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OBJECTIVE To assess the effect of tibial compression on radiographic cranial tibial translation measurements in healthy dogs and those with cranial cruciate ligament (CCL) rupture and establish specific criteria for the radiographic diagnosis of CCL rupture. ANIMALS 60 dogs. PROCEDURES Dogs were divided into 3 groups with 20 dogs each: group 1, healthy adult dogs; group 2, adult dogs with CCL rupture; and group 3, healthy young dogs. For each dog, 2 images of the stifle joint in mediolateral projection were taken, of which 1 was conventional and 1 was under tibial compression. Variables were measured in each radiographic projection: the patellar ligament angle, the patellar ligament insertion angle, the angle of tibial translation measured by 2 different methods, and the linear distance between the points of CCL origin and insertion (DPOI). Additionally, a novel variable, DPOI ratio, was evaluated. RESULTS Regarding radiographic positioning, tibial compression significantly changed most of the variables in the within-group comparison. The variable DPOI were not different with and without tibial compression in the group of healthy adult dogs but were different for dogs with CCL rupture. Thus, these are important parameters in the diagnosis of CCL rupture. In the analysis of a novel variable, DPOI ratio, dogs with CCL rupture could be distinguished from healthy dogs at a high level of specificity and sensitivity. CLINICAL RELEVANCE DPOI ratio values above 1.18 were consistently indicative of CCL rupture, thus allowing for a precise radiographic diagnosis of the condition.

As surgeons, in order to appreciate the possibilities of the future we must look back at our past. In honor of the 75th anniversary of the American Society of Maxillofacial Surgeons (ASMS), this historical article—the first in a series of 3 papers looking at the history of the ASMS and the evolution of craniomaxillofacial surgery as a distinct surgical subspecialty—reviews key figures and events that are germane to the development of our field from 1947, when the ASMS was founded, to 1971.

Background: Foreign accent syndrome is a rare speech disorder in which patients develop a sudden change in accent (eg, from American English to British accent) secondary to neurogenic, psychogenic, structural, or mixed causes. Orthognathic surgery may produce alterations in speech in select patients. Until now, foreign accent syndrome has not been noted after orthognathic surgery. Methods: A retrospective study of patients who underwent orthognathic surgery and developed foreign accent syndrome was conducted to document surgical details, postoperative course, speech evaluations, perioperative imaging and follow-up outcome (n = 5). Results: Patients who developed FAS after orthognathic procedures had an age range of 19 to 42 years and changed speech from American English to a British accent almost immediately in the postoperative period. There were no perioperative complications. Speech therapy revealed similar speech patterns and articulation changes. Patients found speech therapy helpful and all but 1 patient had resolution of their FAS speech within 2 years. Conclusion: Foreign Accent Syndrome is very rare but may result after orthognathic surgery when presumably a minor neurologic insult from temporary brain ischemia occurs during surgery. However, this phenomenon typically resolves and speech therapy may be helpful.

This study investigated the simultaneous removal of Cd2+ and Pb2+ from wastewater using commercially available Japanese zeolite (JPZ) and its mixtures. A series of batch adsorption experiments were carried out to examine the simultaneous removal of Cd2+ and Pb2+ in binary and multi-metal solutions. Results revealed that JPZ (0.105–2.0 mm) exhibited a higher affinity for Pb2+ (>250 mg/g) over Cd2+ (

Introduction Saethre-Chotzen syndrome is a genetic condition characterized by craniofacial and limb anomalies, with craniosynostosis (mainly coronal) being the most frequent craniofacial finding. Cranial and facial deformities can be extremely variable requiring individualization of treatment strategies. We present our case series to highlight clinical findings, treatment philosophy, and challenges facing Saethre-Chotzen patients. Methods A retrospective review was performed on records of patients given a diagnosis of Saethre-Chotzen syndrome at the University of California Los Angeles (UCLA) Craniofacial Clinic (n = 7) between 1980 and 2010. Patients with complete records were included in this study, and review of demographic data, clinical findings, surgical interventions and postoperative follow-up, and stability were performed. Results Seven patients (1 male and 6 female) were included in this study. The average age at which the patients were first seen was 6.5 years. Suture involvement was bicoronal (n = 6) and unicoronal (n = 1). There was 1 patient having superimposed metopic synostosis, and there was another patient having Kleeblattschadel deformity. Previous procedures performed for patients before establishing care at UCLA were strip craniectomy (n = 2) and fronto-orbital advancement (n = 2). All patients (n = 7) had fronto-orbital advancements at UCLA. Other skeletal operations included the following: redo forehead advancement and contouring (n = 3), monobloc advancement (n = 1), and LeFort III distraction (n = 1). Five patients reached skeletal maturity, and 2 patients received LeFort I advancement for class III malocclusion, one of which also required a bilateral sagittal split osteotomy of the mandible. Conclusion Clinical presentation and severity of deformity in Saethre-Chotzen syndrome are variable. Our current report reviews our treatment strategies and illustrates the predominance of cranial and upper face deformities and frequent need for redo surgeries to address forehead asymmetry in this group of syndromic craniosynostosis patients.

Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related death worldwide. Society guidelines recommend surveillance with abdominal ultrasound with or without serum alpha‐fetoprotein every 6 months for adults at increased risk of developing HCC. However, adherence is often suboptimal. We assessed the feasibility of a coordinated telephone outreach program for unscreened patients with cirrhosis within the Veteran’s Affairs (VA) health care system. Using a patient care dashboard of advanced chronic liver disease in the VA Greater Los Angeles Healthcare System, we identified veterans with a diagnosis of cirrhosis, a platelet count ≤ 150,000/uL, and no documented HCC surveillance in the previous 8 months. Eligible veterans received a telephone call from a patient navigator to describe the risks and benefits of HCC surveillance. Orders for an abdominal ultrasound and alpha‐fetoprotein were placed for veterans who agreed to surveillance. Veterans who were not reached by telephone received an informational letter by mail to encourage participation. Of the 129 veterans who met the eligibility criteria, most were male (96.9%). The most common etiology for cirrhosis was hepatitis C (64.3%), and most of the patients had compensated cirrhosis (68.2%). The patient navigators reached 32.5% of patients by phone. Patients in each group were similar across clinical and demographic characteristics. Patients who were called were more likely to undergo surveillance (adjusted odds ratio = 2.56, 95% confidence interval: 1.03‐6.33). Most of the patients (72.1%) completed abdominal imaging when reached by phone. Conclusion: Targeted outreach increased uptake of HCC surveillance among patients with cirrhosis in a large, integrated, VA health care system., HCC surveillance in patients with cirrhosis is recommended by society guidelines, yet suboptimal. In this quality improvement outreach pilot study within a large VA, we demonstrate that HCC surveillance improves by telephone and mail outreach of patients who have confirmed cirrhosis and had not been screened.

This paper presents a newly-developed billet flow formation method, which produces discontinuous carbon fiber thermoplastic ribbed panels by using the die cushion motion of a press. Billets of discontinuous fiber reinforced thermoplastic were extruded into rib cavities by die cushion motion while press-forming a panel of continuous fiber reinforced thermoplastic. Using billet flow formation, 200 mm long, 46 mm high, 1.4 mm thick ribs comprised of 30 mm long discontinuous fibers were formed on 400 mm wide, 300 mm depth, 50 mm high panels. The rigidity of a ribbed panel was five times greater than a panel without ribs. The tensile strength of the formed ribs was approximately 250 MPa, the same strength of the material before forming. Material behavior such as fiber flow and billet deformation during formation is discussed. This study has shown that the billet flow formation can create ribs with high mechanical strength using only a press with a die cushion.

BACKGROUND Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. METHODS Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. RESULTS Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). CONCLUSIONS Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure.

Transabdominal preperitoneal (TAPP) repair is the most widely used laparoscopic technique for the treatment of inguinal hernia in Japan. Many studies have shown that in comparison with open hernia repair, laparoscopic repair results in less pain and a shorter convalescence. However, postoperative pain remains a concern. One possible cause of postoperative pain in the early postoperative phase is strain or cough on removal of the endotracheal tube. Use of a supraglottic airway (SGA) device helps to avoid such complaints. We evaluated postoperative pain after TAPP repair using the SGA for general anesthesia. We evaluated the postoperative pain in 146 patients with inguinal hernia repaired by TAPP in our hospital between May 2013 and May 2016. A total of 144 adult patients of American Society of Anesthesiologists physical status I and II who underwent needlescopic TAPP surgery were randomly allocated to one of two groups of 72 patients: group A (SGA), in which the patient’s airway was secured with an appropriately sized I-gel, and group B (endotracheal tube), in which the airway was secured under laryngoscopy. There was no significant difference between the groups regarding patient background, postoperative hospital stay, and operation time, and TAPP was performed safely in all cases. In the analysis of postoperative pain, the mean Numerical Rating Scale score of peak pain in group A was significantly less than that of group B (2.10 ± 2.05 vs 2.90 ± 2.65; p = 0.043). In group A, the percentage of patients who had an NRS score of 0 was 51.4% 30 min after surgery, 62.5% after 6 h and 68.1% at POD1, and compared to group B, the NRS scores were significantly higher at POD1 (p = 0.003), and the level of postoperative pain in group A tended to decrease earlier than that in group B. The results of this study are the first to show that an SGA device can reduce postoperative pain after laparoscopic surgery.

