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Objective The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) criteria for posttraumatic stress disorder (PTSD), which includes modified criteria for young children, raises questions regarding the need for developmentally appropriate standalone psychiatric diagnosis encompassing complex trauma presentations in children. The present study addresses these questions by examining how DSM-5 PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. Method We surveyed psychotherapists across the United States, and asked them to report on the symptom characteristics, functional impairment, and trauma exposure of children, adolescents, and young adults under their care (n = 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. Results Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. Conclusions These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The article provides an overview of current data from the scientific literature on the epidemiological features of onychomycosis at present, including changes in the spectrum of pathogens, the nature of the course and clinical manifestations of fungal nail lesions. Current data on the characteristic manifestation of onychomycosis point out the importance of age factor: age-related changes in old population are associated with involutional processes in the skin and its appendages, decreased growth rate of nails, angiopathy, etc. This review demonstrated the relationship between chronic dermatoses and onychomycosis. In chronic dermatoses, including psoriasis, eczema, etc., there are fungal lesions of the nail plates, which cause not only the progression of trophic disorders, increased dryness of the skin and violation of its integrity, but also sensitization of the patient. Onychomycosis complicates the course of chronic dermatoses. In the absence of onychomycosis treatment there is a significant risk of complete destruction of the nail plates with further involvement of the adjacent skin in the pathological process and infection spreading. Three components of effective therapy are identified: accurate diagnosis, correctly selected therapy and compliance. This article also provides the brief description of existing treatment methods of onychomycosis ranging from monotherapy with systemic antifungals to the combined use of systemic and topical antifungals, as well as the use of non-medicinal methods, and in particular methods of ultraphonophoresis, electrophoresis and photodynamics.

Suppurative and inflammatory processes in soft tissues make up a considerable share, 35 – 40%, in the structure of surgical problems in inpatients. Suppurative and inflammatory processes are often characterized as acute, resulting in systemic infection, sepsis, and even fatal outcomes. In the total structure of lethal outcomes in surgical inpatient departments the mortality rate due to acute surgical infection makes up 40 – 60%. Long hospital treatment, insufficient effectiveness of existing treatment methods, additional expenses for recovery and rehabilitation put this issue in the forefront of the most challenging healthcare tasks. This review states out that management of suppurative wounds is still remaining the most pressing for surgeons nowadays. Despite the rich experience and ever-increasing techniques and approaches in treating suppurative wounds, the elaboration of more effective physical methods to stimulate the healing of the wounds seems to be promising. The physical methods can include vacuum treatment, laser and ultrasound wound treatment, ozon therapy, hyperbaric oxygenation, phototherapy, hydropress sanation. The above methods can considerably contribute to the wound treatment thus promote its rapid healing. However, each of the techniques listed has its own disadvantages (technical, biological, economical), and can be applied only at a particular stage of wound healing. In-depth analysis of all advantages and shortcomings, contraindications to each method, enables to improve the treatment outcomes for patients with suppurative wounds thus reducing the time of hospital staying and expenses.

The new coronavirus disease 2019 (COVID-19) was declared a global pandemic in early 2020. The ongoing COVID-19 pandemic has affected morbidity and mortality tremendously. Even though multiple drugs are being used throughout the world since the advent of COVID-19, only limited treatment options are available for COVID-19. Therefore, drugs targeting various pathologic aspects of the disease are being explored. Multiple studies have been published to demonstrate their clinical efficacy until now. Based on the current evidence to date, we summarized the mechanism, roles, and side effects of all existing treatment options to target this potentially fatal virus.

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.

Selective oncotropism and cytolytic activity against tumors have made certain viruses subject to investigation as novel treatment modalities. However, monotherapy with oncolytic viruses (OVs) has shown limited success and modest clinical benefit. The capacity to genetically engineer OVs makes them a desirable platform to design complementary treatment modalities to overcome the existing treatment options' shortcomings. In recent years, our knowledge of interactions of the tumors with the immune system has expanded profoundly. There is a growing body of literature supporting immunomodulatory roles for OVs. The concept of bioengineering these platforms to induce the desired immune response and complement the current immunotherapeutic modalities to make immune-resistant tumors responsive to immunotherapy is under investigation in preclinical and early clinical trials. This review provides an overview of attempts to optimize oncolytic virotherapy as essential components of the multimodality anticancer therapeutic approach and discusses the challenges in translation to clinical practice.

The most distinctive pathological characteristics of diabetes mellitus induced by various stressors or immune-mediated injuries are reductions of pancreatic islet β-cell populations and activity. Existing treatment strategies cannot slow disease progression; consequently, research to genetically engineer β-cell mimetics through bi-directional plasticity is ongoing. The current consensus implicates β-cell dedifferentiation as the primary etiology of reduced β-cell mass and activity. This review aims to summarize the etiology and proposed mechanisms of β-cell dedifferentiation and to explore the possibility that there might be a time interval from the onset of β-cell dysfunction caused by dedifferentiation to the development of diabetes, which may offer a therapeutic window to reduce β-cell injury and to stabilize functionality. In addition, to investigate β-cell plasticity, we review strategies for β-cell regeneration utilizing genetic programming, small molecules, cytokines, and bioengineering to transdifferentiate other cell types into β-cells; the development of biomimetic acellular constructs to generate fully functional β-cell-mimetics. However, the maturation of regenerated β-cells is currently limited. Further studies are needed to develop simple and efficient reprogramming methods for assembling perfectly functional β-cells. Future investigations are necessary to transform diabetes into a potentially curable disease.

