular coupling ratio assessed by cardiovascular MRI would provide insight into this relationship. We also sought to compare MRI-derived ventricular–vascular coupling ratio to echocardiography and patient outcomes.Methods:Children with cardiac disease and biventricular physiology were included. Sanz’s and Bullet methods were used to calculate ventricular–vascular coupling ratio by MRI and echocardiography, respectively. Subgroup analysis was performed for right and left heart diseases. Univariate and multivariate regressions were performed to determine associations with outcomes.Results:A total of 55 patients (age 14.3 ± 2.5 years) were included. Biventricular ventricular–vascular coupling ratio by MRI correlated with each other (r = 0.41; p = 0.003), with respect to ventricle’s ejection fraction (r = −0.76 to −0.88; p < 0.001) and other ventricle’s ejection fraction (r = −0.42 to −0.47; p < 0.01). However, biventricular ejection fraction had only weak correlation with each other (r = 0.31; p = 0.02). Echo underestimated ventricular–vascular coupling ratio for the left ventricle (p < 0.001) with modest correlation to MRI-derived ventricular–vascular coupling ratio (r = 0.43; p = 0.002). There seems to be a weak correlation between uncoupled right ventricular–vascular coupling ratio with the need for intervention and performance on exercise testing (r = 0.33; p = 0.02).Conclusion:MRI-derived biventricular ventricular–vascular coupling ratio provides a better estimate of ventriculo-ventricular interaction in children and adolescents with CHD. These associations are stronger than traditional parameters and applicable to right and left heart conditions.

Introduction Understanding congenital heart disease (CHD) is vital for medical personnel and parents of affected children. While traditional 2D schematics serve as the typical approach used, several studies have shown these models to be limiting in understanding complex structures. Recent world-emphasis has shifted to 3D printed models as a complement to 2D imaging to bridge knowledge and create new opportunities for experiential learning. We sought to systematically compare 3D digital and physical models for medical personnel and parent education compared to traditional methods. Methods 3D printed and digital models were made out of MRI and CT data for 20 common CHD. Fellows and nurse practitioners used these models to explore intra-cardiac pathologies following traditional teaching. The models were also used for parent education in outpatient settings after traditional education. The participants were then asked to fill out a Likert scale questionnaire to assess their understanding and satisfaction with different teaching techniques. These ratings were compared using paired t-tests and Pearson’s correlation. Results Twenty-five medical personnel (18 fellows; 2 nurses; 4 nurse practitioners and one attending) and twenty parents participated in the study. The diagnosis varied from simple mitral valve pathology to complex single ventricle palliation. Parent and medical personnel perceived understanding with digital models was significantly higher than traditional (p = 0.01). Subjects also felt that physical models were overall more useful than digital ones (p = 0.001). Physicians using models for parent education also perceived the models to be useful, not significantly impacting their clinical workflow. Conclusions 3D models, both digital and printed, enhance medical personnel and parental perceived understanding of CHD.

Introduction Appropriate use criteria (AUC) guide initial transthoracic echocardiogram (TTE) use in outpatient pediatrics. We sought to improve pediatric cardiologist TTE ordering appropriateness (mean AUC score) with a quality improvement initiative. Methods The outcome of interest was the prospective AUC score for all initial outpatient TTEs ordered between November 2016 and August 2017, categorized per the AUC: "appropriate" (score 7-9), "may be appropriate" (4-6), "rarely appropriate" (1-3). Interventions included a didactic review of 2014 AUC and participant documentation of AUC criteria for each TTE. Participants met quarterly to evaluate outcome, process, and balancing measures, intervention effectiveness, and to identify and mitigate barriers. Results Twenty-two pediatric cardiologists participated. TTE appropriateness level before (n = 216) and after (n = 557) intervention was high. There was no significant difference in mean baseline and post-intervention AUC score (7.42 ± 1.87 versus 7.16 ± 2.87, P = 0.1), nor in TTE sensitivity (27% versus 25%, P > 0.1) as a balancing measure. Among baseline studies, 81% were "appropriate," and 6% "rarely appropriate." Among post-intervention studies, 76% were "appropriate," and 11% "rarely appropriate." Barriers identified to implementing AUC include TTE indications not specified by current AUC, expectations of referring provider or parent to perform TTE, consistent provider application of AUC, and ability of AUC to capture comprehensive clinical judgment. Conclusions Although the mean AUC appropriateness level was high, we were able to identify significant barriers to the implementation of AUC. Future efforts should focus on the reduction of "rarely appropriate" TTE ordering.