In the absence of randomized controlled data and even propensity-matched data, indications for, and outcomes of, laparoscopic repeat liver resection for hepatocellular carcinoma (HCC) remain uncertain. This study aimed to clarify the current indications for laparoscopic repeat liver resection for HCC, and to evaluate outcomes.Forty-two liver surgery centres around the world registered patients who underwent repeat liver resection for HCC. Patient characteristics, preoperative liver function, tumour characteristics, surgical method, and short- and long-term outcomes were recorded.Analyses showed that the laparoscopic procedure was generally used in patients with relatively poor performance status and liver function, but favourable tumour characteristics. Intraoperative blood loss (mean(s.d.) 254(551) versus 748(1128) ml; P 0·001), duration of operation (248(156) versus 285(167) min; P 0·001), morbidity (12·7 versus 18·1 per cent; P = 0·006) and duration of postoperative hospital stay (10·1(14·3) versus 11·8(11·8) days; P = 0·013) were significantly reduced for laparoscopic compared with open procedures, whereas survival time was comparable (median 10·04 versus 8·94 years; P = 0·297). Propensity score matching showed that laparoscopic repeat liver resection for HCC resulted in less intraoperative blood loss (268(730) versus 497(784) ml; P = 0·001) and a longer operation time (272(187) versus 232(129); P = 0·007) than the open approach, and similar survival time (12·55 versus 8·94 years; P = 0·086).Laparoscopic repeat liver resection is feasible in selected patients with recurrent HCC.Dado que no existen ensayos clínicos controlados ni estudios de datos emparejados por puntaje de propensión, todavía hay dudas sobre las indicaciones y los resultados de la resección iterativa laparocópica de un carcinoma hepatocelular (hepatocellular carcinoma, HCC). Este estudio tuvo como objetivo esclarecer las indicaciones actuales y los resultados de la resección hepática laparoscópica iterativa del HCC. MÉTODOS: Se incluyeron los pacientes de 42 centros de cirugía hepática a nivel mundial en los que se había realizado una resección hepática iterativa por HCC. Se analizaron las características del paciente, la función hepática preoperatoria, las características del tumor, el abordaje quirúrgico y los resultados a corto y largo plazo.El análisis demostró que la vía laparoscópica generalmente se utilizaba en pacientes con carácteristicas tumorales favorables, pero con estado funcional y función hepatica relativamente peores. La pérdida de sangre intraoperatoria (254,3 ± 551,2 versus 748,0 ± 1127,7 mL, P 0,001), la duración de la intervención (247,6 ± 155,8 versus 285,1 ± 167,0 minutos, P 0,001), la morbilidad (12,7 versus 18,1%, P = 0,005) y la estancia hospitalaria postoperatoria (10,07 ± 14,29 versus 11,80 ± 11,79 días, P = 0,010) fueron significativamente menores para los pacientes tratados por via laparoscópica en comparacion con la vía abierta, mientra que el tiempo de supervivencia fue comparable (mediana 10,04 versus 8,94 años, P = 0,297). El estudio de emparejamiento por puntaje de propensión mostró que la resección hepática iterativa por vía laparoscópica de un HCC (frente a la vía abierta) conllevaba una menor pérdida sanguínea intraoperatoria (268,0 ± 730,2 versus 496,5 ± 784,2 mL, P = 0,01), una mayor duración de la intervención (272,1 ± 187,2 versus 231,8 ± 129,1 minutos , P = 0,07) y un tiempo de supervivencia similar (mediana 12,55 versus 8,94 años, P = 0,0855). CONCLUSIÓN: La resección hepática iterativa por vía laparoscópica es factible en pacientes seleccionados con HCC recidivado.