Introduction. Effective therapy of occupational polyneuropathy of the upper extremities is a difficult task, because the characteristic clinical and neurophysiological manifestations of this disease persist for many years even after the termination of contact with the etiological harmful production factor - physical overload. Taking into account the low efficiency of existing treatment methods, as well as the peculiarities of the effect of low-intensity laser therapy (LILT), the task of developing a technique for using LILT for the treatment of patients with professional polyneuropathy and assessing its effectiveness during follow-up is very urgent. The aim of the study was to evaluate the effectiveness of LILT for the treatment of occupational polyneuropathy of the upper extremities. Materials and methods. The results of treatment of 236 patients with an established diagnosis of occupational polyneuropathy of the upper extremities are presented. All patients received usual drug therapy, the treatment of patients of the main group differed from the comparison group in that they were additionally treated with LILT according to the developed method. Results. The effectiveness of the therapy was assessed by studying the dynamics of pain in the hands using a visual pain rating scale, pulse velocity along the sensory fibers of the median and ulnar nerves. Changes in each of these parameters in subgroups were assessed at different stages of follow-up (before and immediately after treatment, after 3 and after 6 months). The division of patients into subgroups was carried out by determining type of the nerve fibers' damage. Conclusion: The developed method of LILT of professional polyneuropathy is simple and convenient for use in clinical practice: it is applicable both in a hospital and on an outpatient basis. After treatment, in patients from the main group, in contrast to the comparison group, there was a statistically significant increase in the parameters of pulse velocity along the sensory fibers of the median and ulnar nerves with a simultaneous decrease in the severity of pain. The effect of LILT in patients from the main group decreased after 6 months, which allows us to recommend such courses of LILT 2 times a year. LILT has a limited list of contraindications and is generally well tolerated by patients with minimal local side effects.

Narcolepsy is a chronic disabling neurological sleep disorder that requires lifelong treatment. We have outlined the clinical features of narcolepsy, the assessment and diagnosis process and have summarised the existing treatment options for children and adolescents with narcolepsy. In the future, the approach to management of paediatric narcolepsy should ideally be in a multidisciplinary setting, involving specialists in sleep medicine, sleep physiology, neurologists and psychologists/psychiatrists. A multidisciplinary approach will help to manage the potential impact of narcolepsy on children and adolescents who are in a stage of their life that is critical to their physical, emotional and social development and their academic attainment.

Focal epilepsy is one of the most frequent specific type of epilepsies, with 30% treatment-resistant patients. There are several directions researchers can follow to improve existing treatment of focal epilepsy: synthesis of new compounds with anticonvulsant activity, repurposing drugs approved for other indications, finding drugs targeted to specific genetic and biochemical defects that underlie focal epilepsy syndromes, development of viral vectors for specific gene therapy, creation of devices and methods for suppression of seizures by electrostimulation and development of methods to increase safety of epilepsy surgery. Improvement of efficacy and safety of current therapies is necessary, as well as developing targeted treatment of genetic epilepsy syndromes that will not only suppress seizures, but stop further epileptogenesis.

Efforts to integrate cultural competence and evidence-based treatments (EBTs) typically take the form of cultural adaptations of EBTs, characterized by modifications to the existing treatment based on presumed cultural notions of a given race or ethnic group. Much less attention has been given to ways EBTs can integrate a process model of cultural competence, which focuses on what clinicians do in-session to identify and integrate key cultural factors for a given individual in the treatment. Our objective is to consider how a process model of cultural competence (Shifting Cultural Lenses) can be integrated with an EBT (Behavioral Activation). We present a theoretical rationale for integrating the SCL model with BA and illustrate this integration, which provides an additional approach to bringing culture to treatments and shows promise for identifying clinicians’ in-session behaviors that reflect cultural competence.

The condition inspection of the existing treatment facilities on the territory of Ukraine (both water and sewage) allowed to objectively determine that one of the most common and urgent needs is the need to replace the filter medium. Given the domestic characteristics and natural resources, the most competitive are two types of raw materials for filter medium: gravel-sand from natural material (rock prepared by grinding) clinoptilolite of the Sokyrnytsky deposit and artificial material based on foamed granules of polystyrene food brands., {"references":["Onanko, Y.A., Prodayvoda, G.T., Vyzhva, S.A., Onanko, A.P., Kulish, N.P. Automated system of treatment of ultrasound longitudinal and transversal velocities measuring. Journal of Metalphysics and New technology. – 2011. – V. 33, № 13. – P. 529–533. DOI: http://doi.org/10.5281/zenodo.4267892","Onanko, A.P., Kuryliuk, V.V., Onanko, Y.A. et al. Peculiarity of elastic and inelastic properties of radiation cross-linked hydrogels. Journal of Nano- and Electronic Physics. – 2020. – V. 12, № 4. – P. 4026–4030. DOI: https://doi.org/10.21272/jnep.12(4).04026","A.P. Onanko, V.V. Kuryliuk, Y.A. Onanko et al. Features of inelastic and elastic characteristics of Si and SiO2/Si structures. J. Nano- Electron. Phys., V. 13, № 5, P. 05017(5) (2021). DOI: https://doi.org/10.21272/jnep.13(5).05017"]}

This research describes the individualization of convict coaching and the special penitentiary for certain convicts. It also analyzes the understanding required to revitalize convicts' correctional facilities, which assess changes in treatment regarding those with "good behavior." Furthermore, this research examined the possibility of revitalizing convicts' penitentiary to focus on the security approach. When the basic concept of the revitalization of the penitentiary is focused on the level of "treatment," which is based on the assessment criteria of "good behavior of the convicts," the convicts are placed in the penitentiary with minimum security. Furthermore, this change assesses the ability to change the existing treatment system for convicts. This is normative legal research, with data obtained from primary and secondary legal materials through literature study. The results showed that the individualization of coaching rests on the fact of the convicts' heterogeneity based on their classification, which affects the type of coaching applied. This variety of coaching affects the facilities and infrastructure needed therefore it is based on the heterogeneity of convicts the need special Penitentiary.

Infectious diseases are a major driver of morbidity and mortality globally. Treatment of malaria, tuberculosis and human immunodeficiency virus infection are particularly challenging, as indicated by the ongoing transmission and high mortality associated with these diseases. The formulation of new and existing drugs in nano-sized carriers promises to overcome several challenges associated with the treatment of these diseases, including low on-target bioavailability, sub-therapeutic drug accumulation in microbial sanctuaries and reservoirs, and low patient adherence due to drug-related toxicities and extended therapeutic regimens. Further, nanocarriers can be used for formulating vaccines, which represent a major weapon in our fight against infectious diseases. Here we review the current burden of infectious diseases with a focus on major drivers of morbidity and mortality. We then highlight how nanotechnology could aid in improving existing treatment modalities. We summarize our progress so far and outline potential future directions to maximize the impact of nanotechnology on the global population. This Review outlines the potential applications of nanotechnology-based treatments for infectious diseases, with a specific focus on the progress and challenges in developing nanomedicines against HIV, tuberculosis and malaria.

