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Sample records for two-stage palatal repair

  1. Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair.

    Science.gov (United States)

    Morén, Staffan; Mani, Maria; Lilian, Stålhammar; Lindestad, Per Åke; Holmström, Mats

    2017-01-31

      To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group.   Cross-sectional study with long-term follow-up.   All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers.   Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings.   Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables.   The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

  2. One-stage (Warsaw) and two-stage (Oslo) repair of unilateral cleft lip and palate: Craniofacial outcomes

    NARCIS (Netherlands)

    Fudalej, P.S.; Wegrodzka, E.; Semb, G.; Hortis-Dzierzbicka, M.

    2015-01-01

    The aim of this study was to compare facial development in subjects with complete unilateral cleft lip and palate (CUCLP) treated with two different surgical protocols. Lateral cephalometric radiographs of 61 patients (42 boys, 19 girls; mean age, 10.9 years; SD, 1) treated consecutively in Warsaw w

  3. Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

    OpenAIRE

    Simona Stoicescu; Dm Enescu

    2013-01-01

    Introduction: Although cleft lip and palate (CLP) is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation) cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closu...

  4. Influence of timing of hard palate repair in a two-stage procedure on early language development in Danish children with cleft palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth

    2012-01-01

    Objective: to investigate the influence of timing of hard palate closure on early language development from 18 months to 3 years of age. Design: a prospective, randomized clinical trial. Participants: thirty-four children with UCLP with velum closure at 4 months of age, and hard palate closure...... vocalizations, consonants, and consonants permissible in word-initial position than the Early HPR group. In addition, both cleft palate groups had a smaller productive vocabulary than the Control group, but unlike the EarlyHPR group, the LateHPU group produced a smaller number of word tokens in social...... language development in cleft palate children. Key words: cleft palate, phonological development, lexical development, surgical timing....

  5. Influence of timing of hard palate repair in a two-stage procedure on early language development in Danish children with cleft palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth

    2012-01-01

    Objective: to investigate the influence of timing of hard palate closure on early language development from 18 months to 3 years of age. Design: a prospective, randomized clinical trial. Participants: thirty-four children with UCLP with velum closure at 4 months of age, and hard palate closure...... were transcribed according to the International Phonetic Alphabet. At 36 months a single word naming test was administered. Results: at 18 months, the LateHPU group produced fewer labial stops and more velar stops than the Early HPR group. Unlike the Early HPR group, the LateHPU group produced fewer...

  6. Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

    Directory of Open Access Journals (Sweden)

    Simona Stoicescu

    2013-12-01

    Full Text Available Introduction: Although cleft lip and palate (CLP is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate. Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed. Results: Fifty-three (66% and twenty-seven (34% patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery

  7. Cleft lip and palate repair

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002979.htm Cleft lip and palate repair To use the sharing features on this page, please enable JavaScript. Cleft lip and cleft palate repair is surgery to fix birth defects ...

  8. Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate.

    Science.gov (United States)

    Xu, Xue; Kwon, Hyuk-Jae; Shi, Bing; Zheng, Qian; Yin, Heng; Li, Chenghao

    2015-01-01

    To address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. Forty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6-12 months and cleft palate repair at age 18-30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov-Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal-Wallis H tests were used for multiple comparisons. Both case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p palate repair had a reduced posterior maxillary vertical height (R-PMP, p palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Cleft lip and palate repair - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000004.htm Cleft lip and palate repair - discharge To use the sharing ... Elsevier Saunders; 2015:chap 8. Read More Cleft lip and palate Cleft lip and palate repair Review Date 5/9/ ...

  10. FREE GRAFT TWO-STAGE URETHROPLASTY FOR HYPOSPADIAS REPAIR

    Institute of Scientific and Technical Information of China (English)

    Zhong-jin Yue; Ling-jun Zuo; Jia-ji Wang; Gan-ping Zhong; Jian-ming Duan; Zhi-ping Wang; Da-shan Qin

    2005-01-01

    Objective To evaluate the effectiveness of free graft transplantation two-stage urethroplasty for hypospadias repair.Methods Fifty-eight cases with different types of hypospadias including 10 subcoronal, 36 penile shaft, 9 scrotal, and 3 perineal were treated with free full-thickness skin graft or (and) buccal mucosal graft transplantation two-stage urethroplasty. Of 58 cases, 45 were new cases, 13 had history of previous failed surgeries. Operative procedure included two stages: the first stage is to correct penile curvature (chordee), prepare transplanting bed, harvest and prepare full-thickness skin graft, buccal mucosal graft, and perform graft transplantation. The second stage is to complete urethroplasty and glanuloplasty.Results After the first stage operation, 56 of 58 cases (96.6%) were successful with grafts healing well, another 2foreskin grafts got gangrened. After the second stage operation on 56 cases, 5 cases failed with newly formed urethras opened due to infection, 8 cases had fistulas, 43 (76.8%) cases healed well.Conclusions Free graft transplantation two-stage urethroplasty for hypospadias repair is a kind of effective treatment with broad indication, comparatively high success rate, less complicationsand good cosmatic results, indicative of various types of hypospadias repair.

  11. Phonology in Swedish-speaking 3-year-olds born with unilateral cleft lip and palate treated with palatal closure in one or two stages.

    Science.gov (United States)

    Klintö, Kristina; Lohmander, Anette

    2017-04-01

    Phonological disorders are common in 3-year-olds born with cleft palate compared to non-cleft peers. However, published results have been based on small samples. The purpose was to expand the knowledge on phonology of Swedish-speaking 3-year-olds with unilateral cleft lip and palate (UCLP), treated with primary palatal closure in one or two stages. The phonology of 26 children with UCLP was assessed with percentage consonants correct adjusted for age (PCC-A) and number of consistent phonological simplification processes (NCP) at age 3. Fifteen of the children were treated with minimal incision technique in one stage (OS) at 13 months and 11 with a two-stage closure (TS) with soft palate repair at 4 months and hard palate repair at 12 months. Their results were compared and then merged with previously obtained data from 10 children treated with OS and nine children treated with TS. Finally, the merged results were compared with those of 20 peers without UCLP. No significant differences between the first two groups were found. In the merged results, NCP in the OS group was significantly lower than in the TS group. The UCLP group displayed significantly poorer results on PCC-A and NCP than peers without UCLP. Surgical procedure did not have a clear impact on phonology at age 3 years. Since children with UCLP are at risk of having impaired phonology at age 3, the results confirm the necessity of having both a phonological and articulatory approach when assessing and treating children born with cleft palate.

  12. Two-stage palatoplasty, is it still a valuable treatment protocol for patients with a cleft of lip, alveolus, and palate?

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    Gundlach, Karsten K H; Bardach, Janusz; Filippow, Daniel; Stahl-de Castrillon, Franka; Lenz, Jan-Hendrik

    2013-01-01

    Speech development is of utmost importance and requires early closure of a palatal cleft. On the other hand, it is well known that all types and timings of surgical repair of facial clefts are detrimental to maxillary growth. Nevertheless, these days one is more and more confronted with a world-wide tendency in favour of the one-in-all operation to close clefts of the lip, alveolus, and palate. Therefore, a three-centre study was performed for testing - once more - the value of two-stage palatoplasty as a means to reduce the detrimental effects of surgery on palatal growth and at the same time to also enable early speech development. Plaster casts from 85 patients have been re-evaluated. All of them had a complete unilateral cleft of lip, alveolus, and palate. They had been treated according to the old therapy protocols followed in either one of the three different cleft centres many years ago, namely in Hamburg, (Western) Germany, Iowa City, IO, USA, and Rostock, (in those days still Eastern) Germany. The impressions had been taken already in 1987 from patients being either 8 years (36 pts.) or 16 years of age (49 pts.). Three different treatment protocols had been followed for these patients in those centres in those days: The main difference was that in centres A and B the palates were closed in two stages whilst in centre C palatoplasty was performed in just one operation. The most interesting results regarding the palatal growth were that: 1. In centre C (one-stage palatoplasty) the patients had more constricted palates. 2. In centre A (two-stage palatoplasty) the patients had least often an anterior cross-bite. It appears that it was possible to show once more that closing the palate in one stage at age 1 year or less is interfering most with maxillary growth. This study leads us to conclude that two-stage palatoplasty is still a valuable treatment protocol for patients with a complete unilateral cleft of lip, alveolus, and palate, especially as apparently

  13. Dental materials for cleft palate repair.

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    Sharif, Faiza; Ur Rehman, Ihtesham; Muhammad, Nawshad; MacNeil, Sheila

    2016-04-01

    Numerous bone and soft tissue grafting techniques are followed to repair cleft of lip and palate (CLP) defects. In addition to the gold standard surgical interventions involving the use of autogenous grafts, various allogenic and xenogenic graft materials are available for bone regeneration. In an attempt to discover minimally invasive and cost effective treatments for cleft repair, an exceptional growth in synthetic biomedical graft materials have occurred. This study gives an overview of the use of dental materials to repair cleft of lip and palate (CLP). The eligibility criteria for this review were case studies, clinical trials and retrospective studies on the use of various types of dental materials in surgical repair of cleft palate defects. Any data available on the surgical interventions to repair alveolar or palatal cleft, with natural or synthetic graft materials was included in this review. Those datasets with long term clinical follow-up results were referred to as particularly relevant. The results provide encouraging evidence in favor of dental and other related biomedical materials to fill the gaps in clefts of lip and palate. The review presents the various bones and soft tissue replacement strategies currently used, tested or explored for the repair of cleft defects. There was little available data on the use of synthetic materials in cleft repair which was a limitation of this study. In conclusion although clinical trials on the use of synthetic materials are currently underway the uses of autologous implants are the preferred treatment methods to date.

  14. Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty.

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    Kappen, I F P M; Schreinemakers, J B S; Oomen, K P Q; Bittermann, D; Kon, M; Breugem, C C; Mink van der Molen, A B

    2017-03-01

    To evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty. Forty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history. In total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty. The present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Influence of timing of two-stage palate closure on early phonological and lexical development in children with cleft palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth

    . However, both groups of children with cleft palate had a smaller productive vocabulary than the control children, but the late group produced a smaller number of word tokens than the early group. This difference between the two cleft palate groups is hypothesized to be caused by reduced intelligibility......  BACKGROUND AND PURPOSE Numerous studies have indicated that early closure of the palatal cleft has a positive influence on the phonological development in children with cleft palate. So far, however, substantial evidence for this assumption has been lacking due to a variety of weaknesses...... of the studies conducted, including the lack of randomized clinical trials (RCT) (Peterson-Falzone 1996). A  prospective RCT was conducted to add to the knowledge of the influence of timing of hard palate closure on early phonological and lexical development from 1 to 3 years. METHODS Fourty-one children...

  16. CLEFT-PALATE REPAIR - FURLOW VERSUS VONLANGENBECK

    NARCIS (Netherlands)

    SPAUWEN, PHM; GOORHUISBROUWER, SM; SCHUTTE, HK

    1992-01-01

    The Furlow cleft palate repair using a double opposing Z-plasty appears to be very promising. In order to detect advantages and disadvantages concerning the technique as well as speech- and hearing results, the Furlow palatoplasty was compared with the classical von Langenbeck technique. Data analys

  17. The Bracka two-stage repair for severe proximal hypospadias: A single center experience

    Directory of Open Access Journals (Sweden)

    Rakesh S Joshi

    2015-01-01

    Full Text Available Background: Surgical correction of severe proximal hypospadias represents a significant surgical challenge and single-stage corrections are often associated with complications and reoperations. Bracka two-stage repair is an attractive alternative surgical procedure with superior, reliable, and reproducible results. Purpose: To study the feasibility and applicability of Bracka two-stage repair for the severe proximal hypospadias and to analyze the outcomes and complications of this surgical technique. Materials and Methods: This prospective study was conducted from January 2011 to December 2013. Bracka two-stage repair was performed using inner preputial skin as a free graft in subjects with proximal hypospadias in whom severe degree of chordee and/or poor urethral plate was present. Only primary cases were included in this study. All subjects received three doses of intra-muscular testosterone 3 weeks apart before first stage. Second stage was performed 6 months after the first stage. Follow-up ranged from 6 months to 24 months. Results: A total of 43 patients operated for Bracka repair, out of which 30 patients completed two-stage repair. Mean age of the patients was 4 years and 8 months. We achieved 100% graft uptake and no revision was required. Three patients developed fistula, while two had metal stenosis. Glans dehiscence, urethral stricture and the residual chordee were not found during follow-up and satisfactory cosmetic results with good urinary stream were achieved in all cases. Conclusion: The Bracka two-stage repair is a safe and reliable approach in select patients in whom it is impractical to maintain the axial integrity of the urethral plate, and, therefore, a full circumference urethral reconstruction become necessary. This gives good results both in terms of restoration of normal function with minimal complication.

  18. Rapid Two-stage Versus One-stage Surgical Repair of Interrupted Aortic Arch with Ventricular Septal Defect in Neonates

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    Meng-Lin Lee

    2008-11-01

    Conclusion: The outcome of rapid two-stage repair is comparable to that of one-stage repair. Rapid two-stage repair has the advantages of significantly shorter cardiopulmonary bypass duration and AXC time, and avoids deep hypothermic circulatory arrest. LVOTO remains an unresolved issue, and postoperative aortic arch restenosis can be dilated effectively by percutaneous balloon angioplasty.

  19. Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes.

    Science.gov (United States)

    Kappen, Isabelle Francisca Petronella Maria; Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom Fjmc; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

    2017-05-01

    No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (Ppalate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

  20. Acute Liver Failure and Hepatic Encephalopathy After Cleft Palate Repair.

    Science.gov (United States)

    Kocaaslan, Nihal Durmuş; Tuncer, Fatma Betul; Tutar, Engin; Celebiler, Ozhan

    2015-09-01

    Paracetamol is the most commonly used analgesic after cleft palate repair. It has rarely caused acute hepatic failure at therapeutic or supratherapeutic doses. Only one case of therapeutic paracetamol toxicity after cleft palate repair had been reported previously. Here, we present a similar patient who developed acute liver failure and hepatic encephalopathy after an uncomplicated cleft palate surgery. Lack of large prospective trials in young children due to ethical concerns increases the value of the case reports of acetaminophen toxicity at therapeutic doses. The dosing recommendations of paracetamol may need to be reconsidered after cleft palate surgery.

  1. Strategies to improve regeneration of the soft palate muscles after cleft palate repair

    NARCIS (Netherlands)

    Carvajal Monroy, P.L.; Grefte, S.; Kuijpers-Jagtman, A.M.; Wagener, F.A.D.T.G.; Hoff, J.W. Von den

    2012-01-01

    Children with a cleft in the soft palate have difficulties with speech, swallowing, and sucking. These patients are unable to separate the nasal from the oral cavity leading to air loss during speech. Although surgical repair ameliorates soft palate function by joining the clefted muscles of the sof

  2. Improving Informed Consent for Cleft Palate Repair

    Science.gov (United States)

    2016-09-22

    Cleft Palate; Jaw Abnormalities; Maxillofacial Abnormalities; Mouth Abnormalities; Congenital Abnormalities; Jaw Diseases; Musculoskeletal Diseases; Craniofacial Abnormalities; Musculoskeletal Abnormalities; Stomatognathic Diseases; Stomatognathic System Abnormalities

  3. Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure

    NARCIS (Netherlands)

    Randag, Anna C.; Dreise, Marieke M.; Ruettermann, Mike

    2014-01-01

    Objective: In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that

  4. Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure

    NARCIS (Netherlands)

    Randag, Anna C.; Dreise, Marieke M.; Ruettermann, Mike

    2014-01-01

    Objective: In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that

  5. How various surgical protocols of the unilateral cleft lip and palate influence the facial growth and possible orthodontic problems? Which is the best timing of lip, palate and alveolus repair? literature review.

    Science.gov (United States)

    Farronato, Giampietro; Kairyte, Laima; Giannini, Lucia; Galbiati, Guido; Maspero, Cinzia

    2014-01-01

    OBJECTIVES. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature. MATERIALS AND METHODS. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were "cleft lip palate", "cleft lip palate facial growth", "cleft lip palate surgery". The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research. RESULTS. The cleft lip and palate is one of the most common birth defects that needs long rehabilitation between birth and adulthood. Several authors have presented surgical protocols and timing. The effects of these diseases on cranio facial growth and the importance of the early intervention have been described. CONCLUSIONS. The review describes the main surgical protocols and treatment strategies of the unilateral lip and palate clefts. The review discusses how surgery effects the midfacial skeletal growth. Studies agree that the palate repair is the main cause of the maxilla growth disturbances. About the timing of palate repair in the unilateral clefts it can be concluded that most studies found no difference between one or two stages palate repair techniques for the midfacial growth. Also from the research, studies agree that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair. Nevertheless good results, delayed hard palate repair technique is abandoned by many hospital centres because of worse speech outcome. The best

  6. Role of tongue flap in palatal fistula repair: A series of 41 cases

    Directory of Open Access Journals (Sweden)

    Ravi Kumar Mahajan

    2014-01-01

    Full Text Available Introduction: Despite the improved techniques of repair of cleft palate, fistula occurrence is still a possibility either due to an error in the surgical technique or due to the poor tissue quality of the patient. Though commonly the fistula closure is established by use of local flaps but at times the site and the size of the fistula make use of local flaps for its repair a remote possibility. The use of tongue flaps because of the central position in the floor of the mouth, mobility and the diversity of positioning the flaps make it a method of choice for closure of anterior palatal fistulae than any other tissues. The aim of this study was to analyse the utility of tongue flap in anterior palatal fistula repair. Materials and Methods: We had 41 patients admitted to our hospital during the period 2006-2012 for repair of palatal fistula and were enrolled into the study. In the entire 41 cases, fistula was placed anteriorly. The size of the fistulae varied from 2 cm × 1.5 cm to 5.5 cm × 3 cm. The flaps were divided after 3-week and final inset of the flap was done. Observation and Result: None of the patients developed flap necrosis, in one case there was the dehiscence of the flap, which was reinset and in one patient there was bleeding. None of our patients developed functional deformity of the tongue. Speech was improved in 75% cases. Conclusion: Leaving apart its only drawback of two-staged procedure and transient patient discomfort, tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulae.

  7. Left thoracoscopic two-stage repair of tracheoesophageal fistula with a right aortic arch and a vascular ring

    Science.gov (United States)

    Oshima, Kazuo; Uchida, Hiroo; Tainaka, Takahisa; Tanano, Akihide; Shirota, Chiyoe; Yokota, Kazuki; Murase, Naruhiko; Shirotsuki, Ryo; Chiba, Kosuke; Hinoki, Akinari

    2017-01-01

    A right aortic arch (RAA) is found in 5% of neonates with tracheoesophageal fistulae (TEF) and may be associated with vascular rings. Oesophageal repairs for TEF with an RAA via the right chest often pose surgical difficulties. We report for the first time in the world a successful two-stage repair by left-sided thoracoscope for TEF with an RAA and a vascular ring. We switched from right to left thoracoscopy after finding an RAA. A proximal oesophageal pouch was hemmed into the vascular ring; therefore, we selected a two-stage repair. The TEF was resected and simple internal traction was placed into the oesophagus at the first stage. Detailed examination showed the patent ductus arteriosus (PDA) completing a vascular ring. The subsequent primary oesophago-oesophagostomy and dissection of PDA was performed by left-sided thoracoscope. Therefore, left thoracoscopic repair is safe and feasible for treating TEF with an RAA and a vascular ring. PMID:27143697

  8. Simple Technique Overcoming a Persistent Problem in Cleft Palate Repair.

    Science.gov (United States)

    Kotrashetti, S M; Dube, Gunjan; Thakkar, Bhushan; Ahuja, Manav

    2016-12-01

    Cleft palate repair mandates use of a mouth gag and Dingmans moth gag is the most commonly used for the same; but the use of Dingmans mouth gag may have the demerit of the suture getting tethered at various places of the instrument during cleft palate closure particularly in the hands of the beginner surgeon. This article discusses about a simple technique of using a rubber dam sheet to cover the frame of the mouth gag. The technique discussed in this article is simple, cost effective method to overcome the potential disadvantage of suture adherence during repair of palatal tissue. The technique also has the potential to reduce the total operative time which needs a further study to validate the same.

  9. Parental satisfaction in Ugandan children with cleft lip and palate following synchronous lip and palatal repair.

    Science.gov (United States)

    Luyten, Anke; D'haeseleer, Evelien; Budolfsen, Dorte; Hodges, Andrew; Galiwango, George; Vermeersch, Hubert; Van Lierde, Kristiane

    2013-01-01

    The purpose of the present case control study was to assess parental satisfaction with speech and facial appearance in Ugandan children with complete unilateral or bilateral cleft lip and palate (CLP), who underwent a synchronous lip and palatal closure. The results are compared with an age- and gender-matched control group. The experimental group consisted of the parents or guardians of 44 Ugandan patients (21 males, 23 females) with complete unilateral or bilateral CLP (mean age: 3;1 years). The control group included the foster mothers of 44 orphan children matched by age and gender (mean age: 3;7 years). A survey based on the Cleft Evaluation Profile was used to assess the perceived satisfaction for individual features related to cleft care. Overall high levels of satisfaction were observed in the experimental group for all features (range: 56-100%). No significant differences could be established regarding age, gender, age of lip and palatal closure, cleft type or maternal vs. paternal judgments. In participants who were dissatisfied with the appearance of the lip, the time period between the cleft closure and the survey was significantly larger compared with satisfied participants. Furthermore, significantly lower levels of satisfaction were observed in the cleft group for speech and the appearance of the teeth and the nose compared with the control group. Satisfaction with speech and facial appearance in Ugandan children with cleft lip and/or palate is important since normal esthetics and speech predominantly determine the children's social acceptance in the Ugandan society. As a result of reading this manuscript, the reader will be able to explain the attitudes of parents toward the surgical repair of their children's cleft lip and palate. As a result of reading this manuscript, the reader will be able to identify differences in parental attitudes toward synchronous lip and palate repair. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate.

    Science.gov (United States)

    Liao, Yu-Fang; Lee, Ying-Hsin; Wang, Ruby; Huang, Chiung-Shing; Chen, Philip Kuo-Ting; Lo, Lun-Jou; Chen, Yu-Ray

    2014-05-01

    Vomer flap repair is assumed to improve maxillary growth because of reduced scarring in growth-sensitive areas of the palate. Our aim was to evaluate whether facial growth in patients with unilateral cleft lip and palate was significantly affected by the technique of hard palate repair (vomer flap versus two-flap). For this retrospective longitudinal study, we analyzed 334 cephalometric radiographs from 95 patients with nonsyndromic complete unilateral cleft lip and palate who underwent hard palate repair by two different techniques (vomer flap versus two-flap). Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. The associations among facial morphology at age 20, facial growth rate, and technique of hard palate repair were assessed using generalized estimating equation analysis. The hard palate repair technique significantly influenced protrusion of the maxilla (SNA: β = -3.5°, 95 % CI = -5.2-1.7; p = 0.001) and the anteroposterior jaw relation (ANB: β = -4.2°, 95 % CI = -6.4-1.9; p = 0.001; Wits: β = -5.7 mm, 95 % CI = -9.6-1.2; p = 0.01) at age 20, and their growth rates (SNA p = 0.001, ANB p cleft lip and palate, vomer flap repair has a smaller adverse effect than two-flap on growth of the maxilla. This effect on maxillary growth is on the anteroposterior development of the alveolar maxilla and is progressive with age. We now perform hard palate closure with vomer flap followed by soft palate closure using Furlow palatoplasty. These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.

  11. Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review.

    Science.gov (United States)

    Lee, Ying-Hsin; Liao, Yu-Fang

    2013-12-01

    The vomer flap technique for repair of the hard palate is assumed to improve maxillary growth because it causes less scarring in growth-sensitive areas of the palate. The aim of this systematic review was to investigate the effect of techniques using the vomer flap compared with the palatal flap on facial growth in patients with cleft lip and palate. All papers published before 21 July 2012 were sought in the databases PubMed and MEDLINE. Search terms included "facial growth", "cleft lip and palate", "palatal repair technique", and "vomer flap". Additional studies were identified by hand searching the reference lists of the papers retrieved from the electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the methods. Six studies met the selection criteria. Outcomes assessed in 4 studies were dentofacial morphology after vomer or palatal flap, maxillary dental arch in 1 study, and dental arch relations in 2 studies. The quality of the methods used in 3 studies was poor. Contradictory results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the vomer flap technique has more or less of an adverse effect on maxillary growth than the palatal flap. Further well-designed, well-controlled, and long-term studies particularly of the vomer flap (2-stage) and palatal flap (von Langenbeck or two-flap, 1-stage) are needed.

  12. One-stage vs two-stage cartilage repair: a current review

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    Daniel Meyerkort

    2010-10-01

    Full Text Available Daniel Meyerkort, David Wood, Ming-Hao ZhengCenter for Orthopaedic Research, School of Surgery and Pathology, University of Western Australia, Perth, AustraliaIntroduction: Articular cartilage has a poor capacity for regeneration if damaged. Various methods have been used to restore the articular surface, improve pain, function, and slow progression to osteoarthritis.Method: A PubMed review was performed on 18 March, 2010. Search terms included “autologous chondrocyte implantation (ACI” and “microfracture” or “mosaicplasty”. The aim of this review was to determine if 1-stage or 2-stage procedures for cartilage repair produced different functional outcomes.Results: The main procedures currently used are ACI and microfracture. Both first-generation ACI and microfracture result in clinical and functional improvement with no significant differences. A significant increase in functional outcome has been observed in second-generation procedures such as Hyalograft C, matrix-induced ACI, and ChondroCelect compared with microfracture. ACI results in a higher percentage of patients with clinical improvement than mosaicplasty; however, these results may take longer to achieve.Conclusion: Clinical and functional improvements have been demonstrated with ACI, microfracture, mosaicplasty, and synthetic cartilage constructs. Heterogeneous products and lack of good-quality randomized-control trials make product comparison difficult. Future developments involve scaffolds, gene therapy, growth factors, and stem cells to create a single-stage procedure that results in hyaline articular cartilage.Keywords: autologous chondrocyte implantation, microfracture, cartilage repair

  13. Two-Stage Thoracoscopic Repair of Long-Gap Esophageal Atresia Using Internal Traction Is Safe and Feasible.

    Science.gov (United States)

    Tainaka, Takahisa; Uchida, Hiroo; Tanano, Akihide; Shirota, Chiyoe; Hinoki, Akinari; Murase, Naruhiko; Yokota, Kazuki; Oshima, Kazuo; Shirotsuki, Ryo; Chiba, Kosuke; Amano, Hizuru; Kawashima, Hiroshi; Tanaka, Yujiro

    2017-01-01

    The treatment of long-gap esophageal atresia remains an issue for pediatric surgeons. Many techniques for treating long-gap esophageal atresia have been proposed, but the optimal method has not been established. The thoracoscopic esophageal elongation technique has recently been developed. We previously reported a case in which two-stage thoracoscopic repair was performed using internal esophageal traction without esophageal tearing, and we retrospectively reviewed the outcomes of this procedure in this study. Five patients underwent thoracoscopic treatment involving internal esophageal traction for esophageal atresia involving a long gap or vascular ring over a 5-year period. Between November 2010 and November 2015, 5 patients were treated with thoracoscopic traction. All of these patients successfully underwent thoracoscopic-delayed primary anastomosis. Conversion to open thoracotomy was not required in any case. The postoperative complications experienced by the patients included minor anastomotic leakage in 2 cases, anastomotic stenosis in 1 case, gastroesophageal reflux (GER) in 4 cases, and a hiatal hernia in 1 case. None of the patients died. Two-stage thoracoscopic repair for esophageal atresia involving a long gap or vascular ring is a safe and feasible procedure; however, we must develop methods for treating minor anastomotic complications and GER due to esophageal traction in future.

  14. Limited Chances of Speech Improvement After Late Cleft Palate Repair.

    Science.gov (United States)

    Schönmeyr, Björn; Wendby, Lisa; Sharma, Mitali; Raud-Westberg, Liisi; Restrepo, Carolina; Campbell, Alex

    2015-06-01

    Late primary palatal repair is a common phenomenon, and many patients across the world will be operated on at a far later age than is suggested for normal speech development. Nevertheless, little is known about the speech outcomes after these procedures and conflicting results exist among the few studies performed. In this study, blinded preoperative and postoperative speech recordings from 31 patients operated on at Guwahati Comprehensive Cleft Care Center in Assam, India, older than 7 years were evaluated. Six non-Indian speech and language pathologists evaluated hypernasal resonance and articulation, and 4 local laymen evaluated the speech intelligibility/acceptability of the samples. In 25 of 31 cases, the evaluators could not detect any speech improvement in the postoperative recordings. A clear trend of postoperative improvement was only found in 6 of the 31 patients. Among these 6 patients, lesser clefts were overrepresented. Our findings together with previous studies suggest that late palate repairs have the potential to improve speech, but the probability for improvement and degree of improvement is low, especially in older adolescents and adults with complete clefts.

  15. Two Stage Repair of Composite Craniofacial Defects with Antibiotic Releasing Porous Poly(methyl methacrylate) Space Maintainers and Bone Regeneration

    Science.gov (United States)

    Spicer, Patrick

    Craniofacial defects resulting from trauma and resection present many challenges to reconstruction due to the complex structure, combinations of tissues, and environment, with exposure to the oral, skin and nasal mucosal pathogens. Tissue engineering seeks to regenerate the tissues lost in these defects; however, the composite nature and proximity to colonizing bacteria remain difficult to overcome. Additionally, many tissue engineering approaches have further hurdles to overcome in the regulatory process to clinical translation. As such these studies investigated a two stage strategy employing an antibiotic-releasing porous polymethylmethacrylate space maintainer fabricated with materials currently part of products approved or cleared by the United States Food and Drug Administration, expediting the translation to the clinic. This porous space maintainer holds the bone defect open allowing soft tissue to heal around the defect. The space maintainer can then be removed and one regenerated in the defect. These studies investigated the individual components of this strategy. The porous space maintainer showed similar soft tissue healing and response to non-porous space maintainers in a rabbit composite tissue defect. The antibiotic-releasing space maintainers showed release of antibiotics from 1-5 weeks, which could be controlled by loading and fabrication parameters. In vivo, space maintainers releasing a high dose of antibiotics for an extended period of time increased soft tissue healing over burst release space maintainers in an infected composite tissue defect model in a rabbit mandible. Finally, stabilization of bone defects and regeneration could be improved through scaffold structures and delivery of a bone forming growth factor. These studies illustrate the possibility of the two stage strategy for repair of composite tissue defects of the craniofacial complex.

  16. One-Stage Cleft Lip and Palate Repair in an Older Population.

    Science.gov (United States)

    Guneren, Ethem; Canter, Halil Ibrahim; Yildiz, Kemalettin; Kayan, Resit Burak; Ozpur, Mustafa Aykut; Baygol, Emre Gonenc; Sagir, Haci Omer; Kuzu, Ismail Melih; Akman, Onur; Arslan, Serap

    2015-07-01

    In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.

  17. Surgical outcome and complications following cleft lip and palate repair in a teaching hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Taiwo O Abdurrazaq

    2013-01-01

    Full Text Available Background: Measurement of treatment outcome is important in estimating the success of cleft management. The aim of this study was to assess the surgical outcome of cleft lip and palate surgery. Patients and Methods: The surgical outcome of 131 consecutive patients with cleft lip and palate surgeries between October 2008 and December 2010 were prospectively evaluated at least 4 weeks postoperatively. Data collected included information about the age, sex, type of cleft defects, and type of surgery performed as well as postoperative complications. For cleft lip repair, the Pennsylvania lip and nose (PLAN score was used to assess the surgical outcome, while the integrity of the closure was used for cleft palate repair. Results: A total of 92 patients had cleft lip repair and 64 had palate repair. Overall, 68.8% cases of cleft lip and palate repair had good outcomes; 67.9% of lip repairs had good lip and nose scores, while 70.2% of palatal repair had a good surgical outcome. Oro-fistula was observed in 29.8% of cleft palate repairs Inter-rater reliability coefficient was substantially significant. Conclusions: The fact that 25.7% of those treated were aged >1 year suggests a continued need to enlighten the public on the availability of cleft lip and palate expertise and treatment. Although an overall good treatment outcome was demonstrated in this study, the nasal score was poorer than the lip score. Complication rate of about 14% following surgical repair is consistent with previous reports in the literature.

  18. Nasalance Scores of Children with Repaired Cleft Palate Who Exhibit Normal Velopharyngeal Closure during Aerodynamic Testing

    Science.gov (United States)

    Zajac, David J.

    2013-01-01

    Purpose: To determine if children with repaired cleft palate and normal velopharyngeal (VP) closure as determined by aerodynamic testing exhibit greater acoustic nasalance than control children without cleft palate. Method: Pressure-flow procedures were used to identify 2 groups of children based on VP closure during the production of /p/ in the…

  19. A novel two-stage complete repair method for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries

    Institute of Scientific and Technical Information of China (English)

    MEI Ju; DING Fang-bao; ZHU Jia-quan; BAO Chun-rong; XIE Xiao; ZHANG Yun-jiao

    2010-01-01

    Background Pulmonary atresia with ventricular septal defect (PA-VSD) and major aortopulmonary collateral arteries (MAPCAs) remains a challenging complex congenital heart disease nowadays. In the present study, we aimed to develop a two-stage surgical method and to evaluate outcomes of this method in managing PA-VSD and MAPCAs.Methods Between December 2003 and December 2008, 7 female and 4 male patients between the age of 5 and 10 years who were suffering from PA-VSD and MAPCAs were selected and recruited. The native pulmonary artery trunks were absent in all patients; the lungs were solely supplied by major aortopulmonary collaterals, and the numbers of supplied lung segments ranged from 15 to 20 (17.9±1.6). There were a total of 43 MAPCAs in all the patients (3-5 (3.9±0.7) MAPCAs per patient). The accumulated Nakata index was (222.9±29.9) mm~2/m~2 (ranged from 182 to 272). All the patients underwent two sequential operations. Stage one included left major aortopulmonary collateral unifocalization and modified Blalock-Taussig shunt from left posterior lateral thoracotomy; stage two comprised right unifocalization, ligation of the shunt, followed by ventricular septal defect closure and right ventricular outflow tract reconstruction assisted with cardiopulmonary bypass from midline stemotomy.Results All the patients survived the initial surgery, but one of them died of low cardiac output syndrome on the third day after the second operation. Postoperative complications included pneumonia in one case and capillary leak syndrome in another. Postoperative oxygen saturation maintained about 95%-100%, which was significantly higher than pre-operation (P <0.01). During the follow-up period of 3-51 (25.4±15.2) months, there were no late death and no need for re-intervention. All the patients enjoyed their lives with good conditions.Conclusions This two-stage complete repair strategy was well-tolerated and effective with good outcome, thus offering an alternative

  20. Evaluation of speech function on repairing defects of maxilla and palate with temporalis muscle flap

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective: To evaluate the speech function on repairing defects of maxilla and palate with temporalis muscle flap after benign or malignant turmor resection. Methods: The lateral cephalogram and speech intelligibility were detected in 19 cases with the operations of repairing defects of maxilla and palate by temporalis muscle flap, and their recovery of the speech function were analyzed.Results: Among the 19 patients, there were 15 cases (78.00%) with complete velopharynx, 3 cases (15.80 % ) with mariginal velopharynx, and 1 case (5.26%) with insufficient velopharynx. The average speech intelligibility was 94.3%, close to the normal speech intelligibility. Conclusion: The operation of repairing defects of maxilla and palate with temporalis muscle flap can reconstruct the phonatory structure, preserve the palate function and restore the speech function after operation.

  1. Speech and Speech-Related Quality of Life After Late Palate Repair: A Patient's Perspective.

    Science.gov (United States)

    Schönmeyr, Björn; Wendby, Lisa; Sharma, Mitali; Jacobson, Lia; Restrepo, Carolina; Campbell, Alex

    2015-07-01

    Many patients with cleft palate deformities worldwide receive treatment at a later age than is recommended for normal speech to develop. The outcomes after late palate repairs in terms of speech and quality of life (QOL) still remain largely unstudied. In the current study, questionnaires were used to assess the patients' perception of speech and QOL before and after primary palate repair. All of the patients were operated at a cleft center in northeast India and had a cleft palate with a normal lip or with a cleft lip that had been previously repaired. A total of 134 patients (7-35 years) were interviewed preoperatively and 46 patients (7-32 years) were assessed in the postoperative survey. The survey showed that scores based on the speech handicap index, concerning speech and speech-related QOL, did not improve postoperatively. In fact, the questionnaires indicated that the speech became more unpredictable (P after surgery. A total of 78% of the patients were still satisfied with the surgery and all of the patients reported that their self-confidence had improved after the operation. Thus, the majority of interviewed patients who underwent late primary palate repair were satisfied with the surgery. At the same time, speech and speech-related QOL did not improve according to the speech handicap index-based survey. Speech predictability may even become worse and nasal regurgitation may increase after late palate repair, according to these results.

  2. Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth.

    Science.gov (United States)

    Liao, Y-F; Prasad, N K K; Chiu, Y-T; Yun, C; Chen, P K-T

    2010-10-01

    Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP-ANS, PMP-A) and the maxillary protrusion (S-N-ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.

  3. Speech outcomes of early palatal repair with or without intravelar veloplasty in children with complete unilateral cleft lip and palate.

    Science.gov (United States)

    Doucet, Jean-Charles; Herlin, Christian; Captier, Guillaume; Baylon, Hélène; Verdeil, Mélanie; Bigorre, Michèle

    2013-12-01

    We compared the early speech outcomes of 40 consecutive children with complete unilateral cleft lip and palate (UCLP) who had been treated according to different 2-stage protocols: the Malek protocol (soft palate closure without intravelar veloplasty at 3 months; lip and hard palate repair at 6 months) (n=20), and the Talmant protocol (cheilorhinoplasty and soft palate repair with intravelar veloplasty at 6 months; hard palate closure at 18 months) (n=20). We compared the speech assessments obtained at a mean (SD) age of 3.3 (0.35) years after treatment by the same surgeon. The main outcome measures evaluated were acquisition and intelligibility of speech, velopharyngeal insufficiency, and incidence of complications. A delay in speech articulation of one year or more was seen more often in patients treated by the Malek protocol (11/20) than in those treated according to the Talmant protocol (3/20, p=0.019). Good intelligibility was noted in 15/20 in the Talmant group compared with 6/20 in the Malek group (p=0.010). Assessment with an aerophonoscope showed that nasal air emission was most pronounced in patients in the Malek group (p=0.007). Velopharyngeal insufficiency was present in 11/20 in the Malek group, and in 3/20 in the Talmant group (p=0.019). No patients in the Talmant group had an oronasal fistula (ppalate, early speech outcomes were better in the Talmant group because intravelar veloplasty was successful and there were no fistulas after closure of the hard palate in 2 layers.

  4. Repair of large palatal fistula using tongue flap

    Directory of Open Access Journals (Sweden)

    Fejjal Nawfal

    2014-01-01

    Full Text Available Large palatal fistulas are a challenging problem in cleft surgery. Many techniques are used to close the defect. The tongue flap is an easy and reproductible procedure for managing this complication. The authors report a case of a large palatal fistula closure with anteriorly based tongue flap.

  5. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration.

    Science.gov (United States)

    Sasaki, A; Takeuchi, Y; Izumi, K; Morimoto, A; Inomata, M; Kitano, S

    2016-06-01

    Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia. We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8-24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5-10 days after TEP repair. At present, no hernia recurrence has been reported in any patient. The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.

  6. Effect of Cleft Palate Repair on the Susceptibility to Contraction-Induced Injury of Single Permeabilized Muscle Fibers From Congenitally-Clefted Goat Palates

    Science.gov (United States)

    Rader, Erik P.; Cederna, Paul S.; McClellan, William T.; Caterson, Stephanie A.; Panter, Kip E.; Yu, Deborah; Buchman, Steven R.; Larkin, Lisa M.; Faulkner, John A.; Weinzweig, Jeffrey

    2009-01-01

    Objective Despite cleft palate repair, velopharyngeal competence is not achieved in ~15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resistant type 1 fibers. As an initial step to determining the validity of this theory, we tested the hypothesis that, in most cases, repair induces the transformation to type 1 fibers, thus diminishing susceptibility to injury. Interventions Single permeabilized levator veli palatini muscle fibers were obtained from normal palates and nonrepaired congenitally-clefted palates of young (2 months old) and adult (14 to 15 months old) goats and from repaired palates of adult goats (8 months old). Repair was done at 2 months of age using a modified von Langenbeck technique. Main Outcome Measures Fiber type was determined by contractile properties and susceptibility to injury was assessed by force deficit, the decrease in maximum force following a lengthening contraction protocol expressed as a percentage of initial force. Results For normal palates and cleft palates of young goats, the majority of the fibers were type 2 with force deficits of ~40%. Following repair, 80% of the fibers were type 1 with force deficits of 20% ± 2%; these deficits were 45% of those for nonrepaired cleft palates of adult goats (p < .0001). Conclusion The decrease in the percentage of type 2 fibers and susceptibility to injury may be important for the development of a functional levator veli palatini muscle postrepair. PMID:18333646

  7. Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip

    Science.gov (United States)

    Laberge, Louise Caouette

    2007-01-01

    Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports. PMID:19554125

  8. Speech Analysis of Bengali Speaking Children with Repaired Cleft Lip & Palate

    Science.gov (United States)

    Chakrabarty, Madhushree; Kumar, Suman; Chatterjee, Indranil; Maheshwari, Neha

    2012-01-01

    The present study aims at analyzing speech samples of four Bengali speaking children with repaired cleft palates with a view to differentiate between the misarticulations arising out of a deficit in linguistic skills and structural or motoric limitations. Spontaneous speech samples were collected and subjected to a number of linguistic analyses…

  9. Speech Analysis of Bengali Speaking Children with Repaired Cleft Lip & Palate

    Science.gov (United States)

    Chakrabarty, Madhushree; Kumar, Suman; Chatterjee, Indranil; Maheshwari, Neha

    2012-01-01

    The present study aims at analyzing speech samples of four Bengali speaking children with repaired cleft palates with a view to differentiate between the misarticulations arising out of a deficit in linguistic skills and structural or motoric limitations. Spontaneous speech samples were collected and subjected to a number of linguistic analyses…

  10. Improving speech outcomes after failed palate repair: evaluating the safety and efficacy of conversion Furlow palatoplasty.

    Science.gov (United States)

    Nayar, Harry S; Cray, James J; MacIsaac, Zoe M; Argenta, Anne E; Ford, Matthew D; Fenton, Regina A; Losee, Joseph E; Grunwaldt, Lorelei J

    2014-03-01

    Velopharyngeal insufficiency occurs in a nontrivial number of cases following cleft palate repair. We hypothesize that a conversion Furlow palatoplasty allows for long-term correction of VPI resulting from a failed primary palate repair, obviating the need for pharyngoplasty and its attendant comorbidities. A retrospective review of patients undergoing a conversion Furlow palatoplasty between 2003 and 2010 was performed. Patients were grouped according to the type of preceding palatal repair. Velopharyngeal insufficiency was assessed using Pittsburgh Weighted Speech Scale (PWSS). Scores were recorded and compared preoperatively and postoperatively at 3 sequential visits. Sixty-two patients met inclusion criteria and were grouped by preceding repair (straight-line repair (n = 37), straight-line repair with subsequent oronasal fistula (n = 14), or pharyngeal flap (n = 11). Median PWSS scores at individual visits were as follows: preoperative = 11, first postoperative = 3 (mean, 114.0 ± 6.7 days), second postoperative = 1 (mean, 529.0 ± 29.1 days), and most recent postoperative = 3 (mean, 1368.6 ± 76.9 days). There was a significant difference between preoperative and postoperative PWSS scores in the entire cohort (P 0.05). Eight patients failed to improve and showed no differences in PWSS scores over time (P > 0.05). Patients with a PWSS score of 7 or greater (n = 8) at the first postoperative visit (0-6 months) displayed improvement at the most recent visit (Pspeech. Future studies should elucidate which factors predict the success of this technique following failed palate repair.

  11. The impact of cleft lip and palate repair on maxillofacial growth

    Science.gov (United States)

    Shi, Bing; Losee, Joseph E

    2015-01-01

    Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate; Veau's pushback palatoplasty and Langenbeck's palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth; timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not. PMID:25394591

  12. The impact of cleft lip and palate repair on maxillofacial growth

    Institute of Scientific and Technical Information of China (English)

    Bing Shi; Joseph E Losee

    2015-01-01

    Surgical correction is central to current team-approached cleft treatment. Cleft surgeons are always concerned about the impact of their surgical maneuver on the growth of the maxilla. Hypoplastic maxilla, concaved mid-face and deformed dental arch have constantly been reported after cleft treatments. It is very hard to completely circumvent these postoperative complications by current surgical protocols. In this paper, we discussed the factors that inhibit the maxillofacial growth on cleft patients. These factors included pre-surgical intervention, the timing of cleft palate and alveolae repair, surgical design and treatment protocol. Also, we made a review about the influence on the maxillary growth in un-operated cleft patients. On the basis of previous researches, we can conclude that most of scholars express identity of views in these aspects: early palatoplasty lead to maxilla growth inhibition in all dimensions; secondary alveolar bone graft had no influence on maxilla sagittal growth; cleft lip repair inhibited maxilla sagittal length in patients with cleft lip and palate;Veau’s pushback palatoplasty and Langenbeck’s palatoplasty with relaxing incisions were most detrimental to growth; Furlow palatoplasty showed little detrimental effect on maxilla growth;timing of hard palate closure, instead of the sequence of hard or soft palate repair, determined the postoperative growth. Still, scholars hold controversial viewpoints in some issues, for example, un-operated clefts have normal growth potential or not, pre-surgical intervention and pharyngoplasty inhibited maxillofacial growth or not.

  13. Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair

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    Mosaad Abdel-Aziz

    Full Text Available ABSTRACT INTRODUCTION: Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. OBJECTIVE: The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. METHODS: Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4 mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. RESULTS: Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p = 0.231, 0.442, 0.118 respectively. CONCLUSIONS: Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.

  14. Speech outcome after palatal repair in nonsyndromic versus syndromic Robin sequence.

    Science.gov (United States)

    Patel, Kamlesh B; Sullivan, Stephen R; Murthy, Ananth S; Marrinan, Eileen; Mulliken, John B

    2012-10-01

    The authors' purpose was to document speech outcome after cleft palate repair in patients with syndromic versus nonsyndromic Robin sequence. Results of secondary correction of velopharyngeal insufficiency using a superiorly based pharyngeal flap or double-opposing Z-palatoplasty are also reported. Charts of patients with Robin sequence and cleft palate between 1980 and 2007 were reviewed. Data collected included date of birth, sex, syndrome/association, cleft palatal type (Veau I or II), age at palatoplasty, incidence of palatal fistula, postoperative speech assessment, videofluoroscopic results, need for secondary operation for velopharyngeal insufficiency, and type of secondary operation (pharyngeal flap or double-opposing Z-palatoplasty). The authors identified 140 patients with Robin sequence who had palatal closure. Postoperative speech evaluation was available for 96 patients (69 percent). A syndrome or association was identified in 42 patients (30 percent). Primary palatoplasty was successful in 74 patients (77 percent); speech was characterized as competent and competent to borderline competent. The authors found a significantly higher incidence of velopharyngeal insufficiency following palatal repair for syndromic (38 percent) than nonsyndromic Robin sequence (16 percent). (p = 0.039). In patients with velopharyngeal insufficiency, competent or borderline competent speech was determined after double-opposing Z-palatoplasty (two of five patients) or pharyngeal flap (eight of 10 patients). The rate of velopharyngeal insufficiency in syndromic Robin sequence is significantly greater than in nonsyndromic Robin sequence. The authors prefer pharyngeal flap for velopharyngeal insufficiency in patients with Robin sequence, whether syndromic or nonsyndromic, without retrognathism or signs/symptoms of obstructive sleep apnea.

  15. Unusual foreign body in the nasal cavity of an adult with repaired cleft lip and palate.

    Science.gov (United States)

    Ravikumar, Nagabhairava; GunaShekhar, M; Prasad, S Raghavendra; Lalitha, N; Raju, P Ramanjaneya; Natesh, Y A

    2015-03-01

    Intranasal foreign bodies arising from dental clinical practice, especially in patients with cleft lip and palate (CLP) occur rarely and are very scarce in the literature. This article reports an unusual case of a dental impression material presenting as a foreign body in the nasal cavity of an adult with repaired CLP who presented for dental prosthetic rehabilitation. To our knowledge, this is only the second report presenting nasal foreign body in a cleft patient arising due to a dental impression procedure.

  16. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

    OpenAIRE

    Gehrke, S. A.; S. Taschieri; Del Fabbro, M.; Corbella, S.

    2012-01-01

    The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation o...

  17. Postoperative analgesia for cleft lip and palate repair in children

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    Reena

    2016-01-01

    Full Text Available Acute pain such as postoperative pain during infancy was ignored approximately three decades ago due to biases and misconceptions regarding the maturity of the infant′s developing nervous system, their inability to verbally report pain, and their perceived inability to remember pain. More recently, these misconceptions are rarely acknowledged due to enhanced understanding of the developmental neurobiology of infant pain pathways and supraspinal processing. Cleft lip and palate is one of the most common congenital abnormalities requiring surgical treatment in children and is associated with intense postoperative pain. The pain management gets further complicated due to association with postsurgical difficult airway and other congenital anomalies. Orofacial blocks like infraorbital, external nasal, greater/lesser palatine, and nasopalatine nerve blocks have been successively used either alone or in combinations to reduce the postoperative pain. Since in pediatric population, regional anesthesia is essentially performed under general anesthesia, association of these two techniques has dramatically cut down the risks of both procedures particularly those associated with the use of opioids and nonsteroidal anti-inflammatory drugs. Definitive guidelines for postoperative pain management in these patients have not yet been developed. Incorporation of multimodal approach as an institutional protocol can help minimize the confusion around this topic.

  18. Efficacy of two-stage urethroplasty for hypospadias repair%分期手术在尿道下裂修复中的应用

    Institute of Scientific and Technical Information of China (English)

    周李; 高文宗; 谢钧韬

    2016-01-01

    目的:评价尿道下裂分期手术的疗效,并与一期手术比较,分析其优缺点。方法自2006年6月至2015年6月我们对320例尿道下裂患者行尿道下裂分期手术,均一期先行阴茎下曲矫正,包皮内板腹侧转移术;待6个月后行二期带蒂包皮卷管尿道成形术。结果320例中,二期手术成功290例(290/320,90.6%),出现尿瘘28例(28/320,8.75%),尿道狭窄2例(2/320,0.65%)。结论①分期手术成功率与一期手术成功率相近,但尿道狭窄发生率明显减少。②分期手术外观更接近正常生理状况。③分期手术适应症广泛,特别适用于长段尿道缺损、阴茎龟头裂开,多次手术失败、阴茎细小病例。④分期手术可简化操作,手术成功率保障性高,值得推广应用。%Objetive To explore the efficiency of two -stage urethroplasty for hypospadias re-pair. Methods From June 2006 to June 201 6,320 cases of hyospadias were corrected with two-stage meth-od.During the first stage,chordee was corrected and dorsal prepuce rotated to ventrum.Six months later,ure-throplasty (second-stage operation)was performed with perimeatal skin flap. Results A total of 209 cases were thoroughly corrected (90.6%).Complications included fistula (n =28,8.75%)and stenosis (n =2, 0.65%). Conclusions As compared with one-staged repair,the success rate of two-stage method is compa-rable yet with less stenosis and streamlined process.The cosmetic outcomes are better.It is also effective for severe cases of glanular dishescense,micropenis,long -defect urethra and multiple failures.

  19. Recurrence rate of repaired hard palate oronasal fistula with conchal cartilage graft

    Science.gov (United States)

    Abdali, Hosein; Hadilou, Mansour; Feizi, Awat; Omranifard, Mahmood; Ardakani, Mehdi Rasti; Emami, Abolhasan

    2014-01-01

    Background: After cleft palate repair, oronasal fistula (ONF) formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. Materials and Methods: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months) after repair. Results: The mean (range) age of studied samples was 10.7 (2-23) years. 16 patients (55.7%) were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68%) and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P 0.1). Conclusion: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure. PMID:25538779

  20. Recurrence rate of repaired hard palate oronasal fistula with conchal cartilage graft

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    Hosein Abdali

    2014-01-01

    Full Text Available Background: After cleft palate repair, oronasal fistula (ONF formation is one of the considerable and troublesome complications. Conchal cartilage graft is one option that can be used in recurrent fistula correction. The aim of the current study is investigating the recurrence rate of the hard palate ONF or ONF at the junction of hard and soft palate after utilizing conchal cartilage graft and comparing this rate with other methods. Materials and Methods: In this observational prospective study, 29 patients suffering from ONF with small, medium and large sizes who were referring to Alzahra university hospital, Isfahan, Iran and Fateme Zahra university hospital, Tehran, Iran between November 2011 and November 2012 were enrolled. All patients had midline cleft palate, 29.6% of them had cleft lip too that was repaired previously. All patients were followed-up for 2 years (every 2 months after repair. Results: The mean (range age of studied samples was 10.7 (2-23 years. 16 patients (55.7% were female, and reminders were male. During 2 years followup, we detected recurrence of ONF in 6 patients (20.68% and the success rate was 79.32%. The recurrence rate, after applying the current approach, among who experienced the several times of recurrence was significantly higher than among those who experienced first time of recurrence (33.3% vs. 7.1%; P 0.1. Conclusion: Using of conchal cartilage graft for recurrent ONF with ≤1 cm was safe and efficacious, in ONF >1 cm conchal cartilage graft can be used as a primary method and if recurrence occurred chooses other complex procedure.