To build a processing method for textile carbon fiber reinforced thermoplastic (CFRTP) sheets, a production system to form, cut, and join the sheets by using a mechanical servo press machine was developed and examined. The system's problems were analyzed, and attempts were made to solve them through a series of processes. In press forming, the effects of sheet geometry, fiber orientation, and slide motion on the forming of the variant-cross-sectional-beam, which has a narrow and wide part, were investigated. In addition, the shear-cutting method was chosen trimming the unnecessary region of the variant-cross-sectional-beam. For the joining process, a thermal welding method that uses a heating-plate was chosen. The closed-sectional-beam was fabricated by thermally welding a pair of the variant-cross-sectional-beams. Finally, the potential of the production system for textile CFRTP sheets using the mechanical servo press machine was discussed. © 2016 The Authors Polymer Composites published by Wiley Periodicals, Inc. on behalf of Society of Plastics Engineers., Embargo Period 12 months

Anaerobic-filters are quite expensive due to the high-cost of artificial filtration media. Hence, introducing alternative low-cost filtration media will make anaerobic-filters more economical. The aim of this study was to investigate the performances of several low-cost/waste materials as filtration media in anaerobic-filters to treat organic compounds, nutrients and heavy metals found in landfill-leachate. The experimental set-up consisted of four down-flow anaerobic-filter columns, two of which were control columns while the others were experimental columns. The control columns were filled with Granular Activated Carbon (GAC) and Plastic Pall Rings (PPR) as single medium. The experimental columns were filled with a mixture of Dewatered Alum Sludge (DAS), Washed Sea Sand (WSS), Firewood Charcoal (FWC), while the other with the same materials as layers. During the application of 10% diluted landfill-leachate within a period of 115 days, the overall removal efficiencies of the filter bed with layered-media were 73%, 84%, 61%, 55%, 76% and 79% for COD, BOD5, TN, Ammonia-N (NH3-N), TP and Orthophosphate-P (PO43- -P), respectively. The filter bed with mixed-media gave the overall removal efficiencies of 59%, 87%, 49%, 26%, 71% and 78% for COD, BOD5, TN, NH3-N, TP and PO43- -P, respectively. The experimental columns showed significant removal efficiencies for heavy metals, namely Pb (40%), Cd (48%), Cu (41%) and Mn (52%) in the mixed-media column and (54%), Cd (37%), Cu (54%) and Mn (57%) in the layered-media column.

Introduction Effective postoperative pain management is important following paediatric renal transplant (pRT). Currently, the mainstay of pain control at Great Ormond Street Hospital (GOSH) is opioid analgesia. A previous audit demonstrated that patients on opioid analgesia on the renal ward at GOSH have significantly more postoperative nausea/vomiting and pruritus than non-renal patients. The use of single-shot transversus abdominis plane block (TAPB) and continuous TAP (cTAP) infusions may reduce opioid consumption and related side effects. They have been shown to reduce opioid consumption in the first 24 hours post-surgery in adults (Farag E, et al. Continuous transversus abdominis plane block catheter analgesia for postoperative pain control in renal transplant. J Anesth 2015;29:1, pg 4–8) Methods After institutional approval, an observational study was conducted of pRT recipients. A standard general anaesthetic was administered to all patients. For those receiving a cTAP infusion, a multi-orifice catheter was placed into the wound under direct vision by the surgeon. Statistical analysis was performed using Man Whitney U-test with significance level p Results 38 patients aged 3–17 years with end-stage kidney disease undergoing living donor RT were analysed. 10 received a cTAPB +N/PCA, 28 received TAPB+N/PCA or N/PCA only. The median dose of total postoperative opioid consumption was 1.39, 22.50 and 22.47 mcg/kg/hr in cTAPB +N/PCA, TAPB+N/PCA and N/PCA groups respectively (IQR=0.33, 4.9; 15.83, 28.00; 15.18, 37.48). A significant difference was seen in morphine consumption between TAPB+N/PCA and cTABP +N/PCA groups on D0 (p=0.00453), D1 (p=0.03515) and D2 (p=0.01578). Conclusions The cTAPB technique shortens the duration of N/PCA use and shows promising results for reduction in opioid requirements postoperatively. Patients receiving cTAPB appeared more comfortable and used their N/PCA less.