Trans Oral Robotic Surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens for head and neck cancer, including smaller incisions, less bleeding, shorter term inpatient hospitalization, and reduced intensive care unit (ICU) length of stay. TORS allows a high resolution, magnified, three-dimensional wide view of the surgical field through an endoscope, avoiding large external cervical incisions and split-lip mandibulotomy, usually required in cancer surgeries of the oropharynx. The anatomy of the Oropharynx viewed from the perspective of the robotic surgeon is different from the anatomy taught in medical schools and residence/fellowship programs, which is more directly related to emergency procedures, open field surgery, and imaging exams. Developing an understanding of the anatomic relationships and landmarks from the "inside out" perspective is critical for any surgeon willing to perform surgical procedures through a transoral robotic approach. Here we address the major anatomic landmarks and structures in head and neck robotic surgeries and advantages and disadvantages of this approach. We emphasize the importance of imaging for successful outcomes, pointing out important anatomic landmarks considered as blind spots for surgeons in clinical and endoscopic evaluations. We also describe the Brazilian current scenario and future perspectives of Robotic Surgery in terms of training and access to this technique, including institutions that currently offer this service in the different regions of Brazil.

The emergence of new ultrasound technologies has improved our understanding of the brain functions and offered new opportunities for the treatment of brain diseases. Ultrasound has become a valuable tool in preclinical animal and clinical studies as it not only provides information about the structure and function of brain tissues but can also be used as a therapy alternative for brain diseases. High-resolution cerebral flow images with high sensitivity can be acquired using novel functional ultrasound and super-resolution ultrasound imaging techniques. The noninvasive treatment of essential tremors has been clinically approved and it has been demonstrated that the ultrasound technology can revolutionize the currently existing treatment methods. Microbubble-mediated ultrasound can remotely open the blood-brain barrier enabling targeted drug delivery in the brain. More recently, ultrasound neuromodulation received a great amount of attention due to its noninvasive and deep penetration features and potential therapeutic benefits. This review provides a thorough introduction to the current state-of-the-art research on brain ultrasound and also introduces basic knowledge of brain ultrasound including the acoustic properties of the brain/skull and engineering techniques for ultrasound. Ultrasound is expected to play an increasingly important role in the diagnosis and therapy of brain diseases.

Diabetic wounds often indicate chronic complications that are difficult to treat. Unfortunately, existing conventional treatment modalities often cause unpremeditated side effects, given the need to develop alternative therapeutic phenotypes that are safe or have minimal side effects and risks. Nanotechnology-based platforms, including nanotherapeutics, nanoparticles (NPs), nanofibers, nanohydrogels, and nanoscaffolds, have garnered attention for their groundbreaking potential to decipher the biological environment and offer personalized treatment methods for wound healing. These nanotechnology-based platforms can successfully overcome the impediments posed by drug toxicity, existing treatment modalities, and the physiology and complexity of the wound sites. Furthermore, studies have shown that they play an essential role in influencing angiogenesis, collagen production, and extracellular matrix (ECM) synthesis, which are integral in skin repair mechanisms. In this review, we emphasized the importance of various nanotechnology-based platforms for healing diabetic wounds and report on the innovative preclinical and clinical outcomes of different nanotechnology-based platforms. This review also outlined the limitations of existing conventional treatment modalities and summarized the physiology of acute and chronic diabetic wounds.

The incidence and mortality of breast cancer (BC) have increased in recent years, and BC is the main cause of cancer-related death in women worldwide. One of the most significant clinical problems in the treatment of patients with BC is the development of therapeutic resistance. Therefore, elucidating the molecular mechanisms involved in drug resistance is critical. The therapeutic decision for the management of patients with BC is based not only on the assessment of prognostic factors but also on the evaluation of clinical and pathological parameters. Although this has been a successful approach, some patients relapse and/or eventually develop resistance to treatment. This review is focused on recent studies on the possible biological and molecular mechanisms involved in both response and resistance to treatment in BC. Additionally, emerging treatments that seek to overcome resistance and reduce side effects are also described. A greater understanding of the mechanisms of action of treatments used in BC might contribute not only to the enhancement of our understanding of the mechanisms involved in the development of resistance but also to the optimization of the existing treatment regimens.

The use of hyaluronic acid (HA) fillers in lip augmentation represents today 1 of the most widely used nonsurgical aesthetic procedures in the world. Regarding the severe complications are rare, insufficient professional experience for recognizing signs of vascular impairment and inadequate technique could lead to severe lip skin necrosis complications. Several of existing treatment protocols in the literature to treat vascular complication are mainly based on the use of hyaluronidase. Nevertheless, there is no consensus on dosage, interval between doses and complementary protocol among the aforementioned studies. This case aims to present a conservative approach for the clinical management of serious vasculature complications with HA injection. A high dose of hyaluronidase(11500 IU) with additional multimodal treatment was performed to the upper lip, nasolabial fold, and nose that successfully reversed a vascular complication process. The present findings suggest that the use of high doses of hyaluronidase with the complementary protocol used herein might be a promising approach in the treatment of severe vascular complication in the lips caused by HA filling.

Need for optimal treatment approaches for adult patients with mucopolysaccharidosis is an urgent problem today. This happened dueto the fact that previously patients with MS rarely lived to adulthood and were observed mainly by pediatricians. But with the evolution of medical technologies and the emergence of modern methods of treatment and rehabilitation of such patients, the number of adult patients with MS is increasing. Clinicians have more and more questions in choosing a strategy for managing each specific clinical case. Currently, a comprehensive approach to treatment allows for the use of a multidisciplinary team to pay due attention to concomitant diseases that occur in patients with impaired GAG metabolism. Due to the rarity of this disease in the modern literature, there are as mall number of publications that cover only certain aspects of the disease, but there are no works devoted to a comprehensive approach to the treatment and rehabilitation of such patients. The analysis of literature data on diagnostics, methods of examination,options for conservative and surgical treatment depending on the type of detected pathology and functional needs of a patient with different types of MS is carried out. Recommendations for testing and evaluating functional status are described, and the most common options for conservative and surgical treatment that take into account specific problems that reduce the patient’s quality of life are presented. It is necessary to study the problem of MPs in adult patients in more detail, as well as to coordinate specialists who have experience in managing patients with metabolic disorders, in order to improve the results of treatment and rehabilitation of patients with this pathology.