  1. Effect of cleft palate repair on the susceptibility to contraction-induced injury of single permeabilized muscle fibers from congenitally-clefted goat palates.

    Science.gov (United States)

    Despite cleft palate repair, velopharyngeal competence is not achieved in ~ 15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resi...

  2. Herpes simplex 1 stomatitis after cleft palate repair: a case report and guidelines for management.

    Science.gov (United States)

    Evangelista, Maristella S; Tracy, Lauren; Wells, James H

    2015-05-01

    Herpes simplex virus (HSV) primary infection and reactivation has been associated with the inflammation and transient decrease in immunocompetence after surgery and local trauma. In addition, HSV infection is known to impair wound healing, increase risk of scarring, and impede connective tissue graft transplantation. To our knowledge, this is the first case of HSV infection complicating cleft palate repair presented in literature. In this report, we present a case of primary HSV infection occurring in a healthy 26-month-old patient after repair of the secondary cleft palate with mucoperichondrial flaps and V-Y pushback. The patient developed high fever on postoperative day 1, which was followed by perioral vesicular lesions and multiple intraoral ulcerations involving the lips, palate, and posterior pharynx. Unknown to the surgeons, the patient was exposed to HSV before surgery by a sibling with orolabial HSV infection. The infective cause was ascertained via polymerase chain reaction for HSV-1 DNA, and the infection was treated with topical and intravenous acyclovir for 1 week. The patient recovered well with adequate flap healing, good aesthetic outcome, and no complications on 1-month follow-up. This report underscores the importance of prompt recognition of herpetic infections in the patient with craniofacial surgery and reviews the association and complications of HSV infection in surgical healing. Early identification with prompt antiviral therapy and meticulous wound care are essential to ameliorate the scarring and delayed wound healing associated with HSV infection.

  3. Do patients with isolated Pierre Robin Sequence have worse outcomes after cleft palate repair: A systematic review.

    Science.gov (United States)

    Wan, Teng; Chen, Yang; Wang, Guomin

    2015-08-01

    Cleft palate repair for Pierre Robin Sequence (PRS) patients has always been a challenge for surgeons and anesthetists. The aim of this systematic review is to investigate the outcome of cleft palate repair for PRS patients compared with cleft palate-only patients. All papers published before October 2014 were searched in the databases PubMed and MEDLINE. Search terms included "Pierre Robin Sequence," "cleft palate repair," and "speech result." Additional studies were identified by hand searching the reference lists of the papers retrieved from electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the studies. Six studies met the inclusion criteria. All but one study had multiple deficiencies in study designs. Four studies assessed the fistula rate of both groups, and all studies assessed some aspect of the speech results. Conflicting results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the outcome of cleft palate repair for PRS patients was better or worse than cleft palate-only patients. Further well-designed, well-controlled, and long-term studies are needed.

  4. The effect of muscle repair on postoperative facial skeletal growth in children with bilateral cleft lip and palate.

    Science.gov (United States)

    Nagase, T; Januszkiewicz, J S; Keall, H J; de Geus, J J

    1998-12-01

    The effect of orbicularis muscle repair on postoperative facial skeletal growth in bilateral cleft lip and palate patients was studied by analysis of cephalometric radiographs and dental casts. Sixty-two patients operated on between 1961-1989 were selected for the study. They were divided into three groups, group 1a (muscle repair; n = 12), group 1b (failed attempt at muscle repair; n = 5), and group 2 (no attempt at muscle repair; n = 45). Comparison of the morphological measurements among these three groups showed that there was a trend towards crossbite in the muscle repair group, but this difference was not significant. Mechanisms by which muscle repair might influence maxillofacial skeletal growth include the possibility that the area around the nasal septum might be the growth centre. The choice of operative technique in bilateral cleft lip and palate should be important.

  5. Assessment of nasalance and nasality in patients with a repaired cleft palate.

    Science.gov (United States)

    Sinko, Klaus; Gruber, Maike; Jagsch, Reinhold; Roesner, Imme; Baumann, Arnulf; Wutzl, Arno; Denk-Linnert, Doris-Maria

    2017-03-15

    In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView(®), we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1-100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

  6. Assessing an avoidable and dispensable reoperative entity: Self-referred flawed cleft lip and palate repair.

    Science.gov (United States)

    Foroglou, Pericles; Tsimponis, Antonis; Goula, Olga-Christina; Demiri, Efterpi

    2015-01-01

    aesthetically improved outcome. Indications for surgery include widened scars, lip contour deformities, shortened lips, poorly defined and flattened nasal tip, short columella and irregularities of the nostrils (narrow or high-riding) and cartilages. Wound dehiscence, contractures, vermilion notching, white roll malalignment and orovestibular fistulas are possible unfavourable results after cleft lip repair. The psychological status of children and adults with repaired cleft lip and palate has been the subject of extensive research especially regarding the way of their evaluation facial appearance, satisfaction and need for secondary corrective surgical procedures in the hope of increasing their self-esteem and self-confidence. The aim of this study was to assess secondary CLP deformity management in an accredited present-day tertiary hospital facility with an existing infrastructure of a specialist teams however not formed in a multidisciplinary group. Equally, to answer questions of specific operation indications and choice as related to prior surgeries, hospitalization time and cost, provision of adequate preoperative information, correlation between paediatric and plastic surgeons and effect of post-plastic surgical care on patients' health and well-being. It also aims at presenting, beyond our current primary cleft lip and palate repair approach, appropriate indications and timing of secondary repair and achieved results.

  7. Cleft Lip and Cleft Palate

    Science.gov (United States)

    ... health conditions > Cleft lip and cleft palate Cleft lip and cleft palate E-mail to a friend Please fill ... repair cleft lip and palate. What are cleft lip and cleft palate? Cleft lip is a birth defect in ...

  8. Palate Fracture Repair With Light-Cured Resin Splint: Technical Note.

    Science.gov (United States)

    Waldrop, Jimmy; Dale, Elizabeth L; Halsey, Jordan; Sargent, Larry A

    2015-10-01

    Palate fractures are rare, and their treatment is a matter of debate. Although some investigators have favored rigid plate fixation, others have reported successful treatment without it. Sagittal split and comminuted fractures can require rigid fixation to reduce the maxillary width; however, additional stabilization is needed. Also, palate repair without a splint is complicated by prolonged intermaxillary fixation (IMF), causing stiffness to the temporomandibular joint. We introduce a technique using a rapid light-cured resin (TRIAD TranSheet) frequently used by orthodontists for making dental retainers. Its use is similar to the splints traditionally created preoperatively, but obviates the need for making impressions, a model, and a molded splint. A series of 13 patients treated with this technique during a 5-year period is presented. The average duration of IMF was 4.7 weeks (range 3 to 6). The average duration of the palate splint was 8.4 weeks (range 5 to 12). One patient had malocclusion, but none had malunion, infection, or oronasal fistula. Our series has demonstrated a simple, cost-effective, and successful technique. It can be used alone or combined with rigid fixation and allows for a shortened duration of maxillomandibular fixation.

  9. The Effect of Cleft Palate Repair on Contractile Properties of Single Permeabilized Muscle Fibers From Congenitally Cleft Goats Palates

    Science.gov (United States)

    A cleft palate goat model was used to study the contractile properties of the levator veli palatini (LVP) muscle which is responsible for the movement of the soft palate. In 15-25% of patients that undergo palatoplasty, residual velopharyngeal insufficiency (VPI) remains a problem and often require...

  10. Effects of lip repair on maxillofacial morphology in patients with unilateral cleft lip with or without cleft palate.

    Science.gov (United States)

    Shao, Qinghua; Chen, Zhengxi; Yang, Yang; Chen, Zhenqi

    2014-11-01

    Objective : To evaluate the effects of lip repair on maxillofacial development of patients with unilateral cleft lip with or without cleft palate. Design : Retrospective. Patients : A total of 75 patients were recruited, including 38 surgical patients with complete unilateral cleft lip and alveolus and 37 patients with complete unilateral cleft lip and palate who had lip but not palate repair. As controls, 38 patients with no cleft were selected. All subjects were divided according to two growth stages: before the pubertal peak (GS1) and after the pubertal peak (GS2). Interventions : Lateral cephalograms of all subjects were obtained. Main Outcome Measures : Cephalograms were analyzed and compared in the study and control groups. Results : The patients with unilateral cleft lip and palate in both GS1 and GS2 demonstrated an almost normal maxillary and mandibular growth with retroclined maxillary incisors. The patients with unilateral cleft lip and palate showed a shorter length of maxilla, a more clockwise-rotated mandible, and retroclined maxillary incisors. Conclusions : There was an almost normal maxillary and mandibular growth but retroclined maxillary incisors in patients with cleft lip with or without cleft palate who had received lip repair only, indicating that lip repair may not have a negative impact on the maxillofacial development and influences only the inclination of the maxillary incisors. The shorter anterior-posterior maxillary length and larger gonial angle in patients with unilateral cleft lip and palate compared with those in patients with unilateral cleft lip and alveolus suggest that these variations in maxillary and mandibular growth may be a consequence of the cleft itself.

  11. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

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    S. A. Gehrke

    2012-01-01

    Full Text Available The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation of the results. Ten consecutives cases with the occurrence of membrane perforation were included in this study. All were repaired with a flap of tissue removed from the palatine portion near to the surgical site. The technique is demonstrated through a clinical case. The results showed successful integration of 88.8% of the implants after 12 months from prosthesis installation. Histological evaluation of the samples showed that the use of nanocrystalized hydroxyapatite showed an adequate stimulation of boné neoformation within 6 months. Radiographic evaluation revealed a small apical implant bone loss, not compromising their anchorages and proservation. Thus, it can be concluded that the use of conjunctive technique with collected palate flap for sealing the perforation of the membrane of the sinus may have predictable result.

  12. Primary treatment for cleft lip and/or cleft palate in children in Japan.

    Science.gov (United States)

    Uchiyama, Takeshi; Yamashita, Yukari; Susami, Takafumi; Kochi, Shoko; Suzuki, Shigehiko; Takagi, Ritsuo; Tachimura, Takashi; Nakano, Yoko; Shibui, Takeo; Michi, Ken-ichi; Nishio, Juntaro; Hata, Yuiro

    2012-05-01

    To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. PARTICIPANTS, PATIENTS: Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

  13. A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results.

    Science.gov (United States)

    Cheng, Ningxin; Zhao, Min; Qi, Kemin; Deng, Hui; Fang, Zeng; Song, Ruyao

    2006-01-01

    During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed.

  14. A case of single atrium and single ventricle physiology with bilateral cleft lip and palate for lip repair surgery

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    Rakhee Goyal

    2012-01-01

    Full Text Available Bilateral cleft lip and palate may occasionally be associated with complex congenital cyanotic heart disease. An infant with common atrium and single ventricle with infundibular pulmonary stenosis (Blalock-Taussig shunt done recently presented for lip repair surgery. Balanced general anesthesia was administered using sevoflurane along with a regional nerve block to maintain optimal pulmonary and systemic vascular resistance.

  15. Speech understandability of repaired cleft palate patients pre and post caregiver training

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    Jobe Andrea L

    2007-01-01

    Full Text Available Background: Treating speech and language problems in repaired cleft palate patients in India is still an uphill task due to lack of facilities. This study attempted to use parents as team members for the speech management of cleft palate patients in Andhra Pradesh, India. Objectives: To investigate whether a positive change in speech understandability for individuals with cleft palate will result from a parent-administered intervention program. Materials and Methods: Twenty-eight parents had enrolled for the speech camp held in September 2004. The parent-training program at the speech camp ensured that parents were given adequate awareness. Out of the 28, 18 (64.28% reported for one follow-up, referred to in this article as Group I. Ten (35.72% out of the 28 came for two consecutive follow-ups, referred to in this article as Group II. Results: Pre and post training understandability scores obtained in the known context (reciting a familiar poem in the native language, counting 1 to 10 and unknown context (peer group names, family information, describing their journey from home to hospital for Group I and Group II were evaluated. Results revealed that a higher percentage of cases showed significant improvement in understandability in the unknown context after treatment. Unknown context can be considered a measure to assess speech understandability after training. Further, it shows that parent training without practice at home may not show the desired results. Conclusion: This study reveals that parents can effect a positive change in the speech understandability of their children following training, provided the exercises are carried out regularly at home and the parents report for the follow-up assessments and guidance.

  16. Bite force of children with repaired unilateral and bilateral cleft lip and palate.

    Science.gov (United States)

    Garcia, Michele Alves; Rios, Daniela; Honório, Heitor Marques; Trindade-Suedam, Ivy Kiemle

    2016-08-01

    To assess the bite force (BF) of children with repaired cleft lip and palate (CLP). Children aged 6-12 years, with and without CLP, were divided into the following 5 groups: (1) control group (CON): 34 children without CLP (17 female, 17 male, mean age 8.2±1.4); (2) cleft lip group (CL): 31 children with cleft lip involving the pre-maxilla (15 female, 16 male, mean age 9.7±1.3); (3) unilateral CLP group (UCLP): 36 children with complete unilateral CLP (11 female, 25 male, mean age 9.4±1.6); (4) bilateral CLP group (BCLP): 32 children with complete bilateral CLP (11 female, 21 male, mean age 9.5±1.7); and 5) cleft palate group (CP): 17 children with complete cleft palate (9 female, 8 male, mean age 9.4±1.6). Briefly, in this clinical trial, BF was assessed before alveolar bone grafting with a gnathodynamometer (IDDK, Kratos, Cotia, SP, Brazil). For CON, BCLP, CL and CP groups, BF was obtained in the anterior and posterior region of the maxilla. For the UCLP group, BF was assessed in the anterior and posterior regions of both segments. Differences among groups were evaluated by ANOVA test, and Tukey's test was used to assess any correlations among variables (Pcleft groups. However, a stronger BF was observed in the CL group when compared to the UCLP and BCLP groups. Next, no differences were observed between the cleft side and the noncleft side in the UCLP group. Lastly, in all groups, BFs from the anterior region of the maxilla were less when compared to the posterior regions. The BF of children with CLP is no different from children without CLP. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Three-dimensional facial analysis of Chinese children with repaired unilateral cleft lip and palate

    Science.gov (United States)

    Othman, Siti Adibah; Aidil Koay, Noor Airin

    2016-08-01

    We analyzed the facial features of Chinese children with repaired unilateral cleft lip and palate (UCLP) and compared them with a normal control group using a three-dimensional (3D) stereophotogrammetry camera. This cross-sectional study examined 3D measurements of the facial surfaces of 20 Chinese children with repaired UCLP and 40 unaffected Chinese children aged 7 to 12 years old, which were captured using the VECTRA 3D five-pod photosystem and analyzed using Mirror software. Twenty-five variables and two ratios were compared between both groups using independent t-test. Intra- and inter-observer reliability was determined using ten randomly selected images and analyzed using intra-class correlation coefficient test (ICC). The level of significance was set at p cleft group exhibited wider alar base root width, flattened nose and broader nostril floor width on the cleft side. They tended to have shorter upper lip length and thinner upper vermillion thickness. Faces of Chinese children with repaired UCLP displayed meaningful differences when compared to the normal group especially in the nasolabial regions.

  18. Auditory complaints and audiologic assessment in children with surgically repaired cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Cerom, Jaqueline Lourenço

    2013-04-01

    Full Text Available Introduction: At the initial consultation, the speech-language pathologist and audiologist may consider possible diagnostic hypotheses based on the child's history and the parents' complaint. Aim: To investigate the association of hearing complaints with the findings obtained in the conventional audiologic assessment in children with cleft lip and palate. Retrospective study. Methods: We analyzed medical charts of 1000 patients with cleft lip and palate who underwent surgical repair between 1988 and 1995 at a mean age of 6 years 8 months. We excluded charts with records of inconsistent audiological responses and charts with missing data for any of the audiologic evaluations considered. Thus, the sample consisted of 393 records. Results: Two hundred thirty-nine patients presented hearing loss in one or both ears, but only 3.8% reported hearing complaints. The most frequent were otorrhea followed by otalgia. There was no statistical significance between the complaint and gender (p = 0.26 nor between the complaint and hearing loss (p = 0.83. Conclusion: This study showed no association between the hearing complaint and the conventional audiologic assessment.

  19. Repair of a submucous cleft palate by W-pushback and levator repositioning without incision to the nasal mucosa.

    Science.gov (United States)

    Hwang, Kun

    2012-03-01

    The author created an innovative method of W-pushback and levator repositioning without having to make an incision to the nasal mucosa for submucous cleft palate repair.The W-shaped mucoperiosteal flap is outlined where the 2 peaks of W are the alveolar processes of both canine teeth and the midpoint of W is the anterior limit of the cleft notch of the hard palate. A short incision, medial to and behind the maxillary tuberosity and curved forward onto the palate and extended forward just medial to the alveolar process, is joined by a second incision from the apex of the cleft to the region of the canine tooth. The W-shaped mucoperiosteal flap is raised until the midline notch of the hard palate is exposed. The nasal mucosa and abnormally inserted levator veli palatini muscle to the posterior border of the hard palate bone are detached. By leaving the nasal mucosa intact, the detached levator veli palatini muscle is approximated at the midline and so the zona pellucida is obliterated. The cleft uvulas are cut in half and closed. The approximated W-flap is joined to the small anterior flap by 1 or more sutures (the W-pushback).Three patients were operated on with this technique without serious complications.The author believes that this method can make the levator sling and increase the length of the soft palate without making an incision to the nasal mucosa.

  20. The Effect of Cleft Lip and Palate, and the Timing of Lip Repair on Mother-Infant Interactions and Infant Development

    Science.gov (United States)

    Murray, Lynne; Hentges, Francoise; Hill, Jonathan; Karpf, Janne; Mistry, Beejal; Kreutz, Marianne; Woodall, Peter; Moss, Tony; Goodacre, Tim

    2008-01-01

    Background: Children with cleft lip and palate are at risk for psychological problems. Difficulties in mother-child interactions may be relevant, and could be affected by the timing of lip repair. Method: We assessed cognitive development, behaviour problems, and attachment in 94 infants with cleft lip (with and without cleft palate) and 96…

  1. The Effect of Cleft Lip and Palate, and the Timing of Lip Repair on Mother-Infant Interactions and Infant Development

    Science.gov (United States)

    Murray, Lynne; Hentges, Francoise; Hill, Jonathan; Karpf, Janne; Mistry, Beejal; Kreutz, Marianne; Woodall, Peter; Moss, Tony; Goodacre, Tim

    2008-01-01

    Background: Children with cleft lip and palate are at risk for psychological problems. Difficulties in mother-child interactions may be relevant, and could be affected by the timing of lip repair. Method: We assessed cognitive development, behaviour problems, and attachment in 94 infants with cleft lip (with and without cleft palate) and 96…

  2. Effect of intravenous magnesium sulphate or dexamethasone as adjuvants to sevoflurane anesthesia to prevent delirium during primary cleft palate repair, controlled randomized blind study

    Directory of Open Access Journals (Sweden)

    M. Elsonbaty

    2017-01-01

    Conclusion: Co-administration of intravenous magnesium sulphate or dexamethasone with to sevoflurane anesthesia during primary cleft palate repair provides more vital hemodynamic state and decrease in postoperative vomiting and delirium when compared with control group.

  3. Treatment outcome after neonatal cleft lip repair in 5-year-old children with unilateral cleft lip and palate.

    Science.gov (United States)

    Košková, Olga; Vokurková, Jitka; Vokurka, Jan; Bryšova, Alena; Šenovský, Pavel; Čefelínová, Julie; Lukášová, Darina; Dorociaková, Petra; Abelovský, Juraj

    2016-08-01

    The aim of this study was to assess speech outcomes and dental arch relationship of 5-year-old Czech patients with unilateral cleft lip and palate (UCLP) who have undergone neonatal cleft lip repair and one-stage palatal closure. Twenty-three patients with UCLP, born between 2009 and 2010, were included in the study. Three universal speech parameters (hypernasality, articulation and speech intelligibility) have been devised for speech recordings evaluation. Outcomes of dental arch relationship were evaluated by applying the GOSLON Yardstick and subsequently compared with the GOSLON outcome of other cleft centers. Moderate hypernasality was present in most cases, the mean value for articulation and speech intelligibility was 2.07 and 1.93, respectively. The Kappa values for inter-examiner agreement for all the three speech outcomes ranged from 0.786 to 0.808. Sixty-three percent of patients were scored GOSLON 1 and 2, 26% GOSLON 3, and 10% GOSLON 4. GOSLON mean score was 2.35. Interrater agreement was very good, represented by kappa value of 0.867. The treatment protocol, involving neonatal cleft lip repair and one-stage palatal repair performed up to the first year of UCLP patient's life, has shown good speech outcomes and produced very good treatment results in regard to maxillary growth, comparable with other cleft centers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Soft tissue chondroma of hard palate associated with cleft palate

    OpenAIRE

    Rajendra Nehete; Anita Nehete; Sandeep Singla; Sudhir Sankalecha

    2012-01-01

    Soft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence af...

  5. Fracture of the Vomero-Premaxillary Junction in a Repaired Bilateral Cleft Lip and Palate Patient

    Science.gov (United States)

    Zwahlen, Roger Arthur; Jayaratne, Yasas Shri Nalaka; Htun, Su Yin; Bütow, Kurt-Wilhelm

    2014-01-01

    Although dental trauma is common in bilateral cleft lip and palate (BCLP), patients' reports on bony fractures of the vomero-premaxillary junction cannot be found. The aim of this report is to illustrate clinical findings and the technique of fracture fixation in a child suffering from a fractured vomero-premaxillary junction as well as subsequent columella lengthening. A 4-year-old girl with a repaired BCLP presented with an open mucosal laceration and fractured vomero-premaxillary junction. Open reduction and fixation of the dislocated premaxilla was performed under general anesthesia. Fractured bone pieces of the vomero-premaxillary junction were removed and sharp bone edges at the vomer and the premaxilla were grinded. The repositioned premaxilla was fixed to the lateral alveolar arches with two mucoperiosteal sutures on each side. Additional columella lengthening was performed 2 years later. All family members were very happy about the new aesthetics of the girl. Although rare, fractures of the vomero-premaxillary junction present several challenges to clinicians related to anatomical, physiological, and psychological issues. Immediate and minimal invasive treatment strategies are recommended when managing such cases. PMID:25383152

  6. Three-Dimensional Assessment of Early Surgical Outcome in Repaired Unilateral Cleft Lip and Palate: Part 1. Nasal changes.

    LENUS (Irish Health Repository)

    Ayoub, Ashraf

    2010-08-11

    Abstract Objective: To evaluate 3D nasal morphology following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous non-cleft data Design: Prospective, cross-sectional, controlled study. Setting: Glasgow Dental Hospital & School, Faculty of Medicine, Glasgow University Patients and Participants: Two groups of 3-year old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a 3D vision based capture technique. Methods: 3D images of the face were reflected so the cleft was on the left side to create a homogenous group for statistical analysis. Three-dimensional co-ordinates of anthropometric landmarks were extracted from facial images by a single operator. A set of linear measurements was utilised to compare cleft and control subjects on right and left sides, adjusting for sex differences Results: the mean nasal base width and the width of the nostril floor on right and left sides differed significantly between control and Unilateral Cleft Lip and Palate (UCLP) groups. The measurements were greater in UCLP children. The difference in the mean nasal height and mean nasal projection between the groups were not statistically significant. Mean columellar lengths were different between the left and right sides in UCLP cases. Conclusions: There were significant nasal deformities following the surgical repair of UCLP. Keywords: child, cleft lip and palate, three-dimensional imaging.

  7. Repair of bilateral clefts of lip, alveolus and palate. Part 1: A refined method for the lip-adhesion in bilateral cleft lip and palate patients.

    Science.gov (United States)

    Bitter, K

    2001-02-01

    The protruding premaxilla represents the most severe problem in the surgical closure of a bilateral cleft lip, alveolus and palate (BCLP). In principle there are two methods to overcome this obstacle: (1) preliminary lip adhesion and (2) presurgical repositioning with intraoral devices. According to the various degrees of premaxillary protrusion, sometimes adhesion alone is sufficient, if the surgical technique is unlikely to break down. In this paper a refined adhesion method is presented, withstanding traction to the wound margins and concomitantly enables lip and nose repairs in a single second operation. For patients with severe premaxillary protrusion, presurgical use of a Latham appliance achieves conditions for safe lip adhesion as above. Both treatment methods are outlined.

  8. Lip Repair Surgery for Bilateral Cleft Lip and Palate in a Patient Diagnosed with Trisomy 13 and Holoprosencephaly.

    Science.gov (United States)

    Akamatsu, Tadashi; Hanai, Ushio; Nakajima, Serina; Kobayashi, Megumi; Miyasaka, Muneo; Matsuda, Shinichi; Ikegami, Mariko

    2015-06-20

    We report a case of lip repair surgery performed for bilateral cleft lip and palate in a patient diagnosed with trisomy 13 and holoprosencephaly. At the age of 2 years and 7 months, the surgery was performed using a modified De Hann design under general anesthesia. The operation was completed in 1 h and 21 min without large fluctuations in the child's general condition. The precise measurement of the intraoperative design was omitted, and the operation was completed using minimal skin sutures. It is possible to perform less-invasive and short surgical procedures after careful consideration during the preoperative planning. Considering the recent improvements in the life expectancy of patients with trisomy 13, we conclude that surgical treatments for non-life threatening malformations such as cleft lip and palate should be performed for such patients.

  9. Acute liver failure following cleft palate repair: a case of therapeutic acetaminophen toxicity.

    Science.gov (United States)

    Iorio, Matthew L; Cheerharan, Meera; Kaufman, Stuart S; Reece-Stremtan, Sarah; Boyajian, Michael

    2013-11-01

    Background : Acetaminophen is a widely used analgesic and antipyretic agent in the pediatric population. While the hepatotoxic effects of the drug have been well recognized in cases of acute overdose and chronic supratherapeutic doses, the toxic effects of acetaminophen are rarely documented in cases where therapeutic guidelines are followed. Case : An 8-month-old boy underwent cleft palate repair and placement of bilateral myringotomy tubes. His anesthetic course was uneventful, consisting of maintenance with desflurane and fentanyl. He received acetaminophen for routine postoperative pain management and was tolerating liquids and discharged home on postoperative day 1. On day 3, the child was profoundly lethargic with multiple episodes of emesis and was taken to the emergency department. He suffered a 45-second tonic-clonic seizure in transport to the regional children's medical center, and initial laboratory results demonstrated acute hepatitis with AST 24,424 U/L, ALT 12,885 U/L, total bilirubin 3.1 mg/dL, and a serum acetaminophen level of 83 μg/mL. Aggressive supportive measures including blood products and periprocedural fresh frozen plasma, piperacillin/tazobactam, and intravenous infusions of N-acetylcysteine, sodium phenylacetate and sodium benzoate, carnitine, and citrulline were administered. His metabolic acidosis and acute hepatitis began to correct by day 4, and he was discharged home without further surgical intervention on day 15. Conclusion : Although acetaminophen is an effective and commonly used analgesic in pediatric practice, hepatotoxicity is a potentially devastating complication. This report challenges the appropriateness of existing guidelines for acetaminophen administration and emphasizes the importance of close follow-up and hydration after even relatively minor surgery.

  10. Three-Dimensional Assessment of Early Surgical Outcome in Repaired Unilateral Cleft Lip and Palate: Part 2. Lip Changes.

    LENUS (Irish Health Repository)

    Ayoub, Ashraf

    2010-09-08

    Abstract Objective: To evaluate 3D lip morphology, following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous non-cleft data Design: Prospective, cross-sectional, controlled study Setting: Glasgow Dental Hospital & School, University of Glasgow, The UK. Patients and Participants: Two groups of 3-year old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a 3D vision based capture technique. Methods: 3D images of the face were reflected so the cleft was on the left side to create a homogenous group for statistical analysis. Three-dimensional co-ordinates of anthropometric landmarks were extracted from facial images. 3D generalised Procustes superimposition was employed and a set of linear measurements were utilised to compare between cleft and control subjects for right and left sides, adjusting for sex differences. Results: Christa philteri on both the cleft and non-cleft sides were displaced laterally and posteriorly; there was also a statistically significant increase in philtrum width. No significant differences between cleft and control regarding the cutaneous height of the upper lip. The lip in the cleft cases was flatter than in the non-cleft cases with less prominence of labialis superioris. Conclusions: Stereophotogrammetry allows detection of residual dysmorphology following cleft repair. There was significant increase of the philtrum width. The lip appeared flatter and more posterior displaced in Unilateral Cleft Lip and Palate (UCLP) cases compared with control. Keywords: child, cleft lip and palate, lip repair, three-dimensional imaging.

  11. Speech outcomes in 10-year-old children with complete unilateral cleft lip and palate after one-stage lip and palate repair in the first year of life.

    NARCIS (Netherlands)

    Hortis-Dzierzbicka, M.; Radkowska, E.; Fudalej, P.S.

    2012-01-01

    An evaluation of the results of one-stage repair of unilateral cleft lip and palate (UCLP) performed at the Institute of Mother and Child, Warsaw, Poland, has shown that the dentofacial outcomes are comparable with those of the best cleft centres. The aim of this study was to assess speech developme

  12. Palatalization and glide strengthening as competing repair strategies: Evidence from Kirundi

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    Alexei Kochetov

    2016-07-01

    Full Text Available Alternations involving place-changing palatalization (e.g. t+j → ʧ in spirit – spiritual are very common and have been a focus of much generative phonological work since Chomsky & Halle’s (1968 ‘Sound Pattern of English’. The interest in palatalization and its mechanisms (see e.g. Sagey 1990; Chen 1996; Bateman 2007 has somewhat obscured the question of how these processes fit into a wider typology of segmental alternations. What happens when palatalization fails to apply? Do other processes take its place and apply under the same circumstances? In this paper, I argue for a close functional and formal affinity between place-changing palatalization and one such process, palatal glide strengthening (e.g. p+j → pc. As evidence I present data from Kirundi (Bantu on the realization of consonant + palatal and velar glide sequences within and across morphemes. As will be shown, palatalization and glide strengthening in Kirundi work in parallel, affecting different subsets of consonants. Specifically, palatalization targets C+j sequences with laryngeals, velars, nasal coronals, and – across morpheme boundaries – non-nasal coronals. In contrast, glide strengthening targets C+j sequences with labials and – within morphemes – non-nasal coronals. In addition, glide strengthening applies to within- and across-morpheme consonant + velar glide sequences, producing a set of outputs (e.g. m+w → mŋ similar to C+j sequences. I further present a unified Optimality Theoretic (Prince & Smolensky 1993/2004 account of these seemingly disparate phenomena as both arising from different rankings of constraints prohibiting consonant + glide sequences (parameterized by place and/or manner and various feature-specific agreement and faithfulness constraints. Finally, I explore typological predictions of this account, reviewing several remarkably similar cases of C + glide resolution patterns from other languages, and outlining questions for further

  13. Abrupt laryngeal engagement during stop plosive-vowel transitions in children with repaired cleft palate and adequate velopharyngeal closure: aerodynamic and sound pressure level evidence.

    Science.gov (United States)

    Zajac, David J; Milholland, Sarah

    2014-01-01

    To determine whether children with repaired cleft palate and adequate velopharyngeal closure exhibit abrupt laryngeal engagement during stop plosive-vowel transitions as compared with children without cleft palate. A prospective group design was used with convenience sampling of patients at a university craniofacial center. PARTICIPANTS were 25 children (15 boys, 10 girls) with repaired cleft palate (mean age = 10.9 years, standard deviation = 1.5 years) and 20 children (10 boys, 10 girls) without cleft palate (mean age = 10.8 years, standard deviation = 1.8 years). All children with cleft palate had adequate velopharyngeal closure as determined by aerodynamic testing. (1) Peak oral airflow was determined during the release of /t/ in the word "two" during a counting task. (2) An index of laryngeal engagement defined as the ratio of the maximum oral airflow declination to peak oral airflow was calculated during the release of /t/. (3) Sound pressure level was determined during the vowel of the word "two." Children with cleft palate exhibited significantly more negative laryngeal engagement ratios (i.e., more abrupt adduction) (P = .002) and greater sound pressure level (P = .049) than controls. There was a significant negative relationship between laryngeal engagement and sound pressure level for all children (r = -.428, P = .003). Children with repaired cleft palate and adequate velopharyngeal function appear to use a strategy of abrupt laryngeal adduction during stop plosive-vowel transitions. This strategy-perhaps learned even prior to palate surgery-may help to achieve either adequate sound pressure level and/or velopharyngeal closure.

  14. Use of a modified Furlow Z-plasty as a secondary cleft palate repair procedure to reduce velopharyngeal insufficiency.

    Science.gov (United States)

    Reddy, R R; Reddy, S G; Banala, B; Bronkhorst, E; Kummer, A W; Kuijpers-Jagtman, A M; Bergé, S J

    2016-02-01

    Cleft palate repair is done to allow for normal speech by separating the oral and nasal cavities and creating a functioning velopharyngeal valve. However, despite cleft palate repair, some patients demonstrate velopharyngeal insufficiency (VPI). An attempt was made to determine the effectiveness of a modified secondary Furlow Z-plasty in improving VPI. Fifty-five children aged between 12 and 15 years, with postoperative VPI following primary palatoplasty, were included in the study. These children underwent a modified Furlow Z-plasty. Nasometry was done to determine the change in velopharyngeal function due to the secondary Furlow Z-plasty by comparing the preoperative with the 1-year postoperative nasalance scores. A test-retest study was performed to determine the reliability of the nasometric measures. Reliability measurements of the nasometer passages revealed good reliability for 18 out of the 25 speech passages. There was a statistically significant reduction in VPI at 1 year postoperative in patients who were treated with the modified Furlow Z-plasty, with a P-value of nasalance scores at 1 year postoperative, indicating significantly improved velopharyngeal function.

  15. A novel computer system for the evaluation of nasolabial morphology, symmetry and aesthetics after cleft lip and palate treatment. Part 2: Comparative anthropometric analysis of patients with repaired unilateral complete cleft lip and palate and healthy individuals.

    Science.gov (United States)

    Pietruski, Piotr; Majak, Marcin; Pawlowska, Elzbieta; Skiba, Adam; Antoszewski, Boguslaw

    2017-04-01

    The aim of this study was to use a novel system, 'Analyse It Doc' (A.I.D.) for a complex anthropometric analysis of the nasolabial region in patients with repaired unilateral complete cleft lip and palate and in healthy individuals. A set of standardized facial photographs in frontal, lateral and submental view have been taken in 50 non-cleft controls (mean age 20.6 years) and 42 patients with repaired unilateral complete cleft and palate (mean age 19.57 years). Then, based on linear, angular and area measurements taken from the digital photographs with the aid of the A.I.D. system, a photogrammetric analysis of intergroup differences in nasolabial morphology and symmetry was conducted. Patients with cleft lip and palate differed from the controls in terms of more than half of analysed angular measurements and proportion indices derived from linear and area measurements of the nasolabial region. The findings presented herein imply that despite primary surgical repair, patients with unilateral complete cleft lip and palate still show some degree of nasolabial dysmorphology. Furthermore, the study demonstrated that the novel computer system is suitable for a reliable, simple and time-efficient anthropometric analysis in a clinical setting. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Roberts-SC syndrome, a rare syndrome and cleft palate repair

    Directory of Open Access Journals (Sweden)

    Murthy Jyotsna

    2008-01-01

    Full Text Available Roberts SC syndrome is a rare syndrome with only 17 previously recognized patients reported in medical literature. The syndrome is characterized by multiple malformations, particularly, symmetrical limb reduction, craniofacial anomalies such as bilateral cleft lip and palate, micrognathia, and severe growth and mental retardation. Our patient, a young child of five years having Roberts-SC, was successfully operated for cleft palate under general anesthesia. The main features of the syndrome and the technical problems of anesthesia and surgery are discussed in this report.

  17. Speech outcome in children born with cleft lip and palate treated with one-stage palate repair : aspects of function and environment

    OpenAIRE

    Nyberg, Jill

    2016-01-01

    Introduction and aims: This project focused on speech outcomes at 5 and 10 years of age after two different surgical protocols and on peer perceptions of speech in children born with cleft palate. The aim was to gain knowledge about speech outcome in children born with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO), treated with one-stage palatoplasty at approximately 12 months of age, according to two different surgical protocols: minimal incision technique (MIT) and minim...

  18. 完全性唇腭裂婴儿期手术对上颌骨发育的影响%The effect of early cleft palate repair on maxillary growth in infantile complete cleft lip and palate children

    Institute of Scientific and Technical Information of China (English)

    赵瑞红

    2011-01-01

    Objective: To obsewe the effect of infantile cleft palate repair on maxillary growth in children with complete cleft lip and palate. Methods: 18 children with complete cleft lip and palate were divided into two groups according to whether cleft palate repair was performed or not in infancy. In the one-stage repair group, 10 children received cleft lip and palate repair in infancy, the mean age was (10.15±0.76) years in follow-up. In the cleft lip repair group (10 patients),cleft lip repair was performed without cleft palate surgery in infancy, the mean age of this group was (10.25±0.75) years in follow-up. 20 cases of noncleft children (ages lO) were normal control group. The X-ray cephalometry and dentognathic models of three groups were obtained and compared. Results: The data analysis of cephalometry and dental cast showed that the difference between the two groups had no obvious significance (P>0.05); but compared with the normal group, the cleft lip and palate patients all had the growth inhibition (P<0.05). Conclusion: The cleft palate repair is not the reason of the difference existing;. Earlier cleft palate operation is favorable to functional recovery for infants.%目的:观察婴儿早期行唇腭裂手术对完全性唇腭裂患儿上颌骨发育的近期影响.方法:18例完全性唇腭裂患儿在婴儿期接受唇腭裂手术作为唇腭裂修复组,随访时平均年龄(10.15±0.76)岁;10例未行唇腭裂手术的单纯唇裂患儿为单纯唇腭裂组,随访时平均年龄(10.25±0.75)岁;另20例正常的10岁龄学童作为正常对照组.三组分别取头颅侧位片与上牙颌模型,进行测量分析.结果:两组唇腭裂患儿之间的上颌骨发育无明显差异(P>0.05),与正常对照组比较,均有生长抑制(P<0.05).结论:早期对完全性唇腭裂患儿行唇裂修复术对上颌骨发育的影响不大,还可以使患者获得正常的语言功能.

  19. Objective assessment of internal nasal dimensions and speech resonance in individuals with repaired unilateral cleft lip and palate after rhinoseptoplasty.

    Science.gov (United States)

    Trindade, Inge Elly Kiemle; Bertier, Carlos Eduardo; Sampaio-Teixeira, Ana Claudia Martins

    2009-03-01

    The objective of the current study was to analyze the effects of rhinoseptoplasty on internal nasal dimensions and speech resonance of individuals with unilateral cleft lip and palate, estimated by acoustic rhinometry and nasometry, respectively. Twenty-one individuals (aged 15-46 years) with previously repaired unilateral cleft lip and palate were analyzed before (PRE), and 6 to 9 (POST1) and 12 to 18 months (POST2) after surgery. Acoustic rhinometry was used to measure the cross-sectional areas (CSAs) of segments corresponding to the nasal valve (CSA1), anterior portion (CSA2), and posterior portion (CSA3) of the lower turbinate, and the volumes at the nasal valve (V1) and turbinate (V2) regions at cleft and noncleft sides, before and after nasal decongestion with a topical vasoconstrictor. Nasometry was used to evaluate speech nasalance during the reading of a set of sentences containing nasal sounds and other devoid of nasal sounds. At the cleft side, before nasal decongestion, there was a significant increase (P nasalance values at PRE, POST1, and POST2 were not different from each other in both oral and nasal sentences. The measurement of CSAs and volumes by acoustic rhinometry revealed that rhinoseptoplasty provided, in most cases analyzed, a significant increase in nasal patency, without concomitant changes in speech resonance, as estimated by nasalance assessment.

  20. Presurgical nasoalveolar molding: A boon to facilitate the surgical repair in infants with cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Prabhakar Ramasetty Attiguppe

    2016-01-01

    Full Text Available Cleft lip and palate (CLP is the most common congenital craniofacial anomaly. Rehabilitation of CLP generally requires a team approach. Alveolar and nasal reconstruction for these patients is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap, so as to obtain esthetic results postsurgically. The presurgical nasoalveolar molding (PNAM technique, developed by Grayson, is a new approach to presurgical infant orthopedics. PNAM reduces the severity of the initial cleft alveolar and nasal deformity. Thus, it enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This article presents a brief insight into PNAM with a case series of three different cases (one unilateral and two bilateral which underwent PNAM treatment and gave an excellent surgical prognosis.

  1. Breastfeeding After Early Repair of Cleft Lip in Newborns With Cleft Lip or Cleft Lip and Palate in a Baby-Friendly Designated Hospital.

    Science.gov (United States)

    Burianova, Iva; Kulihova, Katarina; Vitkova, Veronika; Janota, Jan

    2017-08-01

    Goals of treatment of orofacial cleft are to improve feeding, speech, hearing, and facial appearance. Early surgery brings faster healing, better cosmetic effect, and fewer complications. Breastfeeding rates after early surgery are unknown. Early repair of the cleft lip may influence breastfeeding rates. Research aim: The aim of this study was to evaluate breastfeeding after early repair of the cleft lip in a Baby-Friendly designated hospital. The rate of breastfeeding in newborns with cleft lip was compared to cleft lip and palate. This was a retrospective cohort study. The study group included infants with cleft lip and cleft lip and palate operated on in the first 2 weeks of life. Newborns and their mothers were supported by a team promoting breastfeeding. One hundred four infants (70 boys and 34 girls) were included. Isolated cleft lip was present in 56 (53.8%) infants, and cleft lip and palate in 48 (46.2%). Forty-four (78.6%) of the infants with a cleft lip were breastfed, 3 (5.4%) received human milk via bottle or syringe, and 9 (16.0%) were formula fed. Three (6.2%) of the infants with a cleft lip and palate were breastfed, 31 (64.6%) received human milk via bottle or Haberman feeder, and 14 (29.2%) were formula fed. The rate of breastfeeding in patients following early surgery of the cleft lip was high and comparable to the general population. The rate of breastfeeding in babies with cleft lip and palate after early repair of the cleft lip remained low.

  2. Effect of unrestricted bottle-feeding on early postoperative course after cleft palate repair.

    Science.gov (United States)

    Kim, Eun Key; Lee, Taik Jong; Chae, Soo Wook

    2009-09-01

    Although bottle-feeding after cheiloplasty is widely accepted, postoperative feeding regimen after palatoplasty is still controversial. The aim of this prospective randomized study was to evaluate the effect of bottle-feeding on early postoperative course after palatoplasty in a relatively homogeneous group of patients. Eighty-two consecutive patients with nonsyndromic cleft palate undergoing 2-flap palatoplasty by a single surgeon were randomized to feeding from a bottle with the usual nipple (G1, N = 42) or to feeding with a spoon, cup, or syringe (G2, N = 40). Complication rates, postoperative sedative use, oral intake for the first 6 days, and relative weight gain at 1 and 2 months were compared. There were no significant complications such as bleeding or respiratory problem. The overall complication rate including wound dehiscence and oronasal fistula was similar in G1 and G2 (11.9% versus 12.5%, P = 1.000) as was postoperative sedative use and mean daily oral intake for the first 5 days. Mean intake on the sixth day was significantly higher in G1. There were no significant between-group differences in relative weight gain after 1 and 2 months. In conclusion, bottle-feeding had no adverse effect on the early postoperative course after palatoplasty including complication rate, oral intake, and weight gain. These findings suggest that an unrestricted feeding regimen is appropriate immediately after palatoplasty.

  3. Experimental study on cleft palate repair of rat using rat fetal membrane%鼠胎膜修复大鼠腭裂的实验研究

    Institute of Scientific and Technical Information of China (English)

    张驰; 娜荷雅; 张幸竹; 王丝墨; 唐喜乐; 马振宇; 肖晶; 李武伟

    2013-01-01

    目的 以鼠胎膜对腭裂进行整复手术,研究修复腭裂的效果.方法 建立腭裂动物模型实验.30只SD大鼠按照腭部裂隙大小分为3组,每组10只.a组:长7 mm×宽0.9 mm;b组:长7 mm×宽1.1 mm;c组:长7mm×宽1.3 mm.术后12周处死所有大鼠,观察裂隙变化.手术关闭裂隙实验.10只SD大鼠分为3组.A组大鼠5只,手术造腭裂并以新鲜双层胎膜关闭裂隙;B组大鼠3只,手术造腭裂,令裂隙自行生长;C组2只作为空白对照组.术后4周处死动物,大体观察;制作切片,行组织学观察.结果 腭裂动物模型成功建立,确立b组7mm×1.1 mm为临界缺损.A组大鼠腭裂得到成功修复,口鼻腔黏膜分别愈合,完全覆盖腭裂,镜下见腭裂处口腔黏膜层次清楚,存在黏膜下层,顶部有完整的鼻腔黏膜.结论 鼠胎膜对SD大鼠腭裂具有良好的修复效果.%Objective To explore the feasibility of repairing the defect in cleft palate using fetal membrane in a rat model. Methods To establish the animal model of cleft palate. Thirty SD rats were randomly divided into three groups with 10 rats in each group according to the different size of man - made cleft, group a: 7 mm × 0. 9 mm, group b: 7 mm × 1. 1 mm, group c: 7 mm × 1.3 mm. Animals were sacrificed at the end of 12 weeks and the changes of clefts were compared. Repairing experiment for cleft palate. Ten SD rats were randomly divided into three groups, group A was underwent reduction with 5 rats, group B was only performed model operation with 3 rats, group C was blank with 2 rats. All rats were sacrificed at the end of 4 weeks and the gross and histological observation was respectively carried out. Results The animal model of cleft palate was successfully established. Group b was determined to be the animal model group for critical - sized defect. Cleft palate was repaired successfully in group A with fetal membrane of rat, the structure of palate mucosa was similar to that of the group C in gross

  4. THE CORRELATION BETWEEN DERIVED NASALANCE MEASURES AND PERCEIVED NASALITY IN CHILDREN WITH REPAIRED CLEFT LIP AND PALATE

    Directory of Open Access Journals (Sweden)

    Attuluri Navya

    2014-04-01

    Full Text Available Context: Velopharyngeal dysfunction (VPD is one of the associated condition reported in individuals with repaired cleft lip and palate (RCLP leading to hypernasality. Nasality can be assessed by nasometer through nasalance values. But, mean nasalance values (N found to be overlapping between individuals with RCLP and normals. To overcome these limitations Nasalance Distance (ND and Nasalance Ratio (NR are derived based on nasalance range. Aims: The study is aimed to evaluate, correlate and compare acoustical (N, ND & NR and perceptual measures of nasality between the children with RCLP and control group. Settings and Design: Institutional setup and standard group comparison design Methods and Material: The study included fifteen children with RCLP ranging from 6 to 11 years and the control group consists of age and gender matched 15 typically developing children. Four point standard rating scale was used to rate the hypernasality by three speech language pathologists (SLP’s and Nasometer was used to measure the mean and derived nasalance scores for vowels and sentences in Kannada. Statistical analysis: SPSS, Cronbach’s Alpha test, multivariate analysis and Pearson’s product movement correlation were used to analyze the data. Results: Significant increase in the mean nasalance value and NR was seen in children with RCLP than the control group, whereas ND was contrary. ND was highly correlated with perceived nasality than N. The NR of sentences shows high negative correlation. Conclusions: The measures based on range of nasalance can be adapted to the routine clinical examinations for better correlation with perceived nasality.

  5. Speech outcomes at age 5 and 10 years in unilateral cleft lip and palate after one-stage palatal repair with minimal incision technique - a longitudinal perspective.

    Science.gov (United States)

    Nyberg, Jill; Peterson, Petra; Lohmander, Anette

    2014-10-01

    To investigate speech outcomes in 5- and 10-year-old children with unilateral cleft lip and palate (UCLP) treated according to minimal incision technique (MIT) - a one-stage palatal method. A retrospective, longitudinal cohort study of a consecutive series of 69 patients born with UCLP, treated with MIT (mean age 13 months) was included. Forty-two children (43%) received a velopharyngeal flap; 12 before 5 years and another 18 before 10 years of age. Cleft speech variables were rated from standardized audio recordings at 5 and 10 years of age, independently by three experienced, external speech-language pathologists, blinded to the material. The prevalences of cleft speech characteristics were determined, and inter- and intra-rater agreement calculated. More than mild hypernasality, weak pressure consonants and perceived incompetent velopharyngeal function were present in 19-22% of the children at 5 years, but improved to less than 5% at 10 years. However, audible nasal air leakage, prevalent in 23% at 5 years, did not improve by age 10. Thirty percent had frequent or almost always persistent compensatory articulation at 5 years, and 6% at age 10. The general impression of speech improved markedly, from 57% giving a normal impression at 5 years to 89% at 10 years. A high prevalence of distorted/s/was found at both 5 and 10 years of age. A high occurrence of speech deviances at 5 years of age after MIT was markedly reduced at 10 years in this study of children with unilateral cleft lip and palate. The high pharyngeal flap rate presumably accounted for the positive speech development. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. MORPHOLOGICAL OUTCOME OF PRIMARY L IP REPAIR IN PATIENTS WITH UNILAT ERAL CLEFT LIP - PALATE WITH THE USE OF INFERIOR TURBINATE F LAP

    Directory of Open Access Journals (Sweden)

    Vijaya Kumar

    2015-06-01

    Full Text Available BACKGROUND: Cleft lip and palate deformity poses problems at every stage of growth and development of the child. Repair of cleft lip - nose complex is a major challenge for the operating surgeon as well the manner in which the deficient tissues are replenished. The major issue which still remains to be tackled is achieving a acceptable nasal correction. In the quest for tissues to bring about a better repair especially in the region of nostril floor and a lar base , the hypertrophied inferior turbinate on the cleft side appears to be a good option. OBJECTIVE: The objective of the study is to evaluate long term aesthetic and morphological outcome of lip and nose in patients with unilateral cleft lip and palate deformity. MATERIALS AND METHOD : A Group of 41 patients were taken in the study and they were randomize d into two groups , Study group 21 cases who underwent primary lip repair with inferior turbinate flap and Control Group B , 20 cases without inferior turbinate flap. Age , sex , side of cleft and photographic evaluation of was done at 2 years and above post o peratively for nostril height , nostril width , nostril basal width and alar base level. RESULTS : On photographic evaluation group a showed statistically significant symmetry in the nasal architecture , and the long term follow up of these patients is necessa ry to comment on the aesthetic outcome. CONCLUSION : Inferior turbinate flap provides an adequate tissue during nostril floor reconstruction and helped in augmenting the depressed alar base on the cleft side.

  7. Technique for Preserving Pterygoid Hamuli and Aponeurosis of Palate in Repairing Child's Cleft Palate%保留翼钩及腭腱膜修复小儿腭裂115例总结

    Institute of Scientific and Technical Information of China (English)

    高景恒; 徐振宽; 郑华翔; 王玉明

    1984-01-01

    From July;1969 to May;1982;115 cases of children's cleft palates were treated;58 boys and 57 girls;the 2 youngest being 1.5 years of age.The surgical technic used could be divided into 3 periods:namely;the first period(mainly hypotensive incisi on);the (Second period(synthetical technic)and the third period(technics of preserving pterygoid hamuli and aponeurosis of the palate).The recurrent disruption rate was 9.57%(11:115)among which 9 happened In the first period and 2 in the second.So far as the age for surgical intervention is concerned;it was believed that adequate closure of the cleft;satisfactory restoration of pronunciation;and not to increase the mortality or morbidity must be taken into consideration.Hence;earlier repair is recommendable only under 2 conditions;i.e.the child is well-nourished and the surgeon and anaesthetist are well-experienced.Otherwise;it is better to delay it until the patient is 5 or 6 years old.The principle for the selection of surgical approaches and the importance of preserving pterygoid hamuli and aponeurosis of palate are also discussed.%@@ 理想的腭裂修复不仅应封闭裂隙,而更重要的是创造良好的发音条件.重建正常的腭咽解剖结构是获得优良发音的必要条件.我院自1969年7月到1982年5月共收治小儿腭裂115例.