AIM To determine whether successful treatment with directacting antivirals (DAA) is associated with improvements in hemoglobin A1c (HbA1c) and if type 2 diabetes mellitus (T2DM) or metabolic syndrome affects sustained virologic response (SVR). METHODS We performed a retrospective analysis of all hepatitis C virus (HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment (SVR12). RESULTS A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2DM. Within that cohort, patients who achieved SVR12 had lower mean HbA1c pre treatment (7.35 vs 8.60, P = 0.02), and lower mean HbA1c post-treatment compared to non-responders (6.55 vs 8.61, P = 0.01). The mean reduction in HbA1c after treatment was greater for those who achieved SVR12 than for non-responders (0.79 vs 0.01, P = 0.03). In adjusted models, patients that achieved SVR12 were more likely to have a HbA1c decrease of ≥ 0.5 than those that did not achieve SVR12 (adjusted OR = 7.24, 95%CI: 1.22-42.94). CONCLUSION In HCV patients with T2DM, successful treatment with DAA was associated with a significant reduction in HbA1c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore, the presence of T2DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. HCV cure has been linked to improved patient outcomes. In the era of direct-acting antivirals (DAAs), HCV cure has become the goal, as defined by sustained virological response 12weeks (SVR12) after completion of therapy. Historically, African-Americans have had lower SVR12 rates compared to White people in the interferon era, which had been attributed to the high prevalence of non-CC interleukin 28B (IL28B) type. Less is known about the association between race/ethnicity and SVR12 in DAA-treated era. The aim of the study is to evaluate the predictors of SVR12 in a diverse, single-center Veterans Affairs population. We conducted a retrospective study of patients undergoing HCV therapy with DAAs from 2014 to 2016 at the VA Greater Los Angeles Healthcare System. We performed a multivariable logistic regression analysis to determine predictors of SVR12, adjusting for age, HCV genotype, DAA regimen and duration, human immunodeficiency virus (HIV) status, fibrosis, nonalcoholic fatty liver disease (NAFLD) fibrosis score, homelessness, mental health, and adherence. Our cohort included 1068 patients, out of which 401 (37.5%) were White people and 400 (37.5%) were African-American. Genotype 1 was the most common genotype (83.9%, N=896). In the adjusted models, race/ethnicity and thepresence of fibrosis were statistically significant predictors of non-SVR. African-Americans had 57% lower odds for reaching SVR12 (adj.OR=0.43, 95% CI=1.5-4.1) compared to White people. Advanced fibrosis (adj.OR=0.40, 95% CI=0.26-0.68) was also a significant predictor of non-SVR. In a single-center VA population on DAAs, African-Americans were less likely than White people to reach SVR12 when adjusting for covariates.

Summary Background To determine the need for latency period in membranous bone distraction, we performed 1) in vitro comparison of preosteoblasts suspended in a 3D microdistraction model and 2) a clinical study comparing mandibular distraction cases with/without latency. Methods In the In Vitro study, Preosteoblasts polymerized in 3D-collagen gel were placed in a microdistractor and separated into three groups: 1) distraction with latency, 2) distraction without latency, and 3) static. After 2, 4, 6, and 8 days, cell proliferation, total protein levels, alkaline phosphatase activity, and osteogenic gene expression were assessed through RT-PCR. In the clinical study, patients underwent mandibular distraction in two groups: 1) latency and 2) no latency (n = 45). The rest of the distraction protocol was identical. Outcome was based on clinical examination, radiographs at six months, and 3D CT scans. Results In the In Vitro study, The distraction without latency group compared to the latency group had delays in: proliferation, total protein count, alkaline phosphatase activity, osteogenic gene expression in CBFA-1 (fourfold vs. eighteenfold), and in osteocalcin (twofold vs. sixfold). The distraction without latency group had higher apoptotic levels during the first four days compared to the latency group (68% vs. 14%). For the clinical study, similar perioperative complications (5% vs. 6%), X-ray mineralization (93% vs. 94%), bone volume, (8.6 vs. 9.1 cc) and bone density of central distraction zone (78% vs. 81%) were observed with or without latency. Conclusions In vitro studies showed poorer results in cell survival, proliferation and osteogenic activity compared to distraction with latency; yet, clinically, there were no differences in distraction with latency versus without.