The prevalence of liver cancer is increasing over the years and it is the fifth leading cause of mortality worldwide. The intrusive features and burden of low survival rate make it a global health issue in both developing and developed countries. The recommended chemotherapy drugs for patients in the intermediate and advanced stages of various liver cancers yield a low response rate due to the nonspecific nature of drug delivery, thus warranting the search for new therapeutic strategies and potential drug delivery carriers. There are several new drug delivery methods available to ferry the targeted molecules to the specific biological environment. In recent years, the nano assembly of lipoprotein moieties (lipidic nanoparticles) has emerged as a promising and efficiently tailored drug delivery system in liver cancer treatment. This increased precision of nano lipoproteins conjugates in chemotherapeutic targeting offers new avenues for the treatment of liver cancer with high specificity and efficiency. This present review is focused on concisely outlining the knowledge of liver cancer diagnosis, existing treatment strategies, lipoproteins, their preparation, mechanism and their potential application in the treatment of liver cancer.

Introduction. The absence of a single surgical tactic for a long gap esophageal atresia (LGEA) treatment as well as frequent unsatisfactory results of applying existing treatment methods urge searching and implementing of a new surgical approach to remediation of malformation. Objective. To optimize surgical treatment of LGEA and provide preservation of native esophagus by elongating and pouches growth inducting. Materials and methods. 6 clinical cases of patients with LGEA who had been treated in National children specialized hospital “Okhmatdyt” during 2018-2019 were analyzed. All patients received staged malformation remediation by elongating of esophagus pouches with traction sutures with further formation of anastomosis. Results. 6 patients with LGEA were surgically treated by esophageal lengthening using the Foker process. The duration of traction varied from 6 to 19 days, the average daily distance of traction of each segment was from 2,4 to 4,8 mm. Segment growth efficiency was observed by diagnostics of metal clips positioning at the ends of esophagus segments on X-ray, or esophagography. In all 6 cases the application of dozed staged traction resulted in esophagus lengthening with elimination of gap from 0-1,0 sm, so that anastomosis of native esophagus was accomplished with the further oral feeding. Conclusions. The method of growth induction allows to overcome a long gap between segments of the atretic esophagus, create conditions for the formation of anastomosis and preserve own esophagus with the restoration of age-related oral nutrition. The concept of induction of esophageal growth eliminates or reduces the use of intestinal plastic of esophagus. The Foker process is an organ-preserving method and is an alternative to operations with loss of an esophagus.

The work deals with the use of flotation combines for the treatment of waste water from heavy metals. The analysis of various methods of treatment of waste water from heavy metals was carried out, which revealed the most promising technical solutions with their possible implementation for modernization of existing treatment facilities of the enterprise. Experimental studies of several versions of technological schemes were carried out on the basis of which a technological scheme of waste water treatment was selected, including all positions of equipment existing at local treatment facilities, and supplemented with a reagent treatment unit, treatment in a flotation complex using reagents, application of filters and pH correction.

The accumulation of micropollutants (MPs) and their increasing concentration in the aquatic environment are an emerging issue for water quality in the world. The complex web of exposure pathways, as well as the variety in the chemical structure and potency of MPs, represents enormous challenges for researchers and policy initiatives. In order to manage MPs, it has to be decided which of them have to be reduced and to what extent, where in the water cycle this would be the most efficient and which technical means that should be applied to be sustainable. All of these aspects require a knowledge of MPs abundance, properties, fate and impact in the environment, which is essentially determined by two related features: the sources and the physico-chemical characteristics of MPs. Micropollutants including pharmaceuticals, antibiotics and hormones can enter the aquatic environment through both diffuse and point sources, but in urbanised regions wastewater treatment plants (WWTPs) play a crucial role in their dissemination. Conventional WWTPs are effective in removal of macropollutants (e.g. nutrients, suspended solids and some trace elements), while MPs may go through the treatment unchanged or be removed at different rates. Most of the EU countries are convinced that the presence of MPs in the environment poses a serious problem, particularly in highly populated regions where surface water resources serve as a source of potable water. Presently, various technical solutions are available and have been proven possible to integrate with existing treatment processes in an expedient manner. The solutions that have been evaluated are mainly based on ozonation and/or activated carbon treatment technologies which may definitely be considered the most effective compared to the costs incurred.

Purpose: To evaluate efficacy and safety of ripasudil for 1 year in addition to or replacing existing treatment regimens. Methods: We retrospectively reviewed the medical records for 128 eyes of 12...

Cancer is one of the leading causes of death worldwide. Despite improvement in existing treatment modalities and addition of new anticancer drugs in the cancer clinic, cancer associated mortalities are continuously increasing. It is therefore, necessary to explore alternative treatment options to reduce the burden of cancer. In recent years, there is growing concern toward the use of natural products for treating cancer because of their ability to target multiple signaling molecules. α-solanine is a glycolalkaloid mainly present in potato tuber and Nightshade family plants. It possesses anti-pyretic, anti-diabetic, anti-allergic, anti-inflammatory and antibiotic activities. In recent years, α-solanine has been explored for its anticancer activity and showed promising results. Among all sources, potato peel contains adequate concentration of α-solanine. Every year, a large volume of potato peel is produced as a waste or sold at low cost. So α-solanine can be proved as an effective and cheap source for cancer therapy. The aim of this review is to summarize the recent data on anticancer activity of α-solanine and discuss it as a potential lead for cancer therapy.