  8. Effect of Relaxing Incisions on the Maxillary Growth after Primary Unilateral Cleft Palate Repair in Mild and Moderate Cases: A Randomized Clinical Trial

    Science.gov (United States)

    Cotrina-Rabanal, Omar; Figallo-Hudtwalcker, Olga; Gonzalez-Vereau, Alicia

    2017-01-01

    Background: The purpose of this study was to evaluate the association between the use of relaxing incisions and maxillary growth disturbance after primary palatoplasty in patients with unilateral cleft lip and palate. Methods: This is a prospective, randomized, double-blind controlled trial study with ethical committee approval between 2 groups of patients with unilateral cleft lip and palate who were operated on using the two-flap and one-flap techniques from 2008 to 2011. Two groups of patients with unilateral cleft lip and palate were operated on using the mentioned techniques by the Outreach Surgical Center Program Lima since 2008. Data collection was accomplished by evaluation of maxillary arch dimensions and dental arch relationships (scored using the 5-year-olds’ index). Results: The mean score for the 5-year-olds’ index was 2.57 for two-flap technique and 2.80 for one-flap technique without statistical significant differences (P = 0.71). Our comparative study did not find statistically significant differences in maxillary arch dimensions between the studied techniques for unilateral cleft palate repair. Good levels of agreement were observed according to the κ statistics. Conclusions: The results arising from this clinical trial do not provide statistical evidence that one technique let us obtain better maxillary development than the other at 5 years. The use of relaxing incisions was not associated with maxillary growth impairment. A technique with limited relaxing incisions does not has better maxillary growth. Additional longer term study is necessary to confirm this preliminary report. PMID:28203502

  9. Evolution of my philosophy in the treatment of unilateral cleft lip and palate.

    Science.gov (United States)

    Brusati, Roberto

    2016-08-01

    At the end of 50-year-long clinical activity, the evolution of my approach to the treatment of unilateral cleft of the lip and palate is discussed. I had several teachers in this field (Rusconi, Reherman, Perko, Delaire, Talmant, Sommerlad and others) and I introduced in my approach what I considered to be improvements from all of them. My current protocol is related to the anatomy of the cleft: for wide clefts a two-stage protocol is applied (1° step: soft palate and lip and nose repair; 2° step: hard palate repair with gingivoalveoloplasty); for narrow cleft (less than 1 cm at the posterior border of hard palate) an "all in one" protocol is performed with or without gingivoalveoloplasty (in accordance to the presence or absence of contact between the stumps at alveolar level). The most important details regarding surgery of the lip and palate are discussed. Robust data collection on speech and skeletal growth is still needed to determine whether the "all in one" approach can be validated as the treatment of choice for unilateral complete lip and palate cleft in selected cases.

  10. The clinical research of one-stage cleft lip and hard palate repair in patients with unilateral complete cleft lip and palate%单侧完全性唇腭裂唇裂及硬腭一期修复临床观察

    Institute of Scientific and Technical Information of China (English)

    熊清华; 刘诚; 雷伟; 汪丹凤; 张建芳

    2016-01-01

    Objective To observe the clinical effect of one-stage cleft lip and hard palate crack repair in unilateral complete cleft lip and palate patient. Methods Thirty patient with unilateral complete cleft lip and palate simultaneously received repair of cleft lip and closure of cleft hard palate with vomer lfaps when they were 4-6 months old. We would observe the wound healing of hard palate and presence or absence of oronasal ifstula in follow-up. Results All operations were successful,and the wound of hard palate healed well,no wound infection occurred. The hard palate crack were fully closed when the cleft palate surgery of second phase were in implementation at 12-18 months old. The oronasal ifstula of patients were inexistent. Conclusion Simultaneous repairs of cleft lip and closure of cleft hard palate are safe and feasible for patients with unilateral complete cleft lip and palate.It contribute to push back the soft palate.The patients had a better function of velopharyngeal closure.%目的:观察单侧完全性唇腭裂患儿在唇裂修复时一期行硬腭裂隙封闭的临床效果。方法:选择30例年龄为4.0~6.0月龄的单侧完全性唇腭裂患儿在唇裂修复时一期行硬腭裂隙犁骨瓣封闭,后期观察硬腭创面愈合及口鼻瘘存在与否。结果:所有患儿的手术均顺利完成,无硬腭创口感染及裂开。至患儿12~18个月龄二期腭裂手术时见硬腭部裂隙已完全关闭,无口鼻瘘存在。结论:单侧完全性唇腭裂患儿唇裂及硬腭一期修复安全、可行,利于腭裂手术时的软腭后退,使患儿有更好的腭咽闭合。

  11. 152例幼儿期腭裂手术治疗的临床探讨%Clinical Analysis of Treatment of Cleft Palate Repair in Infancy

    Institute of Scientific and Technical Information of China (English)

    阿依努尔·达吾提; 艾克拜尔·阿合买提; 韩洁; 莫红

    2013-01-01

    目的 探讨基层医院在幼儿期开展早期腭裂修复手术的可行性、安全性和成功率等.方法 分析新疆民政康复医院于2009年1月-2011年12月收治152例先天性腭裂患者的临床资料,所有患者术前常规及辅助检查后均行早期腭裂修复手术.手术年龄11个月~4岁,手术方法单侧完全性腭裂采用两大瓣后推术,双侧完全性腭裂采用犁骨瓣加两大瓣后推术,不完全腭裂采用兰氏术式.手术后给予全身抗炎治疗,局部每日漱口清洁,术后第2日给予0.9%氯化钠注射液20 ml、地塞米松注射液3 mg、庆大霉素注射液2ml雾化吸入,预防术后喉头水肿和切口感染.结果 152例先天性腭裂患者中,治愈149例(98.03%),穿孔3例(1.97%)所有病例均一期愈合出院,腭部愈合好,悬雍垂重建良好,语言功能有不同程度改善,患儿家长均感满意.结论 先天性唇腭裂患儿饮食困难,体质差,手术惠儿普遍年龄小在具备可靠的手术麻醉与护理条件的医院收治腭裂患儿是可行的和安全的.在幼儿期开展早期腭裂修复术为临床上腭裂手术的最佳时机.%Objective To investigate feasibility, safety and achievement ratio of early cleft palate repair in early childhood development in basic hospital. Methods Analysis on Xinjiang home rehabilitation hospital between January 2009 and admitted to 152 cases of congenital cleft palate patients with clinical data,all General and after the auxiliary examination before operation in patients with early surgical repair of cleft palate. Surgery 11 months up to 4 years of age,of unilateral complete cleft palate surgery method uses two push the big flap,double cleft palate with Vomer flap and two great after a flap operation,incomplete cleft palate using Orchid' s operation. Systemic anti-inflammatory therapy after the operation,a local daily mouthwash clean,after second day of 0.9% sodium chloride injection 20ml 3mg 2ml aerosol inhalation of

  12. The use of SymNose for quantitative assessment of lip symmetry following repair of complete bilateral cleft lip and palate.

    Science.gov (United States)

    Russell, James H B; Kiddy, Harriet C; Mercer, Nigel S

    2014-07-01

    The SymNose computer program has been proposed as an objective method for the quantitative assessment of lip symmetry following unilateral cleft lip repair. This study aims to demonstrate the use of SymNose in patients with complete bilateral cleft lip and palate (BCLP), a group previously excluded from computer-based analysis. A retrospective cohort study compared several parameters of lip symmetry between BCLP cases and non-cleft controls. 15 BCLP cases aged 10 (±1 year) who had undergone primary repair were recruited from the patient database at the South West Cleft Unit, Frenchay Hospital. Frontal facial photographs were selected for measurement. 15 age-matched controls were recruited from a local school. Lip symmetry was expressed as: percentage mismatch of left vermillion border and upper lip area over the right, horizontal lip tilt and lateral deviation of the lip. A significant increase in lip asymmetry was found in the BCLP group expressed as upper vermillion border mismatch across computer-defined and user-defined midlines (mean difference was 16.4% (p lip asymmetry remains in BCLP patients even after primary repair. This challenges previous assumptions that those with bilateral defects would be relatively symmetrical. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. The construction of two-stage tests

    NARCIS (Netherlands)

    Adema, Jos J.

    1988-01-01

    Although two-stage testing is not the most efficient form of adaptive testing, it has some advantages. In this paper, linear programming models are given for the construction of two-stage tests. In these models, practical constraints with respect to, among other things, test composition, administrat

  14. Children with repaired bilateral cleft lip/palate: effect of age at premaxillary osteotomy on facial growth.

    Science.gov (United States)

    Padwa, B L; Sonis, A; Bagheri, S; Mulliken, J B

    1999-10-01

    This study compared facial growth in three groups of patients with bilateral complete cleft lip/palate: those who had (1) no premaxillary osteotomy, (2) premaxillary osteotomy before age 8 years, and (3) premaxillary osteotomy after age 8 years. Of 24 children with bilateral complete cleft lip/palate, 7 had early premaxillary osteotomy (mean age, 6.1; range, 3.7 to 7.6 years), 10 had late osteotomy (mean age, 11.2; range, 8.3 to 20.7 years), and 7 did not require premaxillary repositioning and served as controls (mean age, 12.4; range, 6.4 to 17.8 years). Presurgical and postsurgical lateral cephalograms were digitized using the Dentofacial Planner software; most current lateral cephalograms comprised the control group. Forty-one bony and 25 soft-tissue landmarks were digitized, and 8 angles were measured: SNA, (sella-nasion-A point), SNPg (sella-nasion-pogonion), ANB (A point-nasion-B point), NAPg (nasion-A point-pogonion), ST convexity (glabella-subnasale-soft-tissue pogonion), Sn-G vertical (line perpendicular to the horizontal plane dropped from glabella and distance measured from subnasale to this vertical), Cm-Sn-Ls (columella-subnasale-abial superioris), and Sn-Gn-C (subnasale-soft-tissue gnathion-chin point). Statistical difference in mean preoperative and postoperative values were measured with analysis of variance. Tests of significance were adjusted for multiple comparisons using the Bonferroni correction. Mean age at follow-up for early, late, and control groups was 11.8, 14.0, and 12.4 years, respectively. Mean follow-up for early and late groups was 5.7 and 2.8 years. There was a significant preoperative difference among the three groups for mean SNA (p premaxillary positioning had more significant preoperative deformity; however, this group's postoperative profile was not, on average, significantly different from either the late or control groups. Our findings that the early group had more significant change with premaxillary osteotomy than the late

  15. 唇裂修复术对上颌骨生长发育影响的初步探讨%The effect of lip repair on maxillary growth in patients with complete unilateral cleft lip and(or) palate

    Institute of Scientific and Technical Information of China (English)

    石冰; 邓典智; 郑广宁; 左晖

    2001-01-01

    目的进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制。方法将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅X线片并测量分析。结果唇裂修复手术对唇腭裂组上颌骨生长发育的影响明显大于唇裂伴牙槽突裂组。结论唇腭裂的裂隙与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。%Objective To investigate the different effects of lip repair on maxillary growth among patients with cleft lip and(or) palate, and also the possible mechanisms accounting for that differences. Methods The lateral cephalometric analysis was applied to 84 Chinese patients with unilateral cleft lip and(or) palate at the early stage of permanent dentition, which included 32 UCLA, 20 UCLP (CP unrepaired), and 32 UCLP, and 37 normal Chinese of the same age as controls. Results The patients with unilateral cleft lip and palate who had lip repaired while the palate was left unrepaired exhibited the similar inhibition on maxillary growth to those who had both lip and palate repaired but the patients with unilateral cleft lip and alveolus had much less inhibition on their maxilla. Conclusions The cleft and tissue defect of patients with cleft lip and palate might be the main cause that induced the inhibitive effects of lip repair on maxillary growth.

  16. Incisor and molar overjet, arch contraction, and molar relationship in the mixed dentition in repaired complete unilateral cleft lip and palate: A qualitative and quantitative appraisal.

    Science.gov (United States)

    Disthaporn, Suteeta; Suri, Sunjay; Ross, Bruce; Tompson, Bryan; Baena, Diogenes; Fisher, David; Lou, Wendy

    2017-07-01

    To compare the mixed dentition incisor and molar overjet, severity of contraction of the dental arch, and the sagittal molar relationship on the cleft side vs the noncleft side in children with repaired complete unilateral cleft of the lip and palate (UCLP). Orthodontic records taken prior to orthodontic preparation for alveolar bone grafting were screened to select study casts from patients with nonsyndromic repaired complete UCLP who did not have mandibular skeletal or dental asymmetry. The study sample comprised dental casts from 74 children aged 8.9 ± 1 years. Standardized digital photographs were acquired at 1:1 magnification. A coordinate system was developed using digital image-processing software (Photoshop CS4 and Adobe Illustrator). Incisor and molar overjet, Angle's classification, and arch contraction were recorded. Descriptive statistics, paired t-tests, and kappa statistics were used to compare the cleft and noncleft sides. A negative overjet of -1 to -5 mm was often present at the incisors, with greater frequency and magnitude on the cleft side. Class II molar relation was more frequent on the cleft side (61.1%) than on the noncleft side (47.2%). Significantly greater contraction of the cleft side deciduous canine and deciduous first molar was noted, while the difference was very minor at the first permanent molar. Cleft side maxillary arch contraction was most severe in the deciduous canine and first deciduous molar region and progressively less severe in the posterior region of the arch. A greater frequency and severity of negative overjet and Class II molar relationship was seen on the cleft side.

  17. Multiple phonetically trained-listener comparisons of speech before and after articulatory intervention in two children with repaired submucous cleft palate.

    Science.gov (United States)

    Roxburgh, Zoe; Cleland, Joanne; Scobbie, James M

    2016-01-01

    Cleft Palate (CP) assessments based on phonetic transcription are the "gold standard" therapy outcome measure, despite reliability difficulties. Here we propose a novel perceptual evaluation, applied to ultrasound-visual biofeedback (U-VBF) therapy and therapy using visual articulatory models (VAMs) for two children with repaired submucous CP. Three comparisons were made: post VAM, post U-VBF and overall pre- and post-therapy. Twenty-two phonetically-trained listeners were asked to determine whether pre- or post-therapy recordings sounded "closer to the English target", using their own implicit phonological knowledge (prompted via orthographic representation). Results are compared with segment-oriented percent target consonant correct (PTCC) derived from phonetic transcriptions. Listener judgements and PTCC suggest that both children made improvements using both VAM and U-VBF. Statistical analysis showed listener agreement in each comparison, though agreement was weak. However, perceptual evaluation offers a straightforward method of evaluating the effectiveness of interventions and can be used by phonetically trained or lay listeners.

  18. Internationally adopted children with cleft lip and/or palate: A retrospective cohort study.

    Science.gov (United States)

    Werker, C L; de Wilde, H; Mink van der Molen, A B; Breugem, C C

    2017-04-23

    The treatment approach for internationally adopted children with cleft lip and/or palate differs from locally born children with cleft lip and/or palate. They are older at initial presentation, may have had treatment abroad of different quality, and are establishing new and still fragile relationships with their adoptive parents. The aim of this study was to describe the characteristics and initial care and treatment of this group. A retrospective cohort study was performed including all internationally adopted children with cleft lip and/or palate presenting to the cleft team outpatient clinic in the Wilhelmina Children's Hospital between January 1994 and December 2014. Medical records of all patients were reviewed; information concerning demographic characteristics, characteristics at initial presentation, and treatment were obtained. A total number of 132 adopted patients were included: 15% had cleft lip, 7% had cleft palate, and 78% had cleft lip and palate. The average age at the time of adoption was 26.5 months. In most cases, China was the country of origin. Seventy-eight percent had surgery in their country of origin, primarily lip repair. Fistulae in need of revision surgery were found in 8% of the patients. Pharyngoplasty was needed in 48% of the patients. No significant differences were found for mean age at adoption, gender, cleft type, and one- or two-stage palatal closure. Internationally adopted children with cleft lip and/or palate are a very diverse group of patients with challenging treatment. These children undergo surgery late and frequently need additional surgery. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    E S Adarsh

    2012-01-01

    Full Text Available Background: Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect. Objective: To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements. Study Design: A randomized clinical trial. Methods: After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group and group C (Conventional group. Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted. Results: We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002. There was no evidence of any increased perioperative bleeding in the diclofenac group. Conclusion: Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

  20. Maxillary Arch Dimensions and Spectral Characteristics of Children with Cleft Lip and Palate Who Produce Middorsum Palatal Stops

    Science.gov (United States)

    Zajac, David J.; Cevidanes, Lucia; Shah, Sonam; Haley, Katarina L.

    2012-01-01

    Purpose: The purpose of this study was twofold: (a) to determine maxillary arch dimensions of children with repaired cleft lip and palate (CLP) who produced middorsum palatal stops and (b) to describe some spectral characteristics of middorsum palatal stops. Method: Maxillary arch width, length, and height dimensions and first spectral moments of…

  1. Maxillary Arch Dimensions and Spectral Characteristics of Children with Cleft Lip and Palate Who Produce Middorsum Palatal Stops

    Science.gov (United States)

    Zajac, David J.; Cevidanes, Lucia; Shah, Sonam; Haley, Katarina L.

    2012-01-01

    Purpose: The purpose of this study was twofold: (a) to determine maxillary arch dimensions of children with repaired cleft lip and palate (CLP) who produced middorsum palatal stops and (b) to describe some spectral characteristics of middorsum palatal stops. Method: Maxillary arch width, length, and height dimensions and first spectral moments of…

  2. Two-stage sampling for acceptance testing

    Energy Technology Data Exchange (ETDEWEB)

    Atwood, C.L.; Bryan, M.F.

    1992-09-01

    Sometimes a regulatory requirement or a quality-assurance procedure sets an allowed maximum on a confidence limit for a mean. If the sample mean of the measurements is below the allowed maximum, but the confidence limit is above it, a very widespread practice is to increase the sample size and recalculate the confidence bound. The confidence level of this two-stage procedure is rarely found correctly, but instead is typically taken to be the nominal confidence level, found as if the final sample size had been specified in advance. In typical settings, the correct nominal [alpha] should be between the desired P(Type I error) and half that value. This note gives tables for the correct a to use, some plots of power curves, and an example of correct two-stage sampling.

  3. Two-stage sampling for acceptance testing

    Energy Technology Data Exchange (ETDEWEB)

    Atwood, C.L.; Bryan, M.F.

    1992-09-01

    Sometimes a regulatory requirement or a quality-assurance procedure sets an allowed maximum on a confidence limit for a mean. If the sample mean of the measurements is below the allowed maximum, but the confidence limit is above it, a very widespread practice is to increase the sample size and recalculate the confidence bound. The confidence level of this two-stage procedure is rarely found correctly, but instead is typically taken to be the nominal confidence level, found as if the final sample size had been specified in advance. In typical settings, the correct nominal {alpha} should be between the desired P(Type I error) and half that value. This note gives tables for the correct a to use, some plots of power curves, and an example of correct two-stage sampling.

  4. Two Stage Gear Tooth Dynamics Program

    Science.gov (United States)

    1989-08-01

    cordi - tions and associated iteration prooedure become more complex. This is due to both the increased number of components and to the time for a...solved for each stage in the two stage solution . There are (3 + ntrrber of planets) degrees of freedom fcr eacb stage plus two degrees of freedom...should be devised. It should be noted that this is not minor task. In general, each stage plus an input or output shaft will have 2 times (4 + number

  5. Condensate from a two-stage gasifier

    DEFF Research Database (Denmark)

    Bentzen, Jens Dall; Henriksen, Ulrik Birk; Hindsgaul, Claus

    2000-01-01

    that the organic compounds and the inhibition effect are very low even before treatment with activated carbon. The moderate inhibition effect relates to a high content of ammonia in the condensate. The nitrifiers become tolerant to the condensate after a few weeks of exposure. The level of organic compounds......Condensate, produced when gas from downdraft biomass gasifier is cooled, contains organic compounds that inhibit nitrifiers. Treatment with activated carbon removes most of the organics and makes the condensate far less inhibitory. The condensate from an optimised two-stage gasifier is so clean...

  6. Two Stage Sibling Cycle Compressor/Expander.

    Science.gov (United States)

    1994-02-01

    vol. 5, p. 424. 11. L. Bauwens and M.P. Mitchell, " Regenerator Analysis: Validation of the MS*2 Stirling Cycle Code," Proc. XVIIIth International...PL-TR--94-1051 PL-TR-- 94-1051 TWO STAGE SIBLING CYCLE COMPRESSOR/EXPANDER Matthew P. Mitchell . Mitchell/ Stirling Machines/Systems, Inc. No\\ 1995...ty. THIS PAGE IS UNCLASSIFIED PL-TR-94-1051 This final report was prepared byMitchell/ Stirling Machines/Systems, Inc., Berkeley, CA under Contract

  7. Oronasal fistula in cleft palate surgery

    Directory of Open Access Journals (Sweden)

    Sadhu Partha

    2009-10-01

    Full Text Available Oronasal fistula (ONF is the commonest complication associated with cleft palate surgery. The main symptoms associated with ONF are nasal regurgitation of food matter and hypernasality of voice. Repair of cleft palate under tension is considered to be the main reason of ONF though vascular accidents and infection can also be the cause. Most of the ONFs are situated in the hard palate or at the junction of hard and soft palate. Repair of ONF depends on its site, size and mode of presentation. A whole spectrum of surgical procedures starting from small local flaps to microvascular tissue transfers have been employed for closure of ONF. Recurrence rate of ONF is 25% on an average after the first attempt of repair.

  8. Comparison of dental arch dimensions in models of preschool children with cleft lip/palate repaired by means of surgery alone versus controls.

    Science.gov (United States)

    Burhan, Ahmad S; Nawaya, Fehmieh R

    2016-09-01

    Cleft lip and palate (CLP) anomaly is one of the most prevalent congenital defects causing disturbances of dental arch dimensions. This study aimed at investigating differences in these dimensions between preschool children with cleft lip/palate and a matched control group representing healthy individuals with normal occlusion (NO). The sample of this cross-sectional analytical study consisted of 108 plaster models of children aged from 4 to 5.5 years. They were divided into five groups: the cleft lip group, the cleft palate (CP) group, the unilateral cleft lip and palate group, the bilateral cleft lip and palate group, and the NO group. The NO group was used as a control group. All cleft-affected children were treated only with surgery. Dental arch length and widths were measured. The dental arch dimensions of the cleft lip group were nearly similar to those in the controls. Moreover, the mandibular transverse widths of the CP group were close to those in the controls. However, the mandibular arch length and all maxillary dimensions of the CP group were smaller than those in the controls. In the unilateral cleft lip and palate group, the arch lengths in both jaws and the maxillary transverse widths were smaller than those in the controls, whereas the mandibular transverse widths were similar to those in the controls. In the bilateral cleft lip and palate group, the arch lengths in both jaws were close to those in the controls, but both arches were narrower than those in the controls. The various types of CLP were found to be associated with differences in most maxillary and some mandibular arch dimensions. These data can be used for cleft patient counseling and treatment planning.

  9. Classification in two-stage screening.

    Science.gov (United States)

    Longford, Nicholas T

    2015-11-10

    Decision theory is applied to the problem of setting thresholds in medical screening when it is organised in two stages. In the first stage that involves a less expensive procedure that can be applied on a mass scale, an individual is classified as a negative or a likely positive. In the second stage, the likely positives are subjected to another test that classifies them as (definite) positives or negatives. The second-stage test is more accurate, but also more expensive and more involved, and so there are incentives to restrict its application. Robustness of the method with respect to the parameters, some of which have to be set by elicitation, is assessed by sensitivity analysis.

  10. Two stage gear tooth dynamics program

    Science.gov (United States)

    Boyd, Linda S.

    1989-01-01

    The epicyclic gear dynamics program was expanded to add the option of evaluating the tooth pair dynamics for two epicyclic gear stages with peripheral components. This was a practical extension to the program as multiple gear stages are often used for speed reduction, space, weight, and/or auxiliary units. The option was developed for either stage to be a basic planetary, star, single external-external mesh, or single external-internal mesh. The two stage system allows for modeling of the peripherals with an input mass and shaft, an output mass and shaft, and a connecting shaft. Execution of the initial test case indicated an instability in the solution with the tooth paid loads growing to excessive magnitudes. A procedure to trace the instability is recommended as well as a method of reducing the program's computation time by reducing the number of boundary condition iterations.

  11. Cleft palate caused by congenital teratoma.

    Science.gov (United States)

    Veyssière, Alexis; Streit, Libor; Traoré, Hamady; Bénateau, Hervé

    2017-02-01

    A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.

  12. 单侧完全性唇腭裂胎儿宫内手术修复的解剖学基础%Anatomic basis on fetal intrauterine surgical repair of unilateral complete cleft lip and palate

    Institute of Scientific and Technical Information of China (English)

    黄海龙; 陈丽娟; 钟卫娟; 邹锦慧; 梁恩来

    2012-01-01

    目的 为单侧性唇腭裂胎儿宫内手术修复提供解剖学基础.方法 制作和观察21~32周正常和单侧完全性唇腭裂胎儿头颈部血管铸型标本,比较他们唇腭部血供的来源及吻合情况. 结果 ①正常胎儿唇腭部的血供主要由上唇动脉、鼻翼下缘动脉和腭大动脉组成.两侧上唇动脉在中线附近吻合成上唇动脉弓,并在鼻中隔前下部形成浅深两层血管网,且上唇动脉鼻中隔支也与腭大动脉穿支相互吻合;②单侧完全性唇腭裂胎儿唇腭部血供由于患侧裂隙的阻隔,导致左右上唇动脉不能吻合成弓,患侧腭大动脉穿过骨残端与患侧鼻腔内的血管相吻合. 结论 单侧完全性唇腭裂胎儿唇腭部血管非常丰富,尤以上唇动脉和腭大动脉为血供主干.%Objective To provide anatomic basis for fetal intrauterine surgical repair of complete cleft lip and palate. Methods Vascular cast specimens of the head and neck from 21 ~32W normal fetus and unilateral complete cleft lip and palate fetus were carried out. Blood supply source and arterial anastomosis of lip and palate were observed and compared. Results ① For healthy fetus, blood supply of lip and palate mainly came from superior labial artery, nasal alar artery and greater palatine artery. The arterial arch formed by the anastomosis between the left and the right superior labial artery. The superficial and deep vascular networks were formed in nasal septum,and the nasal septum branch of superior labial artery anastomosed with the perforator branch of greater palatine artery. ② Due to the slit separation, The lip and palate vessels of unilateral complete cleft lip and palate fetus absent the anastomosis between the left and the right superior labial artery, however the greater palatine artery and nasal vessel anastomosed with each other through bone stump. Conclusions For fetus of cleft lip and palate, blood supply of the lip and palate was plentiful, especially

  13. Clinical Study of Heterogeneous Acellular Dermal Matrix for Repairing Hard Palatal Fistula%异种脱细胞真皮基质整复硬腭部腭瘘的临床研究

    Institute of Scientific and Technical Information of China (English)

    张波; 李健

    2013-01-01

    [Objective]To explore the clinical efficacy of heterogeneous acellular dermal matrix( Heal-All Oral Biofilm) for repairing hard palatal fistula. [Methods]Thirty-eight patients with hard palate fistula were randomly divided into treatment group and control group. Palatal fistulas of patients in treatment group( n = 18) was repaired with heterogeneous acellular dermal matrix. Palatal fistulas of patients in control group( n = 20) was repaired with traditional method. The recurrence in the closed fistula and the incidence of buccal gingi-val sulcus becoming shallow in patients of two groups were observed 1~3 months after the operation. [Results]The recurrence rate of closed fistula in treatment group was 11. 1 % (2/18) 1 ~ 3 months after the operation, which was markedly lower than that in control group(25. 0%, 5/20) , and there was significant differ-ence( P <0. 05). The incidence of buccal gingival sulcus becoming shallow in treatment group was 5. 5% (1/ 18), which was markedly higher than that in control group(90% , 18/20), and there was significant difference ( P <0. 01). [Conclusion]The efficacy of heterogeneous acellular dermal matrix(Oral Biofilm) for repairing hard palatal fistula is satisfactory, and has simple operation, little damage of surrounding tissue and no incidence of buccal gingival sulcus becoming shallow after the operation.%[目的]探讨异种脱细胞真皮基质(下称口腔修复膜)修补硬腭部腭瘘的临床疗效.[方法]38例硬腭部腭瘘的患者随机分为治疗组和对照组,治疗组18例患者采用口腔修复膜修补硬腭部腭瘘,对照组20例患者采用传统方法修复硬腭部腭瘘,观察两组患者术后1~3个月手术部位是否再次穿孔及龈颊沟是否变浅.[结果]治疗组在术后1~3个月再次穿孔的发生率为11.1%(2/18)显著低于对照组25.0%(5/20),其差异有统计学意义(P<0.05);治疗组龈颊沟变浅发生率为5.5%(1/18)显著低于对照组发生率为90%(18

  14. Capacity Analysis of Two-Stage Production lines with Many Products

    NARCIS (Netherlands)

    M.B.M. de Koster (René)

    1987-01-01

    textabstractWe consider two-stage production lines with an intermediate buffer. A buffer is needed when fluctuations occur. For single-product production lines fluctuations in capacity availability may be caused by random processing times, failures and random repair times. For multi-product producti

  15. Two-Stage Modelling Of Random Phenomena

    Science.gov (United States)

    Barańska, Anna

    2015-12-01

    The main objective of this publication was to present a two-stage algorithm of modelling random phenomena, based on multidimensional function modelling, on the example of modelling the real estate market for the purpose of real estate valuation and estimation of model parameters of foundations vertical displacements. The first stage of the presented algorithm includes a selection of a suitable form of the function model. In the classical algorithms, based on function modelling, prediction of the dependent variable is its value obtained directly from the model. The better the model reflects a relationship between the independent variables and their effect on the dependent variable, the more reliable is the model value. In this paper, an algorithm has been proposed which comprises adjustment of the value obtained from the model with a random correction determined from the residuals of the model for these cases which, in a separate analysis, were considered to be the most similar to the object for which we want to model the dependent variable. The effect of applying the developed quantitative procedures for calculating the corrections and qualitative methods to assess the similarity on the final outcome of the prediction and its accuracy, was examined by statistical methods, mainly using appropriate parametric tests of significance. The idea of the presented algorithm has been designed so as to approximate the value of the dependent variable of the studied phenomenon to its value in reality and, at the same time, to have it "smoothed out" by a well fitted modelling function.

  16. Speech disorder correction after cleft palate repair with levator veli palatini retropositioning%腭帆提肌重建腭裂修补后的言语障碍矫治

    Institute of Scientific and Technical Information of China (English)

    闫大勇; 张瑞; 董汉华; 苏会芝

    2015-01-01

    BACKGROUND:Cleft palate repair with levator veli palatini retropositioning can achieve good effects on pharyngeal function and voice quality by dissecting the muscle and rebuilding the muscle function only at the incision, without opening the mucoperiosteal flap, OBJECTIVE: To investigate the clinical effects of cleft palate repair with levator veli palatini retropositioning versus traditional surgery treatment on speech disorder correction. METHODS:Totaly 176 children with cleft palate were randomly assigned into treatment group and control group, 88 cases in each group. Patients were subjected to traditional surgery treatment in the control group and levator veli palatini retropositioning in the treatment group. RESULTS AND CONCLUSION:The postoperative speech inteligibility in the treatment group and the control group were 81.8% and 54.5%, respectively, and there was a significant difference between the two groups (P < 0.05). After cleft palate repair, the folowing indicators were al improved in the two groups, including soft palate functional length at static state and when pronouncing, and soft palate elevation angle (P < 0.05), and moreover, these indicators were better in the treatment group than the control group (P < 0.05). Scores on high nasal tone and rhinorrhea tone were decreased significantly in the two groups after repair, and the scores were significantly lower in the treatment group than the control group (P < 0.05). These findings indicate that cleft palate repair with levator veli palatini retropositioning can effectively rebuild soft palate function and perfect velopharyngeal competence in patients, which is of great significance for speech disorder correction and voice quality recovery.%背景:腭帆提肌重建腭裂修补仅从裂隙缘切口处行肌肉的解剖和功能重建,不需要两侧黏骨膜瓣的翻开,能使修补后达到较好的腭咽功能与语音效果。目的:比较腭帆提肌重建腭裂修补后与传统手术

  17. Composite likelihood and two-stage estimation in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2002-01-01

    Composite likelihood; Two-stage estimation; Family studies; Copula; Optimal weights; All possible pairs......Composite likelihood; Two-stage estimation; Family studies; Copula; Optimal weights; All possible pairs...

  18. On the robustness of two-stage estimators

    KAUST Repository

    Zhelonkin, Mikhail

    2012-04-01

    The aim of this note is to provide a general framework for the analysis of the robustness properties of a broad class of two-stage models. We derive the influence function, the change-of-variance function, and the asymptotic variance of a general two-stage M-estimator, and provide their interpretations. We illustrate our results in the case of the two-stage maximum likelihood estimator and the two-stage least squares estimator. © 2011.

  19. Cleft lip repair - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100010.htm Cleft lip repair - series—Normal anatomy To use the sharing ... abnormal opening in the middle of the upper lip. A cleft palate is an opening in the roof of ...

  20. Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries.

    Science.gov (United States)

    Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar

    2016-08-01

    [Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs.

  1. Incidence of Cleft Lip and Palate in Uganda

    NARCIS (Netherlands)

    Dreise, Marieke; Galiwango, George; Hodges, Andrew

    Objective: The purpose of the study was to estimate the need for resources for cleft repairs in Uganda by determining the overall incidence of oral-facial clefts and the ratio of isolated cleft lip to isolated cleft palate to cleft lip and palate. Design: A 1-year prospective study was implemented

  2. Incidence of Cleft Lip and Palate in Uganda

    NARCIS (Netherlands)

    Dreise, Marieke; Galiwango, George; Hodges, Andrew

    2011-01-01

    Objective: The purpose of the study was to estimate the need for resources for cleft repairs in Uganda by determining the overall incidence of oral-facial clefts and the ratio of isolated cleft lip to isolated cleft palate to cleft lip and palate. Design: A 1-year prospective study was implemented i

  3. Incidence of Cleft Lip and Palate in Uganda

    NARCIS (Netherlands)

    Dreise, Marieke; Galiwango, George; Hodges, Andrew

    2011-01-01

    Objective: The purpose of the study was to estimate the need for resources for cleft repairs in Uganda by determining the overall incidence of oral-facial clefts and the ratio of isolated cleft lip to isolated cleft palate to cleft lip and palate. Design: A 1-year prospective study was implemented i

  4. Micro-structured Beta-Tricalcium Phosphate for Repair of the Alveolar Cleft in Cleft Lip and Palate Patients : A Pilot Study

    NARCIS (Netherlands)

    de Ruiter, AP; Janssen, Nard; van Es, Robert; Frank, Michael; Meijer, Gert; Koole, Ron; Rosenberg, Toine

    2015-01-01

    OBJECTIVES: Can a synthetic bone substitute be used to repair the alveolar cleft to bypass donor site morbidity as well as to shorten the operating time? In earlier experimental studies, micro-structured beta-tricalcium phosphate (β-TCP) provided similar bone healing when compared with grafting with

  5. 单侧完全性唇(腭)裂患者术后上唇特征的研究%The study of characteristics of upper lip after lip repair in patients with complete cleft lip with or without cleft palate

    Institute of Scientific and Technical Information of China (English)

    左晖; 石冰; 张萍; 邓典智; 郑广宁

    2001-01-01

    Objective In order to understand the characteristics of upper lipafter lip repair in complete unilateral cleft lip with or without cleft palate.Methods The area of the upper lip,height of upper white lip,height of upper red lip,width of the mouth,as well as,the protruding of nose floor,upper and lower lip respectively were measured on the front and lateral standard photographs of patients with complete unilateral cleft lip and patients with complete unilateral cleft lip and palate who only had lip repaired or had both lip and palate repaired.Results The area and height of upper lip in both complete unilateral cleft lip group and cleft lip and palate group decreased significantly than that of normal group.The index of protruding of upper and lower lip in complete unilateral cleft lip and palate group was significantly smaller than that of normal group and complete unilateral cleft lip group.Conclusion The heigh of upper lip in patients with complete unilateral cleft lip and or palate would decrease significantly compared to normal group.The relationships of upper and lower lip positions were correlated to the senousness of retrusion and collapse of hard tissues supporting the upper lip in the unilateral cleft lip and or palate.%目的 了解单侧完全性唇(腭)裂患者术后上唇的形态特征。方法 将单侧完全性唇裂组和唇腭裂组患者,以及正常对照组的正、侧位标准相片上的上唇白唇面积,上唇白唇高,上唇红唇高,口裂宽,以及鼻底凸度,上唇和下唇凸度进行测量分析。结果 单侧完全性唇裂和唇腭裂患者唇裂术后的上唇面积和上白唇高均明显小于正常对照组。唇腭裂患者的唇突指数,明显小于正常对照组和唇裂组。结论 单侧完全性唇(腭)裂患者术后唇高短于正常对照组;唇突指数可较好地反映唇(腭)裂患者上唇支持硬组织凹陷畸形的程度。

  6. Cleft Palate Foundation

    Science.gov (United States)

    ... available in English , Spanish , and Mandarin ! Information on Cleft Lip and Palate Our booklets and factsheets address a variety of issues related to cleft lip and palate, such as speech, hearing, genetics, and what to ...

  7. Cleft Lip and Palate

    Science.gov (United States)

    Cleft lip and cleft palate are birth defects that occur when a baby's lip or mouth do not form properly. They ... during pregnancy. A baby can have a cleft lip, a cleft palate, or both. A cleft lip happens if ...

  8. The histological analyse about repairing cleft palate through osteogenesis by periosteal distraction%腭裂缘骨膜牵张成骨不同阶段的组织学变化分析

    Institute of Scientific and Technical Information of China (English)

    宋庆高; 邓金勇; 陈尚; 黄桂林; 蒋练

    2011-01-01

    目的 对腭裂裂隙缘的骨膜进行牵张,研究新骨形成的过程及规律,初步探讨骨膜牵张成骨方法修复腭裂的机制.方法 选用健康杂种幼犬8只制作腭裂动物模型,采用安置骨膜牵张器的方法对裂隙缘的一侧骨膜进行牵张,牵张力为(2.45±0.20)N.在牵张器放置后20、30、40、60 d各处死动物2只,未放置一侧为对照侧.结果 裂隙缘骨膜受牵张后,新生成骨细胞数量随时间变化而增多,大量沿牵张方向排列的胶原纤维组织在增生的成骨细胞作用下,钙化沉积成新骨,并逐渐改建成熟.结论 新骨形成是沿牵张方向的膜内成骨方式完成的,在骨膜牵张器放置20d后牵张区已有新骨形成,随着牵张时间的延长,成骨量逐渐增加,40d时的成骨活动最活跃,至60d时新骨钙化程度较成熟,以骨改建和塑形为主.%Objective Based on a periosteal distraction to periosteum of cleft palate edge, to observe the structural features of newly formed bone in each phase, study its forming process and rule, and make a preliminary study on the mechanism of repairing cleft palate. Methods Firstly, develop model of cleft palate in 8 healthy hybrid juvenile dogs. Then place Nitinol periosteal distraction device under the periosteum of cleft palate edge and fix it and distract the periosteum with a force of (2.45±0.20) N. The opposite edge belongs to control group.Every 2 dogs were killed after 20, 30, 40, 60 days respectively. Results New bone eventually generated under the periosteum after the periosteal distraction at the edge of cleft. Histological observation indicates the increase of osteoblasts in the new bone and the changes of the directions of the collagenous fiber and bone trabecula. A large amount of collagenous fibers arrayed toward the direction of distraction, under the influence of proliferation of osteoblasts, was calcified and become new bone, which gradually became more mature. Conclusion Newly formed bone is

  9. Contractile Properties of Single Permeabilized Muscle Fibers from Congenital Cleft Palates and Normal Palates of Spanish Goats

    Science.gov (United States)

    Hanes, Michael C.; Weinzweig, Jeffrey; Kuzon, William M.; Panter, Kip E.; Buchman, Steven R.; Faulkner, John A.; Yu, Deborah; Cederna, Paul S.; Larkin, Lisa M.

    2009-01-01

    Background Analysis of the composition of muscle fibers constituent to a cleft palate could provide significant insight into the cause of velopharyngeal inadequacy. The authors hypothesized that levator veli palatini muscle dysfunction inherent to cleft palates could affect the timing and outcome of cleft palate repair. Methods Single, permeabilized muscle fibers from levator veli palatini muscles of three normal (n = 19 fibers) and three chemically induced congenital cleft palates (n = 21 fibers) of 14-month-old goats were isolated, and contractile properties were evaluated. The maximum isometric force and rate constants of tension redevelopment (ktr) were measured, and the specific force and normalized power were calculated for each fiber. Results The ktr measures indicate that cleft fibers are predominantly fast-fatigable; normal fibers are slow fatigue-resistant: after a 10-minute isometric contraction, fibers from cleft palates had a loss of force 16 percent greater than that from normal palates (p = 0.0001). The cross-sectional areas of the fibers from cleft palates (2750 ± 209 μm2) were greater (p = 0.05) than those from normal palates (2226 ± 143 μm2). Specific forces did not differ between the two groups. Maximum normalized power of fibers from cleft palates (11.05 ± 1.82 W/l) was greater (p = 0.0001) than fibers from normal palates (1.60 ± 0.12 W/l). Conclusions There are clear physiologic differences in single muscle fibers from cleft palates and normal palates: cleft palate fibers are physiologically fast, have greater fatigability, and have greater power production. Detection of functional and/or fiber type differences in muscles of cleft palates may provide preoperative identification of a patient's susceptibility to velopharyngeal inadequacy and permit early surgical intervention to correct this clinical condition. PMID:17440342

  10. Treatment of cadmium dust with two-stage leaching process

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The treatment of cadmium dust with a two-stage leaching process was investigated to replace the existing sulphation roast-leaching processes. The process parameters in the first stage leaching were basically similar to the neutralleaching in zinc hydrometallurgy. The effects of process parameters in the second stage leaching on the extraction of zincand cadmium were mainly studied. The experimental results indicated that zinc and cadmium could be efficiently recoveredfrom the cadmium dust by two-stage leaching process. The extraction percentages of zinc and cadmium in two stage leach-ing reached 95% and 88% respectively under the optimum conditions. The total extraction percentage of Zn and Cdreached 94%.

  11. Evaluation of the Transverse Craniofacial Morphology of Adolescents With Repaired Unilateral Cleft Lip and Palate Using Cone-Beam Computed Tomography.

    Science.gov (United States)

    Buyuk, Suleyman Kutalmiş; Celikoglu, Mevlut; Benkli, Yasin Atakan; Sekerci, Ahmet Ercan

    2016-10-01

    The aim of the study was to evaluate the transverse craniofacial morphology of the adolescent patients affected by unilateral cleft lip and palate (UCLP) and to compare the findings with age- and sex-matched control group without any cleft using their cone-beam computed tomography (CBCT) images. The study sample (n = 56 patients; mean age: 14.35 ± 3.06 years) consisted of 26 UCLP (n = 26 patients; 10 women and 16 men; mean age: 13.70 ± 2.94 years) and 30 control (n = 30 patients; 19 women and 11 men; mean age: 14.90 ± 3.10 years) subjects. Twenty-five conventional skeletal and dental tissue landmarks were identified. Twenty widely used frontal cephalometric variables (14 linear distances, 3 angles, and 3 ratios) were measured. The data were analyzed using the independent t-test between the groups. Patients affected by UCLP had statistically significantly smaller interorbital width (89.83 ± 4.16 mm), maxillary width (58.02 ± 5.77 mm), maxillary intermolar width (52.83 ± 4.83 mm), and upper face height (57.64 ± 4.57 mm) (P cleft width had significant effect on Cr-ANS (r = 0.446, P = 0.022) and the ANS-isf (r = 0.459, P = 0.018) measurements. The UCLP group showed statistically significantly smaller values for interorbital width, maxillary width, maxillary intermolar width, and upper face height than the noncleft controls.

  12. LOGISTICS SCHEDULING: ANALYSIS OF TWO-STAGE PROBLEMS

    Institute of Scientific and Technical Information of China (English)

    Yung-Chia CHANG; Chung-Yee LEE

    2003-01-01

    This paper studies the coordination effects between stages for scheduling problems where decision-making is a two-stage process. Two stages are considered as one system. The system can be a supply chain that links two stages, one stage representing a manufacturer; and the other, a distributor.It also can represent a single manufacturer, while each stage represents a different department responsible for a part of operations. A problem that jointly considers both stages in order to achieve ideal overall system performance is defined as a system problem. In practice, at times, it might not be feasible for the two stages to make coordinated decisions due to (i) the lack of channels that allow decision makers at the two stages to cooperate, and/or (ii) the optimal solution to the system problem is too difficult (or costly) to achieve.Two practical approaches are applied to solve a variant of two-stage logistic scheduling problems. The Forward Approach is defined as a solution procedure by which the first stage of the system problem is solved first, followed by the second stage. Similarly, the Backward Approach is defined as a solution procedure by which the second stage of the system problem is solved prior to solving the first stage. In each approach, two stages are solved sequentially and the solution generated is treated as a heuristic solution with respect to the corresponding system problem. When decision makers at two stages make decisions locally without considering consequences to the entire system,ineffectiveness may result - even when each stage optimally solves its own problem. The trade-off between the time complexity and the solution quality is the main concern. This paper provides the worst-case performance analysis for each approach.

  13. Residential Two-Stage Gas Furnaces - Do They Save Energy?

    Energy Technology Data Exchange (ETDEWEB)

    Lekov, Alex; Franco, Victor; Lutz, James

    2006-05-12

    Residential two-stage gas furnaces account for almost a quarter of the total number of models listed in the March 2005 GAMA directory of equipment certified for sale in the United States. Two-stage furnaces are expanding their presence in the market mostly because they meet consumer expectations for improved comfort. Currently, the U.S. Department of Energy (DOE) test procedure serves as the method for reporting furnace total fuel and electricity consumption under laboratory conditions. In 2006, American Society of Heating Refrigeration and Air-conditioning Engineers (ASHRAE) proposed an update to its test procedure which corrects some of the discrepancies found in the DOE test procedure and provides an improved methodology for calculating the energy consumption of two-stage furnaces. The objectives of this paper are to explore the differences in the methods for calculating two-stage residential gas furnace energy consumption in the DOE test procedure and in the 2006 ASHRAE test procedure and to compare test results to research results from field tests. Overall, the DOE test procedure shows a reduction in the total site energy consumption of about 3 percent for two-stage compared to single-stage furnaces at the same efficiency level. In contrast, the 2006 ASHRAE test procedure shows almost no difference in the total site energy consumption. The 2006 ASHRAE test procedure appears to provide a better methodology for calculating the energy consumption of two-stage furnaces. The results indicate that, although two-stage technology by itself does not save site energy, the combination of two-stage furnaces with BPM motors provides electricity savings, which are confirmed by field studies.

  14. Surgical correction of cleft lip and palate.

    Science.gov (United States)

    Jayaram, Rahul; Huppa, Christoph

    2012-01-01

    Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.

  15. Two-stage local M-estimation of additive models

    Institute of Scientific and Technical Information of China (English)

    JIANG JianCheng; LI JianTao

    2008-01-01

    This paper studies local M-estimation of the nonparametric components of additive models. A two-stage local M-estimation procedure is proposed for estimating the additive components and their derivatives. Under very mild conditions, the proposed estimators of each additive component and its derivative are jointly asymptotically normal and share the same asymptotic distributions as they would be if the other components were known. The established asymptotic results also hold for two particular local M-estimations: the local least squares and least absolute deviation estimations. However,for general two-stage local M-estimation with continuous and nonlinear ψ-functions, its implementation is time-consuming. To reduce the computational burden, one-step approximations to the two-stage local M-estimators are developed. The one-step estimators are shown to achieve the same efficiency as the fully iterative two-stage local M-estimators, which makes the two-stage local M-estimation more feasible in practice. The proposed estimators inherit the advantages and at the same time overcome the disadvantages of the local least-squares based smoothers. In addition, the practical implementation of the proposed estimation is considered in details. Simulations demonstrate the merits of the two-stage local M-estimation, and a real example illustrates the performance of the methodology.

  16. Two-stage local M-estimation of additive models

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    This paper studies local M-estimation of the nonparametric components of additive models.A two-stage local M-estimation procedure is proposed for estimating the additive components and their derivatives.Under very mild conditions,the proposed estimators of each additive component and its derivative are jointly asymptotically normal and share the same asymptotic distributions as they would be if the other components were known.The established asymptotic results also hold for two particular local M-estimations:the local least squares and least absolute deviation estimations.However,for general two-stage local M-estimation with continuous and nonlinear ψ-functions,its implementation is time-consuming.To reduce the computational burden,one-step approximations to the two-stage local M-estimators are developed.The one-step estimators are shown to achieve the same effciency as the fully iterative two-stage local M-estimators,which makes the two-stage local M-estimation more feasible in practice.The proposed estimators inherit the advantages and at the same time overcome the disadvantages of the local least-squares based smoothers.In addition,the practical implementation of the proposed estimation is considered in details.Simulations demonstrate the merits of the two-stage local M-estimation,and a real example illustrates the performance of the methodology.

  17. Fissura palatina reparada: fechamento velofaríngeo antes e durante o som basal Cleft palate repair: velopharyngeal closure before and during the basal tone

    Directory of Open Access Journals (Sweden)

    Giseane Conterno

    2010-04-01

    Full Text Available Portadores de fissura palatina apresentam inadequado fechamento velofaríngeo (FVF, com consequente hipernasalidade vocal que pode ser diminuída com o som basal. OBJETIVO: Comparar o FVF durante a realização do som basal com a emissão em registro modal, em pacientes com fissura palatina pós-forame reparada. MATERIAIS E MÉTODOS: Estudo de Casos com quatro homens adultos, portadores de fissura palatina pós-forame reparada. Imagens do FVF por nasofaringoscopia, durante a emissão da vogal [a] em registro modal e basal. Julgamento das imagens realizado por quatro otorrinolaringologistas. RESULTADOS: Em três sujeitos, não houve mudança no tipo de FVF entre os registros analisados; as modificações que ocorreram na maioria dos sujeitos referem-se apenas ao grau de movimentação das estruturas envolvidas, pois, em registro basal, o movimento das paredes laterais da faringe se manteve, o movimento da parede posterior da faringe estabilizou, o movimento do véu palatino diminuiu discretamente, e a Prega de Passavant se evidenciou. CONCLUSÕES: O tipo de FVF se manteve em três dos quatro sujeitos analisados, quando comparado o registro modal com o basal, havendo modificações no grau da movimentação das estruturas envolvidas, evidenciando a Prega de Passavant.Patients with palatine fissure have inadequate velopharyngeal closure (VPC, with consequent vocal hypernasality which can be reduced by a basal tone. AIM: to compare VPC during a basal tone with the emission of a modal recording, in patients with repaired post-foramen palatine fissure. MATERIALS AND METHODS: case study with four adult men, all with repaired post-foramen palatine fissure. VPC images through nasal-pharyngoscopy during the emission o f the [a] vowel in a modal and basal recording. The images were studied by four ENTs. RESULTS: in three subjects there was no change in the type of VPC considering the recordings analyzed; the changes which happened to most of the subjects

  18. Phonetic features by babies with unilateral cleft lip and palate.

    Science.gov (United States)

    O'Gara, M M; Logemann, J A; Rademaker, A W

    1994-11-01

    Twenty-three babies with nonsyndromic unilateral cleft lip and palate were audiotaped at regular intervals from 5 to 35 months of age. Narrow phonetic transcription of their comfort-state vocalizations and word approximations was accomplished to describe phonetic development over time and according to the nonrandomized age of palatoplasty. The babies that had earlier palatal repair produced significantly higher percentages of oral stops after 12 months of age than babies with similar clefts that had later palatal repair. No significant differences are evident, however, according to age of palatoplasty, for mean frequency use of oral fricatives up to 3 years of age. For all 23 babies, regardless of the age of palatoplasty intervention, time is an even stronger variable than age of palatoplasty for development of palatal, alveolar and velar place features, oral stops, and oral fricatives.