Adenovirus 5 (Ad-5) infection is a common cause of acute respiratory infections and the main vector used in gene therapy. There are few studies on the relationship of Ad-5 to obesity. In the present study, we evaluated the chronic effects of Ad-5 infection on golden (Syrian) hamsters fed either a balanced diet (BD) or a high-fat diet (HFD). After a single inoculation with Ad-5 (1 × 107 pfu), the body weight of the animals was measured weekly. Medium-term (22 weeks) serum biochemical analyses and long-term (44 weeks) liver morphology, adiposity, and locomotive functionality (movement velocity) assessments were carried out. In the animals fed the BD, adenovirus infection produced hyperglycemia and hyperlipidemia. In the long term, it produced a 57% increase in epididymal pad fat and a 30% body weight gain compared with uninoculated animals. In addition, morphological changes related to non-alcoholic fatty liver disease (NAFLD) were observed. The animals fed the HFD had similar but more severe changes. In addition, the hamsters presented an obesity paradox: at the end of the study, the animals that had the most morphological and functional changes (significantly reduced movement velocity) had the lowest body weight. Despite the fact that an HFD appears to be a more harmful factor in the long term than adenovirus infection alone, infection could increase the severity of harmful effects in individuals with an HFD. Epidemiological studies are needed to evaluate the effect of adenovirus as a precursor of chronic liver and cardiovascular diseases, including the chronic effects of gene therapy.

The ploughing force related with action of edge radius is an important factor which influences flow stress, chip formation or surface integrity. Some fraction of the cutting forces are called parasitic (additional) forces and they do not contribute on chip formation process. These forces are usually assumed to be the cutting force (constant value) for zero feed. However, this effect is related with the edge radius. To improve force modelling prediction, a new mechanistic model to predict cutting force considering edge radius is presented. The model was developed for two cutting speeds and in a wide range of feeds for three edge radii. The model was validated with additional experimental tests, achieving relative errors lower than 3%.

Over the last decade, the release of Wolbachia-infected Aedes aegypti into the natural habitat of this mosquito species has become the most sustainable and long-lasting technique to prevent and control vector-borne diseases, such as dengue, zika, or chikungunya. However, the limited resources to generate such mosquitoes and their effective distribution in large areas dominated by the Aedes aegypti vector represent a challenge for policymakers. Here, we introduce a mathematical framework for the spread of dengue in which competition between wild and Wolbachia-infected mosquitoes, the cross-contagion patterns between humans and vectors, the heterogeneous distribution of the human population in different areas, and the mobility flows between them are combined. Our framework allows us to identify the most effective areas for the release of Wolbachia-infected mosquitoes to achieve a large decrease in the global dengue prevalence.

Objectives To report the results of the Nit‐Occlud PDA prospective postapproval study (PAS) along with a comparison to the results of the pivotal and continued access trials. Background The Nit‐Occlud PDA (PFM Medical, Cologne, Germany), a nitinol coil patent ductus arteriosus (PDA) occluder, was approved by the Food and Drug Administration in 2013. Methods The PAS enrolled a total of 184 subjects greater than 6 months of age, weighing at least 5 kg, with PDAs less than 4 mm by angiography at 11 centers. Patients were followed prospectively at 2 months, 12 months, and 24 months postprocedure. These outcomes were compared to the 357 subjects enrolled in the pivotal and continued access protocols. Efficacy and safety data were reported. Results Among 184 subjects enrolled for the PAS between 2014 and 2017, 180 (97.8%) had successful device implantation. After 12 months, 98.7% (150/152) had trivial or no residual shunt by echocardiography and two subjects had only small residual shunts. There were three device embolizations that were all retrieved by snare without clinical consequence. Together with the pivotal and continued access study, 97.4% (449/461) had complete echocardiographic closure at 12 months in 541 enrolled subjects. The composite success was 94.4%. There were no mortalities and no serious device‐related adverse events. Conclusions The Nit‐Occlud PDA is a safe and effective device for closure of a small to moderate sized PDA. There were no serious device‐related adverse events in a large cohort of three clinical trials.