Numerous microbial contaminants persist after the implementation of rainwater treatment strategies, which necessitates the investigation of combination treatment methods. As the development of cost-effective combination treatment methods may aid in increasing global access to safe water, this study aimed to highlight the innovative ways in which existing treatment technologies, such as solar disinfection, may easily be adapted and improved for use in specifically developing countries. In addition, as biological treatment approaches (application of bacteriophages and predatory bacteria) have recently been investigated for rainwater treatment, the advantages and disadvantages associated with the use of these techniques as well as future research needs were reviewed. Finally, the assessment of water treatment systems using molecular-based viability assays was highlighted, as recent studies have reported that these assays may provide a more accurate indication of treatment efficiency (as compared to traditional culture-based analysis), and the data generated can be used in quantitative microbial risk assessment.

Inflammatory bowel disease, a group of inflammatory conditions of the colon and small intestine, principally includes ulcerative colitis and Crohn's disease. Current attention to inflammatory bowel disease is promoted by worldwide increase in its incidence and morbidity as well as shortcomings of existing treatment. Extraintestinal (musculoskeletal, skin, renal, hepatic etc.) manifestations of inflammatory bowel disease significantly complicate the diagnosis and may predict the development of intestinal symptoms. In certain cases, the severity of extraskeletal manifestations may exceed that of the main diagnosis. Here we describe a clinical example of this scenario.

The article is devoted to the urgent problem of practical medicine – the treatment of primary cephalgia. The prevalence of chronic tension headache among the population of European countries is extremely high. Primary headaches are on the list of the most common causes of disability in all over the world. At the same time, existing treatment methods are often not able to completely cure this pain syndrome. In this work, the authors conducted a study on a new approach in the treatment of chronic daily headache: a combination of the non-pharmacological approach – stimulation of the trigeminal system using the Cefaly and the medication – the use of Kalmirex myorelaxant.In 61 patients with chronic daily headache, the effectiveness of the proposed approach was shown both in the relief of pain and in positive changes in the psychoemotional status and quality of life of patients.

Background Although treatment guidelines exist for melanoma in situ and invasive melanoma, guidelines for other melanocytic skin lesions do not exist. Objective To examine pathologists' treatment suggestions for a broad spectrum of melanocytic skin lesions and compare them with existing guidelines. Methods Pathologists (N = 187) completed a survey and then provided diagnoses and treatment suggestions for 240 melanocytic skin lesions. Physician characteristics associated with treatment suggestions were evaluated with multivariable modeling. Results Treatment suggestions were concordant with National Comprehensive Cancer Network guidelines for the majority of cases interpreted as melanoma in situ (73%) and invasive melanoma (86%). Greater variability of treatment suggestions was seen for other lesion types without existing treatment guidelines. Characteristics associated with provision of treatment suggestions discordant with National Comprehensive Cancer Network guidelines were low caseloads (invasive melanoma), lack of fellowship training or board certification (melanoma in situ), and more than 10 years of experience (invasive melanoma and melanoma in situ). Limitations Pathologists could not perform immunohistochemical staining or other diagnostic tests; only 1 glass side was provided per biopsy case. Conclusions Pathologists' treatment suggestions vary significantly for melanocytic lesions, with lower variability for lesion types with national guidelines. Results suggest the need for standardization of treatment guidelines for all melanocytic lesion types.

Pancreaticobiliary cancers are a group of malignancies affecting the pancreas and biliary tract and are often associated with poor prognosis. Existing treatment strategies for these malignancies are limited. However, with the development of more advanced genomic analysis techniques, several mutations have been identified that may be targeted for the development of novel treatments. Key targets of interest include DNA damage repair (DDR) pathways for both pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancer (BTC) as well as isocitrate dehydrogenase 1 (IDH1) and fibroblast growth factor receptor (FGFR) in BTC and mismatch repair (MMR) genes and germline mutations in PDAC. Additionally, a better understanding of the immune microenvironment of pancreatic and biliary cancers has revealed cell types and signaling pathways that may be leveraged for treatment. This includes PD-L1 and CTLA-4 immune checkpoints, tumor-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), and dendritic cells (DCs). Together, targeted agents and immunotherapy strategies have the potential to significantly improve the existing treatment landscape for pancreaticobiliary cancers.

With the rising prevalence of type 2 diabetes (T2D), there is a substantial interest in novel, glucose-lowering drugs that may complement existing treatment options. Imeglimin is an oral antidiabetic agent currently in clinical development.This review is based on a literature search using PubMed and Embase including all published manuscripts and presentations concerning imeglimin. Supplementary information was retrieved from the manufacturer's official webpage. Preclinical and clinical data are summarized with a focus on mechanisms of action as well as clinical efficacy and safety in T2D.Imeglimin's mode of action seems to be improved mitochondrial function in pancreatic beta cells leading to improved insulin secretion and lowering of plasma glucose levels. In clinical trials of up to 24 weeks, imeglimin in doses of 1,000-1,500 mg twice daily conferred modest reductions in glycates hemoglobin A1c of 6-11 mmol/mol (0.5-1.0%) (placebo-adjusted) as a monotherapy and 7 mmol/mol (0.6%) as an add-on therapy to metformin or sitagliptin in patients with T2D. Reported adverse effects were mainly gastrointestinal discomfort. The position of imeglimin among other pharmacotherapies in the treatment of T2D will be determined based on future studies more clearly outlining the safety and long-term cardiovascular effects.AUC: area under the curve; BID: twice daily; DPP-4: dipeptidyl peptidase 4; GLP-1R: glucagon-like peptide-1 receptor; HbA1c: glycated hemoglobin A1c; HFHSD: high-fat high-sucrose diet; OAD: oral antidiabetic; OD: once daily; OGTT: oral glucose tolerance test; PPAR-γ: peroxisome proliferator-activated receptor gamma; PTP: permeability transition pore; SGLT-2: sodium-glucose transport protein 2; STZ: streptozotocin; T2D: type 2 diabetes.

Melanoma, as for many other cancers, undergoes a selection process during progression that limits many innate and adaptive tumor control mechanisms. Immunotherapy with immune checkpoint blockade overcomes one of the escape mechanisms but if the tumor is not eliminated other escape mechanisms evolve that require new approaches for tumor control. Some of the innate mechanisms that have evolved against infections with microorganisms and viruses are proving to be active against cancer cells but require better understanding of how they are activated and what inhibitory mechanisms may need to be targeted. This is particularly so for inflammasomes which have evolved against many different organisms and which recruit a number of cytotoxic mechanisms that remain poorly understood. Equally important is understanding of where these mechanisms will fit into existing treatment strategies and whether existing strategies already involve the innate killing mechanisms.