  19. STARS A Two Stage High Gain Harmonic Generation FEL Demonstrator

    Energy Technology Data Exchange (ETDEWEB)

    M. Abo-Bakr; W. Anders; J. Bahrdt; P. Budz; K.B. Buerkmann-Gehrlein; O. Dressler; H.A. Duerr; V. Duerr; W. Eberhardt; S. Eisebitt; J. Feikes; R. Follath; A. Gaupp; R. Goergen; K. Goldammer; S.C. Hessler; K. Holldack; E. Jaeschke; Thorsten Kamps; S. Klauke; J. Knobloch; O. Kugeler; B.C. Kuske; P. Kuske; A. Meseck; R. Mitzner; R. Mueller; M. Neeb; A. Neumann; K. Ott; D. Pfluckhahn; T. Quast; M. Scheer; Th. Schroeter; M. Schuster; F. Senf; G. Wuestefeld; D. Kramer; Frank Marhauser

    2007-08-01

    BESSY is proposing a demonstration facility, called STARS, for a two-stage high-gain harmonic generation free electron laser (HGHG FEL). STARS is planned for lasing in the wavelength range 40 to 70 nm, requiring a beam energy of 325 MeV. The facility consists of a normal conducting gun, three superconducting TESLA-type acceleration modules modified for CW operation, a single stage bunch compressor and finally a two-stage HGHG cascaded FEL. This paper describes the faciliy layout and the rationale behind the operation parameters.

  20. Dynamic Modelling of the Two-stage Gasification Process

    DEFF Research Database (Denmark)

    Gøbel, Benny; Henriksen, Ulrik B.; Houbak, Niels

    1999-01-01

    A two-stage gasification pilot plant was designed and built as a co-operative project between the Technical University of Denmark and the company REKA.A dynamic, mathematical model of the two-stage pilot plant was developed to serve as a tool for optimising the process and the operating conditions...... of the gasification plant.The model consists of modules corresponding to the different elements in the plant. The modules are coupled together through mass and heat conservation.Results from the model are compared with experimental data obtained during steady and unsteady operation of the pilot plant. A good...

  1. Perspectives on palatalization

    Directory of Open Access Journals (Sweden)

    Martin Krämer

    2016-08-01

    Full Text Available In this article we provide a discussion of the definition of palatalization as a ­phonological ­phenomenon, its crosslinguistic variation, phonetic or functional grounding and phonetic (unnaturalness of palatalization, and theoretical approaches to palatalization patterns. After ­providing this background to the collection of articles in this special issue of 'Glossa' we will give an overview of the contributions collected here.

  2. Two-Stage Fuzzy Portfolio Selection Problem with Transaction Costs

    Directory of Open Access Journals (Sweden)

    Yanju Chen

    2015-01-01

    Full Text Available This paper studies a two-period portfolio selection problem. The problem is formulated as a two-stage fuzzy portfolio selection model with transaction costs, in which the future returns of risky security are characterized by possibility distributions. The objective of the proposed model is to achieve the maximum utility in terms of the expected value and variance of the final wealth. Given the first-stage decision vector and a realization of fuzzy return, the optimal value expression of the second-stage programming problem is derived. As a result, the proposed two-stage model is equivalent to a single-stage model, and the analytical optimal solution of the two-stage model is obtained, which helps us to discuss the properties of the optimal solution. Finally, some numerical experiments are performed to demonstrate the new modeling idea and the effectiveness. The computational results provided by the proposed model show that the more risk-averse investor will invest more wealth in the risk-free security. They also show that the optimal invested amount in risky security increases as the risk-free return decreases and the optimal utility increases as the risk-free return increases, whereas the optimal utility increases as the transaction costs decrease. In most instances the utilities provided by the proposed two-stage model are larger than those provided by the single-stage model.

  3. Efficient Two-Stage Group Testing Algorithms for DNA Screening

    CERN Document Server

    Huber, Michael

    2011-01-01

    Group testing algorithms are very useful tools for DNA library screening. Building on recent work by Levenshtein (2003) and Tonchev (2008), we construct in this paper new infinite classes of combinatorial structures, the existence of which are essential for attaining the minimum number of individual tests at the second stage of a two-stage disjunctive testing algorithm.

  4. High Performance Gasification with the Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Gøbel, Benny; Hindsgaul, Claus; Henriksen, Ulrik Birk

    2002-01-01

    Based on more than 15 years of research and practical experience, the Technical University of Denmark (DTU) and COWI Consulting Engineers and Planners AS present the two-stage gasification process, a concept for high efficiency gasification of biomass producing negligible amounts of tars. In the ......Based on more than 15 years of research and practical experience, the Technical University of Denmark (DTU) and COWI Consulting Engineers and Planners AS present the two-stage gasification process, a concept for high efficiency gasification of biomass producing negligible amounts of tars....... In the two-stage gasification concept, the pyrolysis and the gasification processes are physical separated. The volatiles from the pyrolysis are partially oxidized, and the hot gases are used as gasification medium to gasify the char. Hot gases from the gasifier and a combustion unit can be used for drying...... a cold gas efficiency exceeding 90% is obtained. In the original design of the two-stage gasification process, the pyrolysis unit consists of a screw conveyor with external heating, and the char unit is a fixed bed gasifier. This design is well proven during more than 1000 hours of testing with various...

  5. Composite likelihood and two-stage estimation in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2004-01-01

    In this paper register based family studies provide the motivation for linking a two-stage estimation procedure in copula models for multivariate failure time data with a composite likelihood approach. The asymptotic properties of the estimators in both parametric and semi-parametric models are d...

  6. A two-stage rank test using density estimation

    NARCIS (Netherlands)

    Albers, Willem/Wim

    1995-01-01

    For the one-sample problem, a two-stage rank test is derived which realizes a required power against a given local alternative, for all sufficiently smooth underlying distributions. This is achieved using asymptotic expansions resulting in a precision of orderm −1, wherem is the size of the first

  7. The construction of customized two-stage tests

    NARCIS (Netherlands)

    Adema, Jos J.

    1990-01-01

    In this paper mixed integer linear programming models for customizing two-stage tests are given. Model constraints are imposed with respect to test composition, administration time, inter-item dependencies, and other practical considerations. It is not difficult to modify the models to make them use

  8. Presurgical orthopedic premaxillary alignment in cleft lip and palate reconstruction.

    Science.gov (United States)

    Papay, F A; Morales, L; Motoki, D S; Yamashiro, D K

    1994-11-01

    Premaxillary malposition is a difficult problem in cleft lip and palate repair. Orthopedic palatal devices are excellent in positioning the premaxilla, though they are somewhat cumbersome and require complex techniques in adjusting precisely the position of the premaxilla prior to repair. A new technique has been developed for premaxillary repositioning in conjunction with palatal shelf expansion and obturation. The procedure implements microplate fixation anterior to the premaxillary segment and linked to a palatal splint by adjustable elastics. The microplate is inserted through a nasal floor incision and secured by a tight submucosal tunnel through minimal dissection between the prolabium and premaxilla. The last hole of each microplate protrudes through the mucosa and is attached to a pin-retained palatal splint by an elastic chain. Differential tension is applied to the chains to allow gradual repositioning of the protruding maxilla while the splint expands and maintains positioning of the lateral palatal segments. These elastic retractors can be adjusted by staff in the outpatient office. During the past 2 years, this technique has been used successfully in 21 consecutive patients with unilateral or bilateral cleft lip and palate. Its technical ease and design allows simple adjustments to control premaxillary positioning and growth before definitive surgical closure.

  9. Use of buccal myomucosal flap for palatal lengthening in cleft palate patient: Experience of 20 cases

    Directory of Open Access Journals (Sweden)

    Don Varghese

    2015-01-01

    Full Text Available Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients. Patients and Methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape. Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon.

  10. Correction of incomplete cleft palate by u-shaped flap palatoplasty

    Directory of Open Access Journals (Sweden)

    Saleh Amin

    2010-01-01

    Full Text Available Objectives: During cleft palate repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve results of surgical treatment of cleft palate and secondary velopharyngeal incompetence, a carefully designed modified procedure for palatoplasty is presented. Materials and Methods: Thirty patients with incomplete cleft palate corrected by this procedure from April 2003 to October 2007 were included. A u-shaped incision was made in the anterior palate to separate bipedicle flap based on the greater palatine arteries of both sides. After complete dissection of the nasal and palatal mucosa, palatal muscles were carefully dissected from the posterior edge of the bones of the hard palate, wherein the well-mobilised flap receded backward spontaneously and elongated the soft palate. After suturing the nasal mucosa in the midline, the dissected palatal muscles of both sides were sutured together in the anterior third of the soft palate. On suturing the nasal mucosa and the palatal muscles, the soft palate became elongated and the oral mucosa was seen receding backward spontaneously to cover the anterior part of the soft palate. Results: All corrected patients showed good results, with no recurrence, no post-operative fistulae, with accepted speech pattern and no need for further pharyngoplasty. The line of the sutured nasal mucosa and the palatal muscles became covered by the healthy non-sutured oral mucosa and the soft palate became elongated, with narrowing of the vellopharyngeal isthmus after this technique. Conclusion: The designed flap allows covering of sutured nasal mucosa and palatal muscles with a healthy unsutured oral mucosa and elongates the soft palate. Thus, there was no incidence of post-operative fistula and no need for further pharyngoplasties.

  11. One-stage closure of the entire primary palate.

    Science.gov (United States)

    Lehman, J A; Douglas, B K; Ho, W C; Husami, T W

    1990-10-01

    Timing of the closure of the anterior palate and alveolus is a subject of debate. Late repair of this defect is complicated by high fistula formation and subjects the patient to the problems of palate fistula for extended periods of time. We have utilized a single procedure performed when the child is 3 months of age that completely closes the anterior hard palate and alveolus along with the cleft lip. Our series consisted of 61 consecutive patients with unilateral clefts of the primary and secondary palate. Mucosal turnover flaps from the vomer along with lateral nasal mucosal flaps provide the nasal lining. A buccal sulcus flap with a Veau flap completes the oral repair. Ninety-five percent (58 of 61) of the patients had complete and stable closure of their anterior palate and alveolus after 1 year. The incidence of fistula formation in our series (3 of 61) is much lower than that reported with the utilization of other protocols. Excellent exposure of the anterior palate and alveolar defect during lip repair, early restoration of anatomic relationships, establishment of a good nostril floor and sill, and very low fistula formation are among the benefits of this procedure. The increase in operative time is considered minimal in light of aforementioned advantages.

  12. Cleft lip and palate: successful management trends

    OpenAIRE

    Bedon Rodriguez, Monica; universidad de manizales; Villota Gonzales, Luis Gerardo; Univerdidad de Manizales

    2011-01-01

    Cleft and palate is one of the most common congenital malformations, represents 2 - 3 % of these and is considered the most common craniofacial anomaly. Surgical repairof a patient with a cleft lip is not an emergency. Primary repair of cleft lip is done about 3 months old, consisting of a series of elective surgeries that are performed individualizingeach case as required by the patient. The aim of this review is to address the innovative treatment alternatives that are beingused in patients...

  13. The Soft Palate Friendly Speech Bulb for Velopharyngeal Insufficiency

    Science.gov (United States)

    Kahlon, Monaliza; Gupta, Shilpa; Dhingra, Parvinder Singh

    2016-01-01

    Velopharyngeal insufficiency is an anatomic defect of the soft palate making palatopharyngeal sphincter incomplete. It is an important concern to address in patients with bilateral cleft lip and palate. Speech aid prosthesis or speech bulbs are best choice in cases where surgically repaired soft palate is too short to contact pharyngeal walls during function but these prosthesis have been associated with inadequate marginal closure, ulcerations and patient discomfort. Here is a case report of untreated bilateral cleft lip and palate associated with palatal insufficiency treated by means of palate friendly innovative speech bulb. This modified speech bulb is a combination of hard acrylic and soft lining material. The hard self-curing acrylic resin covers only the hard palate area and a permanent soft silicone lining material covering the soft palate area. A claw-shaped wire component was extended backwards from acrylic and was embedded in soft silicone to aid in retention and approximation of two materials. The advantage of adding the soft lining material in posterior area helped in covering the adequate superior extension and margins for maximal pharyngeal activity. This also improved the hypernasality, speech, comfort and overall patient acceptance. PMID:27790589

  14. Simultaneous premaxillary repositioning and cheiloplasty in adult patients with unrepaired bilateral cleft lip and palate.

    Science.gov (United States)

    Lee, Ui-Lyong; Cho, Jun-Bum; Choung, Pill-Hoon

    2013-03-01

    Primary cheiloplasty in adult patients with unrepaired complete bilateral cleft lip and palate is quite challenging due to severe premaxillary anterior projection. To get the best repair results, the author carried out repositioning of the premaxilla and repair of the lip deformity in a single stage. Positive results for the primary lip repair and appropriate repositioning of the premaxilla were achieved. No avascular necrosis of the premaxilla was observed. Repositioning of the premaxilla and repair of the lip deformity in a single operation appears to be a reliable method for treating adult patients with previously unrepaired or poorly repaired bilateral cleft lip and palate.

  15. Isolated congenital palatal fistula without submucous cleft palate.

    Science.gov (United States)

    Karacan, Mehmet; Olgun, Haşim; Tan, Onder; Caner, Ibrahim

    2009-09-01

    Congenital fistula of the palate is a rare deformity. It has been generally associated with cleft palate. Treatment of cleft palate is surgical intervention. We present a child with congenital fistula of palate that was not associated with submucous cleft and closed spontaneously at 18 months.

  16. Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate.

    Science.gov (United States)

    Reiser, Erika; Andlin-Sobocki, Anna; Mani, Maria; Holmström, Mats

    2011-06-01

    The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3-4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm(2)) and volume (cm(3)) (acoustic rhinometry), air flow resistance (Pa s/cm(3)) (rhinomanometry), peak inspiratory flow (l/min) (peak nasal inspiratory flow) and number of identified odours (Scandinavian odor-identification test) were assessed in adulthood. The size of the maxillary cleft varied considerably at infancy. The size of the nasal airway and its function on the cleft side in adulthood were reduced compared with the non-cleft side, but no correlations were found between size of the initial cleft in infancy and size and function of the nasal airway in adulthood. In adults born with UCLP, therefore, size of the maxillary cleft in infancy does not seem to affect size and function of the nasal airway in adulthood.

  17. Square Kilometre Array station configuration using two-stage beamforming

    CERN Document Server

    Jiwani, Aziz; Razavi-Ghods, Nima; Hall, Peter J; Padhi, Shantanu; de Vaate, Jan Geralt bij

    2012-01-01

    The lowest frequency band (70 - 450 MHz) of the Square Kilometre Array will consist of sparse aperture arrays grouped into geographically-localised patches, or stations. Signals from thousands of antennas in each station will be beamformed to produce station beams which form the inputs for the central correlator. Two-stage beamforming within stations can reduce SKA-low signal processing load and costs, but has not been previously explored for the irregular station layouts now favoured in radio astronomy arrays. This paper illustrates the effects of two-stage beamforming on sidelobes and effective area, for two representative station layouts (regular and irregular gridded tile on an irregular station). The performance is compared with a single-stage, irregular station. The inner sidelobe levels do not change significantly between layouts, but the more distant sidelobes are affected by the tile layouts; regular tile creates diffuse, but regular, grating lobes. With very sparse arrays, the station effective area...

  18. Two stage sorption type cryogenic refrigerator including heat regeneration system

    Science.gov (United States)

    Jones, Jack A.; Wen, Liang-Chi; Bard, Steven

    1989-01-01

    A lower stage chemisorption refrigeration system physically and functionally coupled to an upper stage physical adsorption refrigeration system is disclosed. Waste heat generated by the lower stage cycle is regenerated to fuel the upper stage cycle thereby greatly improving the energy efficiency of a two-stage sorption refrigerator. The two stages are joined by disposing a first pressurization chamber providing a high pressure flow of a first refrigerant for the lower stage refrigeration cycle within a second pressurization chamber providing a high pressure flow of a second refrigerant for the upper stage refrigeration cycle. The first pressurization chamber is separated from the second pressurization chamber by a gas-gap thermal switch which at times is filled with a thermoconductive fluid to allow conduction of heat from the first pressurization chamber to the second pressurization chamber.

  19. Recursive algorithm for the two-stage EFOP estimation method

    Institute of Scientific and Technical Information of China (English)

    LUO GuiMing; HUANG Jian

    2008-01-01

    A recursive algorithm for the two-stage empirical frequency-domain optimal param-eter (EFOP) estimation method Was proposed. The EFOP method was a novel sys-tem identificallon method for Black-box models that combines time-domain esti-mation and frequency-domain estimation. It has improved anti-disturbance perfor-mance, and could precisely identify models with fewer sample numbers. The two-stage EFOP method based on the boot-strap technique was generally suitable for Black-box models, but it was an iterative method and takes too much computation work so that it did not work well online. A recursive algorithm was proposed for dis-turbed stochastic systems. Some simulation examples are included to demonstrate the validity of the new method.

  20. Two-stage approach to full Chinese parsing

    Institute of Scientific and Technical Information of China (English)

    Cao Hailong; Zhao Tiejun; Yang Muyun; Li Sheng

    2005-01-01

    Natural language parsing is a task of great importance and extreme difficulty. In this paper, we present a full Chinese parsing system based on a two-stage approach. Rather than identifying all phrases by a uniform model, we utilize a divide and conquer strategy. We propose an effective and fast method based on Markov model to identify the base phrases. Then we make the first attempt to extend one of the best English parsing models i.e. the head-driven model to recognize Chinese complex phrases. Our two-stage approach is superior to the uniform approach in two aspects. First, it creates synergy between the Markov model and the head-driven model. Second, it reduces the complexity of full Chinese parsing and makes the parsing system space and time efficient. We evaluate our approach in PARSEVAL measures on the open test set, the parsing system performances at 87.53% precision, 87.95% recall.

  1. Income and Poverty across SMSAs: A Two-Stage Analysis

    OpenAIRE

    1993-01-01

    Two popular explanations of urban poverty are the "welfare-disincentive" and "urban-deindustrialization" theories. Using cross-sectional Census data, we develop a two-stage model to predict an SMSAs median family income and poverty rate. The model allows the city's welfare level and industrial structure to affect its median family income and poverty rate directly. It also allows welfare and industrial structure to affect income and poverty indirectly, through their effects on family structure...

  2. A Two-stage Polynomial Method for Spectrum Emissivity Modeling

    OpenAIRE

    Qiu, Qirong; Liu, Shi; Teng, Jing; Yan, Yong

    2015-01-01

    Spectral emissivity is a key in the temperature measurement by radiation methods, but not easy to determine in a combustion environment, due to the interrelated influence of temperature and wave length of the radiation. In multi-wavelength radiation thermometry, knowing the spectral emissivity of the material is a prerequisite. However in many circumstances such a property is a complex function of temperature and wavelength and reliable models are yet to be sought. In this study, a two stages...

  3. Measuring the Learning from Two-Stage Collaborative Group Exams

    CERN Document Server

    Ives, Joss

    2014-01-01

    A two-stage collaborative exam is one in which students first complete the exam individually, and then complete the same or similar exam in collaborative groups immediately afterward. To quantify the learning effect from the group component of these two-stage exams in an introductory Physics course, a randomized crossover design was used where each student participated in both the treatment and control groups. For each of the two two-stage collaborative group midterm exams, questions were designed to form matched near-transfer pairs with questions on an end-of-term diagnostic which was used as a learning test. For learning test questions paired with questions from the first midterm, which took place six to seven weeks before the learning test, an analysis using a mixed-effects logistic regression found no significant differences in learning-test performance between the control and treatment group. For learning test questions paired with questions from the second midterm, which took place one to two weeks prio...

  4. Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Boers, Maria; Schöps, Antje

    2017-01-01

    BACKGROUND: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. AIMS: To assess the influence of different timing of hard palate closure in a two-stage procedure...... on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery...

  5. Prosthodontic Rehabilitation for Edentulous Patients With Palatal Defect: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Fen-Huey Lin

    2011-02-01

    Full Text Available Cancer resection is the most common cause of acquired palatal defects, whereas cleft palate is the main cause of congenital defects. Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. We present prosthodontic rehabilitation of two maxillary edentulous patients, one with a surgically induced palatal defect and the other with congenital cleft palate. In case 1, an 86-year-old man underwent surgical removal of soft-palate squamous cell carcinoma. The acquired palatal defect was repaired by a maxillary complete denture with a posteriorly extended speech bulb. The final prostheses provided good chewing and speech functions. In case 2, a congenital cleft palate in a 65-year-old man was repaired by a maxillary complete denture with superior extension of the obturator, which was designed to improve retention and stability of the upper single denture. He was satisfied with the upper denture after prosthesis placement. Conventional maxillary complete denture with a posteriorly extended speech bulb or modified obturator provides a good chance to restore oral functions in patients with palatal defects. The patients' skill and previous experience of denture wearing might have been important in their successful treatment. However, different patients present with unique problems and need to be treated individually.

  6. Perception of Place of Articulation by Children with Cleft Palate and Posterior Placement.

    Science.gov (United States)

    Whitehill, Tara L.; Francis, Alexander L.; Ching, Christine K-Y.

    2003-01-01

    A study examined if 10 children (ages 4-12) with repaired cleft palate who demonstrate posterior placement of alveolar targets differed from 10 children with cleft palate without such error patterns, and from 10 controls in the perception of alveolar targets. Children with posterior placement appeared unable to distinguish alveolar targets.…

  7. Forty-five-degree two-stage venous cannula: advantages over standard two-stage venous cannulation.

    Science.gov (United States)

    Lawrence, D R; Desai, J B

    1997-01-01

    We present a 45-degree two-stage venous cannula that confers advantage to the surgeon using cardiopulmonary bypass. This cannula exits the mediastinum under the transverse bar of the sternal retractor, leaving the rostral end of the sternal incision free of apparatus. It allows for lifting of the heart with minimal effect on venous return and does not interfere with the radially laid out sutures of an aortic valve replacement using an interrupted suture technique.

  8. On Two-stage Seamless Adaptive Design in Clinical Trials

    Directory of Open Access Journals (Sweden)

    Shein-Chung Chow

    2008-12-01

    Full Text Available In recent years, the use of adaptive design methods in clinical research and development based on accrued data has become very popular because of its efficiency and flexibility in modifying trial and/or statistical procedures of ongoing clinical trials. One of the most commonly considered adaptive designs is probably a two-stage seamless adaptive trial design that combines two separate studies into one single study. In many cases, study endpoints considered in a two-stage seamless adaptive design may be similar but different (e.g. a biomarker versus a regular clinical endpoint or the same study endpoint with different treatment durations. In this case, it is important to determine how the data collected from both stages should be combined for the final analysis. It is also of interest to know how the sample size calculation/allocation should be done for achieving the study objectives originally set for the two stages (separate studies. In this article, formulas for sample size calculation/allocation are derived for cases in which the study endpoints are continuous, discrete (e.g. binary responses, and contain time-to-event data assuming that there is a well-established relationship between the study endpoints at different stages, and that the study objectives at different stages are the same. In cases in which the study objectives at different stages are different (e.g. dose finding at the first stage and efficacy confirmation at the second stage and when there is a shift in patient population caused by protocol amendments, the derived test statistics and formulas for sample size calculation and allocation are necessarily modified for controlling the overall type I error at the prespecified level.

  9. Two stage treatment of dairy effluent using immobilized Chlorella pyrenoidosa.

    Science.gov (United States)

    Yadavalli, Rajasri; Heggers, Goutham Rao Venkata Naga

    2013-12-19

    Dairy effluents contains high organic load and unscrupulous discharge of these effluents into aquatic bodies is a matter of serious concern besides deteriorating their water quality. Whilst physico-chemical treatment is the common mode of treatment, immobilized microalgae can be potentially employed to treat high organic content which offer numerous benefits along with waste water treatment. A novel low cost two stage treatment was employed for the complete treatment of dairy effluent. The first stage consists of treating the diary effluent in a photobioreactor (1 L) using immobilized Chlorella pyrenoidosa while the second stage involves a two column sand bed filtration technique. Whilst NH4+-N was completely removed, a 98% removal of PO43--P was achieved within 96 h of two stage purification processes. The filtrate was tested for toxicity and no mortality was observed in the zebra fish which was used as a model at the end of 96 h bioassay. Moreover, a significant decrease in biological oxygen demand and chemical oxygen demand was achieved by this novel method. Also the biomass separated was tested as a biofertilizer to the rice seeds and a 30% increase in terms of length of root and shoot was observed after the addition of biomass to the rice plants. We conclude that the two stage treatment of dairy effluent is highly effective in removal of BOD and COD besides nutrients like nitrates and phosphates. The treatment also helps in discharging treated waste water safely into the receiving water bodies since it is non toxic for aquatic life. Further, the algal biomass separated after first stage of treatment was highly capable of increasing the growth of rice plants because of nitrogen fixation ability of the green alga and offers a great potential as a biofertilizer.

  10. Two-stage series array SQUID amplifier for space applications

    Science.gov (United States)

    Tuttle, J. G.; DiPirro, M. J.; Shirron, P. J.; Welty, R. P.; Radparvar, M.

    We present test results for a two-stage integrated SQUID amplifier which uses a series array of d.c. SQUIDS to amplify the signal from a single input SQUID. The device was developed by Welty and Martinis at NIST and recent versions have been manufactured by HYPRES, Inc. Shielding and filtering techniques were employed during the testing to minimize the external noise. Energy resolution of 300 h was demonstrated using a d.c. excitation at frequencies above 1 kHz, and better than 500 h resolution was typical down to 300 Hz.

  11. A Two Stage Classification Approach for Handwritten Devanagari Characters

    CERN Document Server

    Arora, Sandhya; Nasipuri, Mita; Malik, Latesh

    2010-01-01

    The paper presents a two stage classification approach for handwritten devanagari characters The first stage is using structural properties like shirorekha, spine in character and second stage exploits some intersection features of characters which are fed to a feedforward neural network. Simple histogram based method does not work for finding shirorekha, vertical bar (Spine) in handwritten devnagari characters. So we designed a differential distance based technique to find a near straight line for shirorekha and spine. This approach has been tested for 50000 samples and we got 89.12% success

  12. Two-Stage Aggregate Formation via Streams in Myxobacteria

    Science.gov (United States)

    Alber, Mark; Kiskowski, Maria; Jiang, Yi

    2005-03-01

    In response to adverse conditions, myxobacteria form aggregates which develop into fruiting bodies. We model myxobacteria aggregation with a lattice cell model based entirely on short range (non-chemotactic) cell-cell interactions. Local rules result in a two-stage process of aggregation mediated by transient streams. Aggregates resemble those observed in experiment and are stable against even very large perturbations. Noise in individual cell behavior increases the effects of streams and result in larger, more stable aggregates. Phys. Rev. Lett. 93: 068301 (2004).

  13. Straw Gasification in a Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Bentzen, Jens Dall; Hindsgaul, Claus; Henriksen, Ulrik Birk

    2002-01-01

    Additive-prepared straw pellets were gasified in the 100 kW two-stage gasifier at The Department of Mechanical Engineering of the Technical University of Denmark (DTU). The fixed bed temperature range was 800-1000°C. In order to avoid bed sintering, as observed earlier with straw gasification...... residues were examined after the test. No agglomeration or sintering was observed in the ash residues. The tar content was measured both by solid phase amino adsorption (SPA) method and cold trapping (Petersen method). Both showed low tar contents (~42 mg/Nm3 without gas cleaning). The particle content...

  14. Two-Stage Fan I: Aerodynamic and Mechanical Design

    Science.gov (United States)

    Messenger, H. E.; Kennedy, E. E.

    1972-01-01

    A two-stage, highly-loaded fan was designed to deliver an overall pressure ratio of 2.8 with an adiabatic efficiency of 83.9 percent. At the first rotor inlet, design flow per unit annulus area is 42 lbm/sec/sq ft (205 kg/sec/sq m), hub/tip ratio is 0.4 with a tip diameter of 31 inches (0.787 m), and design tip speed is 1450 ft/sec (441.96 m/sec). Other features include use of multiple-circular-arc airfoils, resettable stators, and split casings over the rotor tip sections for casing treatment tests.

  15. Two-Stage Eagle Strategy with Differential Evolution

    CERN Document Server

    Yang, Xin-She

    2012-01-01

    Efficiency of an optimization process is largely determined by the search algorithm and its fundamental characteristics. In a given optimization, a single type of algorithm is used in most applications. In this paper, we will investigate the Eagle Strategy recently developed for global optimization, which uses a two-stage strategy by combing two different algorithms to improve the overall search efficiency. We will discuss this strategy with differential evolution and then evaluate their performance by solving real-world optimization problems such as pressure vessel and speed reducer design. Results suggest that we can reduce the computing effort by a factor of up to 10 in many applications.

  16. The Epidemiology of Cleft Lip and Palate in Canada, 1998 to 2007.

    Science.gov (United States)

    Matthews, Jennifer L K; Oddone-Paolucci, Elizabeth; Harrop, Robertston A

    2015-07-01

    To examine the birth prevalence, gender distribution, and pattern of surgical intervention for clefts in Canada (1998 to 2007). Also to highlight the difficulties associated with studying the epidemiology of clefts using the current data collection mechanisms. Epidemiologic data acquired from the Canadian Institute for Health Information. Population-based study in Canada 1998 to 2007. All live births with an International Classification of Diseases (9th or 10th revision) diagnostic code for cleft palate or for cleft lip with or without cleft palate or with a surgical intervention code for repair of cleft lip or cleft palate. Birth prevalence, gender distribution, and pattern of surgical intervention. There were 3,015,325 live births in Canada (1998 to 2007). The mean birth prevalence was 0.82 per 1000 live births for cleft lip with or without cleft palate and 0.58 per 1000 live births for cleft palate. The birth prevalence of cleft lip with or without cleft palate was significantly higher in boys, with a stable boy to girl ratio of 1.75:1. Cleft palate was significantly greater in girls; however, the boy to girl ratio decreased from 0.97:1 in 1998 to 0.59:1 in 2007. The median age of repair in Canada from 1998 to 2007 was 4.7 months for cleft lip and 11.6 months for cleft palate. Thirty percent of patients underwent cleft palate repair after age 1. The birth prevalence of cleft palate and cleft lip with or without cleft palate is stable in Canada. An increasing birth prevalence of cleft palate in girls is suggested. The timing of surgical intervention is consistent with current standards. The challenges associated with collecting these data in Canada are discussed.

  17. Kista Palatal Mediana

    OpenAIRE

    Yumna Asmita

    2008-01-01

    Kista palatal mediana adalah kista non-odontogenik (kista fisural) yang iarang terjadi. Tertetak pada garis tengah palatum keras diantara prosessus palatal lateral di belakang papila palatinal. Kista ini bisa bertambah bssar dan menghasilkan pembengkakan (penggembungan) yang dapat terlihat secara klinis. Sering ditemukan tanpa sengaja pada pemeriksaan klinis atau radiografi. rutin. Etiologi kista ini diduga timbul dari terperangkapnya sisa epitelium di sepanjang garis tengah palatum selama...

  18. Two-stage perceptual learning to break visual crowding.

    Science.gov (United States)

    Zhu, Ziyun; Fan, Zhenzhi; Fang, Fang

    2016-01-01

    When a target is presented with nearby flankers in the peripheral visual field, it becomes harder to identify, which is referred to as crowding. Crowding sets a fundamental limit of object recognition in peripheral vision, preventing us from fully appreciating cluttered visual scenes. We trained adult human subjects on a crowded orientation discrimination task and investigated whether crowding could be completely eliminated by training. We discovered a two-stage learning process with this training task. In the early stage, when the target and flankers were separated beyond a certain distance, subjects acquired a relatively general ability to break crowding, as evidenced by the fact that the breaking of crowding could transfer to another crowded orientation, even a crowded motion stimulus, although the transfer to the opposite visual hemi-field was weak. In the late stage, like many classical perceptual learning effects, subjects' performance gradually improved and showed specificity to the trained orientation. We also found that, when the target and flankers were spaced too finely, training could only reduce, rather than completely eliminate, the crowding effect. This two-stage learning process illustrates a learning strategy for our brain to deal with the notoriously difficult problem of identifying peripheral objects in clutter. The brain first learned to solve the "easy and general" part of the problem (i.e., improving the processing resolution and segmenting the target and flankers) and then tackle the "difficult and specific" part (i.e., refining the representation of the target).

  19. Runway Operations Planning: A Two-Stage Heuristic Algorithm

    Science.gov (United States)

    Anagnostakis, Ioannis; Clarke, John-Paul

    2003-01-01

    The airport runway is a scarce resource that must be shared by different runway operations (arrivals, departures and runway crossings). Given the possible sequences of runway events, careful Runway Operations Planning (ROP) is required if runway utilization is to be maximized. From the perspective of departures, ROP solutions are aircraft departure schedules developed by optimally allocating runway time for departures given the time required for arrivals and crossings. In addition to the obvious objective of maximizing throughput, other objectives, such as guaranteeing fairness and minimizing environmental impact, can also be incorporated into the ROP solution subject to constraints introduced by Air Traffic Control (ATC) procedures. This paper introduces a two stage heuristic algorithm for solving the Runway Operations Planning (ROP) problem. In the first stage, sequences of departure class slots and runway crossings slots are generated and ranked based on departure runway throughput under stochastic conditions. In the second stage, the departure class slots are populated with specific flights from the pool of available aircraft, by solving an integer program with a Branch & Bound algorithm implementation. Preliminary results from this implementation of the two-stage algorithm on real-world traffic data are presented.

  20. Two-Stage Heuristic Algorithm for Aircraft Recovery Problem

    Directory of Open Access Journals (Sweden)

    Cheng Zhang

    2017-01-01

    Full Text Available This study focuses on the aircraft recovery problem (ARP. In real-life operations, disruptions always cause schedule failures and make airlines suffer from great loss. Therefore, the main objective of the aircraft recovery problem is to minimize the total recovery cost and solve the problem within reasonable runtimes. An aircraft recovery model (ARM is proposed herein to formulate the ARP and use feasible line of flights as the basic variables in the model. We define the feasible line of flights (LOFs as a sequence of flights flown by an aircraft within one day. The number of LOFs exponentially grows with the number of flights. Hence, a two-stage heuristic is proposed to reduce the problem scale. The algorithm integrates a heuristic scoring procedure with an aggregated aircraft recovery model (AARM to preselect LOFs. The approach is tested on five real-life test scenarios. The computational results show that the proposed model provides a good formulation of the problem and can be solved within reasonable runtimes with the proposed methodology. The two-stage heuristic significantly reduces the number of LOFs after each stage and finally reduces the number of variables and constraints in the aircraft recovery model.

  1. Cone-Beam Computed Tomography Analysis of the Nasopharyngeal Airway in Nonsyndromic Cleft Lip and Palate Subjects.

    Science.gov (United States)

    Al-Fahdawi, Mahmood Abd; Farid, Mary Medhat; El-Fotouh, Mona Abou; El-Kassaby, Marwa Abdelwahab

    2017-03-01

      To assess the nasopharyngeal airway volume, cross-sectional area, and depth in previously repaired nonsyndromic unilateral cleft lip and palate versus bilateral cleft lip and palate patients compared with noncleft controls using cone-beam computed tomography with the ultimate goal of finding whether cleft lip and palate patients are more liable to nasopharyngeal airway obstruction.   A retrospective analysis comparing bilateral cleft lip and palate, unilateral cleft lip and palate, and control subjects. Significance at P ≤ .05.   Cleft Care Center and the outpatient clinic that are both affiliated with our faculty.   Cone-beam computed tomography data were selected of 58 individuals aged 9 to 12 years: 14 with bilateral cleft lip and palate and 20 with unilateral cleft lip and palate as well as 24 age- and gender-matched noncleft controls.   Volume, depth, and cross-sectional area of nasopharyngeal airway were measured.   Patients with bilateral cleft lip and palate showed significantly larger nasopharyngeal airway volume than controls and patients with unilateral cleft lip and palate (P cleft lip and palate showed significantly larger cross-sectional area than those with unilateral cleft lip and palate (P .05). Patients with bilateral cleft lip and palate showed significantly larger depth than controls and those with unilateral cleft lip and palate (P cleft lip and palate showed insignificant nasopharyngeal airway volume, cross-sectional area, and depth compared with controls (P > .05).   Unilateral and bilateral cleft lip and palate patients did not show significantly less volume, cross-sectional area, or depth of nasopharyngeal airway than controls. From the results of this study we conclude that unilateral and bilateral cleft lip and palate patients at the studied age and stage of repaired clefts are not more prone to nasopharyngeal airway obstruction than controls.

  2. Two-Stage Part-Based Pedestrian Detection

    DEFF Research Database (Denmark)

    Møgelmose, Andreas; Prioletti, Antonio; Trivedi, Mohan M.

    2012-01-01

    Detecting pedestrians is still a challenging task for automotive vision system due the extreme variability of targets, lighting conditions, occlusions, and high speed vehicle motion. A lot of research has been focused on this problem in the last 10 years and detectors based on classifiers has...... gained a special place among the different approaches presented. This work presents a state-of-the-art pedestrian detection system based on a two stages classifier. Candidates are extracted with a Haar cascade classifier trained with the DaimlerDB dataset and then validated through part-based HOG...... of several metrics, such as detection rate, false positives per hour, and frame rate. The novelty of this system rely in the combination of HOG part-based approach, tracking based on specific optimized feature and porting on a real prototype....

  3. A two-stage method for inverse medium scattering

    KAUST Repository

    Ito, Kazufumi

    2013-03-01

    We present a novel numerical method to the time-harmonic inverse medium scattering problem of recovering the refractive index from noisy near-field scattered data. The approach consists of two stages, one pruning step of detecting the scatterer support, and one resolution enhancing step with nonsmooth mixed regularization. The first step is strictly direct and of sampling type, and it faithfully detects the scatterer support. The second step is an innovative application of nonsmooth mixed regularization, and it accurately resolves the scatterer size as well as intensities. The nonsmooth model can be efficiently solved by a semi-smooth Newton-type method. Numerical results for two- and three-dimensional examples indicate that the new approach is accurate, computationally efficient, and robust with respect to data noise. © 2012 Elsevier Inc.

  4. Laparoscopic management of a two staged gall bladdertorsion

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommonentity and rarely diagnosed preoperatively. A constantfactor in all occurrences of GBT is a freely mobilegall bladder due to congenital or acquired anomalies.GBT is commonly observed in elderly white females.We report a 77-year-old, Caucasian lady who wasoriginally diagnosed as gall bladder perforation butwas eventually found with a two staged torsion of thegall bladder with twisting of the Riedel's lobe (partof tongue like projection of liver segment 4A). Thistogether, has not been reported in literature, to thebest of our knowledge. We performed laparoscopiccholecystectomy and she had an uneventful postoperativeperiod. GBT may create a diagnostic dilemmain the context of acute cholecystitis. Timely diagnosisand intervention is necessary, with extra care whileoperating as the anatomy is generally distorted. Thefundus first approach can be useful due to alteredanatomy in the region of Calot's triangle. Laparoscopiccholecystectomy has the benefit of early recovery.

  5. Lightweight Concrete Produced Using a Two-Stage Casting Process

    Directory of Open Access Journals (Sweden)

    Jin Young Yoon

    2015-03-01

    Full Text Available The type of lightweight aggregate and its volume fraction in a mix determine the density of lightweight concrete. Minimizing the density obviously requires a higher volume fraction, but this usually causes aggregates segregation in a conventional mixing process. This paper proposes a two-stage casting process to produce a lightweight concrete. This process involves placing lightweight aggregates in a frame and then filling in the remaining interstitial voids with cementitious grout. The casting process results in the lowest density of lightweight concrete, which consequently has low compressive strength. The irregularly shaped aggregates compensate for the weak point in terms of strength while the round-shape aggregates provide a strength of 20 MPa. Therefore, the proposed casting process can be applied for manufacturing non-structural elements and structural composites requiring a very low density and a strength of at most 20 MPa.

  6. TWO-STAGE OCCLUDED OBJECT RECOGNITION METHOD FOR MICROASSEMBLY

    Institute of Scientific and Technical Information of China (English)

    WANG Huaming; ZHU Jianying

    2007-01-01

    A two-stage object recognition algorithm with the presence of occlusion is presented for microassembly. Coarse localization determines whether template is in image or not and approximately where it is, and fine localization gives its accurate position. In coarse localization, local feature, which is invariant to translation, rotation and occlusion, is used to form signatures. By comparing signature of template with that of image, approximate transformation parameter from template to image is obtained, which is used as initial parameter value for fine localization. An objective function, which is a function of transformation parameter, is constructed in fine localization and minimized to realize sub-pixel localization accuracy. The occluded pixels are not taken into account in objective function, so the localization accuracy will not be influenced by the occlusion.

  7. Two-stage designs for cross-over bioequivalence trials.

    Science.gov (United States)

    Kieser, Meinhard; Rauch, Geraldine

    2015-07-20

    The topic of applying two-stage designs in the field of bioequivalence studies has recently gained attention in the literature and in regulatory guidelines. While there exists some methodological research on the application of group sequential designs in bioequivalence studies, implementation of adaptive approaches has focused up to now on superiority and non-inferiority trials. Especially, no comparison of the features and performance characteristics of these designs has been performed, and therefore, the question of which design to employ in this setting remains open. In this paper, we discuss and compare 'classical' group sequential designs and three types of adaptive designs that offer the option of mid-course sample size recalculation. A comprehensive simulation study demonstrates that group sequential designs can be identified, which show power characteristics that are similar to those of the adaptive designs but require a lower average sample size. The methods are illustrated with a real bioequivalence study example.

  8. The hybrid two stage anticlockwise cycle for ecological energy conversion

    Directory of Open Access Journals (Sweden)

    Cyklis Piotr

    2016-01-01

    Full Text Available The anticlockwise cycle is commonly used for refrigeration, air conditioning and heat pumps applications. The application of refrigerant in the compression cycle is within the temperature limits of the triple point and the critical point. New refrigerants such as 1234yf or 1234ze have many disadvantages, therefore natural refrigerants application is favourable. The carbon dioxide and water can be applied only in the hybrid two stages cycle. The possibilities of this solutions are shown for refrigerating applications, as well some experimental results of the adsorption-compression double stages cycle, powered with solar collectors are shown. As a high temperature cycle the adsorption system is applied. The low temperature cycle is the compression stage with carbon dioxide as a working fluid. This allows to achieve relatively high COP for low temperature cycle and for the whole system.

  9. Versatility of Tongue Flaps for Closure of Palatal Defects- Case Report

    Science.gov (United States)

    Mohan, Vishnu; Nair, Roopesh U

    2017-01-01

    Palatal defects following congenital anomalies, traumatic injuries, benign and malignant pathologies frequently require resection and reconstruction. Reconstruction of these defects is challenging and complex due to the amount of tissue left for primary closure after excision, compromised vasculature as on repaired cleft palate and limited pedicled flaps around the lesion. Tongue flap though doesn’t fulfil all the ideal requirements of a flap, however because of its flexibility, good blood supply and position it can be considered as the best among other flaps for reconstruction of oral and palatal defects. In this article we describe two different cases in which tongue flap was used to reconstruct palatal defects, one an oroantral communication secondary to a tumour excision and the other an oro-nasal fistula secondary to cleft palate repair. PMID:28274072

  10. Two Stage Assessment of Thermal Hazard in An Underground Mine

    Science.gov (United States)

    Drenda, Jan; Sułkowski, Józef; Pach, Grzegorz; Różański, Zenon; Wrona, Paweł

    2016-06-01

    The results of research into the application of selected thermal indices of men's work and climate indices in a two stage assessment of climatic work conditions in underground mines have been presented in this article. The difference between these two kinds of indices was pointed out during the project entitled "The recruiting requirements for miners working in hot underground mine environments". The project was coordinated by The Institute of Mining Technologies at Silesian University of Technology. It was a part of a Polish strategic project: "Improvement of safety in mines" being financed by the National Centre of Research and Development. Climate indices are based only on physical parameters of air and their measurements. Thermal indices include additional factors which are strictly connected with work, e.g. thermal resistance of clothing, kind of work etc. Special emphasis has been put on the following indices - substitute Silesian temperature (TS) which is considered as the climatic index, and the thermal discomfort index (δ) which belongs to the thermal indices group. The possibility of the two stage application of these indices has been taken into consideration (preliminary and detailed estimation). Based on the examples it was proved that by the application of thermal hazard (detailed estimation) it is possible to avoid the use of additional technical solutions which would be necessary to reduce thermal hazard in particular work places according to the climate index. The threshold limit value for TS has been set, based on these results. It was shown that below TS = 24°C it is not necessary to perform detailed estimation.

  11. Long-term influence of infant periosteoplasty on facial growth and occlusion in patients with bilateral cleft lip and palate.

    Science.gov (United States)

    Andlin Sobocki, Anna; Tehrani, David; Skoog, Valdemar

    2012-09-01

    This retrospective, long-term study evaluated the influence of two different treatment protocols, one including infant periosteoplasty, on facial growth and occlusion in patients with complete bilateral cleft lip and palate (BCLP). Thirty-five patients with records of 5-, 8- and 16-19-year-olds were included. Sixteen of these received infant periosteoplasty (BCLP-pp) to the cleft alveolus in conjunction with lip repair and a one-stage closure of the palate. The remaining 19 patients with a two-stage closure of the palate did not have an infant periosteoplasty (BCLP-np). The bone formation induced by periosteoplasty in the BCLP-np group was insufficient and both groups had secondary bone grafting to the alveolar clefts before the eruption of the lateral incisor or the canine. Facial growth was evaluated with cephalometry at the recorded ages and dental arch relationships with the Huddart and Bodenham crossbite scores at the age of 16-19 years. Until 19 years a significant retrusion of the maxillary position (SNA) was observed in both groups. At 16-19 years of age there was no significant difference of maxillary protrusion (SNA), intermaxillary position (ANB), maxillary length (ss-pm) or vertical skeletal relationships (ML/NSL, Ml/NL) between the two groups. However, a significant difference of the crossbite scores was found. The BCLP-pp group did not show more facial growth problems but more malocclusion and the insufficient bone formation of the alveolar clefts after infant periosteoplasty required a secondary bone grafting.

  12. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  13. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... correct a physical defect caused by a cleft lip or cleft palate, which occur once in every 600 live ... recommend additional treatment for complications caused by cleft lip and cleft palate. Additional treatments may include: • Surgery to correct ...

  14. Dynamic two-stage mechanism of versatile DNA damage recognition by xeroderma pigmentosum group C protein

    Energy Technology Data Exchange (ETDEWEB)

    Clement, Flurina C.; Camenisch, Ulrike; Fei, Jia; Kaczmarek, Nina; Mathieu, Nadine [Institute of Pharmacology and Toxicology, University of Zuerich-Vetsuisse, Winterthurerstrasse 260, CH-8057 Zuerich (Switzerland); Naegeli, Hanspeter, E-mail: naegelih@vetpharm.uzh.ch [Institute of Pharmacology and Toxicology, University of Zuerich-Vetsuisse, Winterthurerstrasse 260, CH-8057 Zuerich (Switzerland)

    2010-03-01

    The recognition and subsequent repair of DNA damage are essential reactions for the maintenance of genome stability. A key general sensor of DNA lesions is xeroderma pigmentosum group C (XPC) protein, which recognizes a wide variety of helix-distorting DNA adducts arising from ultraviolet (UV) radiation, genotoxic chemicals and reactive metabolic byproducts. By detecting damaged DNA sites, this unique molecular sensor initiates the global genome repair (GGR) pathway, which allows for the removal of all the aforementioned lesions by a limited repertoire of excision factors. A faulty GGR activity causes the accumulation of DNA adducts leading to mutagenesis, carcinogenesis, neurological degeneration and other traits of premature aging. Recent findings indicate that XPC protein achieves its extraordinary substrate versatility by an entirely indirect readout strategy implemented in two clearly discernible stages. First, the XPC subunit uses a dynamic sensor interface to monitor the double helix for the presence of non-hydrogen-bonded bases. This initial screening generates a transient nucleoprotein intermediate that subsequently matures into the ultimate recognition complex by trapping undamaged nucleotides in the abnormally oscillating native strand, in a way that no direct contacts are made between XPC protein and the offending lesion itself. It remains to be elucidated how accessory factors like Rad23B, centrin-2 or the UV-damaged DNA-binding complex contribute to this dynamic two-stage quality control process.

  15. Effect of Silica Fume on two-stage Concrete Strength

    Science.gov (United States)

    Abdelgader, H. S.; El-Baden, A. S.

    2015-11-01

    Two-stage concrete (TSC) is an innovative concrete that does not require vibration for placing and compaction. TSC is a simple concept; it is made using the same basic constituents as traditional concrete: cement, coarse aggregate, sand and water as well as mineral and chemical admixtures. As its name suggests, it is produced through a two-stage process. Firstly washed coarse aggregate is placed into the formwork in-situ. Later a specifically designed self compacting grout is introduced into the form from the lowest point under gravity pressure to fill the voids, cementing the aggregate into a monolith. The hardened concrete is dense, homogeneous and has in general improved engineering properties and durability. This paper presents the results from a research work attempt to study the effect of silica fume (SF) and superplasticizers admixtures (SP) on compressive and tensile strength of TSC using various combinations of water to cement ratio (w/c) and cement to sand ratio (c/s). Thirty six concrete mixes with different grout constituents were tested. From each mix twenty four standard cylinder samples of size (150mm×300mm) of concrete containing crushed aggregate were produced. The tested samples were made from combinations of w/c equal to: 0.45, 0.55 and 0.85, and three c/s of values: 0.5, 1 and 1.5. Silica fume was added at a dosage of 6% of weight of cement, while superplasticizer was added at a dosage of 2% of cement weight. Results indicated that both tensile and compressive strength of TSC can be statistically derived as a function of w/c and c/s with good correlation coefficients. The basic principle of traditional concrete, which says that an increase in water/cement ratio will lead to a reduction in compressive strength, was shown to hold true for TSC specimens tested. Using a combination of both silica fume and superplasticisers caused a significant increase in strength relative to control mixes.

  16. Cleft Palate; A Multidiscipline Approach.

    Science.gov (United States)

    Stark, Richard B., Ed.

    Nineteen articles present a multidisciplinary approach to the management of facial clefts. The following subjects are discussed: the history of cleft lip and cleft palate surgery; cogenital defects; classification; the operation of a cleft palate clinic; physical examination of newborns with cleft lip and/or palate; nursing care; anesthesia;…

  17. Characterization of component interactions in two-stage axial turbine

    Directory of Open Access Journals (Sweden)

    Adel Ghenaiet

    2016-08-01

    Full Text Available This study concerns the characterization of both the steady and unsteady flows and the analysis of stator/rotor interactions of a two-stage axial turbine. The predicted aerodynamic performances show noticeable differences when simulating the turbine stages simultaneously or separately. By considering the multi-blade per row and the scaling technique, the Computational fluid dynamics (CFD produced better results concerning the effect of pitchwise positions between vanes and blades. The recorded pressure fluctuations exhibit a high unsteadiness characterized by a space–time periodicity described by a double Fourier decomposition. The Fast Fourier Transform FFT analysis of the static pressure fluctuations recorded at different interfaces reveals the existence of principal harmonics and their multiples, and each lobed structure of pressure wave corresponds to the number of vane/blade count. The potential effect is seen to propagate both upstream and downstream of each blade row and becomes accentuated at low mass flow rates. Between vanes and blades, the potential effect is seen to dominate the quasi totality of blade span, while downstream the blades this effect seems to dominate from hub to mid span. Near the shroud the prevailing effect is rather linked to the blade tip flow structure.

  18. A continuous two stage solar coal gasification system

    Science.gov (United States)

    Mathur, V. K.; Breault, R. W.; Lakshmanan, S.; Manasse, F. K.; Venkataramanan, V.

    The characteristics of a two-stage fluidized-bed hybrid coal gasification system to produce syngas from coal, lignite, and peat are described. Devolatilization heat of 823 K is supplied by recirculating gas heated by a solar receiver/coal heater. A second-stage gasifier maintained at 1227 K serves to crack remaining tar and light oil to yield a product free from tar and other condensables, and sulfur can be removed by hot clean-up processes. CO is minimized because the coal is not burned with oxygen, and the product gas contains 50% H2. Bench scale reactors consist of a stage I unit 0.1 m in diam which is fed coal 200 microns in size. A stage II reactor has an inner diam of 0.36 m and serves to gasify the char from stage I. A solar power source of 10 kWt is required for the bench model, and will be obtained from a central receiver with quartz or heat pipe configurations for heat transfer.

  19. Characterization of component interactions in two-stage axial turbine

    Institute of Scientific and Technical Information of China (English)

    Adel Ghenaiet; Kaddour Touil

    2016-01-01

    This study concerns the characterization of both the steady and unsteady flows and the analysis of stator/rotor interactions of a two-stage axial turbine. The predicted aerodynamic perfor-mances show noticeable differences when simulating the turbine stages simultaneously or sepa-rately. By considering the multi-blade per row and the scaling technique, the Computational fluid dynamics (CFD) produced better results concerning the effect of pitchwise positions between vanes and blades. The recorded pressure fluctuations exhibit a high unsteadiness characterized by a space–time periodicity described by a double Fourier decomposition. The Fast Fourier Transform FFT analysis of the static pressure fluctuations recorded at different interfaces reveals the existence of principal harmonics and their multiples, and each lobed structure of pressure wave corresponds to the number of vane/blade count. The potential effect is seen to propagate both upstream and downstream of each blade row and becomes accentuated at low mass flow rates. Between vanes and blades, the potential effect is seen to dominate the quasi totality of blade span, while down-stream the blades this effect seems to dominate from hub to mid span. Near the shroud the prevail-ing effect is rather linked to the blade tip flow structure.