High-temperature and high-voltage characteristics of Cu/diamond Schottky diodes were investigated. Cu Schottky diodes showed clear rectification up to ~ 700 °C. The current–voltage characteristics of the diodes at 400 °C were almost unchanged after keeping them for 30 h, implying they have high stability at ~ 400 °C. The diodes showed specific on-resistance and breakdown voltage of 83.4 mΩ cm2 and 713 V at 400 °C, respectively, which are comparable to reported highest values for diamond Schottky diodes and close to the theoretical limit for 6H-SiC at several hundred °C. These results indicate that Cu/diamond Schottky diodes are promising for high-temperature power applications.

We report a disposable point-of-care sensing platform specific to salivary cortisol detection. The sensor is inkjet printed on a paper substrate with a metalloporphyrin based macrocyclic catalyst ink that can electrochemically reduce cortisol, captured by aptamer functionalized magnetic nanoparticles. The sensor consists of a thin magnet disc, aligned at the back of the electrode, in order to populate the magnetic nanoparticle bound cortisol at the sensing electrode area. Proof of concept studies were performed to detect salivary cortisol levels in human subjects with high and low risks for obstructive sleep apnea (OSA). High selectivity was observed to salivary cortisol against a background of closely related steroids.

To improve the stability of multilayer graphene (MLG) doped with molybdenum pentachloride (MoCl 5 ) for low-resistance interconnects, we have newly developed an in-situ passivation process with molybdenum oxides. The improved air stability of dopants was confirmed with Raman spectroscopy by the direct MoO x passivation at room temperature.

The Tessier number 3 cleft is one of the most intricate and destructive of all facial clefts, presenting surgeons with a difficult task for reconstruction. We present a series of 10 patients with this rare cleft all treated by a single surgeon over 30 years. All patients with Tessier number 3 clefts treated between 1978 and 2008 by the senior surgeon were reviewed. Demographic data and all associated clinical findings including cranial and extracranial anomalies were recorded. Methods used to reconstruct each patient were also noted. Seven males and three females were identified and age at initial treatment ranged from 12 months to 12 years. Mean follow-up was 6.3 years. Multiple craniofacial anomalies were appreciated including other rare facial clefts, hypertelorbitism, lacrimal obstruction, anophthalmia, choanal atresia, and hemifacial microsomia. Amniotic banding was the most prominent extracranial finding noted in these patients. Tessier number 3 clefts can be associated with multiple other craniofacial anomalies making reconstruction challenging. Soft tissue and bony reconstruction must be considered separately, and a variety of tools may be employed to accomplish each goal. As the presentation can be highly variable, an individualized treatment plan must be made to meet each patient's specific needs.

When already limited safe groundwater is rapidly contaminated with landfillleachate, it is a timely need to investigate feasible remediation techniques. In this scenario, Permeable Reactive Barrier (PRB) is a potential groundwater treatment method. If waste materials can be effectively applied as PRB reactive media, the system can be made more economical. This study was focused on a treatment system with two mixed-media PRB models (PRB 1 and PRB 2) connected in series, in which dewatered alum sludge (DAS), washed quarry dust (WQD), washed sea sand (WSS), red soil (RS), bio char (BC) and saw dust (SD) were emplaced in reactive beds, to treat organic compounds and nutrients of leachate-contaminated groundwater. Wastewater parameters were measured in terms of BOD5, COD, NO–3–N , NH3-N , TN, PO3–4–P and TP. Mean removal efficiencies of BOD5 (88.2+5.7%), COD (84.2+9.6%) and NH3-N (95.6+4.2%) were phenomenal with 13.1 days of pore volume hydraulic retention time (HRT) during an experimental period of 140 days. Reactive material properties were not much affected by the interaction with landfillleachate, thus no considerable change in the removal efficiencies occurred within 140 days. The treatment efficiency of the present system with two reactors connected in series is greater than that of a single PRB reactor filled with the same reactive materials in the same packing configuration.

The fine structures of the whole bodies and the posterior silk glands of Bombyx mori during metamorphosis from larvae to pupae in the cocoon were preserved virtually without damage when frozen sections were prepared using an adhesive plastic film. We used frozen sections for histochemical and enzyme histochemistry to characterize the metamorphosis of the posterior silk glands. Frozen sections were stained with DAPI to observe nuclear changes, examined using the TUNEL method to detect DNA fragments, and investigated using in situ hybridization to detect B. mori caspase expression. Both DNA fragments and expression of B. mori caspase increased with progressing metamorphosis. The degeneration of the posterior silk gland during metamorphosis appears to be an apoptotic event.