Objective: Urethral stricture is a highly prevalent disease and has a continued rising incidence. The global burden of disease keeps rising as there are significant rates of recurrence with the existing management options with the need for additional repeat procedures. Moreover, the existing treatment options are associated with significant morbidity in the patient. Long segment urethral strictures are most commonly managed by augmentation urethroplasty. We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from urethral stricture disease. The decreased morbidity due to the avoidance of harvest of buccal mucosa, decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty. Methods: Nine patients with long segment anterior urethral strictures (involving penile and/or bulbar urethra and stricture length >4 cm) were included in the study after proper informed consent was obtained. Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique. Results: A total of nine patients underwent tissue engineered indigenous pericardial patch urethroplasty for long segment urethral strictures, mostly catheter injury induced or associated with balanitis xerotica obliterans. Median follow-up was 8 months (range: 2–12 months). Out of nine patients, eight (88.9%) were classified as success and one (11.1%) was classified as failure. Conclusion: Our study brings a product of tissue engineering, already being used in the cardiovascular surgery domain, into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty. Keywords: Stricture urethra, Urethroplasty, Bovine pericardial patch, Tissue engineering, Long segment

Resource Recovery from Waste Electronics has emerged as one of the most imperative processes due to its pressing challenges all over the world. The Printed Circuit Board (PCB) is one of the typical E-waste components that comprise large varieties of metals and nonmetals. Urban Mining of these metals has received major attention all over the world. The existing treatment procedures used extensively for the resource extraction are hydrometallurgy and pyro-metallurgy and crude recycling practices in the informal sector. However, these methods are prone to cause secondary pollutants with certain drawbacks. Also, the existing informal recycling procedures resulted in insignificant occupational health hazards and severe environmental threats. The application of biotechnology is extensively exploited for metal extraction and emerged as one of the sustainable and eco-friendly tools. However, a limited field-scale study is prevailing in the realm of resource recovery from E-waste using bioleaching method. Hence, the application of bioleaching requires more attention and technical know-how in developing countries to curtail crude practices. The application of bioleaching in E-waste, including its available methods, kinetics mechanism associated opportunities, and barriers, have been discussed in this paper. A glance of E-waste management in India and the menace of 95% crude E-waste recycling are also elaborated. The incentives toward profit, socio-economic, and environmentally sustainable approaches have been delineated based on critical analysis of the available literature., Graphical Abstract

The treatment of source-separated biowaste is still a challenge due to its high proportion of impurities. Biowaste bins are intended exclusively for the collection of biodegradable matter, such as food, kitchen and garden waste. However, plastics, metals, glass and textiles are also found in biowaste bins. If not properly removed, these impurities cause problems to the treatment facility and depreciate the quality of the final product, when the biowaste is converted to compost. There is ongoing discussion whether the existing treatment systems are able to remove impurities, especially plastics, from biowaste thoroughly enough to ensure that the produced compost complies with state regulations. In this work, two wet mechanical pre-treatment systems were tested for their efficiency to remove impurities. The first system consisted of a screw mill, a star screen, and a food unpacking machine (process I). The second system consisted of a shredder, followed by a piston press with 12 mm pore size (process II). Both processes produced a dry output, which contained the concentrated impurities, and a wet output, which could be used as substrate for anaerobic digestion. Results showed that, although 99% of the incoming plastics were efficiently removed in process I, the impurities concentration was still too high to meet the legal standards of plastics concentration in the final product, according to the German Federal Compost Quality Association (Bundesgutegemeinschaft Kompost e.V.). The removal efficiency of glass particles was low for both processes: at least 80% of the incoming particles were transferred to the wet output.

This article aims to provide an overview on the diagnosis and management of hypersensitivity pneumonitis (HP). We will focus on the issues surrounding the lack of an international consensus on the diagnosis of HP, and review the existing treatment options for HP. There is emerging international consensus that HP should be classified based on clinical, radiologic, and pathologic features and not solely on disease duration. Environmental assessment and antigen avoidance remains the most important step in managing HP. Antifibrotics may soon become a viable option for chronic HP in the near future. Well-designed prospective controlled studies are underway. Substantial gaps still remain in our understanding of the diagnosis and management of HP. Further research should focus on establishing internationally accepted diagnostic criteria and clinical practice guidelines to aid the clinician in the challenging treatment of patients with HP.

Aim. To review and analyze the basic methods of treating early laryngeal cancer used in clinical practice. Material and Methods. Scientific articles on the subject listed in the international science-computer bases were selected for analysis. The basic indications and contraindications for application of various surgical and non-surgical methods of treatment of early laryngeal cancer were determined. Results and Discussion. The goal of treatment of early laryngeal cancer at the present stage is not only ablastic elimination of the tumor, but also preservation of the organ and its linguistic function. The development of endoscopic and robotic surgical techniques as well as of radiation therapy equipment has greatly expanded the arsenal of procedures for a physician over the last decade. At the same time, the accumulated experience of large medical centers allowed to separate indications for each of the methods. Analysis and systematization of their results will allow changing the existing treatment principles, identifying groups of patients for the optimal surgical or radiotherapy treatment, which will preserve voice and reduce the frequency of relapse. Conclusions. In early laryngeal cancer patients have two main methods of treatment: radiotherapy or surgery. For the final choice, it is necessary to take into account a number of circumstances: the location and prevalence of the process; the duration of treatment; the cost and effectiveness of treatment; the experience and skills of ENT-surgeon.

Fear of driving is common in the general population and can lead to serious constraints in everyday life. There has been increased attention to this area of research and clinical practice over the past few decades, and a summary of the literature on treatment approaches is timely. This article gives an overview of the current state of research on driving fear and its treatment. First, the main findings about the construct and diagnosis are summarized, including understandings of the epidemiology and etiology of driving fear. Second, existing treatment studies of cognitive and behavioral therapy, virtual reality therapy, trauma-focused and hypnosis-based interventions and treatment approaches using technological aids such as driving-simulators are presented. Until now, no randomized controlled trials (RCT) on the treatment of driving fear have been conducted. Suggestions for future research are made, especially with regard to further exploration of diagnostic features of driving fear and the need for RCTs and robust treatment procedures.