  20. Two stages kinetics of municipal solid waste inoculation composting processes

    Institute of Scientific and Technical Information of China (English)

    XI Bei-dou1; HUANG Guo-he; QIN Xiao-sheng; LIU Hong-liang

    2004-01-01

    In order to understand the key mechanisms of the composting processes, the municipal solid waste(MSW) composting processes were divided into two stages, and the characteristics of typical experimental scenarios from the viewpoint of microbial kinetics was analyzed. Through experimentation with advanced composting reactor under controlled composting conditions, several equations were worked out to simulate the degradation rate of the substrate. The equations showed that the degradation rate was controlled by concentration of microbes in the first stage. The degradation rates of substrates of inoculation Run A, B, C and Control composting systems were 13.61 g/(kg·h), 13.08 g/(kg·h), 15.671 g/(kg·h), and 10.5 g/(kg·h), respectively. The value of Run C is around 1.5 times higher than that of Control system. The decomposition rate of the second stage is controlled by concentration of substrate. Although the organic matter decomposition rates were similar to all Runs, inoculation could reduce the values of the half velocity coefficient and could be more efficient to make the composting stable. Particularly. For Run C, the decomposition rate is high in the first stage, and is low in the second stage. The results indicated that the inoculation was efficient for the composting processes.

  1. Gas loading system for LANL two-stage gas guns

    Science.gov (United States)

    Gibson, Lee; Bartram, Brian; Dattelbaum, Dana; Lang, John; Morris, John

    2015-06-01

    A novel gas loading system was designed for the specific application of remotely loading high purity gases into targets for gas-gun driven plate impact experiments. The high purity gases are loaded into well-defined target configurations to obtain Hugoniot states in the gas phase at greater than ambient pressures. The small volume of the gas samples is challenging, as slight changing in the ambient temperature result in measurable pressure changes. Therefore, the ability to load a gas gun target and continually monitor the sample pressure prior to firing provides the most stable and reliable target fielding approach. We present the design and evaluation of a gas loading system built for the LANL 50 mm bore two-stage light gas gun. Targets for the gun are made of 6061 Al or OFHC Cu, and assembled to form a gas containment cell with a volume of approximately 1.38 cc. The compatibility of materials was a major consideration in the design of the system, particularly for its use with corrosive gases. Piping and valves are stainless steel with wetted seals made from Kalrez and Teflon. Preliminary testing was completed to ensure proper flow rate and that the proper safety controls were in place. The system has been used to successfully load Ar, Kr, Xe, and anhydrous ammonia with purities of up to 99.999 percent. The design of the system, and example data from the plate impact experiments will be shown. LA-UR-15-20521

  2. Palatal lifting prosthesis and velopharyngeal insufficiency: Preliminary report

    Directory of Open Access Journals (Sweden)

    Ali Ibrahim Aboloyoun

    2013-05-01

    Full Text Available Objectives. Our study aimed to highlight the effectiveness of palatal lift prosthesis in patients with velopharyngeal insufficiency with previous operated cleft palate. Methods. This study was done undertaken January 2008 to December of 2009 in the Phoniatic unit of Alnoor Specialist Hospital, Makkah, Saudi Arabia. Ten patients of ≥ 8 years to ≤ 10 years of age, who had previously undergone surgery for cleft palate, with or without cleft lip, with no other systemic illness and normal intelligent quotient level, were selected and managed by palatal lift prosthesis. All the study subjects were subjected to auditory perceptual speech evaluation for assessment of the degree of hypernasality, compensatory articulator mechanisms, glottal and pharyngeal articulation, audible nasal emission, facial grimace and overall intelligibility of speech. Data were analyzed using SPSS version 16. Results. The study included 10 subjects whose mean ± standard deviation of age was (8.9±0.9. On auditory speech perceptual evaluation after prosthesis application, significant improvement was found in glottal articulation 6 (85.7%, p=0.04, facial grimace 6 (85.7% p=0.04, hyper nasality 10 (10% p=0.008, and speech intelligibility 9 (90% p=0.008. Conclusion. Young patients with repaired palatal cleft have significant improvement after application of palatal lift prosthesis.

  3. Accommodating Picky Palates

    Science.gov (United States)

    Lum, Lydia

    2007-01-01

    Healthy gourmet offerings are fast becoming the norm at college dining halls around the country. At a time when the children of Baby Boomers are hitting higher education in record numbers, college officials have scrambled to accommodate their picky palates and their insistence for healthier meals than were served to past generations. At the same…

  4. Epileptic palatal myoclonus

    Energy Technology Data Exchange (ETDEWEB)

    Tatum, W.O.; Sperling, M.R.; Jacobstein, J.G. (Graduate Hospital, Philadelphia, PA (USA))

    1991-08-01

    Palatal myoclonus (PM) is usually caused by lesions of the brainstem. The authors report a case of PM of focal cortical origin in a patient with epilepsia partialis continua. The PM sometimes occurred in isolation, and at other times was accompanied by unilateral face, neck, and arm twitching. This was documented by both EEG and SPECT.

  5. Cleft Lip and Palate

    Science.gov (United States)

    ... With Cleft Lip or Cleft Palate en español Labio leporino y paladar hendido Tilt your head back a bit and look in the mirror. Do you see the way your nose connects to your upper lip? Now open your mouth. Do you see the ...

  6. PERFORMANCE STUDY OF A TWO STAGE SOLAR ADSORPTION REFRIGERATION SYSTEM

    Directory of Open Access Journals (Sweden)

    BAIJU. V

    2011-07-01

    Full Text Available The present study deals with the performance of a two stage solar adsorption refrigeration system with activated carbon-methanol pair investigated experimentally. Such a system was fabricated and tested under the conditions of National Institute of Technology Calicut, Kerala, India. The system consists of a parabolic solar concentrator,two water tanks, two adsorbent beds, condenser, expansion device, evaporator and accumulator. In this particular system the second water tank is act as a sensible heat storage device so that the system can be used during night time also. The system has been designed for heating 50 litres of water from 25oC to 90oC as well ascooling 10 litres of water from 30oC to 10oC within one hour. The performance parameters such as specific cooling power (SCP, coefficient of performance, solar COP and exergetic efficiency are studied. The dependency between the exergetic efficiency and cycle COP with the driving heat source temperature is also studied. The optimum heat source temperature for this system is determined as 72.4oC. The results show that the system has better performance during night time as compared to the day time. The system has a mean cycle COP of 0.196 during day time and 0.335 for night time. The mean SCP values during day time and night time are 47.83 and 68.2, respectively. The experimental results also demonstrate that the refrigerator has cooling capacity of 47 to 78 W during day time and 57.6 W to 104.4W during night time.

  7. A rat model for muscle regeneration in the soft palate.

    Directory of Open Access Journals (Sweden)

    Paola L Carvajal Monroy

    Full Text Available BACKGROUND: Children with a cleft in the soft palate have difficulties with speech, swallowing, and sucking. Despite successful surgical repositioning of the muscles, optimal function is often not achieved. Scar formation and defective regeneration may hamper the functional recovery of the muscles after cleft palate repair. Therefore, the aim of this study is to investigate the anatomy and histology of the soft palate in rats, and to establish an in vivo model for muscle regeneration after surgical injury. METHODS: Fourteen adult male Sprague Dawley rats were divided into four groups. Groups 1 (n = 4 and 2 (n = 2 were used to investigate the anatomy and histology of the soft palate, respectively. Group 3 (n = 6 was used for surgical wounding of the soft palate, and group 4 (n = 2 was used as unwounded control group. The wounds (1 mm were evaluated by (immunohistochemistry (AZAN staining, Pax7, MyoD, MyoG, MyHC, and ASMA after 7 days. RESULTS: The present study shows that the anatomy and histology of the soft palate muscles of the rat is largely comparable with that in humans. All wounds showed clinical evidence of healing after 7 days. AZAN staining demonstrated extensive collagen deposition in the wound area, and initial regeneration of muscle fibers and salivary glands. Proliferating and differentiating satellite cells were identified in the wound area by antibody staining. CONCLUSIONS: This model is the first, suitable for studying muscle regeneration in the rat soft palate, and allows the development of novel adjuvant strategies to promote muscle regeneration after cleft palate surgery.

  8. Right Axillary Sweating After Left Thoracoscopic Sypathectomy in Two-Stage Surgery

    Directory of Open Access Journals (Sweden)

    Berkant Ozpolat

    2013-06-01

    Full Text Available One stage bilateral or two stage unilateral video assisted thoracoscopic sympathectomy could be performed in the treatment of primary focal hyperhidrosis. Here we present a case with compensatory sweating of contralateral side after a two stage operation.

  9. The Two-stage Constrained Equal Awards and Losses Rules for Multi-Issue Allocation Situation

    NARCIS (Netherlands)

    Lorenzo-Freire, S.; Casas-Mendez, B.; Hendrickx, R.L.P.

    2005-01-01

    This paper considers two-stage solutions for multi-issue allocation situations.Characterisations are provided for the two-stage constrained equal awards and constrained equal losses rules, based on the properties of composition and path independence.

  10. Congenital Palatal Fistula Associated with Submucous Cleft Palate

    OpenAIRE

    Eshete, Mekonen; Camison, Liliana; Abate, Fikre; Hailu, Taye; Demissie, Yohannes; Mohammed, Ibrahim; Butali, Azeez; Losken, H. Wolfgang; Spiess, Alexander M.

    2016-01-01

    Background: Although cleft lip and cleft palate are among the most common congenital malformations, the presence of an isolated congenital palatal fistula along with a submucous cleft is very rare. This appears as an oval-shaped, full-thickness fenestration in the palatal midline that does not fully extend anteriorly or posteriorly, accompanied by the findings of a submucous cleft. Because of the uncommon nature of this entity, there is controversy about its etiology, diagnosis, and managemen...

  11. The modified Koyanagi hypospadias repair for the one-stage repair of proximal hypospadias

    Directory of Open Access Journals (Sweden)

    Venkata R Jayanthi

    2008-01-01

    Full Text Available Perineal and penoscrotal hypospadias were often managed by two-stage urethroplasty with variable results and significant number of these may need third surgery. Though modified Koyanagi one-stage repair has a learning curve, it has all the advantages of two-stage repair. The aim was to review the results of modified Koyonagi repair from the literature and our own centre experience.

  12. Two-Stage Exams Improve Student Learning in an Introductory Geology Course: Logistics, Attendance, and Grades

    Science.gov (United States)

    Knierim, Katherine; Turner, Henry; Davis, Ralph K.

    2015-01-01

    Two-stage exams--where students complete part one of an exam closed book and independently and part two is completed open book and independently (two-stage independent, or TS-I) or collaboratively (two-stage collaborative, or TS-C)--provide a means to include collaborative learning in summative assessments. Collaborative learning has been shown to…

  13. Palatal plasmacytoid myoepithelioma

    Directory of Open Access Journals (Sweden)

    Divya Sethi

    2012-01-01

    Full Text Available Myoepitheliomas are benign neoplasms of salivary glands derived from myoepithelial cells. These tumors can occur at any age but are most common in young adults. This tumor is usually located in the parotid gland and the minor salivary glands of the soft palate and represents less than 1% of all salivary gland tumors. The myoepithelioma is classified in the follow cells types: spindle, plasmacytoid, reticular, epitheliod, and clear, additionally, mixed histological forms are described. The plasmacytoid myoepithelioma from palate salivary glands is considered as a rare entity. A 45-year-old lady presented with an asymptomatic, well-circumscribed, solid mass located on the hard palate, which was gradually increasing in size. A clinical impression of Pleomorphic Adenoma was made which on histopathological examination revealed cords, clusters, and sheets of homogenous, large cells with plasmacytoid characteristics and a prominent eosinophilic cytoplasm. Ductal and acinar differentiation were absent thus ruling out the pleomorphic adenoma, whereas, features consistent with plasmacytoid myoepithelioma were evident.

  14. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Lohmander, Anette; Persson, Christina; Willadsen, Elisabeth

    2017-01-01

    BACKGROUND AND AIM: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP......) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10...... cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children...

  15. Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Albrechstn, Helle

    2006-01-01

    Objective: To investigate prelinguistic vocalization sequences of 1-year-old children with and without cleft lip and palate. Design: Prospective study. Participants: Thirty-eight children born with unilateral cleft lip and palate and 36 control children born without clefts. The cleft children had...... the lip, soft palate, and posterior part of the hard palate repaired at 4 months of age. The lip was closed ad modum Millard, the nose was corrected according to McComb, and the soft palate was closed with a posteriorly based vomer flap. Methods: Data were obtained from a clinical visit during which...... the canonical babbling stage. Results: No significant differences were observed between the cleft and control groups concerning frequency of occurrence of vocalization sequences, contoids, or vocoids. Structural differences between the groups seem to influence the contoid inventory, with a higher frequency...

  16. Schwannoma of the hard palate

    OpenAIRE

    2009-01-01

    Schwannomas are benign encapsulated perineural tumors. The head and neck region is the most common site. Intraoral origin is seen in only 1% of cases, tongue being the most common site; its location in the palate is rare. We report a case of hard-palate schwannoma with bony erosion which was immunohistochemically confirmed. The tumor was excised completely intraorally. After two months of follow-up, the defect was found to be completely covered with palatal mucosa.

  17. Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

    Science.gov (United States)

    Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

    2017-07-25

    Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p cleft speech characteristics than children with EHPC (p treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables. © 2017 Royal College of Speech and Language Therapists.

  18. Management of cleft lip and palate in adults

    Directory of Open Access Journals (Sweden)

    Murthy Jyotsna

    2009-10-01

    Full Text Available Introduction: With advancement of medical services in developed countries and awareness among the patients, it is rare to find an adult with an unoperated cleft lip and palate. However, the scenario is totally different in developing countries. Working as a part of a team in developing country, where co-coordinated team work is primitive, resources to provide treatment are very thin, public awareness of availability of treatment for this anomaly is minimal, the age of patients reaching for primary treatment varies from few days to late forties. Though the aim and aspiration is to provide holistic multidisciplinary care, the priority is getting treatment for all cleft patients. In such situation, the management of cleft lip and palate demands changes of approach, techniques and philosophy. Aims and Objectives: The deformed anatomy especially the facial bones and dentition is described. Due to well established deformities, the approach for management is individualized. The procedures and modification of procedures has been described. Results and Outcome: The outcome of the primary repair is adults certainly have less than satisfactory outcome for obvious reasons. The expected outcome and expectation of patients and families following primary surgeries in cleft lip and palate has been discussed. Though all adult patients got some improvement in speech after palate repair, achieving normal speech was difficult. The naso-labial appearance was not perfect, but well accepted by the patients and families. There are many psychosocial problems in these patients, the objective evaluation could not be done due to too many variables. However, primary repair of cleft lip and palate is justified and beneficial for the patients.

  19. Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes.

    Science.gov (United States)

    Justin, Grant A; Brietzke, Scott E

    2017-01-01

      This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes.   The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate.   Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes.   A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean = $2,470,552, range = $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P = .0101).   Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.

  20. Suction Cup Induced Palatal Fistula: Surgical Closure by Palatal ...

    African Journals Online (AJOL)

    a maxillary complete denture with a suction cup.[2] A suction cup because of its ... lead to the necrosis of the palatal mucosa and the bone leading ... is not being recommended because of its pathological effect on the palatal tissues leading to.

  1. A restricted test of single word intelligibility in 3-year-old children with and without cleft palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Poulsen, Mads

    2012-01-01

    Abstract Objective: In a previous study, children with cleft palate with hard palate closure at 12 months of age showed more typical phonological development than children with an unrepaired hard palate at 36 months of age. This finding was based on narrow transcription of word initial target...... consonants obtained from a simple naming test. To evaluate the relevance of this finding, we investigated how well the children's target words were understood by 84 naïve listeners. Design: A cross-sectional study. Participants: Data obtained from twenty-eight children with UCLP, 3 years of age, who received...... hard palate closure at either12 months (HPR (hard palate repaired)) or 36 months (HPU (hard palate unrepaired)), were compared to data obtained from 14 age-matched, typically developing, control children. Methods: Video recordings of the children naming target words were shown to 84 naïve listeners...

  2. Fetal Cleft Lip/Palate Surgery: End of a Dream?

    Science.gov (United States)

    Ozturk, Sinan; Karagoz, Huseyin; Zor, Fatih; Inangil, Gökhan; Kara, Kemal

    2016-01-01

    Recognition that a fetus can scarlessly heal in intrauterine life led to various animal studies in the mid 1980s exploring the possibility of fetal cleft lip/palate surgery. The idea of scarless cleft repair seemed like a possible dream after the promising results from the early animal studies. In this review, we analyze the progress made in the 30 years since our first experience with animal models.

  3. Presurgical nasoalveolar molding in unilateral cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Rahul J Hegde

    2015-01-01

    Full Text Available Unilateral cleft lip and palate (UCLP patients have an esthetic and functional compromise of the middle third of the face and nasal structures. To improve the esthetic result of lip repair, the concept of presurgical nasoalveolar molding (PNAM was brought into conception. PNAM is an easy and passive method of bringing the alveolus and lips together by redirecting the forces of natural growth. This case report documents a 2-year follow-up of PNAM in UCLP.

  4. 七氟烷复合瑞芬太尼麻醉行小儿唇腭裂修复术的临床分析%Clinic analysis of compound anesthesia with Sevoflurane and Remifentanil in cleft lip and palate repair surgery of children

    Institute of Scientific and Technical Information of China (English)

    高保国; 韩冲芳; 杨文曲

    2013-01-01

      目的观察七氟烷复合瑞芬太尼麻醉行小儿唇腭裂修复术的麻醉效果。方法60例行唇腭裂修复术患者,随机分为七氟烷复合瑞芬太尼麻醉组(A组)和丙泊酚复合瑞芬太尼麻醉组(B组)。观测诱导前(T1)、插管时(T2)、手术开始(T3)、手术开始15 min(T4)、手术开始30 min(T5)及清醒拔管(T6)时的血流动力学变化,记录诱导时间、清醒及拔管时间及不良反应。结果2组患儿诱导给药后心率、血压有所下降,B组较A组心率、血压波动明显,诱导时间和拔管时间明显长于A组,不良反应多。结论七氟烷复合瑞芬太尼麻醉用于小儿唇腭裂修复术,是一种更为安全、有效的麻醉方法。%Objective to observe the effect of compound anesthesia with sevoflurane and remifentanil in cleft lip and palate repair surgery of children. Methods firstly, sixty children with cleft lip and palate repair surgery were selected and randomly divided into two groups,sevoflurane co-mbined with remifentanil (group A)and propofol combined with remifentanil (group B). Secondly, to compare and record the medical effect in four times, which are the time(T1)before operating, the time(T2) for cannula, the time(T3) to start the surgery, the time(T4) after 15 min. surgery, the time(T5) after 30 min. surgery and the time(T6) to pull the tube off when the children awaked. Results the heart rate and blood pressure of children in group A and group B were declined(P<0.05)after induction.Compared to group A, the children in gro-up B had declined heart rate and blood pressure (P<0.05),increased longer induction and extuba-tion time and adverse reactions. Conclusion compound anesthesia with sevoflurane and remifen- tanil is a more safety and effective method in cleft lip and palate repair surgery of children.

  5. Late detection of cleft palate

    NARCIS (Netherlands)

    Hanny, K H; de Vries, I A C; Haverkamp, S J; Oomen, K P Q; Penris, W M; Eijkemans, M J C; Kon, M; Mink van der Molen, A B; Breugem, C C

    2016-01-01

    Cleft palate only (CPO) is a common congenital malformation, and most patients are diagnosed within the first weeks after birth. Late diagnosis of the cleft palate (CP) could initially result in feeding and growth impairment, and subsequently speech and hearing problems later in life. The purpose of

  6. Post-surgical dentofacial deformities and dental treatment needs in cleft-lip-palate children: A clinical study

    Directory of Open Access Journals (Sweden)

    V Krishna Priya

    2011-01-01

    Full Text Available Background: Cleft lip and palate is a common congenital defect. It is one of the most common facial deformities occurring in major racial and ethnic groups. Aims: The aim of the present study was to record the post-surgical dentofacial deformities in operated cleft lip and palate children, as well as to assess the multitude and magnitude of their dental and other related problems so as to formulate an appropriate treatment plan for complete oral rehabilitation of these children. Materials and Methods: The present in vivo study was conducted on 50 operated cleft lip and palate children (23 males and 27 females ranging from 3 to 14 years of age in an attempt to evaluate the post-surgical dentofacial abnormalities in these children. Results and Conclusions: The study revealed that the distribution of cleft deformity is shown out of 23 male children, 11 children with unilateral cleft lip, 9 children with bilateral cleft lip palate, and remaining 3 children were with cleft palate. Out of 27 female children, 19 children with unilateral cleft lip palate, 3 children with bilateral cleft lip palate, and 5 children with cleft palate. This study showed a wide range of surgical, dental, and functional problems in all operated cleft lip and palate patients. Hence, the study concluded that the effect of timing of the cleft repair on the overall development of facio skeletal-dental structures showed insignificant differences among the various operated cleft-lip-palate children.

  7. Receptive and expressive language performance in children with and without Cleft Lip and Palate.

    Science.gov (United States)

    Lamônica, Dionísia Aparecida Cusin; Silva-Mori, Mariana Jales Felix da; Ribeiro, Camila da Costa; Maximino, Luciana Paula

    2016-01-01

    To compare the performance in the abilities of receptive and expressive language of children with cleft lip and palate with that of children without cleft lip and palate with typical 12 to 36-month chronological development. The sample consisted of 60 children aged 12 and 36 months: 30 with cleft lip and palate diagnosis and 30 without cleft lip and palate diagnosis with typical development. The groups were paired according to gender, age (in months), and socioeconomic level. The procedures consisted of analysis of medical records, anamnesis with family members, and valuation of the Early Language Milestone Scale (ELMS). The chart analysis showed 63.34% of the children with unilateral cleft lip and palate, 16.66% with bilateral incisive transforamen cleft, and 20% with post-foramen cleft. Children with cleft lip and palate underwent surgeries (lip repair and/or palatoplasty) at the recommended ages and participated in early intervention programs; 40% presented recurrent otitis history, and 50% attended schools. Statistical analysis included the use of the Mann Whitney test with significance level of p cleft lip and palate showed statistically significant low performance in receptive and expressive language compared with children without cleft lip and palate.

  8. The Rate of Oronasal Fistula Following Primary Cleft Palate Surgery: A Meta-Analysis.

    Science.gov (United States)

    Bykowski, Michael R; Naran, Sanjay; Winger, Daniel G; Losee, Joseph E

    2015-07-01

    Despite decades of craniofacial surgeons repairing cleft palates, there is no consensus for the rate of fistula formation following surgery. The authors present a meta-analysis of studies that reported on primary cleft palate to determine the rate of oronasal fistula and to identify risk factors for their development. A literature search for the period between 2000 and 2012 was performed. Articles were queried and strict inclusion and exclusion criteria were applied to focus on primary cleft palate repair. A meta-analysis of these data was conducted. The meta-analysis included 11 studies, comprising 2505 children. The rate of oronasal fistula development was 4.9% (95% confidence interval, 3.8% to 6.1%). When analyzing a larger cohort, there was a significant relationship between Veau classification and the occurrence of a fistula (P fistulae most prevalent in patients with a Veau IV cleft. The most common location for a fistula was at the soft palate-hard palate junction. One study used decellularized dermis in cleft repair with a fistula rate of 3.2%. Using 11 studies comprising 2505 children, we find the rate of reported fistula occurrence to be 4.9%. Furthermore, patients with a Veau IV cleft are significantly more likely to develop an oronasal fistula. When fistulae do occur, they do so most often at the soft palate-hard palate junction. A deeper understanding of fistula formation will help cleft palate surgeons improve their outcomes in the operating room and will allow them to effectively communicate expectations with patients' families in the clinic.

  9. Molecular basis of cleft palates in mice

    Institute of Scientific and Technical Information of China (English)

    Noriko; Funato; Masataka; Nakamura; Hiromi; Yanagisawa

    2015-01-01

    Cleft palate, including complete or incomplete cleft palates, soft palate clefts, and submucosal cleft palates, is the most frequent congenital craniofacial anomaly in humans. Multifactorial conditions, including genetic and environmental factors, induce the formation of cleft palates. The process of palatogenesis is temporospatially regulated by transcription factors, growth factors, extracellular matrix proteins, and membranous molecules; a single ablation of these molecules can result in a cleft palate in vivo. Studies on knockout mice were reviewed in order to identify genetic errors that lead to cleft palates. In this review, we systematically describe these mutant mice and discuss the molecular mechanisms of palatogenesis.

  10. Presurgical nasoalveolar moulding in unilateral cleft lip and palate.

    Science.gov (United States)

    Zuhaib, Mohammed; Bonanthaya, Krishnamurthy; Parmar, Renu; Shetty, Pritham N; Sharma, Pradeep

    2016-01-01

    Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. The study was conducted to evaluate the efficacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Prospective study. A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Student's t-test for paired comparisons. Results of the study showed a promising reduction in the cleft size before the surgery, significant improvement in nasal symmetry, including the columellar length on the cleft side. PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.

  11. Presurgical nasoalveolar moulding in unilateral cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Mohammed Zuhaib

    2016-01-01

    Full Text Available Context: Presurgical nasoalveolar moulding (PNAM is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. Aims: The study was conducted to evaluate the effi cacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1 To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM. (2 To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM. (3 To assess the changes in the position of the alar base and the alar cartilages. Settings and Design: Prospective study. Subjects and Methods: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Statistical Analysis Used: Student's t-test for paired comparisons. Results: Results of the study showed a promising reduction in the cleft size before the surgery, signifi cant improvement in nasal symmetry, including the columellar length on the cleft side. Conclusions: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle

  12. The repairing application of presurgical nasoalveolar molding used for infants with complete cleft lip and palate%鼻-牙槽塑形矫治器在完全性唇腭裂修复中的应用

    Institute of Scientific and Technical Information of China (English)

    刘颖萍; 张婧; 郭雪松; 梁惠惠; 张丽霞

    2016-01-01

    目的:观察鼻-牙槽突塑形矫治器(PNAM)在术前矫治完全性唇腭裂患儿中的作用。方法对20例完全性唇腭裂患者(平均年龄为18 d)采用 PNAM进行术前矫治,其中双侧唇腭裂8例,单侧12例。测量患儿治疗前后鼻小柱长度、病变侧鼻孔宽度、上唇裂隙宽度及牙槽突裂隙宽度的变化,用 SPSS 13.0软件进行统计分析。结果患儿应用 PNAM治疗后病变侧鼻孔宽度[双侧组:(9.01±1.04)mm、(8.87±1.62)mm;单侧组:(12.32±1.91)mm]、上唇裂隙[双侧组:(9.86±3.05)mm、(9.45±2.78)mm;单侧组:(8.76±2.7)mm]及牙槽突裂隙宽度[双侧组:(4.39±2.23)mm、(4.06±2.41)mm;单侧组:(6.49±1.15)mm]明显缩小,鼻小柱长度[双侧组:(3.36±1.98)mm;单侧组:(5.06±2.03)mm]增加,与治疗前[双侧组:(12.43±2.02)mm,(11.91±1.55)mm,(12.95±2.39)mm,(12.31±1.92)mm,(8.45±2.67)mm,(8.05±2.48)mm,(1.03±0.51)mm;单侧组:(16.89±2.36)mm,(13.85±2.52)mm,(9.23±2.37)mm,(1.78±0.61)mm]相比差异有统计学意义(t 值:双侧组:9.286、8.847、6.659、5.672、8.596、6.121、6.896,单侧组:10.537、11.497、10.001、9.391;均 P <0.05)。结论PNAM术前矫治能有效改善患儿的唇腭裂原发畸形和鼻部形态,为Ⅰ期手术创造良好的条件,有助于患儿建立正常的吮吸、呼吸及语言功能,同时缓解患儿家长的焦虑,使之对治疗充满信心并积极配合,进一步完善临床整复效果。%Objective To analyze the effect of presurgical nasoalveolar molding(PNAM)used for infants with complete cleft lip and palate in preoperative orthopedics.Methods 20 infants of complete cleft lip and palate (with an average age of 18 days),including 8 infants of bilateral

  13. Preemptive scheduling in a two-stage supply chain to minimize the makespan

    NARCIS (Netherlands)

    Pei, Jun; Fan, Wenjuan; Pardalos, Panos M.; Liu, Xinbao; Goldengorin, Boris; Yang, Shanlin

    2015-01-01

    This paper deals with the problem of preemptive scheduling in a two-stage supply chain framework. The supply chain environment contains two stages: production and transportation. In the production stage jobs are processed on a manufacturer's bounded serial batching machine, preemptions are allowed,

  14. Two-stage urethroplasty is a better choice for proximal hypospadias with severe chordee after urethral plate transection: a single-center experience

    Science.gov (United States)

    Zheng, Da-Chao; Yao, Hai-Jun; Cai, Zhi-Kang; Da, Jun; Chen, Qi; Chen, Yan-Bo; Zhang, Ke; Xu, Ming-Xi; Lu, Mu-Jun; Wang, Zhong

    2015-01-01

    It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent: 32 and 34 patients underwent single-stage (Duckett) or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months (20−60 months) and 35 months (18−60 months) in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure (18.75% vs 0%). The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup (10.52%) than in the postpubescent cohort (46.15%). These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection. PMID:25248656

  15. Primary myoepithelial carcinoma of palate

    OpenAIRE

    Yang Ya; Yang Yunyi; Li Zongfang; Zhang Xiaozhi; Li Yi; Liu Xiaoping; Liu Zi; Ren Juan; Chen Yuanyuan; Jiang Shiwen

    2011-01-01

    Abstract Objectives The aim of this study was to present a rare neoplasm, Primary myoepithelial carcinoma arising from the palate, and to review its diagnostic criteria, pathologic and clinical characteristics, treatment options and prognosis. Clinical Presentation and Intervention Myoepitheliomas are tumors arising from myoepithelial cells mainly or exclusively. Myoepitheliomas mostly occur in salivary glands, as well as in breast, skin, and lung. Case of myoepitheliomas in palate has rarely...

  16. Surgical reconstruction versus prosthetic obturation of extensive soft palate defects: a comparison of speech outcomes.

    Science.gov (United States)

    Rieger, Jana; Bohle Iii, George; Huryn, Joseph; Tang, Judith Lam; Harris, Jeffrey; Seikaly, Hadi

    2009-01-01

    The restoration of speech after an extensive resection of the soft palate has been a challenge faced by both prosthodontists and surgeons. Few comparisons between prosthetic rehabilitations and surgical reconstructions of large soft palate defects exist in equally matched groups of patients. The purpose of this study was to evaluate speech outcomes in patients with soft palate defects that were rehabilitated with either a pharyngeal obturator or surgical reconstruction. Nine patients who were treated via prosthetic obturation were compared to nine patients who underwent surgical reconstruction of the oropharynx with a radial forearm free flap and a soft palate insufficiency repair modification. Speech intelligibility data, perceptual ratings of resonance, and aeromechanical measurements of velopharyngeal function were collected. There were no differences in any of the speech outcome measures between the two groups of patients. Future studies should focus on the patient's perspective on rehabilitative options and potential quality of life issues.

  17. Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate.

    Science.gov (United States)

    Morén, Staffan; Mani, Maria; Lundberg, Kristina; Holmström, Mats

    2013-10-01

    The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.

  18. DEVELOPMENT OF COLD CLIMATE HEAT PUMP USING TWO-STAGE COMPRESSION

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Bo [ORNL; Rice, C Keith [ORNL; Abdelaziz, Omar [ORNL; Shrestha, Som S [ORNL

    2015-01-01

    This paper uses a well-regarded, hardware based heat pump system model to investigate a two-stage economizing cycle for cold climate heat pump applications. The two-stage compression cycle has two variable-speed compressors. The high stage compressor was modelled using a compressor map, and the low stage compressor was experimentally studied using calorimeter testing. A single-stage heat pump system was modelled as the baseline. The system performance predictions are compared between the two-stage and single-stage systems. Special considerations for designing a cold climate heat pump are addressed at both the system and component levels.

  19. DEVELOPMENT OF COLD CLIMATE HEAT PUMP USING TWO-STAGE COMPRESSION

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Bo [ORNL; Rice, C Keith [ORNL; Abdelaziz, Omar [ORNL; Shrestha, Som S [ORNL

    2015-01-01

    This paper uses a well-regarded, hardware based heat pump system model to investigate a two-stage economizing cycle for cold climate heat pump applications. The two-stage compression cycle has two variable-speed compressors. The high stage compressor was modelled using a compressor map, and the low stage compressor was experimentally studied using calorimeter testing. A single-stage heat pump system was modelled as the baseline. The system performance predictions are compared between the two-stage and single-stage systems. Special considerations for designing a cold climate heat pump are addressed at both the system and component levels.

  20. Protocols in Cleft Lip and Palate Treatment: Systematic Review

    Science.gov (United States)

    de Ladeira, Pedro Ribeiro Soares; Alonso, Nivaldo

    2012-01-01

    Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs). Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2). Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice. PMID:23213503

  1. Protocols in Cleft Lip and Palate Treatment: Systematic Review

    Directory of Open Access Journals (Sweden)

    Pedro Ribeiro Soares de Ladeira

    2012-01-01

    Full Text Available Objectives. To find clinical decisions on cleft treatment based on randomized controlled trials (RCTs. Method. Searches were made in PubMed, Embase, and Cochrane Library on cleft lip and/or palate. From the 170 articles found in the searches, 28 were considered adequate to guide clinical practice. Results. A scarce number of RCTs were found approaching cleft treatment. The experimental clinical approaches analyzed in the 28 articles were infant orthopedics, rectal acetaminophen, palatal block with bupivacaine, infraorbital nerve block with bupivacaine, osteogenesis distraction, intravenous dexamethasone sodium phosphate, and alveoloplasty with bone morphogenetic protein-2 (BMP-2. Conclusions. Few randomized controlled trials were found approaching cleft treatment, and fewer related to surgical repair of this deformity. So there is a need for more multicenter collaborations, mainly on surgical area, to reduce the variety of treatment modalities and to ensure that the cleft patient receives an evidence-based clinical practice.

  2. Phonological Proficiency of Two Cleft Palate Toddlers with School-Age Follow-Up.

    Science.gov (United States)

    Lynch, Joan I.; And Others

    1983-01-01

    A comprehensive analysis of the speech-sound production at ages two-three, five, and seven of two children with repaired bilateral cleft lip and palate. Results indicated individual differences in that one S's emerging phonological system was more characteristic of developmental delay while the other was more characteristic of structural…

  3. Numerical simulation of a step-piston type series two-stage pulse tube refrigerator

    Science.gov (United States)

    Zhu, Shaowei; Nogawa, Masafumi; Inoue, Tatsuo

    2007-09-01

    A two-stage pulse tube refrigerator has a great advantage in that there are no moving parts at low temperatures. The problem is low theoretical efficiency. In an ordinary two-stage pulse tube refrigerator, the expansion work of the first stage pulse tube is rather large, but is changed to heat. The theoretical efficiency is lower than that of a Stirling refrigerator. A series two-stage pulse tube refrigerator was introduced for solving this problem. The hot end of the regenerator of the second stage is connected to the hot end of the first stage pulse tube. The expansion work in the first stage pulse tube is part of the input work of the second stage, therefore the efficiency is increased. In a simulation result for a step-piston type two-stage series pulse tube refrigerator, the efficiency is increased by 13.8%.

  4. Theory and calculation of two-stage voltage stabilizer on zener diodes

    Directory of Open Access Journals (Sweden)

    G. S. Veksler

    1966-12-01

    Full Text Available Two-stage stabilizer is compared with one-stage. There have been got formulas, which give the possibility to make an engineering calculation. There is an example of the calculation.

  5. Two-stage fungal pre-treatment for improved biogas production from sisal leaf decortication residues

    National Research Council Canada - National Science Library

    Muthangya, Mutemi; Mshandete, Anthony Manoni; Kivaisi, Amelia Kajumulo

    2009-01-01

    .... Pre-treatment of the residue prior to its anaerobic digestion (AD) was investigated using a two-stage pre-treatment approach with two fungal strains, CCHT-1 and Trichoderma reesei in succession in anaerobic batch bioreactors...

  6. Experiment research on two-stage dry-fed entrained flow coal gasifier

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The process flow and the main devices of a new two-stage dry-fed coal gasification pilot plant with a throughout of 36 t/d are introduced in this paper. For comparison with the traditional one-stage gasifiers, the influences of the coal feed ratio between two stages on the performance of the gasifier are detailedly studied by a series of experiments. The results reveal that the two-stage gasification decreases the temperature of the syngas at the outlet of the gasifier, simplifies the gasification process, and reduces the size of the syngas cooler. Moreover, the cold gas efficiency of the gasifier can be improved by using the two-stage gasification. In our experiments, the efficiency is about 3%-6% higher than the existing one-stage gasifiers.

  7. TWO-STAGE CHARACTER CLASSIFICATION : A COMBINED APPROACH OF CLUSTERING AND SUPPORT VECTOR CLASSIFIERS

    NARCIS (Netherlands)

    Vuurpijl, L.; Schomaker, L.

    2000-01-01

    This paper describes a two-stage classification method for (1) classification of isolated characters and (2) verification of the classification result. Character prototypes are generated using hierarchical clustering. For those prototypes known to sometimes produce wrong classification results, a

  8. A Two-Stage Waste Gasification Reactor for Mars In-Situ Resource Utilization Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to design, build, and test a two-stage waste processing reactor for space applications. Our proposed technology converts waste from space missions into...

  9. A new multi-motor drive system based on two-stage direct power converter

    OpenAIRE

    Kumar, Dinesh

    2011-01-01

    The two-stage AC to AC direct power converter is an alternative matrix converter topology, which offers the benefits of sinusoidal input currents and output voltages, bidirectional power flow and controllable input power factor. The absence of any energy storage devices, such as electrolytic capacitors, has increased the potential lifetime of the converter. In this research work, a new multi-motor drive system based on a two-stage direct power converter has been proposed, with two motors c...

  10. Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

    Directory of Open Access Journals (Sweden)

    Chia-Chang Chien

    2009-01-01

    Full Text Available Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST and the Wechsler Adult Intelligence Scale-Revised (WAIS-R assessments.Results: Logistic regression analysis showed the conceptual level responses (CLR index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84. We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.Keywords: intellectual disability, intelligence screening, two-stage positive screening, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Revised

  11. Two-Stage Conversion of Land and Marine Biomass for Biogas and Biohydrogen Production

    OpenAIRE

    Nkemka, Valentine

    2012-01-01

    The replacement of fossil fuels by renewable fuels such as biogas and biohydrogen will require efficient and economically competitive process technologies together with new kinds of biomass. A two-stage system for biogas production has several advantages over the widely used one-stage continuous stirred tank reactor (CSTR). However, it has not yet been widely implemented on a large scale. Biohydrogen can be produced in the anaerobic two-stage system. It is considered to be a useful fuel for t...

  12. The Management of Iatrogenic Obstructive Sleep Apnoea Syndrome Following Bimaxillary Surgery in a Patient with Cleft Lip and Palate.

    Science.gov (United States)

    Gerbino, Giovanni; Gervasio, Fernando Carmine; Blythe, John; Bianchi, Francesca Antonella

    2016-07-01

    A 26-year-old man presented with a 6-year history of severe obstructive sleep apnoea syndrome followed a bimaxillary osteotomy procedure for a class III skeletal pattern. The patient was born with a unilateral cleft lip and palate and underwent primary lip and palate repair and later a pharyngeal flap for severe velopharyngeal insufficiency. Surgical management of obstructive sleep apnoea syndrome with conventional osteotomy, in cleft lip and palate patients, is a difficult problem. Distraction osteogenesis may provide a safer alternative. The authors describe and discuss the indications and the technical challenge of a multistage treatment protocol with distraction osteogenesis.

  13. Lithium inhibits palatal fusion and osteogenic differentiation in palatal shelves in vitro

    NARCIS (Netherlands)

    Meng, L.; Wang, X.; Torensma, R.; Hoff, J.W. Von den; Bian, Z.

    2014-01-01

    OBJECTIVE: Glycogen synthase kinase-3beta (Gsk-3beta)/beta-catenin signaling regulates development of the secondary palate. It has been unclear about the effects of Gsk-3beta/beta-catenin signaling on palatal fusion and osteogenic differentiation in palatal shelves. DESIGN: In this study, palatal sh

  14. Lithium inhibits palatal fusion and osteogenic differentiation in palatal shelves in vitro

    NARCIS (Netherlands)

    Meng, L.; Wang, X.; Torensma, R.; Hoff, J.W. Von den; Bian, Z.

    2015-01-01

    OBJECTIVE: Glycogen synthase kinase-3beta (Gsk-3beta)/beta-catenin signaling regulates development of the secondary palate. It has been unclear about the effects of Gsk-3beta/beta-catenin signaling on palatal fusion and osteogenic differentiation in palatal shelves. DESIGN: In this study, palatal sh

  15. Cleft Lip and Palate (For Parents)

    Science.gov (United States)

    ... or genes that cause cleft palate or cleft lip. Clefts happen more often in children of Asian, Latino, ... with a facial birth defect like a cleft lip or cleft palate. Related Health Problems As you might imagine, ...

  16. Acquired Palatal Fistula in Patients with Submucous and Incomplete Cleft Palate before Surgery

    Directory of Open Access Journals (Sweden)

    Ie Hyon Park

    2016-11-01

    Full Text Available It is uncommon for a palatal fistula to be detected in individuals who have not undergone surgery, and only sporadic cases have been reported. It is even more difficult to find cases of acquired palatal fistula in patients with submucous or incomplete cleft palate. Herein, we present 2 rare cases of this phenomenon. Case 1 was a patient with submucous cleft palate who acquired a palatal fistula after suffering from oral candidiasis at the age of 5 months. Case 2 was a patient with incomplete cleft palate who spontaneously, without trauma or infection, presented with a palatal fistula at the age of 9 months.

  17. 3D analysis of effects of primary surgeries in cleft lip/palate children during the first two years of life.

    Science.gov (United States)

    Sakoda, Karine Laskos; Jorge, Paula Karine; Carrara, Cleide Felício Carvalho; Machado, Maria Aparecida de Andrade Moreira; Valarelli, Fabrício Pinelli; Pinzan, Arnaldo; Oliveira, Thais Marchini

    2017-06-05

    This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student's ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey's test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. Plip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

  18. Repair of incomplete cleft palate and its clinical analysis by NPF and spectrum technology which were given modified Lan's operations%鼻咽内窥镜和频谱技术对改良兰氏法修复不完全性腭裂效果的回顾性分析

    Institute of Scientific and Technical Information of China (English)

    闫冰冰; 闫漫; 赵增强; 苏波; 丁元刚; 刘国华; 汪涛

    2012-01-01

    目的:通过对2006年6月~2009年12月就诊于解放军第5 37医院口腔科的80例行改良兰氏法修复不完全性腭裂患者进行回访,评估该法临床治疗效果,为术式选择提供依据.方法:对80例改良兰氏法修复不完全性腭裂患者术后腭咽闭合状况进行评估,并行频谱分析,测出前三个共振峰F1、F2、F3的数据,与80例正常儿童对照.结果:在66例行鼻咽镜检查的患者中,有81.81%手术后的患儿达到腭咽闭合完全;在行频谱分析检查中,F1值两组患儿无统计学差异,F2、F3两组间有显著性差异.结论:改良兰氏法能有效改善患者腭咽闭合和语音功能,是一种较好的不完全性腭裂患者的修复术式.%Objective Through to the from June 2006 to December 2009 537 hospital dental clinic in the people's liberation army (PLA) 40 incomplete repair cleft patients visit which were given modified Lan's operations,evaluate the clinical treatment effect, which provides the basis for the selection of clinical work procedures. Methods In 80 cases improved method of incomplete bacterium repair cleft recovery after patient Velopharyngeal function, parallel spectrum analysis,measure the first three F1 and F2, resonant F3 data,and 80 patients with normal children controls. Results In 66 the routine nose pharynx of colonoscopy patients,81.81% of children after surgery to swallow gum closed completely; Spectrum analysis at the inspection,F1 value two groups was not statistically different children, F2, F3 between the two groups have significant differences. Conculsion Until now, Lan's operation Can effectively improve the patients swallow gum closed and speech function,which is still a good way to recover incomplete cleft palate.

  19. CLEFT PALATE. FOUNDATIONS OF SPEECH PATHOLOGY SERIES.

    Science.gov (United States)

    RUTHERFORD, DAVID; WESTLAKE, HAROLD

    DESIGNED TO PROVIDE AN ESSENTIAL CORE OF INFORMATION, THIS BOOK TREATS NORMAL AND ABNORMAL DEVELOPMENT, STRUCTURE, AND FUNCTION OF THE LIPS AND PALATE AND THEIR RELATIONSHIPS TO CLEFT LIP AND CLEFT PALATE SPEECH. PROBLEMS OF PERSONAL AND SOCIAL ADJUSTMENT, HEARING, AND SPEECH IN CLEFT LIP OR CLEFT PALATE INDIVIDUALS ARE DISCUSSED. NASAL RESONANCE…

  20. Occlusal Classification in Relation to Original Cleft Width in Patients With Unilateral Cleft Lip and Palate.

    Science.gov (United States)

    Huang, Andrew H; Patel, Kamlesh B; Maschhoff, Clayton W; Huebener, Donald V; Skolnick, Gary B; Naidoo, Sybill D; Woo, Albert S

    2015-09-01

    To determine a correlation between the width of the cleft palate measured at the time of lip adhesion, definitive lip repair, and palatoplasty and the subsequent occlusal classification of patients born with unilateral cleft lip and palate. Retrospective, observational study. Referral, urban, children's hospital Participants : Dental models and records of 270 patients were analyzed. None. Angle occlusion classification. The mean age at which occlusal classification was determined was 11 ± 0.3 years. Of the children studies, 84 were diagnosed with Class I or II occlusion, 67 were diagnosed with Class III occlusion, and 119 were lost to follow up or transferred care. Mean cleft widths were significantly larger in subjects with Class III occlusion for all measures at time of lip adhesion and definitive lip repair (P cleft widths were significantly greater at the alveolus (P = .025) but not at the midportion of the hard palate (P = .35) or posterior hard palate (P = .10). Cleft widths from the lip through to the posterior hard palate are generally greater in children who are diagnosed with Class III occlusion later in life. Notably, the alveolar cleft width is significantly greater at each time point for patients who went on to develop Class III occlusion. There were no significant differences in cleft widths between patients diagnosed later with Class I and Class II occlusions.

  1. Method of oxygen-enriched two-stage underground coal gasification

    Institute of Scientific and Technical Information of China (English)

    Liu Hongtao; Chen Feng; Pan Xia; Yao Kai; Liu Shuqin

    2011-01-01

    Two-stage underground coal gasification was studied to improve the caloric value of the syngas and to extend gas production times. A model test using the oxygen-enriched two-stage coal gasification method was carried out. The composition of the gas produced, the time ratio of the two stages, and the role of the temperature field were analysed. The results show that oxygen-enriched two-stage gasification shortens the time of the first stage and prolongs the time of the second stage. Feed oxygen concentrations of 30%,35%, 40%, 45%, 60%, or 80% gave time ratios (first stage to second stage) of 1:0.12, 1:0.21, 1:0.51, 1:0.64,1:0.90, and 1:4.0 respectively. Cooling rates of the temperature field after steam injection decreased with time from about 19.1-27.4 ℃/min to 2.3-6.8 ℃/min. But this rate increased with increasing oxygen concentrations in the first stage. The caloric value of the syngas improves with increased oxygen concentration in the first stage. Injection of 80% oxygen-enriched air gave gas with the highest caloric value and also gave the longest production time. The caloric value of the gas obtained from the oxygenenriched two-stage gasification method lies in the range from 5.31 MJ/Nm3 to 10.54 MJ/Nm3.

  2. High magnetostriction parameters for low-temperature sintered cobalt ferrite obtained by two-stage sintering

    Energy Technology Data Exchange (ETDEWEB)

    Khaja Mohaideen, K.; Joy, P.A., E-mail: pa.joy@ncl.res.in

    2014-12-15

    From the studies on the magnetostriction characteristics of two-stage sintered polycrystalline CoFe{sub 2}O{sub 4} made from nanocrystalline powders, it is found that two-stage sintering at low temperatures is very effective for enhancing the density and for attaining higher magnetostriction coefficient. Magnetostriction coefficient and strain derivative are further enhanced by magnetic field annealing and relatively larger enhancement in the magnetostriction parameters is obtained for the samples sintered at lower temperatures, after magnetic annealing, despite the fact that samples sintered at higher temperatures show larger magnetostriction coefficients before annealing. A high magnetostriction coefficient of ∼380 ppm is obtained after field annealing for the sample sintered at 1100 °C, below a magnetic field of 400 kA/m, which is the highest value so far reported at low magnetic fields for sintered polycrystalline cobalt ferrite. - Highlights: • Effect of two-stage sintering on the magnetostriction characteristics of CoFe{sub 2}O{sub 4} is studied. • Two-stage sintering is very effective for enhancing the density and the magnetostriction parameters. • Higher magnetostriction for samples sintered at low temperatures and after magnetic field annealing. • Highest reported magnetostriction of 380 ppm at low fields after two-stage, low-temperature sintering.

  3. 13 K thermally coupled two-stage Stirling-type pulse tube refrigerator

    Institute of Scientific and Technical Information of China (English)

    TANG Ke; CHEN Guobang; THUMMES Günter

    2005-01-01

    Stirling-type pulse tube refrigerators have attracted academic and commercial interest in recent years due to their more compact configuration and higher efficiency than those of G-M type pulse tube refrigerators. In order to achieve a no-load cooling temperature below 20 K, a thermally coupled two-stage Stirling-type pulse tube refrigerator has been built. The thermally coupled arrangement was expected to minimize the interference between the two stages and to simplify the adjustment and optimization of the phase shifters. A no-load cooling temperature of 14.97 K has been realized with the two-stage cooler driven by one linear compressor of 200 W electric input. When the two stages are driven by two compressors respectively, with total electric input of 400 W, the prototype has attained a no-load cooling temperature of 12.96 K, which is the lowest temperature ever reported with two-stage Stirling-type pulse tube refrigerators.

  4. Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Ladan Jamshidy

    2016-01-01

    Full Text Available Introduction. One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods. A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with two-stage technique using an appropriate tray. To measure the marginal gap, the distance between the restoration margin and preparation finish line of plaster dies was vertically determined in mid mesial, distal, buccal, and lingual (MDBL regions by a stereomicroscope using a standard method. Results. The results of independent test showed that the mean value of the marginal gap obtained by one-stage impression technique was higher than that of two-stage impression technique. Further, there was no significant difference between one- and two-stage impression techniques in mid buccal region, but a significant difference was reported between the two impression techniques in MDL regions and in general. Conclusion. The findings of the present study indicated higher accuracy for two-stage impression technique than for the one-stage impression technique.

  5. Orbicularis oris musculomucosal flap for anterior palatal fistula

    Directory of Open Access Journals (Sweden)

    Tiwari V

    2006-01-01

    Full Text Available Anterior palatal fistulae or residual anterior clefts are a frequent problem following palatoplasty. Various techniques have been used to repair such fistulae, each having its own advantages and disadvantages. We have successfully used orbicularis oris musculomucosal flap to close anterior fistula and residual clefts in 25 patients. This study shows the superiority of this flap over other techniques because of its reliable blood supply, easy elevation and transfer to fistula site and finally because it is a single-stage procedure.