The high-temperature characteristics of diamond Schottky diodes fabricated using Ag or Ni on in-situ boron-doped diamond were examined. Up to 600 °C, Ag Schottky diodes exhibited a high rectification ratio of the order of 10 4 . Even at ~ 750 °C, their rectification ratio was about 10, indicating that diamond field effect transistors with Ag Schottky diodes can operate at this temperature. In contrast, Ni Schottky diodes did not show clear rectification above 600 °C. An analysis of the I – V curves indicated that the Ag Schottky diodes have a higher rectification ratio than the Ni Schottky diodes at high temperatures due to their higher barrier heights ( ϕ B = ~ 2.0 and ~ 0.7 eV for Ag and Ni, respectively).

Background: Gemcitabine-based chemotherapy is the standard treatment for pancreatic cancer. However, the issue of resistance remains unresolved. The aim of this study was to identify microRNAs (miRNAs) that govern the resistance to gemcitabine in pancreatic cancer. Methods: miRNA microarray analysis using gemcitabine-resistant clones of MiaPaCa2 (MiaPaCa2-RGs), PSN1 (PSN1-RGs), and their parental cells (MiaPaCa2-P, PSN1-P) was conducted. Changes in the anti-cancer effects of gemcitabine were studied after gain/loss-of-function analysis of the candidate miRNA. Further assessment of the putative target gene was performed in vitro and in 66 pancreatic cancer clinical samples. Results: miR-320c expression was significantly higher in MiaPaCa2-RGs and PSN1-RGs than in their parental cells. miR-320c induced resistance to gemcitabine in MiaPaCa2. Further experiments showed that miR-320c-related resistance to gemcitabine was mediated through SMARCC1, a core subunit of the switch/sucrose nonfermentable (SWI/SNF) chromatin remodeling complex. In addition, clinical examination revealed that only SMARCC1-positive patients benefited from gemcitabine therapy with regard to survival after recurrence (P=0.0463). Conclusion: The results indicate that miR-320c regulates the resistance of pancreatic cancer cells to gemcitabine through SMARCC1, suggesting that miR-320c/SMARCC1 could be suitable for prediction of the clinical response and potential therapeutic target in pancreatic cancer patients on gemcitabine-based therapy.

AIMS/HYPOTHESIS: The nuclear receptor peroxisome proliferator-activated receptor gamma (PPARgamma) is an important gene regulator in glucose and lipid metabolism. Unfortunately, PPARgamma-activating drugs of the thiazolidinedione class provoke adverse side effects. As recently shown, amorfrutin A1 is a natural glucose-lowering compound that selectively modulates PPARgamma. In this study we aimed to characterise, in vitro, a large spectrum of the amorfrutins and similar molecules, which we isolated from various plants. We further studied in vivo the glucose-lowering effects of the so far undescribed amorfrutin B, which featured the most striking PPARgamma-binding and pharmacological properties of this family of plant metabolites. METHODS: Amorfrutins were investigated in vitro by binding and cofactor recruitment assays and by transcriptional activation assays in primary human adipocytes and murine preosteoblasts, as well as in vivo using insulin-resistant high-fat-diet-fed C57BL/6 mice treated for 27 days with 100 mg kg(-1) day(-1) amorfrutin B. RESULTS: Amorfrutin B showed low nanomolar binding affinity to PPARgamma, and micromolar binding to the isotypes PPARalpha and PPARbeta/delta. Amorfrutin B selectively modulated PPARgamma activity at low nanomolar concentrations. In insulin-resistant mice, amorfrutin B considerably improved insulin sensitivity, glucose tolerance and blood lipid variables after several days of treatment. Amorfrutin B treatment did not induce weight gain and furthermore showed liver-protecting properties. Additionally, amorfrutins had no adverse effects on osteoblastogenesis and fluid retention. CONCLUSIONS/INTERPRETATION: The application of plant-derived amorfrutins or synthetic analogues thereof constitutes a promising approach to prevent or treat complex metabolic diseases such as insulin resistance or type 2 diabetes.