The treatment of different types of wastewater by physicochemical or biological (nonmicroalgal) methods could often be either inefficient or energy-intensive. Microalgae are ubiquitous microscopic organisms, which thrive in water bodies that contain the necessary nutrients. Wastewaters are typically contaminated with nitrogen, phosphorus, and other trace elements, which microalgae require for their cell growth. In addition, most of the microalgae are photosynthetic in nature, and these organisms do not require an organic source for their proliferation, although some strains could utilize organics both in the presence and absence of light. Therefore, microalgal bioremediation could be integrated with existing treatment methods or adopted as the single biological method for efficiently treating wastewater. This review paper summarized the mechanisms of pollutants removal by microalgae, microalgal bioremediation potential of different types of wastewaters, the potential application of wastewater-grown microalgal biomass, existing challenges, and the future direction of microalgal application in wastewater treatment. 2020 by the authors. Licensee MDPI, Basel, Switzerland. Funding: This research was funded by Qatar National Research Fund, grant number NPRP8-646-2-272, and the APC was funded by Qatar National Library. Scopus

Ansha Bharath,1 Srikanth SC Madabhushi2 1Government Dental College and Research Institute, Bangalore, India; 2University of Colorado, Boulder, CO, USACorrespondence: Srikanth SC Madabhushi Tel +1-303-735-0262Email mscs@colorado.eduIntroduction: Infection of the facial spaces and the associated exudate can often necessitate surgical intervention. Whilst traditional decompression methodologies have reduced the mortality rate from complications such as Ludwig’s Angina, there has been relatively little innovation in the procedure to minimize treatment times and patient distress. Negative pressure wound therapy, which can yield improvements to treatment time, wound healing and patient experience, has gained traction in abscess treatments in other parts of the body but seen limited adoption in maxillofacial surgeries.Methods: A focused literature review explores the existing treatment methodologies for infected facial space decompression and identifies obstacles to implementing negative pressure wound therapy in maxillofacial surgeries. A novel drainage tool, which features a sleeved sponge over a perforated drainage tube, is proposed. Virtual prototyping and structural analyses of the novel drainage device including a parametric design study are presented.Results: The parametric study validates the proposed tool’s biocompatibility in terms of overall flexural and axial stiffness between the tool and complex structures in the head and neck. Ultimately, this work presents a necessary first step in the development of specialized drainage tools to promote the adoption of negative pressure wound therapy for infections of facial spaces.Keywords: space decompression, facial space infection, vacuum-assisted drainage, negative pressure wound therapy, drainage devices, virtual prototyping

Background and Objectives: Anterior canal BPPV is a rare BPPV variant. Various diagnostic and therapeutic maneuvers have been described for its management. The aim of this study was to use three-dimensional simulation models to visualize otoconial debris movement within the anterior canal during diagnostic tests and different liberatory maneuvers. This can help to optimize existing treatment maneuvers and help in the development of better management protocols.Methods: Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Simulations of the supine head-hanging test for diagnosis of ac-BPPV were studied. Three repositioning maneuvers were simulated: 1) the Yacovino maneuver and its modifications, 2) the reverse Epley maneuver and 3) the short canal repositioning (CRP) maneuver.Results: The simulation showed that the supine head-hanging test is a good test for diagnosis of ac-BPPV affecting both labyrinths and demonstrated why there is no inversion of nystagmus on sitting up. The Yacovino maneuver was seen to be an effective treatment option for ac-BPPV without having to determine the side involved. However, simulations showed that the classical Yacovino maneuver carried a risk of canal switch to the posterior canal. To overcome this risk, a modified Yacovino maneuver is suggested. The reverse Epley maneuver was not an effective treatment. Short CRP is useful in ac-BPPV treatment; however, it requires determination of side of involvement.Conclusion: The 3D simulator of the movement of the otoconial debris presented here can be used to test the mechanism of action and the theoretical efficacy of existing diagnostic tests and maneuvers as well as to develop new treatment maneuvers to optimize BPPV treatment.

The bioremediation of emerging pollutants in wastewater via algal biotechnology has been emerging as a cost-effective and low-energy input technological solution. However, the algal bioremediation technology is still not fully developed at a commercial level. The development of different technologies and new strategies to cater specific needs have been studied. The existence of multiple emerging pollutants and the selection of microalgal species is a major concern. The rate of algal bioremediation is influenced by various factors, including accidental contaminations and operational conditions in the pilot-scale studies. Algal-bioremediation can be combined with existing treatment technologies for efficient removal of emerging pollutants from wastewater. This review mainly focuses on algal-bioremediation systems for wastewater treatment and pollutant removal, the impact of emerging pollutants in the environment, selection of potential microalgal species, mechanisms involved, and challenges in removing emerging pollutants using algal-bioremediation systems.

Intervertebral disc (IVD) represents a structure of crucial structural and functional importance for human spine. Pathology of IVD institutes a frequently encountered condition in current clinical practice. Degenerative disc disease (DDD), the principal clinical representative of IVD pathology, constitutes an increasingly diagnosed spinal disorder associated with substantial morbidity and mortality in recent years. Despite the considerable incidence and socioeconomic burden of DDD, existing treatment modalities including conservative and surgical methods have been demonstrated to provide a limited therapeutic effect, being not capable of interrupting or reversing natural progress of underlying disease. These limitations underline the requirement for development of novel, innovative, and more effective therapeutic strategies for DDD management. Within this literature framework, compromised IVD replacement with a viable IVD construct manufactured with tissue-engineering (TE) methods has been recommended as a promising therapeutic strategy for DDD. Existing preliminary preclinical data demonstrate that proper combination of cells from various sources, different scaffold materials, and appropriate signaling molecules renders manufacturing of whole-IVD tissue-engineered constructs a technically feasible process. The aim of this narrative review was to critically summarize current published evidence regarding particular aspects of IVD-TE, primarily emphasizing in providing researchers in this field with practicable knowledge to enhance clinical translatability of their research and informing clinical practitioners about the features and capabilities of innovative TE science in the field of IVD-TE. Impact Statement Human intervertebral disc (IVD) pathology represents an extremely frequent condition in current clinical practice. Given the considerable limitations of available treatment options, deployment of novel and groundbreaking therapeutic modalities constitutes a rather urgent need. Tissue engineering of entire human IVD, a technically feasible process within laboratory framework, is theoretically capable of overcoming limitations that characterize currently applied therapeutic measures. Optimization of laboratory manufacturing techniques in conjunction with more diligent