  6. Comparison of Intercanine and Intermolar Width Between Cleft Lip Palate and Normal Class I Occlusion Group.

    Science.gov (United States)

    Wahaj, Aiyesha; Ahmed, Imtiaz

    2015-11-01

    To determine the mean difference of arch dimensions (both intercanine and intermolar width) between cleft lip palate and normal class I occlusion group. Cross-sectional analytic study. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, [Dow University of Health Sciences (DUHS)], Karachi, from March 2012 to April 2013. Group 1 consisted of 32 subjects with complete repaired, non-syndromic unilateral and bilateral cleft lip palate. Group 2 consisted of 32 subjects with normal facial morphology and class I occlusion. Exclusion criteria were cleft lip palate subjects with systemic diseases, any arch expansion procedure, incomplete repaired palate, open fistulas, developmental or acquired craniofacial muscular deformities, autoimmune conditions, syndromes, endocrine abnormalities, neurological problems, or previous history of orthodontic treatment and signs and symptoms of temporomandibular disorders, history of trauma, impacted or missing teeth, periodontally involved teeth, subdivision molar classification, skeletal base II and III with molar class I. The transverse width (intercanine and intermolar width) of dental casts was measured with the help of digital caliper. The intercanine width was measured between cusp tips of the canine while the intermolar width distance was measured between mesiobuccal cusp tips of first molars, and buccal grooves of the mandibular first molars in both cleft lip palate and normal class I occlusion group, respectively. There were 64 subjects with mean 14.7 ±6.8 years in the cleft palate and 14.7 ±6.3 years in the normal group. There was statistically significant differences found between intercanine and intermolar width in maxillary arch (p < 0.001). In mandibular arch, only intercanine width has showed significant difference (p < 0.001) between cleft and normal occlusion class I group. Maxillary and mandibular intercanine width was found to be significantly reduced in cleft lip palate group (both unilateral and bilateral) as

  7. Six years analysis of cleft palate in a university hospital center

    Directory of Open Access Journals (Sweden)

    Farahvash M

    1999-08-01

    Full Text Available Cleft palate is a congenital condition that occurs with the incidence rate of one out of 2000 births. This anomaly produces intraoral pressure changes (increase or decrease, can cause speech, sucking and feeding problems of involved patient. On the other hand, if cleft palate is associated with cleft of the lip or alveolar area, growth and alignment of teeth may change the appearance of the patient and affect the psychologic and occupational future of the patient. Eustatian tube malfunction in involved neonates increase. Many procedures are used to repair the cleft palate and correction of palatal muscles which are: 1 Von Langenbeck (18.5%. 2 Veau-Wardil-Kilner (72.5%. 3 Double opposing Z-Plasty (9%. In this research the demographic criteria of patients including age of the patient at operation rime (mean age 30.14 months, city of residence, family history of cleft palate (12.4%, familial relation of parents (15.2%, associated anomalies, complete or incomplete lesion, weight of patients at the time of surgery (mean 11.28 Kg, hemoglobin (11.3 mg/dl, complications, otitis media and the side of cleft palate are studied in 178 admitted patients to Imam General Hospital between 1989 and 1995.

  8. Assessment of complete unilateral cleft lip and palate treatment outcome using EUROCRAN index and associated factors.

    Science.gov (United States)

    Arshad, Anas Imran; Alam, Mohammad Khursheed; Khamis, Mohd Fadhli

    2017-09-01

    Assessment of treatment outcome is the only non-invasive approach to identify the effects of cleft lip and palate repair and modify management accordingly. Here the aim is to assess the outcome of complete unilateral cleft lip and palate (CUCLP) patients using EUROCRAN index and to check whether there are any factors associated with the treatment outcome. It is a retrospective cross sectional study. Dental models were collected from archives of two cleft referral centers in Pakistan. Five blinded examiners scored 101 models twice at two week interval. The primary outcome was mean EUROCRAN scores based on dental arch relationships and palatal surface morphology. A mean(SD) score of 2.72 (0.76) and 2.20 (0.73) was determined based on dental arch relationships and palatal surface morphology, respectively. According to the final logistic regression model, modified Millard technique (cheiloplasty) and Veau-Wardill-Kilners' method (palatoplasty) had higher odds of producing unfavorable treatment outcome. Present study determined a fair and a fair to poor treatment outcome based on dental arch relationships and palatal surface morphology, respectively. Our study suggests a significant association between treatment outcome and primary surgical techniques for lip and palate. These findings could warrant a modification of management protocols to ensure improvement in future cleft outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Design and construction of the X-2 two-stage free piston driven expansion tube

    Science.gov (United States)

    Doolan, Con

    1995-01-01

    This report outlines the design and construction of the X-2 two-stage free piston driven expansion tube. The project has completed its construction phase and the facility has been installed in the new impulsive research laboratory where commissioning is about to take place. The X-2 uses a unique, two-stage driver design which allows a more compact and lower overall cost free piston compressor. The new facility has been constructed in order to examine the performance envelope of the two-stage driver and how well it couple to sub-orbital and super-orbital expansion tubes. Data obtained from these experiments will be used for the design of a much larger facility, X-3, utilizing the same free piston driver concept.

  10. Analysis of performance and optimum configuration of two-stage semiconductor thermoelectric module

    Institute of Scientific and Technical Information of China (English)

    Li Kai-Zhen; Liang Rui-Sheng; Wei Zheng-Jun

    2008-01-01

    In this paper, the theoretical analysis and simulating calculation were conducted for a basic two-stage semiconductor thermoelectric module, which contains one thermocouple in the second stage and several thermocouples in the first stage. The study focused on the configuration of the two-stage semiconductor thermoelectric cooler, especially investigating the influences of some parameters, such as the current I1 of the first stage, the area A1 of every thermocouple and the number n of thermocouples in the first stage, on the cooling performance of the module. The obtained results of analysis indicate that changing the current I1 of the first stage, the area A1 of thcrmocouples and the number n of thermocouples in the first stage can improve the cooling performance of the module. These results can be used to optimize the configuration of the two-stage semiconductor thermoelectric module and provide guides for the design and application of thermoelectric cooler.

  11. Effects of earthworm casts and zeolite on the two-stage composting of green waste.

    Science.gov (United States)

    Zhang, Lu; Sun, Xiangyang

    2015-05-01

    Because it helps protect the environment and encourages economic development, composting has become a viable method for organic waste disposal. The objective of this study was to investigate the effects of earthworm casts (EWCs) (at 0.0%, 0.30%, and 0.60%) and zeolite (clinoptilolite, CL) (at 0%, 15%, and 25%) on the two-stage composting of green waste. The combination of EWCs and CL improved the conditions of the composting process and the quality of the compost products in terms of the thermophilic phase, humification, nitrification, microbial numbers and enzyme activities, the degradation of cellulose and hemicellulose, and physico-chemical characteristics and nutrient contents of final composts. The compost matured in only 21days with the optimized two-stage composting method rather than in the 90-270days required for traditional composting. The optimal two-stage composting and the best quality compost were obtained with 0.30% EWCs and 25% CL.

  12. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

  13. The CSS and The Two-Staged Methods for Parameter Estimation in SARFIMA Models

    Directory of Open Access Journals (Sweden)

    Erol Egrioglu

    2011-01-01

    Full Text Available Seasonal Autoregressive Fractionally Integrated Moving Average (SARFIMA models are used in the analysis of seasonal long memory-dependent time series. Two methods, which are conditional sum of squares (CSS and two-staged methods introduced by Hosking (1984, are proposed to estimate the parameters of SARFIMA models. However, no simulation study has been conducted in the literature. Therefore, it is not known how these methods behave under different parameter settings and sample sizes in SARFIMA models. The aim of this study is to show the behavior of these methods by a simulation study. According to results of the simulation, advantages and disadvantages of both methods under different parameter settings and sample sizes are discussed by comparing the root mean square error (RMSE obtained by the CSS and two-staged methods. As a result of the comparison, it is seen that CSS method produces better results than those obtained from the two-staged method.

  14. A two-stage subsurface vertical flow constructed wetland for high-rate nitrogen removal.

    Science.gov (United States)

    Langergraber, Guenter; Leroch, Klaus; Pressl, Alexander; Rohrhofer, Roland; Haberl, Raimund

    2008-01-01

    By using a two-stage constructed wetland (CW) system operated with an organic load of 40 gCOD.m(-2).d(-1) (2 m2 per person equivalent) average nitrogen removal efficiencies of about 50% and average nitrogen elimination rates of 980 g N.m(-2).yr(-1) could be achieved. Two vertical flow beds with intermittent loading have been operated in series. The first stage uses sand with a grain size of 2-3.2 mm for the main layer and has a drainage layer that is impounded; the second stage sand with a grain size of 0.06-4 mm and a drainage layer with free drainage. The high nitrogen removal can be achieved without recirculation thus it is possible to operate the two-stage CW system without energy input. The paper shows performance data for the two-stage CW system regarding removal of organic matter and nitrogen for the two year operating period of the system. Additionally, its efficiency is compared with the efficiency of a single-stage vertical flow CW system designed and operated according to the Austrian design standards with 4 m2 per person equivalent. The comparison shows that a higher effluent quality could be reached with the two-stage system although the two-stage CW system is operated with the double organic load or half the specific surface area requirement, respectively. Another advantage is that the specific investment costs of the two-stage CW system amount to 1,200 EUR per person (without mechanical pre-treatment) and are only about 60% of the specific investment costs of the singe-stage CW system. IWA Publishing 2008.

  15. Methane production from sweet sorghum residues via a two-stage process

    Energy Technology Data Exchange (ETDEWEB)

    Stamatelatou, K.; Dravillas, K.; Lyberatos, G. [University of Patras (Greece). Department of Chemical Engineering, Laboratory of Biochemical Engineering and Environmental Technology

    2003-07-01

    The start-up of a two-stage reactor configuration for the anaerobic digestion of sweet sorghum residues was evaluated. The sweet sorghum residues were a waste stream originating from the alcoholic fermentation of sweet sorghum and the subsequent distillation step. This waste stream contained high concentration of solid matter (9% TS) and thus could be characterized as a semi-solid, not easily biodegradable wastewater with high COD (115 g/l). The application of the proposed two-stage configuration (consisting of one thermophilic hydrolyser and one mesophilic methaniser) achieved a methane production of 16 l/l wastewater under a hydraulic retention time of 19 d. (author)

  16. Two Stage Fully Differential Sample and Hold Circuit Using .18µm Technology

    Directory of Open Access Journals (Sweden)

    Dharmendra Dongardiye

    2014-05-01

    Full Text Available This paper presents a well-established Fully Differential sample & hold circuitry, implemented in 180-nm CMOS technology. In this two stage method the first stage give us very high gain and second stage gives large voltage swing. The proposed opamp provides 149MHz unity-gain bandwidth , 78 degree phase margin and a differential peak to peak output swing more than 2.4v. using the improved fully differential two stage operational amplifier of 76.7dB gain. Although the sample and hold circuit meets the requirements of SNR specifications.

  17. One-stage and two-stage penile buccal mucosa urethroplasty

    Directory of Open Access Journals (Sweden)

    G. Barbagli

    2016-03-01

    Full Text Available The paper provides the reader with the detailed description of current techniques of one-stage and two-stage penile buccal mucosa urethroplasty. The paper provides the reader with the preoperative patient evaluation paying attention to the use of diagnostic tools. The one-stage penile urethroplasty using buccal mucosa graft with the application of glue is preliminary showed and discussed. Two-stage penile urethroplasty is then reported. A detailed description of first-stage urethroplasty according Johanson technique is reported. A second-stage urethroplasty using buccal mucosa graft and glue is presented. Finally postoperative course and follow-up are addressed.

  18. Development of a linear compressor for two-stage pulse tube cryocoolers

    Institute of Scientific and Technical Information of China (English)

    Peng-da YAN; Wei-li GAO; Guo-bang CHEN

    2009-01-01

    A valveless linear compressor was built up to drive a self-made two-stage pulse tube cryocooler. With a designed maximum swept volume of 60 cm~3, the compressor can provide the cryocooler with a pressure volume (PV) power of 400 W.Preliminary measurements of the compressor indicated that both an efficiency of 35%~55% and a pressure ratio of 1.3~1.4 could be obtained. The two-stage pulse tube cryocooler driven by this compressor achieved the lowest temperature of 14.2 K.

  19. Terephthalic acid wastewater treatment by using two-stage aerobic process

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Based on the tests between anoxic and aerobic process, the two-stage aerobic process with a biological selector was chosen to treat terephthalic acid wastewater (PTA). By adopting the two- stage aerobic process, the CODCr in PTA wastewater could be reduced from 4000-6000 mg/L to below 100 mg/L; the COD loading in the first aerobic tank could reach 7.0-8.0 kgCODCr/(m3.d) and that of the second stage was from 0.2 to 0.4 kgCODCr/(m3.d). Further researches on the kinetics of substrate degradation were carried out.

  20. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

    OpenAIRE

    Vijaya Prasad Kamavaram Ellore; Naveen Kumar Ramagoni; Mahantesha Taranatha; Asha Nara; Gururaj Gunjalli; Ashwin Devasya Bhat

    2012-01-01

    Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this arti...

  1. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Heliövaara, Arja; Küseler, Annelise; Skaare, Pål

    2017-01-01

    BACKGROUND AND AIM: Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP. DESIGN: Three parallel randomised clinical trials were...... undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born...

  2. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

    Directory of Open Access Journals (Sweden)

    Vijaya Prasad Kamavaram Ellore

    2012-01-01

    Full Text Available Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article.

  3. First Law Analysis of a Two-stage Ejector-vapor Compression Refrigeration Cycle working with R404A

    National Research Council Canada - National Science Library

    Feiza Memet; Daniela-Elena Mitu

    2011-01-01

    The traditional two-stage vapor compression refrigeration cycle might be replaced by a two-stage ejector-vapor compression refrigeration cycle if it is aimed the decrease of irreversibility during expansion...

  4. Pre-speech in children with cleft lip and palate or cleft palate only: phonetic analysis related to morphologic and functional factors.

    Science.gov (United States)

    Lohmander-Agerskov, A; Söderpalm, E; Friede, H; Persson, E C; Lilja, J

    1994-07-01

    Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (i.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.

  5. Overcoming the bottlenecks of anaerobic digestion of olive mill solid waste by two-stage fermentation.

    Science.gov (United States)

    Stoyanova, Elitza; Lundaa, Tserennyam; Bochmann, Günther; Fuchs, Werner

    2017-02-01

    Two-stage anaerobic digestion (AD) of two-phase olive mill solid waste (OMSW) was applied for reducing the inhibiting factors by optimizing the acidification stage. Single-stage AD and co-fermentation with chicken manure were conducted coinstantaneous for direct comparison. Degradation of the polyphenols up to 61% was observed during the methanogenic stage. Nevertheless the concentration of phenolic substances was still high; the two-stage fermentation remained stable at OLR 1.5 kgVS/m³day. The buffer capacity of the system was twice as high, compared to the one-stage fermentation, without additives. The two-stage AD was a combined process - thermophilic first stage and mesophilic second stage, which pointed out to be the most profitable for AD of OMSW for the reduced hydraulic retention time (HRT) from 230 to 150 days, and three times faster than the single-stage and the co-fermentation start-up of the fermentation. The optimal HRT and incubation temperature for the first stage were determined to four days and 55°C. The performance of the two-stage AD concerning the stability of the process was followed by the co-digestion of OMSW with chicken manure as a nitrogen-rich co-substrate, which makes them viable options for waste disposal with concomitant energy recovery.

  6. The Design, Construction and Operation of a 75 kW Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Henriksen, Ulrik Birk; Ahrenfeldt, Jesper; Jensen, Torben Kvist

    2003-01-01

    The Two-Stage Gasifier was operated for several weeks (465 hours) and of these 190 hours continuously. The gasifier is operated automatically unattended day and night, and only small adjustments of the feeding rate were necessary once or twice a day. The operation was successful, and the output a...... of the reactor had to be constructed in some other material....

  7. Treatment of corn ethanol distillery wastewater using two-stage anaerobic digestion.

    Science.gov (United States)

    Ráduly, B; Gyenge, L; Szilveszter, Sz; Kedves, A; Crognale, S

    In this study the mesophilic two-stage anaerobic digestion (AD) of corn bioethanol distillery wastewater is investigated in laboratory-scale reactors. Two-stage AD technology separates the different sub-processes of the AD in two distinct reactors, enabling the use of optimal conditions for the different microbial consortia involved in the different process phases, and thus allowing for higher applicable organic loading rates (OLRs), shorter hydraulic retention times (HRTs) and better conversion rates of the organic matter, as well as higher methane content of the produced biogas. In our experiments the reactors have been operated in semi-continuous phase-separated mode. A specific methane production of 1,092 mL/(L·d) has been reached at an OLR of 6.5 g TCOD/(L·d) (TCOD: total chemical oxygen demand) and a total HRT of 21 days (5.7 days in the first-stage, and 15.3 days in the second-stage reactor). Nonetheless the methane concentration in the second-stage reactor was very high (78.9%); the two-stage AD outperformed the reference single-stage AD (conducted at the same reactor loading rate and retention time) by only a small margin in terms of volumetric methane production rate. This makes questionable whether the higher methane content of the biogas counterbalances the added complexity of the two-stage digestion.

  8. A two-stage ethanol-based biodiesel production in a packed bed reactor

    DEFF Research Database (Denmark)

    Xu, Yuan; Nordblad, Mathias; Woodley, John

    2012-01-01

    A two-stage enzymatic process for producing fatty acid ethyl ester (FAEE) in a packed bed reactor is reported. The process uses an experimental immobilized lipase (NS 88001) and Novozym 435 to catalyze transesterification (first stage) and esterification (second stage), respectively. Both stages...

  9. Two-Stage MAS Technique for Analysis of DRA Elements and Arrays on Finite Ground Planes

    DEFF Research Database (Denmark)

    Larsen, Niels Vesterdal; Breinbjerg, Olav

    2007-01-01

    A two-stage Method of Auxiliary Sources (MAS) technique is proposed for analysis of dielectric resonator antenna (DRA) elements and arrays on finite ground planes (FGPs). The problem is solved by first analysing the DRA on an infinite ground plane (IGP) and then using this solution to model the FGP...... problem....

  10. Use a Log Splitter to Demonstrate Two-Stage Hydraulic Pump

    Science.gov (United States)

    Dell, Timothy W.

    2012-01-01

    The two-stage hydraulic pump is commonly used in many high school and college courses to demonstrate hydraulic systems. Unfortunately, many textbooks do not provide a good explanation of how the technology works. Another challenge that instructors run into with teaching hydraulic systems is the cost of procuring an expensive real-world machine…

  11. Two-Stage Sampling Procedures for Comparing Means When Population Distributions Are Non-Normal.

    Science.gov (United States)

    Luh, Wei-Ming; Olejnik, Stephen

    Two-stage sampling procedures for comparing two population means when variances are heterogeneous have been developed by D. G. Chapman (1950) and B. K. Ghosh (1975). Both procedures assume sampling from populations that are normally distributed. The present study reports on the effect that sampling from non-normal distributions has on Type I error…

  12. Some design aspects of a two-stage rail-to-rail CMOS op amp

    NARCIS (Netherlands)

    Gierkink, S.L.J.; Holzmann, Peter J.; Wiegerink, R.J.; Wassenaar, R.F.

    1999-01-01

    A two-stage low-voltage CMOS op amp with rail-to-rail input and output voltage ranges is presented. The circuit uses complementary differential input pairs to achieve the rail-to-rail common-mode input voltage range. The differential pairs operate in strong inversion, and the constant transconductan

  13. Kinetics analysis of two-stage austenitization in supermartensitic stainless steel

    DEFF Research Database (Denmark)

    Nießen, Frank; Villa, Matteo; Hald, John

    2017-01-01

    The martensite-to-austenite transformation in X4CrNiMo16-5-1 supermartensitic stainless steel was followed in-situ during isochronal heating at 2, 6 and 18 K min−1 applying energy-dispersive synchrotron X-ray diffraction at the BESSY II facility. Austenitization occurred in two stages, separated...

  14. An intracooling system for a novel two-stage sliding-vane air compressor

    Science.gov (United States)

    Murgia, Stefano; Valenti, Gianluca; Costanzo, Ida; Colletta, Daniele; Contaldi, Giulio

    2017-08-01

    Lube-oil injection is used in positive-displacement compressors and, among them, in sliding-vane machines to guarantee the correct lubrication of the moving parts and as sealing to prevent air leakage. Furthermore, lube-oil injection allows to exploit lubricant also as thermal ballast with a great thermal capacity to minimize the temperature increase during the compression. This study presents the design of a two-stage sliding-vane rotary compressor in which the air cooling is operated by high-pressure cold oil injection into a connection duct between the two stages. The heat exchange between the atomized oil jet and the air results in a decrease of the air temperature before the second stage, improving the overall system efficiency. This cooling system is named here intracooling, as opposed to intercooling. The oil injection is realized via pressure-swirl nozzles, both within the compressors and inside the intracooling duct. The design of the two-stage sliding-vane compressor is accomplished by way of a lumped parameter model. The model predicts an input power reduction as large as 10% for intercooled and intracooled two-stage compressors, the latter being slightly better, with respect to a conventional single-stage compressor for compressed air applications. An experimental campaign is conducted on a first prototype that comprises the low-pressure compressor and the intracooling duct, indicating that a significant temperature reduction is achieved in the duct.

  15. Development of a heavy-duty diesel engine with two-stage turbocharging

    NARCIS (Netherlands)

    Sturm, L.; Kruithof, J.

    2001-01-01

    A mean value model was developed by using Matrixx/ Systembuild simulation tool for designing real-time control algorithms for the two-stage engine. All desired characteristics are achieved, apart from lower A/F ratio at lower engine speeds and Turbocharger matches calculations. The CANbus is used to

  16. Two-stage, dilute sulfuric acid hydrolysis of wood : an investigation of fundamentals

    Science.gov (United States)

    John F. Harris; Andrew J. Baker; Anthony H. Conner; Thomas W. Jeffries; James L. Minor; Roger C. Pettersen; Ralph W. Scott; Edward L Springer; Theodore H. Wegner; John I. Zerbe

    1985-01-01

    This paper presents a fundamental analysis of the processing steps in the production of methanol from southern red oak (Quercus falcata Michx.) by two-stage dilute sulfuric acid hydrolysis. Data for hemicellulose and cellulose hydrolysis are correlated using models. This information is used to develop and evaluate a process design.

  17. Two-stage data envelopment analysis technique for evaluating internal supply chain efficiency

    Directory of Open Access Journals (Sweden)

    Nisakorn Somsuk

    2014-12-01

    Full Text Available A two-stage data envelopment analysis (DEA which uses mathematical linear programming techniques is applied to evaluate the efficiency of a system composed of two relational sub-processes, by which the outputs from the first sub-process (as the intermediate outputs of the system are the inputs for the second sub-process. The relative efficiencies of the system and its sub-processes can be measured by applying the two-stage DEA. According to the literature review on the supply chain management, this technique can be used as a tool for evaluating the efficiency of the supply chain composed of two relational sub-processes. The technique can help to determine the inefficient sub-processes. Once the inefficient sub-process was improved its efficiency, it would result in better aggregate efficiency of the supply chain. This paper aims to present a procedure for evaluating the efficiency of the supply chain by using the two-stage DEA, under the assumption of constant returns to scale, with an example of internal supply chain efficiency measurement of insurance companies by applying the two-stage DEA for illustration. Moreover, in this paper the authors also present some observations on the application of this technique.

  18. Two-stage estimation in copula models used in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2005-01-01

    In this paper register based family studies provide the motivation for studying a two-stage estimation procedure in copula models for multivariate failure time data. The asymptotic properties of the estimators in both parametric and semi-parametric models are derived, generalising the approach by...

  19. Innovative two-stage anaerobic process for effective codigestion of cheese whey and cattle manure.

    Science.gov (United States)

    Bertin, Lorenzo; Grilli, Selene; Spagni, Alessandro; Fava, Fabio

    2013-01-01

    The valorisation of agroindustrial waste through anaerobic digestion represents a significant opportunity for refuse treatment and renewable energy production. This study aimed to improve the codigestion of cheese whey (CW) and cattle manure (CM) by an innovative two-stage process, based on concentric acidogenic and methanogenic phases, designed for enhancing performance and reducing footprint. The optimum CW to CM ratio was evaluated under batch conditions. Thereafter, codigestion was implemented under continuous-flow conditions comparing one- and two-stage processes. The results demonstrated that the addition of CM in codigestion with CW greatly improved the anaerobic process. The highest methane yield was obtained co-treating the two substrates at equal ratio by using the innovative two-stage process. The proposed system reached the maximum value of 258 mL(CH4) g(gv(-1), which was more than twice the value obtained by the one-stage process and 10% higher than the value obtained by the two-stage one.

  20. Extraoral implants for orbit rehabilitation: a comparison between one-stage and two-stage surgeries.

    Science.gov (United States)

    de Mello, M C L M P; Guedes, R; de Oliveira, J A P; Pecorari, V A; Abrahão, M; Dib, L L

    2014-03-01

    The aim of the study was to compare the osseointegration success rate and time for delivery of the prosthesis among cases treated by two-stage or one-stage surgery for orbit rehabilitation between 2003 and 2011. Forty-five patients were included, 31 males and 14 females; 22 patients had two-stage surgery and 23 patients had one-stage surgery. A total 138 implants were installed, 42 (30.4%) on previously irradiated bone. The implant survival rate was 96.4%, with a success rate of 99.0% among non-irradiated patients and 90.5% among irradiated patients. Two-stage patients received 74 implants with a survival rate of 94.6% (four implants lost); one-stage surgery patients received 64 implants with a survival rate of 98.4% (one implant lost). The median time interval between implant fixation and delivery of the prosthesis for the two-stage group was 9.6 months and for the one-stage group was 4.0 months (P < 0.001). The one-stage technique proved to be reliable and was associated with few risks and complications; the rate of successful osseointegration was similar to those reported in the literature. The one-stage technique should be considered a viable procedure that shortens the time to final rehabilitation and facilitates appropriate patient follow-up treatment.

  1. Validation of Continuous CHP Operation of a Two-Stage Biomass Gasifier

    DEFF Research Database (Denmark)

    Ahrenfeldt, Jesper; Henriksen, Ulrik Birk; Jensen, Torben Kvist

    2006-01-01

    The Viking gasification plant at the Technical University of Denmark was built to demonstrate a continuous combined heat and power operation of a two-stage gasifier fueled with wood chips. The nominal input of the gasifier is 75 kW thermal. To validate the continuous operation of the plant, a 9-d...

  2. High rate treatment of terephthalic acid production wastewater in a two-stage anaerobic bioreactor

    NARCIS (Netherlands)

    Kleerebezem, R.; Beckers, J.; Pol, L.W.H.; Lettinga, G.

    2005-01-01

    The feasibility was studied of anaerobic treatment of wastewater generated during purified terephthalic acid (PTA) production in two-stage upflow anaerobic sludge blanket (UASB) reactor system. The artificial influent of the system contained the main organic substrates of PTA-wastewater: acetate, be

  3. Thermal design of two-stage evaporative cooler based on thermal comfort criterion

    Science.gov (United States)

    Gilani, Neda; Poshtiri, Amin Haghighi

    2017-04-01

    Performance of two-stage evaporative coolers at various outdoor air conditions was numerically studied, and its geometric and physical characteristics were obtained based on thermal comfort criteria. For this purpose, a mathematical model was developed based on conservation equations of mass, momentum and energy to determine heat and mass transfer characteristics of the system. The results showed that two-stage indirect/direct cooler can provide the thermal comfort condition when outdoor air temperature and relative humidity are located in the range of 34-54 °C and 10-60 %, respectively. Moreover, as relative humidity of the ambient air rises, two-stage evaporative cooler with the smaller direct and larger indirect cooler will be needed. In building with high cooling demand, thermal comfort may be achieved at a greater air change per hour number, and thus an expensive two-stage evaporative cooler with a higher electricity consumption would be required. Finally, a design guideline was proposed to determine the size of required plate heat exchangers at various operating conditions.

  4. ADM1-based modeling of methane production from acidified sweet sorghum extractin a two stage process

    DEFF Research Database (Denmark)

    Antonopoulou, Georgia; Gavala, Hariklia N.; Skiadas, Ioannis

    2012-01-01

    The present study focused on the application of the Anaerobic Digestion Model 1 οn the methane production from acidified sorghum extract generated from a hydrogen producing bioreactor in a two-stage anaerobic process. The kinetic parameters for hydrogen and volatile fatty acids consumption were...

  5. Thermal design of two-stage evaporative cooler based on thermal comfort criterion

    Science.gov (United States)

    Gilani, Neda; Poshtiri, Amin Haghighi

    2016-09-01

    Performance of two-stage evaporative coolers at various outdoor air conditions was numerically studied, and its geometric and physical characteristics were obtained based on thermal comfort criteria. For this purpose, a mathematical model was developed based on conservation equations of mass, momentum and energy to determine heat and mass transfer characteristics of the system. The results showed that two-stage indirect/direct cooler can provide the thermal comfort condition when outdoor air temperature and relative humidity are located in the range of 34-54 °C and 10-60 %, respectively. Moreover, as relative humidity of the ambient air rises, two-stage evaporative cooler with the smaller direct and larger indirect cooler will be needed. In building with high cooling demand, thermal comfort may be achieved at a greater air change per hour number, and thus an expensive two-stage evaporative cooler with a higher electricity consumption would be required. Finally, a design guideline was proposed to determine the size of required plate heat exchangers at various operating conditions.

  6. A Two-Stage Exercise on the Binomial Distribution Using Minitab.

    Science.gov (United States)

    Shibli, M. Abdullah

    1990-01-01

    Describes a two-stage experiment that was designed to explain binomial distribution to undergraduate statistics students. A manual coin flipping exercise is explained as the first stage; a computerized simulation using MINITAB software is presented as stage two; and output from the MINITAB exercises is included. (two references) (LRW)

  7. The rearrangement process in a two-stage broadcast switching network

    DEFF Research Database (Denmark)

    Jacobsen, Søren B.

    1988-01-01

    The rearrangement process in the two-stage broadcast switching network presented by F.K. Hwang and G.W. Richards (ibid., vol.COM-33, no.10, p.1025-1035, Oct. 1985) is considered. By defining a certain function it is possible to calculate an upper bound on the number of connections to be moved...

  8. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

    Directory of Open Access Journals (Sweden)

    Yukio Iwashita

    2012-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both post-operative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  9. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

    Directory of Open Access Journals (Sweden)

    Iwashita Yukio

    2005-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both postoperative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  10. Two-stage bargaining with coverage extension in a dual labour market

    DEFF Research Database (Denmark)

    Roberts, Mark A.; Stæhr, Karsten; Tranæs, Torben

    2000-01-01

    This paper studies coverage extension in a simple general equilibrium model with a dual labour market. The union sector is characterized by two-stage bargaining whereas the firms set wages in the non-union sector. In this model firms and unions of the union sector have a commonality of interest...

  11. Preoperative evaluation of micro-organisms in non-operated cleft in soft palate: impact on use of antibiotics.

    Science.gov (United States)

    Roode, G J; Bütow, K-W; Naidoo, S

    2017-02-01

    To identify the pathogenic micro-organisms that had colonised preoperatively in clefts in the soft palate and oro-nasopharynx, we retrospectively studied the preoperative microbiological profiles of 200 infants who had had primary repair of all types of cleft in the soft palate. Data from a private practice that specialises in the repair of facial clefts were extracted randomly from patients' files. We analysed the results of the culture of preoperative swabs taken from clefts in the soft palate and oro-nasopharynx, and the resistance profile of organisms towards various antibiotics. A total of 23 different pathogenic micro-organisms were isolated from 115 (57%) of the sample. Klebsiella pneumoniae most commonly colonised clefts in the lip, alveolus, and palate. This was considerably higher than in other groups. The second most common micro-organism was Staphylococcus aureus, which was found most often in patients with isolated clefts in the hard palate. Those with complete cleft lip and palate presented with more pathogenic micro-organisms in preoperative cultures than those with other types of cleft. We need to find a way to control pathogenic micro-organisms in the oral and oro-nasopharyngeal region preoperatively to limit postoperative complications.

  12. Factors contributing to hearing impairment in patients with cleft lip/palate in Malaysia: A prospective study of 346 ears.

    Science.gov (United States)

    Cheong, Jack Pein; Soo, Siew Shuin; Manuel, Anura Michelle

    2016-09-01

    To determine the factors contributing towards hearing impairment in patients with cleft lip/palate. A prospective analysis was conducted on 173 patients (346 ears) with cleft lip and palate (CL/P) who presented to the combined cleft clinic at University Malaya Medical Centre (UMMC) over 12 months. The patients' hearing status was determined using otoacoustic emission (OAE), pure tone audiometry (PTA) and auditory brainstem response (ABR). These results were analysed against several parameters, which included age, gender, race, types of cleft pathology, impact and timing of repair surgery. The patients' age ranged from 1-26 years old. They comprised 30% with unilateral cleft lip and palate (UCLP), 28% with bilateral cleft lip and palate (BCLP), 28% with isolated cleft palate (ICP) and 14% with isolated cleft lip (ICL). Majority of the patients (68.2%) had normal otoscopic findings. Out of the 346 ears, 241 ears (70%) ears had passed the hearing tests. There was no significant relationship between patients' gender and ethnicity with their hearing status. The types of cleft pathology significantly influenced the outcome of PTA and ABR screening results (p cleft groups and the outcome of hearing tests. However, hearing improvement occurred when palatal repair was performed at the age of cleft patients had normal hearing (70%). Hearing threshold varied significantly between the different types of cleft pathology. Surgery conferred no significant impact on the hearing outcome unless surgery was performed at the age of <1 year old. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Optimisation of two-stage screw expanders for waste heat recovery applications

    Science.gov (United States)

    Read, M. G.; Smith, I. K.; Stosic, N.

    2015-08-01

    It has previously been shown that the use of two-phase screw expanders in power generation cycles can achieve an increase in the utilisation of available energy from a low temperature heat source when compared with more conventional single-phase turbines. However, screw expander efficiencies are more sensitive to expansion volume ratio than turbines, and this increases as the expander inlet vapour dryness fraction decreases. For singlestage screw machines with low inlet dryness, this can lead to under expansion of the working fluid and low isentropic efficiency for the expansion process. The performance of the cycle can potentially be improved by using a two-stage expander, consisting of a low pressure machine and a smaller high pressure machine connected in series. By expanding the working fluid over two stages, the built-in volume ratios of the two machines can be selected to provide a better match with the overall expansion process, thereby increasing efficiency for particular inlet and discharge conditions. The mass flow rate though both stages must however be matched, and the compromise between increasing efficiency and maximising power output must also be considered. This research uses a rigorous thermodynamic screw machine model to compare the performance of single and two-stage expanders over a range of operating conditions. The model allows optimisation of the required intermediate pressure in the two- stage expander, along with the rotational speed and built-in volume ratio of both screw machine stages. The results allow the two-stage machine to be fully specified in order to achieve maximum efficiency for a required power output.

  14. Palate size and shape in schizophrenia.

    Science.gov (United States)

    Delice, Mehtap; Gurbuz, Ozlem; Oflezer, Ceyhan; Kurt, Erhan; Mandali, Gamze

    2016-10-30

    The palate is considered typical of the structures in which schizophrenia-related minor physical anomalies may occur. In this study, we aimed to compare the dimensions and form of palate in patients with schizophrenia with nonpsychiatric controls in a blinded manner. Dental stone casts of 127 patients with schizophrenia and 127 controls were prepared from impressions of the maxillary dental arch. Palate dimensions were measured on the stone casts using a digital caliper and palatometer. Palate length did not differ significantly between the groups, but there was a significant difference in palate width and depth, which were significantly higher in the schizophrenia group. As a result of using multivariate analysis for assessing independent risk factors affecting patients with schizophrenia, furrowed palate shape, palate width, and ellipsoid maxillary dental arch shape were found to be significant. This study also revealed that patients with schizophrenia demonstrate certain gender-related predilections in the differences of palate parameters compared to same-sex controls. As the palate develops in conjunction with both the face and brain, our study findings can significantly contribute to the assumption that there might be structural abnormalities of the palate that could represent specific markers of embryological dysmorphogenesis underlying schizophrenia.

  15. Bony defect of palate and vomer in submucous cleft palate patients.

    Science.gov (United States)

    Ren, S; Ma, L; Zhou, X; Sun, Z

    2015-01-01

    The aim of this study was to visualize bony defects of the palate and vomer in submucous cleft palate patients (SMCP) by three-dimensional (3D) computed tomography (CT) reconstruction and to classify the range of bony defects. Forty-eight consecutive non-operated SMCP patients were included. Diagnosis was based on the presence of at least one of three classical signs of SMCP: bifid uvula, a translucent zone in the midline of the soft palate, and a palpable 'V' notch on the posterior border of the bony palate. Patients were imaged using spiral CT. 3D reconstruction models were created of the palate and vomer. The sagittal extent of the bony cleft in SMCP was classified into four types: type I, no V-shaped hard palate cleft (8.3%); type II, cleft involving the partial palate (43.8%); type III, cleft involving the complete palate and extending to the incisive foramen (43.8%); type IV, cleft involving the complete palate and the alveolar bone (4.2%). The extent of the vomer defect was classified into three types: type A, vomer completely fused with the palate (8.3%); type B, vomer partially fused with the palate (43.8%); type C, vomer not fused with the palate up to the incisive foramen (47.9%). Significant variability in hard palate defects in SMCP is the rule rather than the exception. The association of velopharyngeal insufficiency with anatomical malformations may be complex.

  16. Presurgical nasoalveolar moulding treatment in cleft lip and palate patients

    Directory of Open Access Journals (Sweden)

    Grayson Barry

    2009-10-01

    Full Text Available Presurgical infant orthopedics has been employed since 1950 as an adjunctive neonatal therapy for the correction of cleft lip and palate. Most of these therapies did not address deformity of the nasal cartilage in unilateral and bilateral cleft lip and palate as well as the deficiency of the columella tissue in infants with bilateral cleft. The nasolaveolar molding (NAM technique a new approach to presurgical infant orthopedics developed by Grayson reduces the severity of the initial cleft alveolar and nasal deformity. This enables the surgeon and the patient to enjoy the benefits associated with repair of a cleft deformity that is minimal in severity. This paper will discuss the appliance design, clinical management and biomechanical principles of nasolaveolar molding therapy. Long term studies on NAM therapy indicate better lip and nasal form, reduced oronasal fistula and labial deformities, 60 % reduction in the need for secondary alveolar bone grafting. No effect on growth of midface in sagittal and vertical plane has been recorded up to the age of 18 yrs. With proper training and clinical skills NAM has demonstrated tremendous benefit to the cleft patients as well as to the surgeon performing the repair.

  17. International confederation for cleft lip and palate and related craniofacial anomalies task force report: palatoplasty in the speaking individual with unrepaired cleft palate.

    Science.gov (United States)

    Sommerlad, Brian C

    2014-11-01

    Introduction : The benefits or otherwise of late palate repair in older children or adults are uncertain. The outcomes, particularly without appropriate speech therapy, are often disappointing. The issue is of special importance in the poorer countries where these patients are most commonly seen and where limited capacity and facilities may have to be rationed. Method : A task force was set up to report back to the International Congress in Orlando in May 2013. The chairman and some members were nominated by the organizers and further members were added during the discussion process. Some of the members had considerable experience of late palate repair. The task force compiled a report after 9 months of e-mail correspondence. The report includes reports of some previously unpublished studies. A summary of the report was presented at Cleft 2013 in Orlando. Conclusions : There was a general consensus that late palate repair is of benefit for many patients and that, even if normal speech is not attained, outcomes are positive. Outcomes depend on the age of the patient (the younger the better), on the skill of the surgeon and, ideally, on the availability of appropriate speech therapy. A protocol for a prospective international multi-center study is proposed.

  18. Palatalization in educated Cairene Arabic

    Directory of Open Access Journals (Sweden)

    Islam Youssef

    2016-03-01

    Full Text Available In the speech of some educated Cairenes, the coronal stops /t d tˤ dˤ/ acquire a secondary palatal articulation before high front vowels and glides, resulting in [tj] or [dj]. Based on first-hand data, this article provides a detailed phonetic and phonological investigation of this palatalization process in an attempt to fill a descriptive gap in the literature on Cairene Arabic. By examining the full range of triggers, targets, and potential blockers, I demonstrate that this is a phonetic coarticulatory effect, and that it should be distinguished from phonological assimilation. I also explore the hypothesis that this process – characterized as a sound change in progress – has been phonologized in a different sociolect of Cairene Arabic.

  19. Schwannoma of the hard palate.

    Science.gov (United States)

    Isildak, Huseyin; Yilmaz, Mehmet; Ibrahimov, Metin; Aslan, Mehmet; Karaman, Emin; Enver, Ozgun

    2010-01-01

    About half of all neurogenic tumors are seen in the head and neck region. The types of neurogenic tumors must be distinguished. Schwannomas originate from Schwann cells of the neural sheath and are solitary, well-encapsulated, slow-growing adjacent to the parental nerve but extrinsic to the nerve fascicles.Approximately 25% to 45% of all schwannomas are seen in the head and neck region and are found rarely in the oral cavity. Most of the intraoral schwannomas are located in the tongue. Other less common locations are the buccal mucosa, palate, base of the mouth, gingiva, and lips.In this study, we report a rare case of schwannoma of the hard palate, which was excised intraorally.

  20. Indolent palatal swelling: Catch 22

    Science.gov (United States)

    Sharma, Preeti; Wadhwan, Vijay; Kumar, K. V. Arun; Venkatesh, Arvind; Thapa, Timsy

    2016-01-01

    We present an interesting but intriguing case of an indolent palatal swelling. The lesion was asymptomatic causing little discomfort to the patient and thus was an incidental clinical finding. Provisional diagnosis was a benign, minor salivary gland tumor. Clinical differential diagnoses included benign lymphoepithelial lesion or mucus extravasation phenomenon. Nevertheless, we also considered malignancies such as mucoepidermoid carcinoma, lymphoma, and neoplasm of the maxillary sinus. However, the histopathology revealed a rare clinicopathologic entity prompting immediate treatment of the lesion.

  1. Pleomorphic adenoma of the palate.

    Science.gov (United States)

    Jiménez, Y

    2005-01-01

    An 82-year-old female with a history of high blood pressure and anorexia. She was referred for a long-evolving, asymptomatic large tumor (3x3 cm) on the right side of the palate (fig 1). The patient was wearing total dentures. Intraoral examination revealed a pediculate tumor of the same color as the adjacent mucosa and presenting a firm consistency. An MRI study (fig 2-3) and biopsy were carried out (fig 4-6).

  2. Primary myoepithelial carcinoma of palate

    Directory of Open Access Journals (Sweden)

    Yang Ya

    2011-09-01

    Full Text Available Abstract Objectives The aim of this study was to present a rare neoplasm, Primary myoepithelial carcinoma arising from the palate, and to review its diagnostic criteria, pathologic and clinical characteristics, treatment options and prognosis. Clinical Presentation and Intervention Myoepitheliomas are tumors arising from myoepithelial cells mainly or exclusively. Myoepitheliomas mostly occur in salivary glands, as well as in breast, skin, and lung. Case of myoepitheliomas in palate has rarely been reported. Myoepithelial carcinoma is malignant counterpart of myoepitheliomas. Adenomyoepithelioma is also a different disease from myoepitheliaomas. Immunohistochemically, tumor cells of myoepithelial carcinoma express not only epithelial markers such as cytokeratin, epithelial membrane antigen (EMA, but also markers of smooth muscle origin such as calponin. The immunohistochemical criteria of myoepithelial differentiation are double positive for both cytokeratins and one or more myoepithelial immunomarkers (i.e., S-100 protein, calponin, p63, GFAP, maspin, and actins. Myoepithelial carcinomas of salivary and breast demonstrate copy number gains and gene deletion. The overall prognosis of myoepithelial carcinoma is poor. There is rarely recurrence or metastasis in benign myoepithelial tumors. Complete excision with tumor-free margin is always the preferred treatment, while local radiation therapy and chemotherapy are suggestive treatment options. Here, a rare case of myoepithelial carcinoma arising from the palate has been described and discussed for the treatment and outcome. Pathological and clinical characters of myoepitheliomas are also compared and discussed. Conclusion The case report serves to increase awareness and improve the index of diagnosis and treatment of myoepitheliomas.

  3. Fibrosis impairs the formation of new myofibers in the soft palate after injury.

    Science.gov (United States)

    Carvajal Monroy, Paola L; Grefte, Sander; Kuijpers-Jagtman, Anne Marie; Helmich, Maria P A C; Wagener, Frank A D T G; Von den Hoff, Johannes W

    2015-01-01

    Muscle repair is a crucial component of palatoplasty but little is known about muscle regeneration after cleft palate repair. We hypothesized that the formation of new myofibers is hampered by collagen accumulation after experimental injury of the soft palate of rats. One-millimeter excisional defects were made in the soft palates of 32 rats. The wound area was evaluated after 3, 7, 28, and 56 days using azocarmine G and aniline blue to stain for collagen and immunohistochemistry to identify myofibroblasts and to monitor skeletal muscle differentiation. To evaluate age effects, 16 unwounded animals were evaluated at 3 and 56 days. Staining was quantified by image analysis, and one-way ANOVA was used for the statistical analysis. At day 56, the area percentage of collagen-rich tissue was higher in the injured palatal muscles (46.7 ± 6.9%) than in nonwounded controls (15.9 ± 1.0%, p < 0.05). Myofibroblasts were present in the injured muscles at days 3 and 7 only. The numbers of proliferating and differentiating myoblasts within the wound area were greater at day 7 (p < 0.05), but only a few new myofibers had formed by 56 days. No age effects were found. The results indicate that surgical wounding of the soft palate results in muscle fibrosis. Although activated satellite cells migrated into the wound area, no new myofibers formed. Thus, regeneration and function of the soft palate muscles after injury may be improved by regenerative medicine approaches.

  4. Matching tutor to student: rules and mechanisms for efficient two-stage learning in neural circuits

    CERN Document Server

    Tesileanu, Tiberiu; Balasubramanian, Vijay

    2016-01-01

    Existing models of birdsong learning assume that brain area LMAN introduces variability into song for trial-and-error learning. Recent data suggest that LMAN also encodes a corrective bias driving short-term improvements in song. These later consolidate in area RA, a motor cortex analogue downstream of LMAN. We develop a new model of such two-stage learning. Using a stochastic gradient descent approach, we derive how 'tutor' circuits should match plasticity mechanisms in 'student' circuits for efficient learning. We further describe a reinforcement learning framework with which the tutor can build its teaching signal. We show that mismatching the tutor signal and plasticity mechanism can impair or abolish learning. Applied to birdsong, our results predict the temporal structure of the corrective bias from LMAN given a plasticity rule in RA. Our framework can be applied predictively to other paired brain areas showing two-stage learning.

  5. HRI catalytic two-stage liquefaction (CTSL) process materials: chemical analysis and biological testing

    Energy Technology Data Exchange (ETDEWEB)

    Wright, C.W.; Later, D.W.

    1985-12-01

    This report presents data from the chemical analysis and biological testing of coal liquefaction materials obtained from the Hydrocarbon Research, Incorporated (HRI) catalytic two-stage liquefaction (CTSL) process. Materials from both an experimental run and a 25-day demonstration run were analyzed. Chemical methods of analysis included adsorption column chromatography, high-resolution gas chromatography, gas chromatography/mass spectrometry, low-voltage probe-inlet mass spectrometry, and proton nuclear magnetic resonance spectroscopy. The biological activity was evaluated using the standard microbial mutagenicity assay and an initiation/promotion assay for mouse-skin tumorigenicity. Where applicable, the results obtained from the analyses of the CTSL materials have been compared to those obtained from the integrated and nonintegrated two-stage coal liquefaction processes. 18 refs., 26 figs., 22 tabs.

  6. Two-stage precipitation process of iron and arsenic from acid leaching solutions

    Institute of Scientific and Technical Information of China (English)

    N.J.BOLIN; J.E.SUNDKVIST

    2008-01-01

    A leaching process for base metals recovery often generates considerable amounts of impurities such as iron and arsenic into the solution.It is a challenge to separate the non-valuable metals into manageable and stable waste products for final disposal,without loosing the valuable constituents.Boliden Mineral AB has patented a two-stage precipitation process that gives a very clean iron-arsenic precipitate by a minimum of coprecipitation of base metals.The obtained product shows to have good sedimentation and filtration properties,which makes it easy to recover the iron-arsenic depleted solution by filtration and washing of the precipitate.Continuos bench scale tests have been done,showing the excellent results achieved by the two-stage precipitation process.

  7. S-band gain-flattened EDFA with two-stage double-pass configuration

    Science.gov (United States)

    Fu, Hai-Wei; Xu, Shi-Chao; Qiao, Xue-Guang; Jia, Zhen-An; Liu, Ying-Gang; Zhou, Hong

    2011-11-01

    A gain-flattened S-band erbium-doped fiber amplifier (EDFA) using standard erbium-doped fiber (EDF) is proposed and experimentally demonstrated. The proposed amplifier with two-stage double-pass configuration employs two C-band suppressing filters to obtain the optical gain in S-band. The amplifier provides a maximum signal gain of 41.6 dB at 1524 nm with the corresponding noise figure of 3.8 dB. Furthermore, with a well-designed short-pass filter as a gain flattening filter (GFF), we are able to develop the S-band EDFA with a flattened gain of more than 20 dB in 1504-1524 nm. In the experiment, the two-stage double-pass amplifier configuration improves performance of gain and noise figure compared with the configuration of single-stage double-pass S-band EDFA.

  8. Power Frequency Oscillation Suppression Using Two-Stage Optimized Fuzzy Logic Controller for Multigeneration System

    Directory of Open Access Journals (Sweden)

    Y. K. Bhateshvar

    2016-01-01

    Full Text Available This paper attempts to develop a linearized model of automatic generation control (AGC for an interconnected two-area reheat type thermal power system in deregulated environment. A comparison between genetic algorithm optimized PID controller (GA-PID, particle swarm optimized PID controller (PSO-PID, and proposed two-stage based PSO optimized fuzzy logic controller (TSO-FLC is presented. The proposed fuzzy based controller is optimized at two stages: one is rule base optimization and other is scaling factor and gain factor optimization. This shows the best dynamic response following a step load change with different cases of bilateral contracts in deregulated environment. In addition, performance of proposed TSO-FLC is also examined for ±30% changes in system parameters with different type of contractual demands between control areas and compared with GA-PID and PSO-PID. MATLAB/Simulink® is used for all simulations.

  9. A two-stage scheme for multi-view human pose estimation

    Science.gov (United States)

    Yan, Junchi; Sun, Bing; Liu, Yuncai

    2010-08-01

    We present a two-stage scheme integrating voxel reconstruction and human motion tacking. By combining voxel reconstruction with human motion tracking interactively, our method can work in a cluttered background where perfect foreground silhouettes are hardly available. For each frame, a silhouette-based 3D volume reconstruction method and hierarchical tracking algorithm are applied in two stages. In the first stage, coarse reconstruction and tracking results are obtained, and then the refinement for reconstruction is applied in the second stage. The experimental results demonstrate our approach is promising. Although our method focuses on the problem of human body voxel reconstruction and motion tracking in this paper, our scheme can be used to reconstruct voxel data and infer the pose of many specified rigid and articulated objects.

  10. Toward Improving Electrocardiogram (ECG) Biometric Verification using Mobile Sensors: A Two-Stage Classifier Approach.

    Science.gov (United States)

    Tan, Robin; Perkowski, Marek

    2017-02-20

    Electrocardiogram (ECG) signals sensed from mobile devices pertain the potential for biometric identity recognition applicable in remote access control systems where enhanced data security is demanding. In this study, we propose a new algorithm that consists of a two-stage classifier combining random forest and wavelet distance measure through a probabilistic threshold schema, to improve the effectiveness and robustness of a biometric recognition system using ECG data acquired from a biosensor integrated into mobile devices. The proposed algorithm is evaluated using a mixed dataset from 184 subjects under different health conditions. The proposed two-stage classifier achieves a total of 99.52% subject verification accuracy, better than the 98.33% accuracy from random forest alone and 96.31% accuracy from wavelet distance measure algorithm alone. These results demonstrate the superiority of the proposed algorithm for biometric identification, hence supporting its practicality in areas such as cloud data security, cyber-security or remote healthcare systems.

  11. Effect of two-stage aging on superplasticity of Al-Li alloy

    Institute of Scientific and Technical Information of China (English)

    LUO Zhi-hui; ZHANG Xin-ming; DU Yu-xuan; YE Ling-ying

    2006-01-01

    The effect of two-stage aging on the microstructures and superplasticity of 01420 Al-Li alloy was investigated by means of OM, TEM analysis and stretching experiment. The results demonstrate that the second phase particles distributed more uniformly with a larger volume fraction can be observed after the two-stage aging (120 ℃, 12 h+300 ℃, 36 h) compared with the single-aging(300 ℃, 48 h). After rolling and recrystallization annealing, fine grains with size of 8-10 μm are obtained, and the superplastic elongation of the specimens reaches 560% at strain rate of 8×10-4 s-1 and 480 ℃. Uniformly distributed fine particles precipitate both on grain boundaries and in grains at lower temperature. When the sheet is aged at high temperature, the particles become coarser with a large volume fraction.

  12. Two stage bioethanol refining with multi litre stacked microbial fuel cell and microbial electrolysis cell.

    Science.gov (United States)

    Sugnaux, Marc; Happe, Manuel; Cachelin, Christian Pierre; Gloriod, Olivier; Huguenin, Gérald; Blatter, Maxime; Fischer, Fabian

    2016-12-01

    Ethanol, electricity, hydrogen and methane were produced in a two stage bioethanol refinery setup based on a 10L microbial fuel cell (MFC) and a 33L microbial electrolysis cell (MEC). The MFC was a triple stack for ethanol and electricity co-generation. The stack configuration produced more ethanol with faster glucose consumption the higher the stack potential. Under electrolytic conditions ethanol productivity outperformed standard conditions and reached 96.3% of the theoretically best case. At lower external loads currents and working potentials oscillated in a self-synchronized manner over all three MFC units in the stack. In the second refining stage, fermentation waste was converted into methane, using the scale up MEC stack. The bioelectric methanisation reached 91% efficiency at room temperature with an applied voltage of 1.5V using nickel cathodes. The two stage bioethanol refining process employing bioelectrochemical reactors produces more energy vectors than is possible with today's ethanol distilleries.