Background The American Society of Echocardiography Committee on Pediatric Echocardiography Laboratory Productivity was formed in 2011 to study institutional factors that could influence the clinical productivity of physicians and sonographers in academic pediatric echocardiography laboratories. In the previous two surveys, staff clinical productivity remained stable while total echocardiography volumes increased. This third survey was designed to assess how clinical productivity is associated with laboratory infrastructure elements such as training, administrative tasks, quality improvement, research, and use of focused cardiac ultrasound (FCU). Methods Survey questions were sent by e-mail to North American laboratories. The aims were to assess (1) educational and training obligations, (2) academic productivity and research, (3) laboratory medical director satisfaction, (4) quality improvement, (5) laboratory leadership roles, and (6) impact and use of FCU. Survey responses were compared with clinical productivity metrics defined in the first two surveys. Results There were 38 responses. Academic productivity was higher at institutions with more dedicated imaging personnel, personnel with dedicated protected academic time, and advanced imaging fellows. Academic productivity did not correlate with clinical productivity and was not significantly affected by the presence of dedicated research sonographers. The satisfaction level of laboratory medical directors was related to dedicated administrative time and an administrative stipend. The majority of administrative roles were tasked to the laboratory medical director with support of the technical director. FCU was listed as a hospital privilege at four institutions (13%). Twenty-two (58%) were training FCU providers in one or more subspecialties. FCU was not associated with clinical or academic productivity. Conclusion This third survey gathered supplemental data to complement the clinical productivity data collected from the first two surveys. Together, the results of these surveys further describe the range of factors that can affect North American academic pediatric echocardiography laboratories.

Metabolic syndrome (MS) has been associated with testicular damage. Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease that affects different organs, but its effect on the testes is unknown. A study analyzing germ cell involvement on BALB/c mice was carried out. A parallel comparative study was conducted that investigated alterations in the germinal epithelium of male humans that died from an unrelated acute event. The complete medical histories and histologic samples of the thoracic aorta, liver tissue, and testicular tissue from the deceased subjects were collected. The degree of germinal epithelial loss (DGEL) was evaluated and the clinical and histologic data were compared between individuals with and without NAFLD. The only metabolic or morphologic variable that caused a significant difference in the DGEL, in both the animal model and humans, was the presence of liver steatosis. The percentage of steatosis was also correlated with the percentage of the DGEL. In humans, steatosis (greater than 20%) increased the risk 12-fold for presenting with a severe DGEL (OR: 12.5; 95% CI [1.2, 128.9]; p = .03). There was no association with age above 50 years or MS components. Steatosis grade was also correlated with atherosclerosis grade. NAFLD was a strongly associated factor implicated in severe DGEL, as well as the testis was identified as a probable target organ for damage caused by the disease. This finding could result in the search for new approach strategies in the management of men with fertility problems. Further studies are required to confirm these results.

We present an unusual case of concordant ventriculoarterial connections, subpulmonary infundibulum, and parallel arterial trunks. This case was complicated by extreme pulmonary artery tortuosity and low arching aorta causing severe tracheal compression. We discuss the difficulty in prenatal diagnosis, necessity for advanced imaging postnatally, and associated airway complications.

[EN] Porous Clays Heterostructures (PCH) from natural pillared clays (bentonite with a high proportion of montmorillonite) have been used as supports of iron oxide for two reactions of environmental interest: i) the elimination of toluene (a representative compound of one of the most toxic subsets of volatile organic compounds, aromatics) by total oxidation and ii) the selective oxidation of H2S to elemental sulfur. For both reactions these catalysts have resulted to be remarkably more efficient than similar catalysts prepared using conventional silica as a support. Thus, in the total oxidation of toluene it has been observed that the catalytic activity obtained using siliceous PCH is two orders of magnitude higher than that with conventional silica. The catalytic activity has shown to be dependant of the capacity of the support for dispersing iron oxide in a way that the higher the dispersion of iron oxide on the surface of the support, the higher is the activity. In the case of the selective oxidation of H2S to S both higher catalytic activity and higher selectivity to S have been observed using siliceous porous clays heterostructures than using conventional silica. Highly dispersed FeOx species have been shown as highly selective towards elemental sulfur whereas more aggregated FeOx species favour the formation of sulphur oxides decreasing the selectivity to S. Analyses of the surface by XPS have shown the predominance of sulfate species in the catalysts presenting low selectivity to elemental sulfur., The authors would like to acknowledge the DGICYT in Spain (CTQ2015-68951-C3-1-R, CTQ2015-68951-C3-3-R, CTQ2012-37925-C03-2, CTQ2012-37925-C03-3 and CTQ2012-37984-C02-01) and FEDER for financial support. We also thank the University of Valencia for funding (UV-INV-AE-16-484416) and SCSIE-UV for assistance.