Depression is a global health crisis that becomes increasingly urgent as depression rates continue to rise. While impressive progress has been made in understanding and treating depression, we face many more unknowns, and existing treatment options are not effective for all patients and all depressive episodes. In recent years, the microbiota-gut-brain axis has emerged as a promising research direction as increasing evidence shows the gut microbiota and the brain to be closely linked. This review presents the most compelling evidence for a bidirectional relationship between the gut microbiota and the brain, zooms in to examine putative neural, neuroimmune, neuroendocrine, and neurometabolic mechanisms involved in bottom-up communication, reviews existing evidence for probiotics, and discusses challenges and future directions of the field. Further research on the microbiota-gut-brain axis could provide a better understanding of the pathogenesis of depression and reveal opportunities for novel preventions and treatments.

In the context of current clinical practice guidance, this paper will analyse the role of GPs in decision-making about the primary prevention of cardiovascular disease (CVD) using the concept of pharmaceuticalisation. Drawing on thematic analysis of semi-structured interviews with 20 GPs, the paper argues that the way GPs approach CVD pharmaceuticalisation is shaped by their understandings of and use of guidelines (and the knowledge they embody), existing treatment perspectives and the moral qualities of preventative treatment, and professional evaluations of ‘relevant’ information. The analysis indicates that there exist disparate and distinct approaches to and understandings of CVD pharmaceuticalisation amongst GPs. Depending on how knowledge, treatment perspectives and values variously combine, GPs sit somewhere on a spectrum of how pharmaceuticalised they are in terms of the approaches to and understandings of the prevention of CVD.

Nose augmentation with Hyaluronic acid (HA) fillers has been considered the preferred technique for minimally invasive cosmetic procedures. Despite severe complications related to HA injection are rare, none of the existing treatment protocols has been established as standard. The aim of this report is to present an alternative approach to treat nasal skin necrosis related to HA injection. A high dose of hyaluronidase - 6000 IU was applied in the nose, for the purpose of reversing a necrotic process. The present findings suggest that a high dose of hyaluronidase could be a promising approach to treat severe nasal skin necrosis caused by HA filler.

Bulimia is an eating disorder characterised primarily by binging and 'inappropriate' compensatory behaviours, such as purging or excessive exercise. Many individuals with bulimia experience chronic disordered eating, dissatisfaction with treatment, and difficulty establishing a 'new life'. Recovery-oriented practice, which focuses holistically on the person and their own aspirations for treatment, has recently been advocated in the treatment of eating disorders in Australia and other countries. However, questions have been raised about how this practice might be integrated into existing treatment approaches. Taking a social constructionist approach and using a case study of one woman's account, together with literature on patients' treatment experiences, we examined recovery from bulimia. Three themes were identified: bulimia was constructed as 'consuming one's life', an experience protracted through treatment ('treatment and becoming the eating disorder'), which makes life 'beyond treatment and attempting to live without bulimia' challenging. Based on this analysis, we argue that recovery-oriented practice, while seemingly commensurate with patients' needs, may be challenged by long-standing meanings of mental illness and experience of bulimia specifically.

In the 1990s, a trial of prescribing pharmaceutical heroin for people with opioid-dependence had support from Australian State Health Ministers. However, in 1997 the proposal was vetoed by the federal Prime Minister in face of a negative tabloid media campaign. The debate then shifted to abstinence-orientated treatments. Later on, reduced heroin availability took opioid-related harms away from public sight. In this commentary, we aimed to explore the current need and the options to implement such program, lately referred to as supervised injectable opioid treatment (SIOT), in Australia. We argue that with the aging populations of opioid-dependent people who have not benefited from existing treatment options, increased misuse of prescription opioids, rising overdose rates, and the risk of unfolding overdose crisis, it seems timely to pilot SIOT here. Since the 1990s, seven RCTs as summarised in two systematic literature reviews, demonstrated that SIOT is effective for treatment-resistant opioid dependence. A sustainable SIOT model should, however, respond to key concerns related to its delivery, such as the lack of a patient exit strategy and the high cost of indefinite treatment. Evidence from long-term studies seem to support the notion that SIOT could be provided as a medium duration treatment (as opposed to short-term or indefinite), with the clear aim to stabilise patients, gradually wean them off injectable medication and transfer to opioid assisted treatment (OAT). Also, SIOT could be integrated into the existing public OAT clinics in Australia. This would reduce costs, but also provide a more patient-centred response to opioid dependence and further improve the acceptability and efficiency of OAT. The controversy that developed in the past should be mitigated by advances in research since the first Australian enquiry, use of a registered medication (open-label hydromorphone) rather than pharmaceutical heroin, and setting up clear treatment aims.

Introduction Timing of cleft palate repair and the method of speech outcome measurement in children with cleft lip and palate are much debated topics. The associated problems and quality of life in these children depend on the timing of the surgery. Aim The aim of this study was to investigate the velopharyngeal (VP) function and resonance parameters in children following early cleft palate repair. Method A total of 25 Kannada-speaking children with early repaired cleft palate were subjected to speech assessment and videofluoroscopic assessment. Perceptual speech parameters measured were severity of hypernasality and presence of nasal air emission. Videofluoroscopy was interpreted in terms of closure ratios to predict the severity of VP dysfunction. Results The analysis of videofluoroscopic images indicated that 48% of children had complete VP closure and 52% had perceptually normal resonance. A good correlation was found between the closure ratio and hypernasality. Conclusion Understanding the perceptual speech parameters and their structural correlates for outcome measurement will give better evidence for refining the existing treatment protocols. Data on a larger population are warranted for establishing predictors of optimum speech outcome.