  13. HRI catalytic two-stage liquefaction (CTSL) process materials: chemical analysis and biological testing

    Energy Technology Data Exchange (ETDEWEB)

    Wright, C.W.; Later, D.W.

    1985-12-01

    This report presents data from the chemical analysis and biological testing of coal liquefaction materials obtained from the Hydrocarbon Research, Incorporated (HRI) catalytic two-stage liquefaction (CTSL) process. Materials from both an experimental run and a 25-day demonstration run were analyzed. Chemical methods of analysis included adsorption column chromatography, high-resolution gas chromatography, gas chromatography/mass spectrometry, low-voltage probe-inlet mass spectrometry, and proton nuclear magnetic resonance spectroscopy. The biological activity was evaluated using the standard microbial mutagenicity assay and an initiation/promotion assay for mouse-skin tumorigenicity. Where applicable, the results obtained from the analyses of the CTSL materials have been compared to those obtained from the integrated and nonintegrated two-stage coal liquefaction processes. 18 refs., 26 figs., 22 tabs.

  14. Performance measurement of insurance firms using a two-stage DEA method

    Directory of Open Access Journals (Sweden)

    Raha Jalili Sabet

    2013-01-01

    Full Text Available Measuring the relative performance of insurance firms plays an important role in this industry. In this paper, we present a two-stage data envelopment analysis to measure the performance of insurance firms, which were active over the period of 2006-2010. The proposed study of this paper performs DEA method in two stages where the first stage considers five inputs and three outputs while the second stage considers the outputs of the first stage as the inputs of the second stage and uses three different outputs for this stage. The results of our survey have indicated that while there were 4 efficient insurance firms most other insurances were noticeably inefficient. This means market was monopolized mostly by a limited number of insurance firms and competition was not fare enough to let other firms participate in economy, more efficiently.

  15. Direct Torque Control of Sensorless Induction Machine Drives: A Two-Stage Kalman Filter Approach

    Directory of Open Access Journals (Sweden)

    Jinliang Zhang

    2015-01-01

    Full Text Available Extended Kalman filter (EKF has been widely applied for sensorless direct torque control (DTC in induction machines (IMs. One key problem associated with EKF is that the estimator suffers from computational burden and numerical problems resulting from high order mathematical models. To reduce the computational cost, a two-stage extended Kalman filter (TEKF based solution is presented for closed-loop stator flux, speed, and torque estimation of IM to achieve sensorless DTC-SVM operations in this paper. The novel observer can be similarly derived as the optimal two-stage Kalman filter (TKF which has been proposed by several researchers. Compared to a straightforward implementation of a conventional EKF, the TEKF estimator can reduce the number of arithmetic operations. Simulation and experimental results verify the performance of the proposed TEKF estimator for DTC of IMs.

  16. Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.

    Science.gov (United States)

    Pinzur, M S; Morrison, C; Sage, R; Stuck, R; Osterman, H; Vrbos, L

    1991-06-01

    Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.

  17. Low-noise SQUIDs with large transfer: two-stage SQUIDs based on DROSs

    Science.gov (United States)

    Podt, M.; Flokstra, J.; Rogalla, H.

    2002-08-01

    We have realized a two-stage integrated superconducting quantum interference device (SQUID) system with a closed loop bandwidth of 2.5 MHz, operated in a direct voltage readout mode. The corresponding flux slew rate was 1.3×10 5Φ0/s and the measured white flux noise was 1.3 μ Φ0/√Hz at 4.2 K. The system is based on a conventional dc SQUID with a double relaxation oscillation SQUID (DROS) as the second stage. Because of the large flux-to-voltage transfer, the sensitivity of the system is completely determined by the sensor SQUID and not by the DROS or the room-temperature preamplifier. Decreasing the Josephson junction area enables a further improvement of the sensitivity of the two-stage SQUID systems.

  18. Interval estimation of binomial proportion in clinical trials with a two-stage design.

    Science.gov (United States)

    Tsai, Wei-Yann; Chi, Yunchan; Chen, Chia-Min

    2008-01-15

    Generally, a two-stage design is employed in Phase II clinical trials to avoid giving patients an ineffective drug. If the number of patients with significant improvement, which is a binomial response, is greater than a pre-specified value at the first stage, then another binomial response at the second stage is also observed. This paper considers interval estimation of the response probability when the second stage is allowed to continue. Two asymptotic interval estimators, Wald and score, as well as two exact interval estimators, Clopper-Pearson and Sterne, are constructed according to the two binomial responses from this two-stage design, where the binomial response at the first stage follows a truncated binomial distribution. The mean actual coverage probability and expected interval width are employed to evaluate the performance of these interval estimators. According to the comparison results, the score interval is recommended for both Simon's optimal and minimax designs.

  19. Experiment and surge analysis of centrifugal two-stage turbocharging system

    Institute of Scientific and Technical Information of China (English)

    Yituan HE; Chaochen MA

    2008-01-01

    To study a centrifugal two-stage turbocharging system's surge and influencing factors, a special test bench was set up and the system surge test was performed. The test results indicate that the measured parameters such as air mass flow and rotation speed of a high pressure (HP) stage compressor can be converted into corrected para-meters under a standard condition according to the Mach number similarity criterion, because the air flow in a HP stage compressor has entered the Reynolds number (Re) auto-modeling range. Accordingly, the reasons leading to a two-stage turbocharging system's surge can be analyzed according to the corrected mass flow characteristic maps and actual operating conditions of HP and low pressure (LP) stage compressors.

  20. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

    Science.gov (United States)

    2012-01-01

    Background In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. Methods All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. Results We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. Conclusions Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current

  1. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics

    Directory of Open Access Journals (Sweden)

    Fitzsimons Kate J

    2012-06-01

    Full Text Available Abstract Background In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. Methods All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. Results We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. Conclusions Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more

  2. 3-D shape analysis of palatal surface in patients with unilateral complete cleft lip and palate.

    Science.gov (United States)

    Rusková, Hana; Bejdová, Sárka; Peterka, Miroslav; Krajíček, Václav; Velemínská, Jana

    2014-07-01

    Facial development of patients with unilateral complete cleft lip and palate (UCLP) is associated with many problems including deformity of the palate. The aim of this study was to evaluate palatal morphology and variability in patients with UCLP compared with Czech norms using methods of geometric morphometrics. The study was based on virtual dental cast analysis of 29 UCLP patients and 29 control individuals at the age of 15 years. The variability of palatal shape in UCLP patients was greater than that in nonclefted palates. Only 24% of clefted palates fell within the variability of controls. The palatal form of UCLP patients (range from 11.8 to 17.2 years) was not correlated with age. Compared with control palates, palates of UCLP patients were narrower, more anteriorly than posteriorly. Apart from the praemaxilla region, they were also shallower, and the difference increased posteriorly. The UCLP palate was characterised by the asymmetry of its vault. The maximum height of the palatal vault was anterior on the clefted side, whereas it was posterior on the nonclefted side. The slope of the UCLP palate was more inclined compared with the control group. The praemaxilla was therefore situated more inferiorly.

  3. SURGICAL METHODS OF CLEFT LIP, CLEFT PALATE AND COMBINED CLEFT LIP WITH CLEFT PALATE - OUR EXPERIENCE

    OpenAIRE

    Polisetti Ravi; Durga Prasad; Soumya; Krishna Sasanka

    2015-01-01

    INTRODUCTION Cleft lip and cleft palate is the most common congenital malformation of the face and its pattern varies with geography world wide. This study was done in 67 patients presenting to Department of ENT, Santhiram Medical College, Nandyal with cleft deformities to assess the surgical outcome of cleft lip, cleft palate and combined cleft lip cleft palate cases.

  4. Prevalence of cleft lip and cleft palate in rural north-central guatemala.

    Science.gov (United States)

    Matute, Jorge; Lydick, Elaine A; Torres, Olga R; Owen, Karen K; Jacobsen, Kathryn H

    2015-05-01

    To estimate the number of new cases of cleft lip and cleft palate in the department (state) of Alta Verapaz, Guatemala, in 2012. Cross-sectional survey of midwives from communities identified through a two-stage cluster-sampling process. Midwives were asked how many babies they had delivered in the past year and how many of those newborns had various types of birth defects, as illustrated in pictures. Indigenous Mayan communities in rural north-central Guatemala. Midwives (n = 129) who had delivered babies in the previous year. Reports of babies born with cleft lip and cleft palate. A 1-year prevalence rate of 18.9 per 10,000 for cleft lip and 4.7 per 10,000 for cleft palate was estimated for Alta Verapaz. None of the cases of cleft lip also had cleft palate. The indigenous communities in north-central Guatemala might have a relatively high cleft lip prevalence rate compared with the global average.

  5. Two-staged management for all types of congenital pouch colon

    Directory of Open Access Journals (Sweden)

    Rajendra K Ghritlaharey

    2013-01-01

    Full Text Available Background: The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC. Patients and Methods: This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December 2011. Results: CPC comprised of 13.71% (97 of 707 of all anorectal malformations (ARM and 28.19% (97 of 344 of high ARM. Eleven CPC cases (all males were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.′s classification into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6, colostomy proximal to pouch (n = 4, and ligation of colovesical fistula and end colostomy (n = 1. As definitive procedures, pouch excision with abdomino-perineal pull through (APPT of colon in eight, and pouch excision with APPT of ileum in three were performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months and the mean weight was 7.5 kg (ranges from 4 to 11 kg. Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following definitive procedures amongst above 11 cases. Conclusions: Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the definitive procedure is being done without protective stoma and therefore, it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay.

  6. Hybrid staging of a Lysholm positive displacement engine with two Westinghouse two stage impulse Curtis turbines

    Energy Technology Data Exchange (ETDEWEB)

    Parker, D.A.

    1982-06-01

    The University of California at Berkeley has tested and modeled satisfactorly a hybrid staged Lysholm engine (positive displacement) with a two stage Curtis wheel turbine. The system operates in a stable manner over its operating range (0/1-3/1 water ratio, 120 psia input). Proposals are made for controlling interstage pressure with a partial admission turbine and volume expansion to control mass flow and pressure ratio for the Lysholm engine.

  7. Noncausal two-stage image filtration at presence of observations with anomalous errors

    Directory of Open Access Journals (Sweden)

    S. V. Vishnevyy

    2013-04-01

    Full Text Available Introduction. It is necessary to develop adaptive algorithms, which allow to detect such regions and to apply filter with respective parameters for suppression of anomalous noises for the purposes of image filtration, which consist of regions with anomalous errors. Development of adaptive algorithm for non-causal two-stage images filtration at pres-ence of observations with anomalous errors. The adaptive algorithm for noncausal two-stage filtration is developed. On the first stage the adaptive one-dimensional algorithm for causal filtration is used for independent processing along rows and columns of image. On the second stage the obtained data are united and a posteriori estimations are calculated. Results of experimental investigations. The developed adaptive algorithm for noncausal images filtration at presence of observations with anomalous errors is investigated on the model sample by means of statistical modeling on PC. The image is modeled as a realization of Gaussian-Markov random field. The modeled image is corrupted with uncorrelated Gaussian noise. Regions of image with anomalous errors are corrupted with uncorrelated Gaussian noise which has higher power than normal noise on the rest part of the image. Conclusions. The analysis of adaptive algorithm for noncausal two-stage filtration is done. The characteristics of accuracy of computed estimations are shown. The comparisons of first stage and second stage of the developed adaptive algorithm are done. Adaptive algorithm is compared with known uniform two-stage algorithm of image filtration. According to the obtained results the uniform algorithm does not suppress anomalous noise meanwhile the adaptive algorithm shows good results.

  8. Full noise characterization of a low-noise two-stage SQUID amplifier

    Energy Technology Data Exchange (ETDEWEB)

    Falferi, P [Istituto di Fotonica e Nanotecnologie, CNR-Fondazione Bruno Kessler, 38100 Povo, Trento (Italy); Mezzena, R [INFN, Gruppo Collegato di Trento, Sezione di Padova, 38100 Povo, Trento (Italy); Vinante, A [INFN, Sezione di Padova, 35131 Padova (Italy)], E-mail: falferi@science.unitn.it

    2009-07-15

    From measurements performed on a low-noise two-stage SQUID amplifier coupled to a high- Q electrical resonator we give a complete noise characterization of the SQUID amplifier around the resonator frequency of 11 kHz in terms of additive, back action and cross-correlation noise spectral densities. The minimum noise temperature evaluated at 135 mK is 10 {mu}K and corresponds to an energy resolution of 18{Dirac_h}.

  9. A covariate adjusted two-stage allocation design for binary responses in randomized clinical trials.

    Science.gov (United States)

    Bandyopadhyay, Uttam; Biswas, Atanu; Bhattacharya, Rahul

    2007-10-30

    In the present work, we develop a two-stage allocation rule for binary response using the log-odds ratio within the Bayesian framework allowing the current allocation to depend on the covariate value of the current subject. We study, both numerically and theoretically, several exact and limiting properties of this design. The applicability of the proposed methodology is illustrated by using some data set. We compare this rule with some of the existing rules by computing various performance measures.

  10. Development of a Novel Type Catalyst SY-2 for Two-Stage Hydrogenation of Pyrolysis Gasoline

    Institute of Scientific and Technical Information of China (English)

    Wu Linmei; Zhang Xuejun; Zhang Zhihua; Wang Fucun

    2004-01-01

    By using the group ⅢB or groupⅦB metals and modulating the characteristics of electric charges on carrier surface, improving the catalyst preparation process and techniques for loading the active metal components, a novel type SY-2 catalyst earmarked for two-stage hydrogenation of pyrolysis gasoline has been developed. The catalyst evaluation results have indicated that the novel catalyst is characterized by a better hydrogenation reaction activity to give higher aromatic yield.

  11. Investigation on a two-stage solvay refrigerator with magnetic material regenerator

    Science.gov (United States)

    Chen, Guobang; Zheng, Jianyao; Zhang, Fagao; Yu, Jianping; Tao, Zhenshi; Ding, Cenyu; Zhang, Liang; Wu, Peiyi; Long, Yi

    This paper describes experimental results that the no-load temperature of a two-stage Solvay refrigerator has been reached in liquid helium temperature region from the original 11.5 K by using magnetic regenerative material instead of lead. The structure and technological characteristics of the prototype machine are presented. The effects of operating frequency and pressure on the refrigerating temperature have been discussed in this paper.

  12. Biological hydrogen production from olive mill wastewater with two-stage processes

    Energy Technology Data Exchange (ETDEWEB)

    Eroglu, Ela; Eroglu, Inci [Department of Chemical Engineering, Middle East Technical University, 06531, Ankara (Turkey); Guenduez, Ufuk; Yuecel, Meral [Department of Biology, Middle East Technical University, 06531, Ankara (Turkey); Tuerker, Lemi [Department of Chemistry, Middle East Technical University, 06531, Ankara (Turkey)

    2006-09-15

    In the present work two novel two-stage hydrogen production processes from olive mill wastewater (OMW) have been introduced. The first two-stage process involved dark-fermentation followed by a photofermentation process. Dark-fermentation by activated sludge cultures and photofermentation by Rhodobacter sphaeroides O.U.001 were both performed in 55ml glass vessels, under anaerobic conditions. In some cases of dark-fermentation, activated sludge was initially acclimatized to the OMW to provide the adaptation of microorganisms to the extreme conditions of OMW. The highest hydrogen production potential obtained was 29l{sub H{sub 2}}/l{sub OMW} after photofermentation with 50% (v/v) effluent of dark fermentation with activated sludge. Photofermentation with 50% (v/v) effluent of dark fermentation with acclimated activated sludge had the highest hydrogen production rate (0.008ll{sup -1}h{sup -1}). The second two-stage process involved a clay treatment step followed by photofermentation by R. sphaeroides O.U.001. Photofermentation with the effluent of the clay pretreatment process (4% (v/v)) gives the highest hydrogen production potential (35l{sub H{sub 2}}/l{sub OMW}), light conversion efficiency (0.42%) and COD conversion efficiency (52%). It was concluded that both pretreatment processes enhanced the photofermentative hydrogen production process. Moreover, hydrogen could be produced with highly concentrated OMW. Two-stage processes developed in the present investigation have a high potential for solving the environmental problems caused by OMW. (author)

  13. The two-stage aegean extension, from localized to distributed, a result of slab rollback acceleration

    OpenAIRE

    Brun, Jean-Pierre; Faccenna, Claudio; Gueydan, Frédéric; Sokoutis, Dimitrios; Philippon, Mélody; Kydonakis, Konstantinos; Gorini, Christian

    2016-01-01

    International audience; Back-arc extension in the Aegean, which was driven by slab rollback since 45 Ma, is described here for the first time in two stages. From Middle Eocene to Middle Miocene, deformation was localized leading to i) the exhumation of high-pressure metamorphic rocks to crustal depths, ii) the exhumation of high-temperature metamorphic rocks in core complexes and iii) the deposition of sedimentary basins. Since Middle Miocene, extension distributed over the whole Aegean domai...

  14. A Two-stage Discriminating Framework for Making Supply Chain Operation Decisions under Uncertainties

    OpenAIRE

    Gu, H; Rong, G

    2010-01-01

    This paper addresses the problem of making supply chain operation decisions for refineries under two types of uncertainties: demand uncertainty and incomplete information shared with suppliers and transport companies. Most of the literature only focus on one uncertainty or treat more uncertainties identically. However, we note that refineries have more power to control uncertainties in procurement and transportation than in demand in the real world. Thus, a two-stage framework for dealing wit...

  15. Low-noise SQUIDs with large transfer: two-stage SQUIDs based on DROSs

    NARCIS (Netherlands)

    Podt, M.; Flokstra, Jakob; Rogalla, Horst

    2002-01-01

    We have realized a two-stage integrated superconducting quantum interference device (SQUID) system with a closed loop bandwidth of 2.5 MHz, operated in a direct voltage readout mode. The corresponding flux slew rate was 1.3×105 Φ0/s and the measured white flux noise was 1.3 μΦ0/√Hz at 4.2 K. The

  16. Latent Inhibition as a Function of US Intensity in a Two-Stage CER Procedure

    Science.gov (United States)

    Rodriguez, Gabriel; Alonso, Gumersinda

    2004-01-01

    An experiment is reported in which the effect of unconditioned stimulus (US) intensity on latent inhibition (LI) was examined, using a two-stage conditioned emotional response (CER) procedure in rats. A tone was used as the pre-exposed and conditioned stimulus (CS), and a foot-shock of either a low (0.3 mA) or high (0.7 mA) intensity was used as…

  17. Two stage dual gate MESFET monolithic gain control amplifier for Ka-band

    Science.gov (United States)

    Sokolov, V.; Geddes, J.; Contolatis, A.

    A monolithic two stage gain control amplifier has been developed using submicron gate length dual gate MESFETs fabricated on ion implanted material. The amplifier has a gain of 12 dB at 30 GHz with a gain control range of over 30 dB. This ion implanted monolithic IC is readily integrable with other phased array receiver functions such as low noise amplifiers and phase shifters.

  18. Exergy analysis of vapor compression refrigeration cycle with two-stage and intercooler

    Science.gov (United States)

    Kılıç, Bayram

    2012-07-01

    In this study, exergy analyses of vapor compression refrigeration cycle with two-stage and intercooler using refrigerants R507, R407c, R404a were carried out. The necessary thermodynamic values for analyses were calculated by Solkane program. The coefficient of performance, exergetic efficiency and total irreversibility rate of the system in the different operating conditions for these refrigerants were investigated. The coefficient of performance, exergetic efficiency and total irreversibility rate for alternative refrigerants were compared.

  19. Exergy analysis of vapor compression refrigeration cycle with two-stage and intercooler

    Energy Technology Data Exchange (ETDEWEB)

    Kilic, Bayram [Mehmet Akif Ersoy University, Bucak Emin Guelmez Vocational School, Bucak, Burdur (Turkey)

    2012-07-15

    In this study, exergy analyses of vapor compression refrigeration cycle with two-stage and intercooler using refrigerants R507, R407c, R404a were carried out. The necessary thermodynamic values for analyses were calculated by Solkane program. The coefficient of performance, exergetic efficiency and total irreversibility rate of the system in the different operating conditions for these refrigerants were investigated. The coefficient of performance, exergetic efficiency and total irreversibility rate for alternative refrigerants were compared. (orig.)

  20. Performance of Combined Water Turbine Darrieus-Savonius with Two Stage Savonius Buckets and Single Deflector

    OpenAIRE

    Sahim, Kaprawi; Santoso, Dyos; Sipahutar, Riman

    2016-01-01

    The objective of this study is to show the effect of single deflector plate on the performance of combined Darrieus-Savonius water turbine. In order to overcome the disadvantages of low torque of solo Darrieus turbine, a plate deflector mounted in front of returning Savonius bucket of combined water turbine composing of Darrieus and Savonius rotor has been proposed in this study. Some configurations of combined turbines with two stage Savonius rotors were experimentally tested in a river of c...

  1. Perceived Health Benefits and Soy Consumption Behavior: Two-Stage Decision Model Approach

    OpenAIRE

    Moon, Wanki; Balasubramanian, Siva K.; Rimal, Arbindra

    2005-01-01

    A two-stage decision model is developed to assess the effect of perceived soy health benefits on consumers' decisions with respect to soy food. The first stage captures whether or not to consume soy food, while the second stage reflects how often to consume. A conceptual/analytical framework is also employed, combining Lancaster's characteristics model and Fishbein's multi-attribute model. Results show that perceived soy health benefits significantly influence both decision stages. Further, c...

  2. Anterior Palatal Island Advancement Flap for Bone Graft Coverage ...

    African Journals Online (AJOL)

    2015 Journal of Surgical Technique and Case Report | Published by Wolters Kluwer - Medknow. 42. Anterior Palatal Island ... prosthodontic treatments should have ideal characteristics, as .... are rotated palatal flap and palatal advanced flap.

  3. High quantum efficiency mid-wavelength interband cascade infrared photodetectors with one and two stages

    Science.gov (United States)

    Zhou, Yi; Chen, Jianxin; Xu, Zhicheng; He, Li

    2016-08-01

    In this paper, we report on mid-wavelength infrared interband cascade photodetectors grown on InAs substrates. We studied the transport properties of the photon-generated carriers in the interband cascade structures by comparing two different detectors, a single stage detector and a two-stage cascade detector. The two-stage device showed quantum efficiency around 19.8% at room temperature, and clear optical response was measured even at a temperature of 323 K. The two detectors showed similar Johnson-noise limited detectivity. The peak detectivity of the one- and two-stage devices was measured to be 2.15 × 1014 cm·Hz1/02/W and 2.19 × 1014 cm·Hz1/02/W at 80 K, 1.21 × 109 cm·Hz1/02/W and 1.23 × 109 cm·Hz1/02/W at 300 K, respectively. The 300 K background limited infrared performance (BLIP) operation temperature is estimated to be over 140 K.

  4. Development of Two-Stage Stirling Cooler for ASTRO-F

    Science.gov (United States)

    Narasaki, K.; Tsunematsu, S.; Ootsuka, K.; Kyoya, M.; Matsumoto, T.; Murakami, H.; Nakagawa, T.

    2004-06-01

    A two-stage small Stirling cooler has been developed and tested for the infrared astronomical satellite ASTRO-F that is planned to be launched by Japanese M-V rocket in 2005. ASTRO-F has a hybrid cryogenic system that is a combination of superfluid liquid helium (HeII) and two-stage Stirling coolers. The mechanical cooler has a two-stage displacer driven by a linear motor in a cold head and a new linear-ball-bearing system for the piston-supporting structure in a compressor. The linear-ball-bearing supporting system achieves the piston clearance seal, the long piston-stroke operation and the low frequency operation. The typical cooling power is 200 mW at 20 K and the total input power to the compressor and the cold head is below 90 W without driver electronics. The engineering, the prototype and the flight models of the cooler have been fabricated and evaluated to verify the capability for ASTRO-F. This paper describes the design of the cooler and the results from verification tests including cooler performance test, thermal vacuum test, vibration test and lifetime test.

  5. Performance analysis of RDF gasification in a two stage fluidized bed-plasma process.

    Science.gov (United States)

    Materazzi, M; Lettieri, P; Taylor, R; Chapman, C

    2016-01-01

    The major technical problems faced by stand-alone fluidized bed gasifiers (FBG) for waste-to gas applications are intrinsically related to the composition and physical properties of waste materials, such as RDF. The high quantity of ash and volatile material in RDF can provide a decrease in thermal output, create high ash clinkering, and increase emission of tars and CO2, thus affecting the operability for clean syngas generation at industrial scale. By contrast, a two-stage process which separates primary gasification and selective tar and ash conversion would be inherently more forgiving and stable. This can be achieved with the use of a separate plasma converter, which has been successfully used in conjunction with conventional thermal treatment units, for the ability to 'polish' the producer gas by organic contaminants and collect the inorganic fraction in a molten (and inert) state. This research focused on the performance analysis of a two-stage fluid bed gasification-plasma process to transform solid waste into clean syngas. Thermodynamic assessment using the two-stage equilibrium method was carried out to determine optimum conditions for the gasification of RDF and to understand the limitations and influence of the second stage on the process performance (gas heating value, cold gas efficiency, carbon conversion efficiency), along with other parameters. Comparison with a different thermal refining stage, i.e. thermal cracking (via partial oxidation) was also performed. The analysis is supported by experimental data from a pilot plant.

  6. Continuous removal of endocrine disruptors by versatile peroxidase using a two-stage system.

    Science.gov (United States)

    Taboada-Puig, Roberto; Lu-Chau, Thelmo A; Eibes, Gemma; Feijoo, Gumersindo; Moreira, Maria T; Lema, Juan M

    2015-01-01

    The oxidant Mn(3+) -malonate, generated by the ligninolytic enzyme versatile peroxidase in a two-stage system, was used for the continuous removal of endocrine disrupting compounds (EDCs) from synthetic and real wastewaters. One plasticizer (bisphenol-A), one bactericide (triclosan) and three estrogenic compounds (estrone, 17β-estradiol, and 17α-ethinylestradiol) were removed from wastewater at degradation rates in the range of 28-58 µg/L·min, with low enzyme inactivation. First, the optimization of three main parameters affecting the generation of Mn(3+) -malonate (hydraulic retention time as well as Na-malonate and H2 O2 feeding rates) was conducted following a response surface methodology (RSM). Under optimal conditions, the degradation of the EDCs was proven at high (1.3-8.8 mg/L) and environmental (1.2-6.1 µg/L) concentrations. Finally, when the two-stage system was compared with a conventional enzymatic membrane reactor (EMR) using the same enzyme, a 14-fold increase of the removal efficiency was observed. At the same time, operational problems found during EDCs removal in the EMR system (e.g., clogging of the membrane and enzyme inactivation) were avoided by physically separating the stages of complex formation and pollutant oxidation, allowing the system to be operated for a longer period (∼8 h). This study demonstrates the feasibility of the two-stage enzymatic system for removing EDCs both at high and environmental concentrations.

  7. A two-stage Stirling-type pulse tube cryocooler with a cold inertance tube

    Science.gov (United States)

    Gan, Z. H.; Fan, B. Y.; Wu, Y. Z.; Qiu, L. M.; Zhang, X. J.; Chen, G. B.

    2010-06-01

    A thermally coupled two-stage Stirling-type pulse tube cryocooler (PTC) with inertance tubes as phase shifters has been designed, manufactured and tested. In order to obtain a larger phase shift at the low acoustic power of about 2.0 W, a cold inertance tube as well as a cold reservoir for the second stage, precooled by the cold end of the first stage, was introduced into the system. The transmission line model was used to calculate the phase shift produced by the cold inertance tube. Effect of regenerator material, geometry and charging pressure on the performance of the second stage of the two-stage PTC was investigated based on the well known regenerator model REGEN. Experimental results of the two-stage PTC were carried out with an emphasis on the performance of the second stage. A lowest cooling temperature of 23.7 K and 0.50 W at 33.9 K were obtained with an input electric power of 150.0 W and an operating frequency of 40 Hz.

  8. A Comparison of Direct and Two-Stage Transportation of Patients to Hospital in Poland

    Directory of Open Access Journals (Sweden)

    Anna Rosiek

    2015-04-01

    Full Text Available Background: The rapid international expansion of telemedicine reflects the growth of technological innovations. This technological advancement is transforming the way in which patients can receive health care. Materials and Methods: The study was conducted in Poland, at the Department of Cardiology of the Regional Hospital of Louis Rydygier in Torun. The researchers analyzed the delay in the treatment of patients with acute coronary syndrome. The study was conducted as a survey and examined 67 consecutively admitted patients treated invasively in a two-stage transport system. Data were analyzed statistically. Results: Two-stage transportation does not meet the timeframe guidelines for the treatment of patients with acute myocardial infarction. Intervals for the analyzed group of patients were statistically significant (p < 0.0001. Conclusions: Direct transportation of the patient to a reference center with interventional cardiology laboratory has a significant impact on reducing in-hospital delay in case of patients with acute coronary syndrome. Perspectives: This article presents the results of two-stage transportation of the patient with acute coronary syndrome. This measure could help clinicians who seek to assess time needed for intervention. It also shows how time from the beginning of pain in chest is important and may contribute to patient disability, death or well-being.

  9. Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

    Directory of Open Access Journals (Sweden)

    Giovanni Varotti

    2010-01-01

    Full Text Available Two-stage liver transplantation (LT has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC, followed by the creation of a temporary end-to-side porto-caval shunt (TPCS. The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.

  10. Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling.

    Science.gov (United States)

    Terza, Joseph V; Basu, Anirban; Rathouz, Paul J

    2008-05-01

    The paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research-two-stage predictor substitution (2SPS) and two-stage residual inclusion (2SRI). 2SPS is the rote extension (to nonlinear models) of the popular linear two-stage least squares estimator. The 2SRI estimator is similar except that in the second-stage regression, the endogenous variables are not replaced by first-stage predictors. Instead, first-stage residuals are included as additional regressors. In a generic parametric framework, we show that 2SRI is consistent and 2SPS is not. Results from a simulation study and an illustrative example also recommend against 2SPS and favor 2SRI. Our findings are important given that there are many prominent examples of the application of inconsistent 2SPS in the recent literature. This study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work.

  11. Two-stage solar concentrators based on parabolic troughs: asymmetric versus symmetric designs.

    Science.gov (United States)

    Schmitz, Max; Cooper, Thomas; Ambrosetti, Gianluca; Steinfeld, Aldo

    2015-11-20

    While nonimaging concentrators can approach the thermodynamic limit of concentration, they generally suffer from poor compactness when designed for small acceptance angles, e.g., to capture direct solar irradiation. Symmetric two-stage systems utilizing an image-forming primary parabolic concentrator in tandem with a nonimaging secondary concentrator partially overcome this compactness problem, but their achievable concentration ratio is ultimately limited by the central obstruction caused by the secondary. Significant improvements can be realized by two-stage systems having asymmetric cross-sections, particularly for 2D line-focus trough designs. We therefore present a detailed analysis of two-stage line-focus asymmetric concentrators for flat receiver geometries and compare them to their symmetric counterparts. Exemplary designs are examined in terms of the key optical performance metrics, namely, geometric concentration ratio, acceptance angle, concentration-acceptance product, aspect ratio, active area fraction, and average number of reflections. Notably, we show that asymmetric designs can achieve significantly higher overall concentrations and are always more compact than symmetric systems designed for the same concentration ratio. Using this analysis as a basis, we develop novel asymmetric designs, including two-wing and nested configurations, which surpass the optical performance of two-mirror aplanats and are comparable with the best reported 2D simultaneous multiple surface designs for both hollow and dielectric-filled secondaries.

  12. Industrial demonstration plant for the gasification of herb residue by fluidized bed two-stage process.

    Science.gov (United States)

    Zeng, Xi; Shao, Ruyi; Wang, Fang; Dong, Pengwei; Yu, Jian; Xu, Guangwen

    2016-04-01

    A fluidized bed two-stage gasification process, consisting of a fluidized-bed (FB) pyrolyzer and a transport fluidized bed (TFB) gasifier, has been proposed to gasify biomass for fuel gas production with low tar content. On the basis of our previous fundamental study, an autothermal two-stage gasifier has been designed and built for gasify a kind of Chinese herb residue with a treating capacity of 600 kg/h. The testing data in the operational stable stage of the industrial demonstration plant showed that when keeping the reaction temperatures of pyrolyzer and gasifier respectively at about 700 °C and 850 °C, the heating value of fuel gas can reach 1200 kcal/Nm(3), and the tar content in the produced fuel gas was about 0.4 g/Nm(3). The results from this pilot industrial demonstration plant fully verified the feasibility and technical features of the proposed FB two-stage gasification process.

  13. Study on two stage activated carbon/HFC-134a based adsorption chiller

    Science.gov (United States)

    >K Habib,

    2013-06-01

    In this paper, a theoretical analysis on the performance of a thermally driven two-stage four-bed adsorption chiller utilizing low-grade waste heat of temperatures between 50°C and 70°C in combination with a heat sink (cooling water) of 30°C for air-conditioning applications has been described. Activated carbon (AC) of type Maxsorb III/HFC-134a pair has been examined as an adsorbent/refrigerant pair. FORTRAN simulation program is developed to analyze the influence of operating conditions (hot and cooling water temperatures and adsorption/desorption cycle times) on the cycle performance in terms of cooling capacity and COP. The main advantage of this two-stage chiller is that it can be operational with smaller regenerating temperature lifts than other heat-driven single-stage chillers. Simulation results shows that the two-stage chiller can be operated effectively with heat sources of 50°C and 70°C in combination with a coolant at 30°C.

  14. Effects of earthworm casts and zeolite on the two-stage composting of green waste

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Lu, E-mail: zhanglu1211@gmail.com; Sun, Xiangyang, E-mail: xysunbjfu@gmail.com

    2015-05-15

    Highlights: • Earthworm casts (EWCs) and clinoptilolite (CL) were used in green waste composting. • Addition of EWCs + CL improved physico-chemical and microbiological properties. • Addition of EWCs + CL extended the duration of thermophilic periods during composting. • Addition of EWCs + CL enhanced humification, cellulose degradation, and nutrients. • Combined addition of 0.30% EWCs + 25% CL reduced composting time to 21 days. - Abstract: Because it helps protect the environment and encourages economic development, composting has become a viable method for organic waste disposal. The objective of this study was to investigate the effects of earthworm casts (EWCs) (at 0.0%, 0.30%, and 0.60%) and zeolite (clinoptilolite, CL) (at 0%, 15%, and 25%) on the two-stage composting of green waste. The combination of EWCs and CL improved the conditions of the composting process and the quality of the compost products in terms of the thermophilic phase, humification, nitrification, microbial numbers and enzyme activities, the degradation of cellulose and hemicellulose, and physico-chemical characteristics and nutrient contents of final composts. The compost matured in only 21 days with the optimized two-stage composting method rather than in the 90–270 days required for traditional composting. The optimal two-stage composting and the best quality compost were obtained with 0.30% EWCs and 25% CL.

  15. A Two-stage injection-locked magnetron for accelerators with superconducting cavities

    CERN Document Server

    Kazakevich, Grigory; Flanagan, Gene; Marhauser, Frank; Neubauer, Mike; Yakovlev, Vyacheslav; Chase, Brian; Nagaitsev, Sergey; Pasquinelli, Ralph; Solyak, Nikolay; Tupikov, Vitali; Wolff, Daniel

    2013-01-01

    A concept for a two-stage injection-locked CW magnetron intended to drive Superconducting Cavities (SC) for intensity-frontier accelerators has been proposed. The concept considers two magnetrons in which the output power differs by 15-20 dB and the lower power magnetron being frequency-locked from an external source locks the higher power magnetron. The injection-locked two-stage CW magnetron can be used as an RF power source for Fermilab's Project-X to feed separately each of the 1.3 GHz SC of the 8 GeV pulsed linac. We expect output/locking power ratio of about 30-40 dB assuming operation in a pulsed mode with pulse duration of ~ 8 ms and repetition rate of 10 Hz. The experimental setup of a two-stage magnetron utilising CW, S-band, 1 kW tubes operating at pulse duration of 1-10 ms, and the obtained results are presented and discussed in this paper.

  16. Study on the Control Algorithm of Two-Stage DC-DC Converter for Electric Vehicles

    Directory of Open Access Journals (Sweden)

    Changhao Piao

    2014-01-01

    Full Text Available The fast response, high efficiency, and good reliability are very important characteristics to electric vehicles (EVs dc/dc converters. Two-stage dc-dc converter is a kind of dc-dc topologies that can offer those characteristics to EVs. Presently, nonlinear control is an active area of research in the field of the control algorithm of dc-dc converters. However, very few papers research on two-stage converter for EVs. In this paper, a fixed switching frequency sliding mode (FSFSM controller and double-integral sliding mode (DISM controller for two-stage dc-dc converter are proposed. And a conventional linear control (lag is chosen as the comparison. The performances of the proposed FSFSM controller are compared with those obtained by the lag controller. In consequence, the satisfactory simulation and experiment results show that the FSFSM controller is capable of offering good large-signal operations with fast dynamical responses to the converter. At last, some other simulation results are presented to prove that the DISM controller is a promising method for the converter to eliminate the steady-state error.

  17. A new yardstick for rating dental arch relationship in patients with complete bilateral cleft lip and palate

    NARCIS (Netherlands)

    Ozawa, T.O.; Shaw, W.C.; Katsaros, C.; Kuijpers-Jagtman, A.M.; Hagberg, C.; Ronning, E.; Semb, G.

    2011-01-01

    Objective: To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development. Participants: Eleven cleft team orthodontists from five countries worked on the projects for 4

  18. A randomized controlled trial comparing two techniques for unilateral cleft lip and palate: Growth and speech outcomes during mixed dentition.

    Science.gov (United States)

    Ganesh, Praveen; Murthy, Jyotsna; Ulaghanathan, Navitha; Savitha, V H

    2015-07-01

    To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7-10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Spectral Analysis of Word-Initial Alveolar and Velar Plosives Produced by Iranian Children with Cleft Lip and Palate

    Science.gov (United States)

    Eshghi, Marziye; Zajac, David J.; Bijankhan, Mahmood; Shirazi, Mohsen

    2013-01-01

    Spectral moment analysis (SMA) was used to describe voiceless alveolar and velar stop-plosive production in Persian-speaking children with repaired cleft lip and palate (CLP). Participants included 11 children with bilateral CLP who were undergoing maxillary expansion and 20 children without any type of orofacial clefts. Four of the children with…

  20. Spectral Analysis of Word-Initial Alveolar and Velar Plosives Produced by Iranian Children with Cleft Lip and Palate

    Science.gov (United States)

    Eshghi, Marziye; Zajac, David J.; Bijankhan, Mahmood; Shirazi, Mohsen

    2013-01-01

    Spectral moment analysis (SMA) was used to describe voiceless alveolar and velar stop-plosive production in Persian-speaking children with repaired cleft lip and palate (CLP). Participants included 11 children with bilateral CLP who were undergoing maxillary expansion and 20 children without any type of orofacial clefts. Four of the children with…

  1. Evaluation of fecal microorganisms of children with cleft palate before and after palatoplasty

    Directory of Open Access Journals (Sweden)

    Narciso Almeida Vieira

    2013-09-01

    Full Text Available This study isolated and quantified intestinal bacteria of children with cleft palate before and after palatoplasty. A prospective study was conducted from May 2007 to September 2008 on 18 children with cleft palate, aged one to four years, of both genders, attending a tertiary cleft center in Brazil for palatoplasty, to analyze the effect of surgical palate repair on the concentration of anaerobes Bacteroides sp, Bifidobacterium sp and microaerophiles Lactobacillus sp in feces of infants with cleft palate before and 24 hours after treatment with cefazolin for palatoplasty. There was significant reduction of Lactobacillus sp (p < 0.002, Bacteroides sp (p < 0.001 and Bifidobacterium sp (p = 0.021 after palatoplasty, revealing that surgery and utilization of cefazolin significantly influenced the fecal microbiota comparing collections before and after surgery. However, due to study limitations, it was not possible to conclude that other isolated factors, such as surgical stress, anesthetics and other medications used in palatoplasty might have a significant influence on the microbiota. Considering the important participation of the intestinal microbiota on both local and systemic metabolic and immunological activities of the host, professionals should be attentive to the possible influence of these changes in patients submitted to cleft repair.

  2. Predictors of poor dental arch relationship in young children with unilateral cleft lip and palate.

    Science.gov (United States)

    Hsieh, Yuh-Jia; Liao, Yu-Fang; Shetty, Akshai

    2012-08-01

    The aim of this cross-sectional outcome study using retrospective data capture of treatment histories was to examine the characteristics of young children with unilateral cleft lip and palate who had poor dental arch relationship (i.e., Goslon 5). The study sample comprised 120 children born with nonsyndromic complete unilateral cleft lip and palate between 1995 and 2003, and were aged between 5.0 and 7.0 years (mean age, 5.1 years) at the time of data collection. The dental arch relationship was assessed using the Goslon yardstick from intraoral dental photographs. An independent investigator recorded treatment histories from the clinical notes. The inter- and intraexaminer agreements evaluated by weighted kappa statistics were high. There was no association between dental arch relationship and the type of presurgical orthopedics or pharyngeal flap. Dental arch relationship was associated with the initial cleft size (odds ratio, OR = 1.3; 95% confidence interval, CI = 1.1-1.5, p palate repair (OR = 5.0, 95% CI = 1.2-19.9, p cleft, high-volume surgeon, and primary gingivoperiosteoplasty are predictors of poor dental arch relationship outcome in young children with unilateral cleft lip and palate. These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.

  3. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Lohmander, Anette; Persson, Christina

    2017-01-01

    for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark......, Finland, Norway, Sweden, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available...... and transcribed phonetically. The main outcome measure was Percent Consonants Correct (PCC) from blinded assessments. RESULTS: In Trial 1, arm A showed statistically significant higher PCC scores (82%) than arm B (78%) (p = .045). No significant differences were found between prevalences in Trial 2, A: 79%, C: 82...

  4. Palatable meal anticipation in mice.

    Directory of Open Access Journals (Sweden)

    Cynthia T Hsu

    Full Text Available The ability to sense time and anticipate events is a critical skill in nature. Most efforts to understand the neural and molecular mechanisms of anticipatory behavior in rodents rely on daily restricted food access, which induces a robust increase of locomotor activity in anticipation of daily meal time. Interestingly, rats also show increased activity in anticipation of a daily palatable meal even when they have an ample food supply, suggesting a role for brain reward systems in anticipatory behavior, and providing an alternate model by which to study the neurobiology of anticipation in species, such as mice, that are less well adapted to "stuff and starve" feeding schedules. To extend this model to mice, and exploit molecular genetic resources available for that species, we tested the ability of wild-type mice to anticipate a daily palatable meal. We observed that mice with free access to regular chow and limited access to highly palatable snacks of chocolate or "Fruit Crunchies" avidly consumed the snack but did not show anticipatory locomotor activity as measured by running wheels or video-based behavioral analysis. However, male mice receiving a snack of high fat chow did show increased food bin entry prior to access time and a modest increase in activity in the two hours preceding the scheduled meal. Interestingly, female mice did not show anticipation of a daily high fat meal but did show increased activity at scheduled mealtime when that meal was withdrawn. These results indicate that anticipation of a scheduled food reward in mice is behavior, diet, and gender specific.

  5. Palatal Mucormycosis in An Infant.

    Science.gov (United States)

    Srivastava, Nikhil; Bansal, Vishal; Kantoor, Pallavi

    2015-01-01

    The maxilla rarely undergoes necrosis due to its rich vascularity. Maxillary necrosis can occur due to bacterial infections, viral infections, or fungal infections. Mucormycosis is an opportunistic fulminant fungal infection that mainly infects immunocompromised patients. The fungus invades the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. The occurrence of mucormycosis is not considered rare in the jaws of adults, but involvement of the maxilla in infants is not usually seen. The purpose of this report is to discuss the diagnosis and management of a rare case of mucormycosis in the palate of a two-month-old boy.

  6. Palatal Swelling: A Diagnostic Enigma

    Directory of Open Access Journals (Sweden)

    Ramalingam Suganya

    2016-01-01

    Full Text Available Giant cell tumor (GCT of bone is a giant-cell-rich bony lesion associated with abundant multinucleated osteoclast-type giant cells. It is a primary neoplasm of bone with characteristic clinical, radiological, and pathological features. It is an expansive and lytic lesion without periosteal reaction and prominent peripheral sclerosis. Giant cells are also seen in other diseases like giant cell granuloma of the jaws, traumatic bone cyst, aneurysmal bone cyst, and jaw tumor of hyperparathyroidism. We present a unique case of GCT of palate in a 30-year-old female.

  7. Lipoma in the Palate: A Rare Presentation

    Directory of Open Access Journals (Sweden)

    A Winnifred Christy

    2010-01-01

    Lipoma occurring in the palate is rare with only six cases reported in the literature so far. This case of oral lipoma occurring in the hard plate is reported for its rarity and can be considered as a rare possibility in the differential diagnosis of various swellings of the palate.

  8. Adenomatoid hyperplasia of palatal minor salivary glands

    OpenAIRE

    Bryant, C. J.; Manisali, M.; Barrett, A. W.

    1996-01-01

    Adenomatoid hyperplasia of palatal minor mucous glands is rare but significant because the clinical appearance mimics malignant disease. The typical history of a painless, indolent palatal swelling, together with the histological picture of benign glandular hyperplasia and hypertrophy, are illustrated in this report.

  9. Palatability, Familiarity, and Underage, Immoderate Drinking

    Science.gov (United States)

    Lemon, Jim; Stevenson, Richard; Gates, Peter; Copeland, Jan

    2011-01-01

    Data gathered in a study of palatability ("liking") and familiarity ratings of alcoholic and nonalcoholic beverages by 350 subjects from 12 to 30 years of age included the usual number of drinks consumed. Blind ratings of palatability and familiarity for the beverages were tested for association with immoderate drinking (more than four for males,…

  10. Short hard palate in prenatal trisomy 21

    DEFF Research Database (Denmark)

    Lauridsen, H; Hansen, Birgit; Reintoft, I;

    2005-01-01

    and palatine parts) in trisomy 21 fetuses, and to compare the results to normal standards. Design - Material from 31 human fetuses with genetically verified trisomy 21 was studied. The fetuses were derived from legally induced or spontaneous abortions. Palates were, after sectioning, radiographed in lateral...... of the palatal components in trisomy 21 was compared to normal standards. Results - For CRL 150 mm and CRL 170 mm it appears that all three palatal lengths, total length, maxillary length, and palatinal length are significantly shorter in fetuses with trisomy 21. Conclusion - The main conclusion of our study...... is that the total palatal length in prenatal trisomy 21 is shorter than normal and that this is due both to a shortness of the maxillary and the palatine components of the hard palate....

  11. Two-Stage Power Factor Corrected Power Supplies: The Low Component-Stress Approach

    DEFF Research Database (Denmark)

    Petersen, Lars; Andersen, Michael Andreas E.

    2002-01-01

    The discussion concerning the use of single-stage contra two-stage PFC solutions has been going on for the last decade and it continues. The purpose of this paper is to direct the focus back on how the power is processed and not so much as to the number of stages or the amount of power processed....... The performance of the basic DC/DC topologies is reviewed with focus on the component stress. The knowledge obtained in this process is used to review some examples of the alternative PFC solutions and compare these solutions with the basic twostage PFC solution....

  12. Generalized Yule-walker and two-stage identification algorithms for dual-rate systems

    Institute of Scientific and Technical Information of China (English)

    Feng DING

    2006-01-01

    In this paper, two approaches are developed for directly identifying single-rate models of dual-rate stochastic systems in which the input updating frequency is an integer multiple of the output sampling frequency. The first is the generalized Yule-Walker algorithm and the second is a two-stage algorithm based on the correlation technique. The basic idea is to directly identify the parameters of underlying single-rate models instead of the lifted models of dual-rate systems from the dual-rate input-output data, assuming that the measurement data are stationary and ergodic. An example is given.

  13. Two-stage bargaining with coverage extension in a dual labour market

    DEFF Research Database (Denmark)

    Roberts, Mark A.; Stæhr, Karsten; Tranæs, Torben

    2000-01-01

    in extending coverage of a minimum wage to the non-union sector. Furthermore, the union sector does not seek to increase the non-union wage to a level above the market-clearing wage. In fact, it is optimal for the union sector to impose a market-clearing wage on the non-union sector. Finally, coverage......This paper studies coverage extension in a simple general equilibrium model with a dual labour market. The union sector is characterized by two-stage bargaining whereas the firms set wages in the non-union sector. In this model firms and unions of the union sector have a commonality of interest...

  14. SQL/JavaScript Hybrid Worms As Two-stage Quines

    CERN Document Server

    Orlicki, José I

    2009-01-01

    Delving into present trends and anticipating future malware trends, a hybrid, SQL on the server-side, JavaScript on the client-side, self-replicating worm based on two-stage quines was designed and implemented on an ad-hoc scenario instantiating a very common software pattern. The proof of concept code combines techniques seen in the wild, in the form of SQL injections leading to cross-site scripting JavaScript inclusion, and seen in the laboratory, in the form of SQL quines propa- gated via RFIDs, resulting in a hybrid code injection. General features of hybrid worms are also discussed.

  15. Two stage DOA and Fundamental Frequency Estimation based on Subspace Techniques

    DEFF Research Database (Denmark)

    Zhou, Zhenhua; Christensen, Mads Græsbøll; So, Hing-Cheung

    2012-01-01

    optimally weighted harmonic multiple signal classification (MCOW-HMUSIC) estimator is devised for the estimation of fundamental frequencies. Secondly, the spatio- temporal multiple signal classification (ST-MUSIC) estimator is proposed for the estimation of DOA with the estimated frequencies. Statistical......In this paper, the problem of fundamental frequency and direction-of-arrival (DOA) estimation for multi-channel harmonic sinusoidal signal is addressed. The estimation procedure consists of two stages. Firstly, by making use of the subspace technique and Markov-based eigenanalysis, a multi- channel...... evaluation with synthetic signals shows the high accuracy of the proposed methods compared with their non-weighting versions....

  16. Performance of the SITP 35K two-stage Stirling cryocooler

    Science.gov (United States)

    Liu, Dongyu; Li, Ao; Li, Shanshan; Wu, Yinong

    2010-04-01

    This paper presents the design, development, optimization experiment and performance of the SITP two-stage Stirling cryocooler. The geometry size of the cooler, especially the diameter and length of the regenerator were analyzed. Operating parameters by experiments were optimized to maximize the second stage cooling performance. In the test the cooler was operated at various drive frequency, phase shift between displacer and piston, fill pressure. The experimental results indicate that the cryocooler has a higher efficiency with a performance of 0.85W at 35K with a compressor input power of 56W at a phase shift of 65°, an operating frequency of 40Hz, 1MPa fill pressure.

  17. Two-Stage Bulk Electron Heating in the Diffusion Region of Anti-Parallel Symmetric Reconnection

    CERN Document Server

    Le, Ari; Daughton, William

    2016-01-01

    Electron bulk energization in the diffusion region during anti-parallel symmetric reconnection entails two stages. First, the inflowing electrons are adiabatically trapped and energized by an ambipolar parallel electric field. Next, the electrons gain energy from the reconnection electric field as they undergo meandering motion. These collisionless mechanisms have been decribed previously, and they lead to highly-structured electron velocity distributions. Nevertheless, a simplified control-volume analysis gives estimates for how the net effective heating scales with the upstream plasma conditions in agreement with fully kinetic simulations and spacecraft observations.

  18. Use of two-stage membrane countercurrent cascade for natural gas purification from carbon dioxide

    Science.gov (United States)

    Kurchatov, I. M.; Laguntsov, N. I.; Karaseva, M. D.

    2016-09-01

    Membrane technology scheme is offered and presented as a two-stage countercurrent recirculating cascade, in order to solve the problem of natural gas dehydration and purification from CO2. The first stage is a single divider, and the second stage is a recirculating two-module divider. This scheme allows natural gas to be cleaned from impurities, with any desired degree of methane extraction. In this paper, the optimal values of the basic parameters of the selected technological scheme are determined. An estimation of energy efficiency was carried out, taking into account the energy consumption of interstage compressor and methane losses in energy units.