Cu2ZnSnSe4 ingot was synthesized and then used as a precursor for selenization process in order to fabricate Cu2ZnSnSe4 thin films. The thin films were prepared at each point A-F in our selenization process and their properties were investigated. Cu2ZnSnSe4 ingot and thin films had a kesterite Cu2ZnSnSe4 structure. From EPMA analysis and XRD studies, the mechanism of Cu2ZnSnSe4 formation was discussed. Cu-Se phases were related to Cu2ZnSnSe4 formation. Cu2ZnSnSe4 may decompose to Sn-Se compound during the annealing process at 550 oC. Cu2ZnSnSe4 thin film solar cells demonstrated Voc=300 mV, Isc=7.25 mA/cm2. The band gap energy of Cu2ZnSnSe4 thin film determined from the QE spectra estimated to be approximately 1.04 eV. (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

BACKGROUND The philtrum and the Cupid's bow are the most prominent features of the upper lip and are crucial for normal appearance. Unfortunately, projection of the philtral column is a common deficiency of the repaired cleft lip. Although a multitude of methods for constructing the philtral dimple and ridge have been described, no single procedure has achieved complete satisfactory results. The authors describe their technique for construction of the philtral column using palmaris longus tendon. METHODS Between 1998 and 2009, a retrospective study was performed for identifying patients with depression of the philtral scar following cleft lip repair. Pre- and postoperative photographs were taken with at least 6 months follow-up. Postoperative patient satisfaction and occurrence of complications are reported. RESULTS In all, 17 patients who developed depression of the philtral ridge following cleft lip repair underwent philtral reconstruction utilizing palmaris longus tendon grafts by the senior author (H.K.K.). At the time of surgery, average age for 11 females and 6 males was 18.5 years. The follow-up period ranged from 6 to 126 months, with an average of 42.3 months. In the early postoperative period, 2 complications in the form of graft exposure occurred. However, both cases were successfully managed with preservation of the graft. All patients were satisfied with their long-term results, and none required further surgery. CONCLUSIONS The use of palmaris longus tendon graft is an effective, reproducible, and safe method by which to construct the philtral column in the secondary cleft lip deformity.

Amorfrutins are a family of natural products with high affinity to the peroxisome proliferator-activated receptor gamma (PPARgamma), a nuclear receptor regulating lipid and glucose metabolism. The PPARgamma agonist rosiglitazone increases insulin sensitivity and is effective against type II diabetes but has severe adverse effects including weight gain. Amorfrutins improve insulin sensitivity and dyslipidemia but do not enhance undesired fat storage. They bear potential as therapeutics or prophylactic dietary supplements. We identified amorfrutin B as a novel partial agonist of PPARgamma with a considerably higher affinity than that of previously reported amorfrutins, similar to that of rosiglitazone. Crystal structures reveal the geranyl side chain of amorfrutin B as the cause of its particularly high affinity. Typical for partial agonists, amorfrutins 1, 2, and B bind helix H3 and the beta-sheet of PPARgamma but not helix H12.

Introduction Pneumosinus dilatans is a rare condition and different techniques have been proposed for its management and correction. The abnormally expanded, aerated frontal sinus has been described in the literature as: frontal sinus hypertrophy, pneumosinus dilatans, pneumosinus frontalis, aerocele, pneumocele, sinus ectasia, hyperpneumatization and others. The precise aetiology and pathogenesis of the condition is unknown, although several basic hypotheses have been proposed Material and methods The authors report two cases of frontal bossing and supraorbital ridge deformity correction using craniofacial surgical principles. Discussion Functional and morphological results are discussed and compared with other open procedures. Conclusion A variety of surgical procedures have been proposed for the correction of the pneumosinus dilatans frontalis. The craniofacial approach is advocated to reproduce the normal anatomy of the forehead in the upper part, the supraorbital rim and glabellar area.

Antley-Bixler syndrome is a rare form of craniosynostosis characterized by unique clinical features that present particular challenges to long-term treatment. Typical craniofacial features include midface hypoplasia, trapezoidocephaly, frontal bossing, ocular proptosis, low-set protrusive ears, and choanal atresia. A staged surgical approach including fronto-orbital and midface advancements is required for intracranial pressure reduction, globe protection, airway patency, and malocclusion. In this case report, the combined, longitudinal surgical and orthodontic treatment strategies employed to correct severe facial deformity in a long-term 21-year survivor of Antley-Bixler syndrome are reviewed.