  19. Forecasting long memory series subject to structural change: A two-stage approach

    DEFF Research Database (Denmark)

    Papailias, Fotis; Dias, Gustavo Fruet

    2015-01-01

    A two-stage forecasting approach for long memory time series is introduced. In the first step, we estimate the fractional exponent and, by applying the fractional differencing operator, obtain the underlying weakly dependent series. In the second step, we produce multi-step-ahead forecasts...... for the weakly dependent series and obtain their long memory counterparts by applying the fractional cumulation operator. The methodology applies to both stationary and nonstationary cases. Simulations and an application to seven time series provide evidence that the new methodology is more robust to structural...... change and yields good forecasting results....

  20. Space Station Freedom carbon dioxide removal assembly two-stage rotary sliding vane pump

    Science.gov (United States)

    Matteau, Dennis

    1992-07-01

    The design and development of a positive displacement pump selected to operate as an essential part of the carbon dioxide removal assembly (CDRA) are described. An oilless two-stage rotary sliding vane pump was selected as the optimum concept to meet the CDRA application requirements. This positive displacement pump is characterized by low weight and small envelope per unit flow, ability to pump saturated gases and moderate amount of liquid, small clearance volumes, and low vibration. It is easily modified to accommodate several stages on a single shaft optimizing space and weight, which makes the concept ideal for a range of demanding space applications.

  1. Two-Stage Maximum Likelihood Estimation (TSMLE for MT-CDMA Signals in the Indoor Environment

    Directory of Open Access Journals (Sweden)

    Sesay Abu B

    2004-01-01

    Full Text Available This paper proposes a two-stage maximum likelihood estimation (TSMLE technique suited for multitone code division multiple access (MT-CDMA system. Here, an analytical framework is presented in the indoor environment for determining the average bit error rate (BER of the system, over Rayleigh and Ricean fading channels. The analytical model is derived for quadrature phase shift keying (QPSK modulation technique by taking into account the number of tones, signal bandwidth (BW, bit rate, and transmission power. Numerical results are presented to validate the analysis, and to justify the approximations made therein. Moreover, these results are shown to agree completely with those obtained by simulation.

  2. Two-Stage Electric Vehicle Charging Coordination in Low Voltage Distribution Grids

    DEFF Research Database (Denmark)

    Bhattarai, Bishnu Prasad; Bak-Jensen, Birgitte; Pillai, Jayakrishnan Radhakrishna

    2014-01-01

    Increased environmental awareness in the recent years has encouraged rapid growth of renewable energy sources (RESs); especially solar PV and wind. One of the effective solutions to compensate intermittencies in generation from the RESs is to enable consumer participation in demand response (DR......). Being a sizable rated element, electric vehicles (EVs) can offer a great deal of demand flexibility in future intelligent grids. This paper first investigates and analyzes driving pattern and charging requirements of EVs. Secondly, a two-stage charging algorithm, namely local adaptive control...

  3. Health care planning and education via gaming-simulation: a two-stage experiment.

    Science.gov (United States)

    Gagnon, J H; Greenblat, C S

    1977-01-01

    A two-stage process of gaming-simulation design was conducted: the first stage of design concerned national planning for hemophilia care; the second stage of design was for gaming-simulation concerning the problems of hemophilia patients and health care providers. The planning design was intended to be adaptable to large-scale planning for a variety of health care problems. The educational game was designed using data developed in designing the planning game. A broad range of policy-makers participated in the planning game.

  4. Influence of capacity- and time-constrained intermediate storage in two-stage food production systems

    DEFF Research Database (Denmark)

    Akkerman, Renzo; van Donk, Dirk Pieter; Gaalman, Gerard

    2007-01-01

    In food processing, two-stage production systems with a batch processor in the first stage and packaging lines in the second stage are common and mostly separated by capacity- and time-constrained intermediate storage. This combination of constraints is common in practice, but the literature hardly...... of systems like this. Contrary to the common sense in operations management, the LPT rule is able to maximize the total production volume per day. Furthermore, we show that adding one tank has considerable effects. Finally, we conclude that the optimal setup frequency for batches in the first stage...

  5. The global stability of a delayed predator-prey system with two stage-structure

    Energy Technology Data Exchange (ETDEWEB)

    Wang Fengyan [College of Science, Jimei University, Xiamen Fujian 361021 (China)], E-mail: wangfy68@163.com; Pang Guoping [Department of Mathematics and Computer Science, Yulin Normal University, Yulin Guangxi 537000 (China)

    2009-04-30

    Based on the classical delayed stage-structured model and Lotka-Volterra predator-prey model, we introduce and study a delayed predator-prey system, where prey and predator have two stages, an immature stage and a mature stage. The time delays are the time lengths between the immature's birth and maturity of prey and predator species. Results on global asymptotic stability of nonnegative equilibria of the delay system are given, which generalize and suggest that good continuity exists between the predator-prey system and its corresponding stage-structured system.

  6. A Two-Stage Assembly-Type Flowshop Scheduling Problem for Minimizing Total Tardiness

    Directory of Open Access Journals (Sweden)

    Ju-Yong Lee

    2016-01-01

    Full Text Available This research considers a two-stage assembly-type flowshop scheduling problem with the objective of minimizing the total tardiness. The first stage consists of two independent machines, and the second stage consists of a single machine. Two types of components are fabricated in the first stage, and then they are assembled in the second stage. Dominance properties and lower bounds are developed, and a branch and bound algorithm is presented that uses these properties and lower bounds as well as an upper bound obtained from a heuristic algorithm. The algorithm performance is evaluated using a series of computational experiments on randomly generated instances and the results are reported.

  7. Biomass waste gasification - can be the two stage process suitable for tar reduction and power generation?

    Science.gov (United States)

    Sulc, Jindřich; Stojdl, Jiří; Richter, Miroslav; Popelka, Jan; Svoboda, Karel; Smetana, Jiří; Vacek, Jiří; Skoblja, Siarhei; Buryan, Petr

    2012-04-01

    A pilot scale gasification unit with novel co-current, updraft arrangement in the first stage and counter-current downdraft in the second stage was developed and exploited for studying effects of two stage gasification in comparison with one stage gasification of biomass (wood pellets) on fuel gas composition and attainable gas purity. Significant producer gas parameters (gas composition, heating value, content of tar compounds, content of inorganic gas impurities) were compared for the two stage and the one stage method of the gasification arrangement with only the upward moving bed (co-current updraft). The main novel features of the gasifier conception include grate-less reactor, upward moving bed of biomass particles (e.g. pellets) by means of a screw elevator with changeable rotational speed and gradual expanding diameter of the cylindrical reactor in the part above the upper end of the screw. The gasifier concept and arrangement are considered convenient for thermal power range 100-350 kW(th). The second stage of the gasifier served mainly for tar compounds destruction/reforming by increased temperature (around 950°C) and for gasification reaction of the fuel gas with char. The second stage used additional combustion of the fuel gas by preheated secondary air for attaining higher temperature and faster gasification of the remaining char from the first stage. The measurements of gas composition and tar compound contents confirmed superiority of the two stage gasification system, drastic decrease of aromatic compounds with two and higher number of benzene rings by 1-2 orders. On the other hand the two stage gasification (with overall ER=0.71) led to substantial reduction of gas heating value (LHV=3.15 MJ/Nm(3)), elevation of gas volume and increase of nitrogen content in fuel gas. The increased temperature (>950°C) at the entrance to the char bed caused also substantial decrease of ammonia content in fuel gas. The char with higher content of ash leaving the

  8. Two-stage continuous fermentation of Saccharomycopsis fibuligeria and Candida utilis.

    Science.gov (United States)

    Admassu, W; Korus, R A; Heimsch, R C

    1983-11-01

    Biomass production and carbohydrate reduction were determined for a two-stage continuous fermentation process with a simulated potato processing waste feed. The amylolytic yeast Saccharomycopsis fibuligera was grown in the first stage and a mixed culture of S. fibuligera and Candida utilis was maintained in the second stage. All conditions for the first and second stages were fixed except the flow of medium to the second stage was varied. Maximum biomass production occurred at a second stage dilution rate, D(2), of 0.27 h (-1). Carbohydrate reduction was inversely proportional to D(2), between 0.10 and 0.35 h (-1).

  9. Structural requirements and basic design concepts for a two-stage winged launcher system (Saenger)

    Science.gov (United States)

    Kuczera, H.; Keller, K.; Kunz, R.

    1988-10-01

    An evaluation is made of materials and structures technologies deemed capable of increasing the mass fraction-to-orbit of the Saenger two-stage launcher system while adequately addressing thermal-control and cryogenic fuel storage insulation problems. Except in its leading edges, nose cone, and airbreathing propulsion system air intakes, Ti alloy-based materials will be the basis of the airframe primary structure. Lightweight metallic thermal-protection measures will be employed. Attention is given to the design of the large lower stage element of Saenger.

  10. Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis

    OpenAIRE

    Ladan Jamshidy; Hamid Reza Mozaffari; Payam Faraji; Roohollah Sharifi

    2016-01-01

    Introduction. One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods. A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with ...

  11. An Investigation on the Formation of Carbon Nanotubes by Two-Stage Chemical Vapor Deposition

    Directory of Open Access Journals (Sweden)

    M. S. Shamsudin

    2012-01-01

    Full Text Available High density of carbon nanotubes (CNTs has been synthesized from agricultural hydrocarbon: camphor oil using a one-hour synthesis time and a titanium dioxide sol gel catalyst. The pyrolysis temperature is studied in the range of 700–900°C at increments of 50°C. The synthesis process is done using a custom-made two-stage catalytic chemical vapor deposition apparatus. The CNT characteristics are investigated by field emission scanning electron microscopy and micro-Raman spectroscopy. The experimental results showed that structural properties of CNT are highly dependent on pyrolysis temperature changes.

  12. FORMATION OF HIGHLY RESISTANT CARBIDE AND BORIDE COATINGS BY A TWO-STAGE DEPOSITION METHOD

    Directory of Open Access Journals (Sweden)

    W. I. Sawich

    2011-01-01

    Full Text Available A study was made of the aspects of forming highly resistant coatings in the surface zone of tool steels and solid carbide inserts by a two-stage method. at the first stage of the method, pure Ta or Nb coatings were electrodeposited on samples of tool steel and solid carbide insert in a molten salt bath containing Ta and Nb fluorides. at the second stage, the electrodeposited coating of Ta (Nb was subjected to carburizing or boriding to form carbide (TaC, NbC or boride (TaB, NbB cladding layers.

  13. Complex Dynamical Behavior of a Two-Stage Colpitts Oscillator with Magnetically Coupled Inductors

    Directory of Open Access Journals (Sweden)

    V. Kamdoum Tamba

    2014-01-01

    Full Text Available A five-dimensional (5D controlled two-stage Colpitts oscillator is introduced and analyzed. This new electronic oscillator is constructed by considering the well-known two-stage Colpitts oscillator with two further elements (coupled inductors and variable resistor. In contrast to current approaches based on piecewise linear (PWL model, we propose a smooth mathematical model (with exponential nonlinearity to investigate the dynamics of the oscillator. Several issues, such as the basic dynamical behaviour, bifurcation diagrams, Lyapunov exponents, and frequency spectra of the oscillator, are investigated theoretically and numerically by varying a single control resistor. It is found that the oscillator moves from the state of fixed point motion to chaos via the usual paths of period-doubling and interior crisis routes as the single control resistor is monitored. Furthermore, an experimental study of controlled Colpitts oscillator is carried out. An appropriate electronic circuit is proposed for the investigations of the complex dynamics behaviour of the system. A very good qualitative agreement is obtained between the theoretical/numerical and experimental results.

  14. Optimization of Two-Stage Peltier Modules: Structure and Exergetic Efficiency

    Directory of Open Access Journals (Sweden)

    Cesar Ramirez-Lopez

    2012-08-01

    Full Text Available In this paper we undertake the theoretical analysis of a two-stage semiconductor thermoelectric module (TEM which contains an arbitrary and different number of thermocouples, n1 and n2, in each stage (pyramid-styled TEM. The analysis is based on a dimensionless entropy balance set of equations. We study the effects of n1 and n2, the flowing electric currents through each stage, the applied temperatures and the thermoelectric properties of the semiconductor materials on the exergetic efficiency. Our main result implies that the electric currents flowing in each stage must necessarily be different with a ratio about 4.3 if the best thermal performance and the highest temperature difference possible between the cold and hot side of the device are pursued. This fact had not been pointed out before for pyramid-styled two stage TEM. The ratio n1/n2 should be about 8.

  15. A two-stage series diode for intense large-area moderate pulsed X rays production

    Science.gov (United States)

    Lai, Dingguo; Qiu, Mengtong; Xu, Qifu; Su, Zhaofeng; Li, Mo; Ren, Shuqing; Huang, Zhongliang

    2017-01-01

    This paper presents a method for moderate pulsed X rays produced by a series diode, which can be driven by high voltage pulse to generate intense large-area uniform sub-100-keV X rays. A two stage series diode was designed for Flash-II accelerator and experimentally investigated. A compact support system of floating converter/cathode was invented, the extra cathode is floating electrically and mechanically, by withdrawing three support pins several milliseconds before a diode electrical pulse. A double ring cathode was developed to improve the surface electric field and emission stability. The cathode radii and diode separation gap were optimized to enhance the uniformity of X rays and coincidence of the two diode voltages based on the simulation and theoretical calculation. The experimental results show that the two stage series diode can work stably under 700 kV and 300 kA, the average energy of X rays is 86 keV, and the dose is about 296 rad(Si) over 615 cm2 area with uniformity 2:1 at 5 cm from the last converter. Compared with the single diode, the average X rays' energy reduces from 132 keV to 88 keV, and the proportion of sub-100-keV photons increases from 39% to 69%.

  16. Study on a high capacity two-stage free piston Stirling cryocooler working around 30 K

    Science.gov (United States)

    Wang, Xiaotao; Zhu, Jian; Chen, Shuai; Dai, Wei; Li, Ke; Pang, Xiaomin; Yu, Guoyao; Luo, Ercang

    2016-12-01

    This paper presents a two-stage high-capacity free-piston Stirling cryocooler driven by a linear compressor to meet the requirement of the high temperature superconductor (HTS) motor applications. The cryocooler system comprises a single piston linear compressor, a two-stage free piston Stirling cryocooler and a passive oscillator. A single stepped displacer configuration was adopted. A numerical model based on the thermoacoustic theory was used to optimize the system operating and structure parameters. Distributions of pressure wave, phase differences between the pressure wave and the volume flow rate and different energy flows are presented for a better understanding of the system. Some characterizing experimental results are presented. Thus far, the cryocooler has reached a lowest cold-head temperature of 27.6 K and achieved a cooling power of 78 W at 40 K with an input electric power of 3.2 kW, which indicates a relative Carnot efficiency of 14.8%. When the cold-head temperature increased to 77 K, the cooling power reached 284 W with a relative Carnot efficiency of 25.9%. The influences of different parameters such as mean pressure, input electric power and cold-head temperature are also investigated.

  17. Planning an Agricultural Water Resources Management System: A Two-Stage Stochastic Fractional Programming Model

    Directory of Open Access Journals (Sweden)

    Liang Cui

    2015-07-01

    Full Text Available Irrigation water management is crucial for agricultural production and livelihood security in many regions and countries throughout the world. In this study, a two-stage stochastic fractional programming (TSFP method is developed for planning an agricultural water resources management system under uncertainty. TSFP can provide an effective linkage between conflicting economic benefits and the associated penalties; it can also balance conflicting objectives and maximize the system marginal benefit with per unit of input under uncertainty. The developed TSFP method is applied to a real case of agricultural water resources management of the Zhangweinan River Basin China, which is one of the main food and cotton producing regions in north China and faces serious water shortage. The results demonstrate that the TSFP model is advantageous in balancing conflicting objectives and reflecting complicated relationships among multiple system factors. Results also indicate that, under the optimized irrigation target, the optimized water allocation rate of Minyou Channel and Zhangnan Channel are 57.3% and 42.7%, respectively, which adapts the changes in the actual agricultural water resources management problem. Compared with the inexact two-stage water management (ITSP method, TSFP could more effectively address the sustainable water management problem, provide more information regarding tradeoffs between multiple input factors and system benefits, and help the water managers maintain sustainable water resources development of the Zhangweinan River Basin.

  18. A separate two-stage pulse tube cooler working at liquid helium temperature

    Institute of Scientific and Technical Information of China (English)

    QIU Limin; HE Yonglin; GAN Zhihua; WAN Laihong; CHEN Guobang

    2005-01-01

    A novel 4 K separate two-stage pulse tube cooler (PTC) was designed and tested. The cooler consists of two separate pulse tube coolers, in which the cold end of the first stage regenerator is thermally connected with the middle part of the second regenerator. Compared to the traditional coupled multi-stage pulse tube cooler, the mutual interference between stages can be significantly eliminated. The lowest refrigeration temperature obtained at the first stage pulse tube was 13.8 K. This is a new record for single stage PTC. With two compressors and two rotary valves driving mode, the separate two-stage PTC obtained a refrigeration temperature of 2.5 K at the second stage. Cooling capacities of 508 mW at 4.2 K and 15 W at 37.5 K were achieved simultaneously. A one-compressor and one-rotary valve driving mode has been proposed to further simplify the structure of separate type PTC.

  19. Multiobjective Two-Stage Stochastic Programming Problems with Interval Discrete Random Variables

    Directory of Open Access Journals (Sweden)

    S. K. Barik

    2012-01-01

    Full Text Available Most of the real-life decision-making problems have more than one conflicting and incommensurable objective functions. In this paper, we present a multiobjective two-stage stochastic linear programming problem considering some parameters of the linear constraints as interval type discrete random variables with known probability distribution. Randomness of the discrete intervals are considered for the model parameters. Further, the concepts of best optimum and worst optimum solution are analyzed in two-stage stochastic programming. To solve the stated problem, first we remove the randomness of the problem and formulate an equivalent deterministic linear programming model with multiobjective interval coefficients. Then the deterministic multiobjective model is solved using weighting method, where we apply the solution procedure of interval linear programming technique. We obtain the upper and lower bound of the objective function as the best and the worst value, respectively. It highlights the possible risk involved in the decision-making tool. A numerical example is presented to demonstrate the proposed solution procedure.

  20. Two-Stage Single-Compartment Models to Evaluate Dissolution in the Lower Intestine.

    Science.gov (United States)

    Markopoulos, Constantinos; Vertzoni, Maria; Symillides, Mira; Kesisoglou, Filippos; Reppas, Christos

    2015-09-01

    The purpose was to propose two-stage single-compartment models for evaluating dissolution characteristics in distal ileum and ascending colon, under conditions simulating the bioavailability and bioequivalence studies in fasted and fed state by using the mini-paddle and the compendial flow-through apparatus (closed-loop mode). Immediate release products of two highly dosed active pharmaceutical ingredients (APIs), sulfasalazine and L-870,810, and one mesalamine colon targeting product were used for evaluating their usefulness. Change of medium composition simulating the conditions in distal ileum (SIFileum ) to a medium simulating the conditions in ascending colon in fasted state and in fed state was achieved by adding an appropriate solution in SIFileum . Data with immediate release products suggest that dissolution in lower intestine is substantially different than in upper intestine and is affected by regional pH differences > type/intensity of fluid convection > differences in concentration of other luminal components. Asacol® (400 mg/tab) was more sensitive to type/intensity of fluid convection. In all the cases, data were in line with available human data. Two-stage single-compartment models may be useful for the evaluation of dissolution in lower intestine. The impact of type/intensity of fluid convection and viscosity of media on luminal performance of other APIs and drug products requires further exploration.

  1. Simultaneous bile duct and portal venous branch ligation in two-stage hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Hiroya Iida; Chiaki Yasui; Tsukasa Aihara; Shinichi Ikuta; Hidenori Yoshie; Naoki Yamanaka

    2011-01-01

    Hepatectomy is an effective surgical treatment for multiple bilobar liver metastases from colon cancer; however, one of the primary obstacles to completing surgical resection for these cases is an insufficient volume of the future remnant liver, which may cause postoperative liver failure. To induce atrophy of the unilateral lobe and hypertrophy of the future remnant liver, procedures to occlude the portal vein have been conventionally used prior to major hepatectomy. We report a case of a 50-year-old woman in whom two-stage hepatectomy was performed in combination with intraoperative ligation of the portal vein and the bile duct of the right hepatic lobe. This procedure was designed to promote the atrophic effect on the right hepatic lobe more effectively than the conventional technique, and to the best of our knowledge, it was used for the first time in the present case. Despite successful induction of liver volume shift as well as the following procedure, the patient died of subsequent liver failure after developing recurrent tumors. We discuss the first case in which simultaneous ligation of the portal vein and the biliary system was successfully applied as part of the first step of two-stage hepatectomy.

  2. Metamodeling and Optimization of a Blister Copper Two-Stage Production Process

    Science.gov (United States)

    Jarosz, Piotr; Kusiak, Jan; Małecki, Stanisław; Morkisz, Paweł; Oprocha, Piotr; Pietrucha, Wojciech; Sztangret, Łukasz

    2016-06-01

    It is often difficult to estimate parameters for a two-stage production process of blister copper (containing 99.4 wt.% of Cu metal) as well as those for most industrial processes with high accuracy, which leads to problems related to process modeling and control. The first objective of this study was to model flash smelting and converting of Cu matte stages using three different techniques: artificial neural networks, support vector machines, and random forests, which utilized noisy technological data. Subsequently, more advanced models were applied to optimize the entire process (which was the second goal of this research). The obtained optimal solution was a Pareto-optimal one because the process consisted of two stages, making the optimization problem a multi-criteria one. A sequential optimization strategy was employed, which aimed for optimal control parameters consecutively for both stages. The obtained optimal output parameters for the first smelting stage were used as input parameters for the second converting stage. Finally, a search for another optimal set of control parameters for the second stage of a Kennecott-Outokumpu process was performed. The optimization process was modeled using a Monte-Carlo method, and both modeling parameters and computed optimal solutions are discussed.

  3. Development and optimization of a two-stage gasifier for heat and power production

    Science.gov (United States)

    Kosov, V. V.; Zaichenko, V. M.

    2016-11-01

    The major methods of biomass thermal conversion are combustion in excess oxygen, gasification in reduced oxygen, and pyrolysis in the absence of oxygen. The end products of these methods are heat, gas, liquid and solid fuels. From the point of view of energy production, none of these methods can be considered optimal. A two-stage thermal conversion of biomass based on pyrolysis as the first stage and pyrolysis products cracking as the second stage can be considered the optimal method for energy production that allows obtaining synthesis gas consisting of hydrogen and carbon monoxide and not containing liquid or solid particles. On the base of the two stage cracking technology, there was designed an experimental power plant of electric power up to 50 kW. The power plant consists of a thermal conversion module and a gas engine power generator adapted for operation on syngas. Purposes of the work were determination of an optimal operation temperature of the thermal conversion module and an optimal mass ratio of processed biomass and charcoal in cracking chamber of the thermal conversion module. Experiments on the pyrolysis products cracking at various temperatures show that the optimum cracking temperature is equal to 1000 °C. From the results of measuring the volume of gas produced in different mass ratios of charcoal and wood biomass processed, it follows that the maximum volume of the gas in the range of the mass ratio equal to 0.5-0.6.

  4. On bi-criteria two-stage transportation problem: a case study

    Directory of Open Access Journals (Sweden)

    Ahmad MURAD

    2010-01-01

    Full Text Available The study of the optimum distribution of goods between sources and destinations is one of the important topics in projects economics. This importance comes as a result of minimizing the transportation cost, deterioration, time, etc. The classical transportation problem constitutes one of the major areas of application for linear programming. The aim of this problem is to obtain the optimum distribution of goods from different sources to different destinations which minimizes the total transportation cost. From the practical point of view, the transportation problems may differ from the classical form. It may contain one or more objective function, one or more stage to transport, one or more type of commodity with one or more means of transport. The aim of this paper is to construct an optimization model for transportation problem for one of mill-stones companies. The model is formulated as a bi-criteria two-stage transportation problem with a special structure depending on the capacities of suppliers, warehouses and requirements of the destinations. A solution algorithm is introduced to solve this class of bi-criteria two-stage transportation problem to obtain the set of non-dominated extreme points and the efficient solutions accompanied with each one that enables the decision maker to choose the best one. The solution algorithm mainly based on the fruitful application of the methods for treating transportation problems, theory of duality of linear programming and the methods of solving bi-criteria linear programming problems.

  5. An integrated two-stage support vector machine approach to forecast inundation maps during typhoons

    Science.gov (United States)

    Jhong, Bing-Chen; Wang, Jhih-Huang; Lin, Gwo-Fong

    2017-04-01

    During typhoons, accurate forecasts of hourly inundation depths are essential for inundation warning and mitigation. Due to the lack of observed data of inundation maps, sufficient observed data are not available for developing inundation forecasting models. In this paper, the inundation depths, which are simulated and validated by a physically based two-dimensional model (FLO-2D), are used as a database for inundation forecasting. A two-stage inundation forecasting approach based on Support Vector Machine (SVM) is proposed to yield 1- to 6-h lead-time inundation maps during typhoons. In the first stage (point forecasting), the proposed approach not only considers the rainfall intensity and inundation depth as model input but also simultaneously considers cumulative rainfall and forecasted inundation depths. In the second stage (spatial expansion), the geographic information of inundation grids and the inundation forecasts of reference points are used to yield inundation maps. The results clearly indicate that the proposed approach effectively improves the forecasting performance and decreases the negative impact of increasing forecast lead time. Moreover, the proposed approach is capable of providing accurate inundation maps for 1- to 6-h lead times. In conclusion, the proposed two-stage forecasting approach is suitable and useful for improving the inundation forecasting during typhoons, especially for long lead times.

  6. The influence of partial oxidation mechanisms on tar destruction in TwoStage biomass gasification

    DEFF Research Database (Denmark)

    Ahrenfeldt, Jesper; Egsgaard, Helge; Stelte, Wolfgang

    2013-01-01

    TwoStage gasification of biomass results in almost tar free producer gas suitable for multiple end-use purposes. In the present study, it is investigated to what extent the partial oxidation process of the pyrolysis gas from the first stage is involved in direct and in-direct tar destruction and ...... tar destruction and a high moisture content of the biomass enhances the decomposition of phenol and inhibits the formation of naphthalene. This enhances tar conversion and gasification in the char-bed, and thus contributes in-directly to the tar destruction.......TwoStage gasification of biomass results in almost tar free producer gas suitable for multiple end-use purposes. In the present study, it is investigated to what extent the partial oxidation process of the pyrolysis gas from the first stage is involved in direct and in-direct tar destruction...... and conversion. The study identifies the following major impact factors regarding tar content in the producer gas: oxidation temperature, excess air ratio and biomass moisture content. In a experimental setup, wood pellets were pyrolyzed and the resulting pyrolysis gas was transferred in a heated partial...

  7. Numerical simulation of municipal solid waste combustion in a novel two-stage reciprocating incinerator.

    Science.gov (United States)

    Huai, X L; Xu, W L; Qu, Z Y; Li, Z G; Zhang, F P; Xiang, G M; Zhu, S Y; Chen, G

    2008-01-01

    A mathematical model was presented in this paper for the combustion of municipal solid waste in a novel two-stage reciprocating grate furnace. Numerical simulations were performed to predict the temperature, the flow and the species distributions in the furnace, with practical operational conditions taken into account. The calculated results agree well with the test data, and the burning behavior of municipal solid waste in the novel two-stage reciprocating incinerator can be demonstrated well. The thickness of waste bed, the initial moisture content, the excessive air coefficient and the secondary air are the major factors that influence the combustion process. If the initial moisture content of waste is high, both the heat value of waste and the temperature inside incinerator are low, and less oxygen is necessary for combustion. The air supply rate and the primary air distribution along the grate should be adjusted according to the initial moisture content of the waste. A reasonable bed thickness and an adequate excessive air coefficient can keep a higher temperature, promote the burnout of combustibles, and consequently reduce the emission of dioxin pollutants. When the total air supply is constant, reducing primary air and introducing secondary air properly can enhance turbulence and mixing, prolong the residence time of flue gas, and promote the complete combustion of combustibles. This study provides an important reference for optimizing the design and operation of municipal solid wastes furnace.

  8. Two stage heterotrophy/photoinduction culture of Scenedesmus incrassatulus: potential for lutein production.

    Science.gov (United States)

    Flórez-Miranda, Liliana; Cañizares-Villanueva, Rosa Olivia; Melchy-Antonio, Orlando; Jerónimo, Fernando Martínez-; Flores-Ortíz, Cesar Mateo

    2017-09-16

    A biomass production process including two stages, heterotrophy/photoinduction (TSHP), was developed to improve biomass and lutein production by the green microalgae Scenedesmus incrassatulus. To determine the effects of different nitrogen sources (yeast extract and urea) and temperature in the heterotrophic stage, experiments using shake flask cultures with glucose as the carbon source were carried out. The highest biomass productivity and specific pigment concentrations were reached using urea+vitamins (U+V) at 30°C. The first stage of the TSHP process was done in a 6L bioreactor, and the inductions in a 3L airlift photobioreactor. At the end of the heterotrophic stage, S. incrassatulus achieved the maximal biomass concentration, increasing from 7.22gL(-1) to 17.98gL(-1) with an increase in initial glucose concentration from 10.6gL(-1) to 30.3gL(-1). However, the higher initial glucose concentration resulted in a lower specific growth rate (μ) and lower cell yield (Yx/s), possibly due to substrate inhibition. After 24h of photoinduction, lutein content in S. incrassatulus biomass was 7 times higher than that obtained at the end of heterotrophic cultivation, and the lutein productivity was 1.6 times higher compared with autotrophic culture of this microalga. Hence, the two-stage heterotrophy/photoinduction culture is an effective strategy for high cell density and lutein production in S. incrassatulus. Copyright © 2017. Published by Elsevier B.V.

  9. Aerobic and two-stage anaerobic-aerobic sludge digestion with pure oxygen and air aeration.

    Science.gov (United States)

    Zupancic, Gregor D; Ros, Milenko

    2008-01-01

    The degradability of excess activated sludge from a wastewater treatment plant was studied. The objective was establishing the degree of degradation using either air or pure oxygen at different temperatures. Sludge treated with pure oxygen was degraded at temperatures from 22 degrees C to 50 degrees C while samples treated with air were degraded between 32 degrees C and 65 degrees C. Using air, sludge is efficiently degraded at 37 degrees C and at 50-55 degrees C. With oxygen, sludge was most effectively degraded at 38 degrees C or at 25-30 degrees C. Two-stage anaerobic-aerobic processes were studied. The first anaerobic stage was always operated for 5 days HRT, and the second stage involved aeration with pure oxygen and an HRT between 5 and 10 days. Under these conditions, there is 53.5% VSS removal and 55.4% COD degradation at 15 days HRT - 5 days anaerobic, 10 days aerobic. Sludge digested with pure oxygen at 25 degrees C in a batch reactor converted 48% of sludge total Kjeldahl nitrogen to nitrate. Addition of an aerobic stage with pure oxygen aeration to the anaerobic digestion enhances ammonium nitrogen removal. In a two-stage anaerobic-aerobic sludge digestion process within 8 days HRT of the aerobic stage, the removal of ammonium nitrogen was 85%.

  10. Dynamics of installation way for the actuator of a two-stage active vibration-isolator

    Institute of Scientific and Technical Information of China (English)

    HU Li; HUANG Qi-bai; HE Xue-song; YUAN Ji-xuan

    2008-01-01

    We investigated the behaviors of an active control system of two-stage vibration isolation with the actuator installed in parallel with either the upper passive mount or the lower passive isolation mount. We revealed the relationships between the active control force of the actuator and the parameters of the passive isolators by studying the dynamics of two-stage active vibration isolation for the actuator at the foregoing two positions in turn. With the actuator installed beside the upper mount, a small active force can achieve a very good isolating effect when the frequency of the stimulating force is much larger than the natural frequency of the upper mount; a larger active force is required in the low-frequency domain; and the active force equals the stimulating force when the upper mount works within the resonance region, suggesting an approach to reducing wobble and ensuring desirable installation accuracy by increasing the upper-mount stiffness. In either the low or the high frequency region far away from the resonance region, the active force is smaller when the actuator is beside the lower mount than beside the upper mount.

  11. Final Report on Two-Stage Fast Spectrum Fuel Cycle Options

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Won Sik [Purdue Univ., West Lafayette, IN (United States); Lin, C. S. [Purdue Univ., West Lafayette, IN (United States); Hader, J. S. [Purdue Univ., West Lafayette, IN (United States); Park, T. K. [Purdue Univ., West Lafayette, IN (United States); Deng, P. [Purdue Univ., West Lafayette, IN (United States); Yang, G. [Purdue Univ., West Lafayette, IN (United States); Jung, Y. S. [Purdue Univ., West Lafayette, IN (United States); Kim, T. K. [Argonne National Lab. (ANL), Argonne, IL (United States); Stauff, N. E. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-01-30

    This report presents the performance characteristics of two “two-stage” fast spectrum fuel cycle options proposed to enhance uranium resource utilization and to reduce nuclear waste generation. One is a two-stage fast spectrum fuel cycle option of continuous recycle of plutonium (Pu) in a fast reactor (FR) and subsequent burning of minor actinides (MAs) in an accelerator-driven system (ADS). The first stage is a sodium-cooled FR fuel cycle starting with low-enriched uranium (LEU) fuel; at the equilibrium cycle, the FR is operated using the recovered Pu and natural uranium without supporting LEU. Pu and uranium (U) are co-extracted from the discharged fuel and recycled in the first stage, and the recovered MAs are sent to the second stage. The second stage is a sodium-cooled ADS in which MAs are burned in an inert matrix fuel form. The discharged fuel of ADS is reprocessed, and all the recovered heavy metals (HMs) are recycled into the ADS. The other is a two-stage FR/ADS fuel cycle option with MA targets loaded in the FR. The recovered MAs are not directly sent to ADS, but partially incinerated in the FR in order to reduce the amount of MAs to be sent to the ADS. This is a heterogeneous recycling option of transuranic (TRU) elements

  12. Hydrogen and methane production from household solid waste in the two-stage fermentation process

    DEFF Research Database (Denmark)

    Lui, D.; Liu, D.; Zeng, Raymond Jianxiong

    2006-01-01

    A two-stage process combined hydrogen and methane production from household solid waste was demonstrated working successfully. The yield of 43 mL H-2/g volatile solid (VS) added was generated in the first hydrogen production stage and the methane production in the second stage was 500 mL CH4/g VS....... Furthermore, this study also provided direct evidence in the dynamic fermentation process that, hydrogen production increase was reflected by acetate to butyrate ratio increase in liquid phase. (c) 2006 Elsevier Ltd. All rights reserved.......A two-stage process combined hydrogen and methane production from household solid waste was demonstrated working successfully. The yield of 43 mL H-2/g volatile solid (VS) added was generated in the first hydrogen production stage and the methane production in the second stage was 500 mL CH4/g VS...... added. This figure was 21% higher than the methane yield from the one-stage process, which was run as control. Sparging of the hydrogen reactor with methane gas resulted in doubling of the hydrogen production. PH was observed as a key factor affecting fermentation pathway in hydrogen production stage...

  13. Two-stage electrodialytic concentration of glyceric acid from fermentation broth.

    Science.gov (United States)

    Habe, Hiroshi; Shimada, Yuko; Fukuoka, Tokuma; Kitamoto, Dai; Itagaki, Masayuki; Watanabe, Kunihiko; Yanagishita, Hiroshi; Sakaki, Keiji

    2010-12-01

    The aim of this research was the application of a two-stage electrodialysis (ED) method for glyceric acid (GA) recovery from fermentation broth. First, by desalting ED, glycerate solutions (counterpart is Na+) were concentrated using ion-exchange membranes, and the glycerate recovery and energy consumption became more efficient with increasing the initial glycerate concentration (30 to 130 g/l). Second, by water-splitting ED, the concentrated glycerate was electroconverted to GA using bipolar membranes. Using a culture broth of Acetobacter tropicalis containing 68.6 g/l of D-glycerate, a final D-GA concentration of 116 g/l was obtained following the two-stage ED process. The total energy consumption for the D-glycerate concentration and its electroconversion to D-GA was approximately 0.92 kWh per 1 kg of D-GA. Copyright © 2010 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

  14. Occurrence of two-stage hardening in C-Mn steel wire rods containing pearlitic microstructure

    Science.gov (United States)

    Singh, Balbir; Sahoo, Gadadhar; Saxena, Atul

    2016-09-01

    The 8 and 10 mm diameter wire rods intended for use as concrete reinforcement were produced/ hot rolled from C-Mn steel chemistry containing various elements within the range of C:0.55-0.65, Mn:0.85-1.50, Si:0.05-0.09, S:0.04 max, P:0.04 max and N:0.006 max wt%. Depending upon the C and Mn contents the product attained pearlitic microstructure in the range of 85-93% with balance amount of polygonal ferrite transformed at prior austenite grain boundaries. The pearlitic microstructure in the wire rods helped in achieving yield strength, tensile strength, total elongation and reduction in area values within the range of 422-515 MPa, 790-950 MPa, 22-15% and 45-35%, respectively. On analyzing the tensile results it was revealed that the material experienced hardening in two stages separable by a knee strain value of about 0.05. The occurrence of two stage hardening thus in the steel with hardening coefficients of 0.26 and 0.09 could be demonstrated with the help of derived relationships existed between flow stress and the strain.

  15. Rules and mechanisms for efficient two-stage learning in neural circuits

    Science.gov (United States)

    Teşileanu, Tiberiu; Ölveczky, Bence; Balasubramanian, Vijay

    2017-01-01

    Trial-and-error learning requires evaluating variable actions and reinforcing successful variants. In songbirds, vocal exploration is induced by LMAN, the output of a basal ganglia-related circuit that also contributes a corrective bias to the vocal output. This bias is gradually consolidated in RA, a motor cortex analogue downstream of LMAN. We develop a new model of such two-stage learning. Using stochastic gradient descent, we derive how the activity in ‘tutor’ circuits (e.g., LMAN) should match plasticity mechanisms in ‘student’ circuits (e.g., RA) to achieve efficient learning. We further describe a reinforcement learning framework through which the tutor can build its teaching signal. We show that mismatches between the tutor signal and the plasticity mechanism can impair learning. Applied to birdsong, our results predict the temporal structure of the corrective bias from LMAN given a plasticity rule in RA. Our framework can be applied predictively to other paired brain areas showing two-stage learning. DOI: http://dx.doi.org/10.7554/eLife.20944.001 PMID:28374674

  16. Two-stage estimation for multivariate recurrent event data with a dependent terminal event.

    Science.gov (United States)

    Chen, Chyong-Mei; Chuang, Ya-Wen; Shen, Pao-Sheng

    2015-03-01

    Recurrent event data arise in longitudinal follow-up studies, where each subject may experience the same type of events repeatedly. The work in this article is motivated by the data from a study of repeated peritonitis for patients on peritoneal dialysis. Due to the aspects of medicine and cost, the peritonitis cases were classified into two types: Gram-positive and non-Gram-positive peritonitis. Further, since the death and hemodialysis therapy preclude the occurrence of recurrent events, we face multivariate recurrent event data with a dependent terminal event. We propose a flexible marginal model, which has three characteristics: first, we assume marginal proportional hazard and proportional rates models for terminal event time and recurrent event processes, respectively; second, the inter-recurrences dependence and the correlation between the multivariate recurrent event processes and terminal event time are modeled through three multiplicative frailties corresponding to the specified marginal models; third, the rate model with frailties for recurrent events is specified only on the time before the terminal event. We propose a two-stage estimation procedure for estimating unknown parameters. We also establish the consistency of the two-stage estimator. Simulation studies show that the proposed approach is appropriate for practical use. The methodology is applied to the peritonitis cohort data that motivated this study. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  17. Two-stage earth-to-orbit vehicles with dual-fuel propulsion in the Orbiter

    Science.gov (United States)

    Martin, J. A.

    1982-01-01

    Earth-to-orbit vehicle studies of future replacements for the Space Shuttle are needed to guide technology development. Previous studies that have examined single-stage vehicles have shown advantages for dual-fuel propulsion. Previous two-stage system studies have assumed all-hydrogen fuel for the Orbiters. The present study examined dual-fuel Orbiters and found that the system dry mass could be reduced with this concept. The possibility of staging the booster at a staging velocity low enough to allow coast-back to the launch site is shown to be beneficial, particularly in combination with a dual-fuel Orbiter. An engine evaluation indicated the same ranking of engines as did a previous single-stage study. Propane and RP-1 fuels result in lower vehicle dry mass than methane, and staged-combustion engines are preferred over gas-generator engines. The sensitivity to the engine selection is less for two-stage systems than for single-stage systems.

  18. Two-stage effects of awareness cascade on epidemic spreading in multiplex networks

    Science.gov (United States)

    Guo, Quantong; Jiang, Xin; Lei, Yanjun; Li, Meng; Ma, Yifang; Zheng, Zhiming

    2015-01-01

    Human awareness plays an important role in the spread of infectious diseases and the control of propagation patterns. The dynamic process with human awareness is called awareness cascade, during which individuals exhibit herd-like behavior because they are making decisions based on the actions of other individuals [Borge-Holthoefer et al., J. Complex Networks 1, 3 (2013), 10.1093/comnet/cnt006]. In this paper, to investigate the epidemic spreading with awareness cascade, we propose a local awareness controlled contagion spreading model on multiplex networks. By theoretical analysis using a microscopic Markov chain approach and numerical simulations, we find the emergence of an abrupt transition of epidemic threshold βc with the local awareness ratio α approximating 0.5 , which induces two-stage effects on epidemic threshold and the final epidemic size. These findings indicate that the increase of α can accelerate the outbreak of epidemics. Furthermore, a simple 1D lattice model is investigated to illustrate the two-stage-like sharp transition at αc≈0.5 . The results can give us a better understanding of why some epidemics cannot break out in reality and also provide a potential access to suppressing and controlling the awareness cascading systems.

  19. Configuration Consideration for Expander in Transcritical Carbon Dioxide Two-Stage Compression Cycle

    Institute of Scientific and Technical Information of China (English)

    MA Yitai; YANG Junlan; GUAN Haiqing; LI Minxia

    2005-01-01

    To investigate the configuration consideration of expander in transcritical carbon dioxide two-stage compression cycle, the best place in the cycle should be searched for to reinvest the recovery work so as to improve the system efficiency. The expander and the compressor are connected to the same shaft and integrated into one unit, with the latter being driven by the former, thus the transfer loss and leakage loss can be decreased greatly. In these systems, the expander can be either connected with the first stage compressor (shortened as DCDL cycle) or the second stage compressor (shortened as DCDH cycle), but the two configuration ways can get different performances. By setting up theoretical model for two kinds of expander configuration ways in the transcritical carbon dioxide two-stage compression cycle, the first and the second laws of thermodynamics are used to analyze the coefficient of performance, exergy efficiency, inter-stage pressure, discharge temperature and exergy losses of each component for the two cycles. From the model results, the performance of DCDH cycle is better than that of DCDL cycle. The analysis results are indispensable to providing a theoretical basis for practical design and operating.

  20. Two-stage coordination multi-radio multi-channel mac protocol for wireless mesh networks

    CERN Document Server

    Zhao, Bingxuan

    2011-01-01

    Within the wireless mesh network, a bottleneck problem arises as the number of concurrent traffic flows (NCTF) increases over a single common control channel, as it is for most conventional networks. To alleviate this problem, this paper proposes a two-stage coordination multi-radio multi-channel MAC (TSC-M2MAC) protocol that designates all available channels as both control channels and data channels in a time division manner through a two-stage coordination. At the first stage, a load balancing breadth-first-search-based vertex coloring algorithm for multi-radio conflict graph is proposed to intelligently allocate multiple control channels. At the second stage, a REQ/ACK/RES mechanism is proposed to realize dynamical channel allocation for data transmission. At this stage, the Channel-and-Radio Utilization Structure (CRUS) maintained by each node is able to alleviate the hidden nodes problem; also, the proposed adaptive adjustment algorithm for the Channel Negotiation and Allocation (CNA) sub-interval is ab...

  1. Development of a Two-Stage Microalgae Dewatering Process – A Life Cycle Assessment Approach

    Science.gov (United States)

    Soomro, Rizwan R.; Zeng, Xianhai; Lu, Yinghua; Lin, Lu; Danquah, Michael K.

    2016-01-01

    Even though microalgal biomass is leading the third generation biofuel research, significant effort is required to establish an economically viable commercial-scale microalgal biofuel production system. Whilst a significant amount of work has been reported on large-scale cultivation of microalgae using photo-bioreactors and pond systems, research focus on establishing high performance downstream dewatering operations for large-scale processing under optimal economy is limited. The enormous amount of energy and associated cost required for dewatering large-volume microalgal cultures has been the primary hindrance to the development of the needed biomass quantity for industrial-scale microalgal biofuels production. The extremely dilute nature of large-volume microalgal suspension and the small size of microalgae cells in suspension create a significant processing cost during dewatering and this has raised major concerns towards the economic success of commercial-scale microalgal biofuel production as an alternative to conventional petroleum fuels. This article reports an effective framework to assess the performance of different dewatering technologies as the basis to establish an effective two-stage dewatering system. Bioflocculation coupled with tangential flow filtration (TFF) emerged a promising technique with total energy input of 0.041 kWh, 0.05 kg CO2 emissions and a cost of $ 0.0043 for producing 1 kg of microalgae biomass. A streamlined process for operational analysis of two-stage microalgae dewatering technique, encompassing energy input, carbon dioxide emission, and process cost, is presented. PMID:26904075

  2. Two-stage image segmentation based on edge and region information

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A two-stage method for image segmentation based on edge and region information is proposed. Different deformation schemes are used at two stages for segmenting the object correctly in image plane. At the first stage, the contour of the model is divided into several segments hierarchically that deform respectively using affine transformation. After the contour is deformed to the approximate boundary of object, a fine match mechanism using statistical information of local region to redefine the external energy of the model is used to make the contour fit the object's boundary exactly. The algorithm is effective, as the hierarchical segmental deformation makes use of the globe and local information of the image, the affine transformation keeps the consistency of the model, and the reformative approaches of computing the internal energy and external energy are proposed to reduce the algorithm complexity. The adaptive method of defining the search area at the second stage makes the model converge quickly. The experimental results indicate that the proposed model is effective and robust to local minima and able to search for concave objects.

  3. Waste-gasification efficiency of a two-stage fluidized-bed gasification system.

    Science.gov (United States)

    Liu, Zhen-Shu; Lin, Chiou-Liang; Chang, Tsung-Jen; Weng, Wang-Chang

    2016-02-01

    This study employed a two-stage fluidized-bed gasifier as a gasification reactor and two additives (CaO and activated carbon) as the Stage-II bed material to investigate the effects of the operating temperature (700°C, 800°C, and 900°C) on the syngas composition, total gas yield, and gas-heating value during simulated waste gasification. The results showed that when the operating temperature increased from 700 to 900°C, the molar percentage of H2 in the syngas produced by the two-stage gasification process increased from 19.4 to 29.7mol% and that the total gas yield and gas-heating value also increased. When CaO was used as the additive, the molar percentage of CO2 in the syngas decreased, and the molar percentage of H2 increased. When activated carbon was used, the molar percentage of CH4 in the syngas increased, and the total gas yield and gas-heating value increased. Overall, CaO had better effects on the production of H2, whereas activated carbon clearly enhanced the total gas yield and gas-heating value. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  4. Two-Stage Orthogonal Least Squares Methods for Neural Network Construction.

    Science.gov (United States)

    Zhang, Long; Li, Kang; Bai, Er-Wei; Irwin, George W

    2015-08-01

    A number of neural networks can be formulated as the linear-in-the-parameters models. Training such networks can be transformed to a model selection problem where a compact model is selected from all the candidates using subset selection algorithms. Forward selection methods are popular fast subset selection approaches. However, they may only produce suboptimal models and can be trapped into a local minimum. More recently, a two-stage fast recursive algorithm (TSFRA) combining forward selection and backward model refinement has been proposed to improve the compactness and generalization performance of the model. This paper proposes unified two-stage orthogonal least squares methods instead of the fast recursive-based methods. In contrast to the TSFRA, this paper derives a new simplified relationship between the forward and the backward stages to avoid repetitive computations using the inherent orthogonal properties of the least squares methods. Furthermore, a new term exchanging scheme for backward model refinement is introduced to reduce computational demand. Finally, given the error reduction ratio criterion, effective and efficient forward and backward subset selection procedures are proposed. Extensive examples are presented to demonstrate the improved model compactness constructed by the proposed technique in comparison with some popular methods.

  5. Two-stage numerical simulation for temperature profile in furnace of tangentially fired pulverized coal boiler

    Institute of Scientific and Technical Information of China (English)

    ZHOU Nai-jun; XU Qiong-hui; ZHOU Ping

    2005-01-01

    Considering the fact that the temperature distribution in furnace of a tangential fired pulverized coal boiler is difficult to be measured and monitored, two-stage numerical simulation method was put forward. First, multi-field coupling simulation in typical work conditions was carried out off-line with the software CFX-4.3, and then the expression of temperature profile varying with operating parameter was obtained. According to real-time operating parameters, the temperature at arbitrary point of the furnace can be calculated by using this expression. Thus the temperature profile can be shown on-line and monitoring for combustion state in the furnace is realized. The simul-ation model was checked by the parameters measured in an operating boiler, DG130-9.8/540. The maximum of relative error is less than 12% and the absolute error is less than 120 ℃, which shows that the proposed two-stage simulation method is reliable and able to satisfy the requirement of industrial application.

  6. A low-voltage sense amplifier with two-stage operational amplifier clamping for flash memory

    Science.gov (United States)

    Guo, Jiarong

    2017-04-01

    A low-voltage sense amplifier with reference current generator utilizing two-stage operational amplifier clamp structure for flash memory is presented in this paper, capable of operating with minimum supply voltage at 1 V. A new reference current generation circuit composed of a reference cell and a two-stage operational amplifier clamping the drain pole of the reference cell is used to generate the reference current, which avoids the threshold limitation caused by current mirror transistor in the traditional sense amplifier. A novel reference voltage generation circuit using dummy bit-line structure without pull-down current is also adopted, which not only improves the sense window enhancing read precision but also saves power consumption. The sense amplifier was implemented in a flash realized in 90 nm flash technology. Experimental results show the access time is 14.7 ns with power supply of 1.2 V and slow corner at 125 °C. Project supported by the National Natural Science Fundation of China (No. 61376028).

  7. Two-stage high temperature sludge gasification using the waste heat from hot blast furnace slags.

    Science.gov (United States)

    Sun, Yongqi; Zhang, Zuotai; Liu, Lili; Wang, Xidong

    2015-12-01

    Nowadays, disposal of sewage sludge from wastewater treatment plants and recovery of waste heat from steel industry, become two important environmental issues and to integrate these two problems, a two-stage high temperature sludge gasification approach was investigated using the waste heat in hot slags herein. The whole process was divided into two stages, i.e., the low temperature sludge pyrolysis at ⩽ 900°C in argon agent and the high temperature char gasification at ⩾ 900°C in CO2 agent, during which the heat required was supplied by hot slags in different temperature ranges. Both the thermodynamic and kinetic mechanisms were identified and it was indicated that an Avrami-Erofeev model could best interpret the stage of char gasification. Furthermore, a schematic concept of this strategy was portrayed, based on which the potential CO yield and CO2 emission reduction achieved in China could be ∼1.92∗10(9)m(3) and 1.93∗10(6)t, respectively.

  8. A two-stage broadcast message propagation model in social networks

    Science.gov (United States)

    Wang, Dan; Cheng, Shun-Jun

    2016-11-01

    Message propagation in social networks is becoming a popular topic in complex networks. One of the message types in social networks is called broadcast message. It refers to a type of message which has a unique and unknown destination for the publisher, such as 'lost and found'. Its propagation always has two stages. Due to this feature, rumor propagation model and epidemic propagation model have difficulty in describing this message's propagation accurately. In this paper, an improved two-stage susceptible-infected-removed model is proposed. We come up with the concept of the first forwarding probability and the second forwarding probability. Another part of our work is figuring out the influence to the successful message transmission chance in each level resulting from multiple reasons, including the topology of the network, the receiving probability, the first stage forwarding probability, the second stage forwarding probability as well as the length of the shortest path between the publisher and the relevant destination. The proposed model has been simulated on real networks and the results proved the model's effectiveness.

  9. A two-stage method to determine optimal product sampling considering dynamic potential market.

    Science.gov (United States)

    Hu, Zhineng; Lu, Wei; Han, Bing

    2015-01-01

    This paper develops an optimization model for the diffusion effects of free samples under dynamic changes in potential market based on the characteristics of independent product and presents a two-stage method to figure out the sampling level. The impact analysis of the key factors on the sampling level shows that the increase of the external coefficient or internal coefficient has a negative influence on the sampling level. And the changing rate of the potential market has no significant influence on the sampling level whereas the repeat purchase has a positive one. Using logistic analysis and regression analysis, the global sensitivity analysis gives a whole analysis of the interaction of all parameters, which provides a two-stage method to estimate the impact of the relevant parameters in the case of inaccuracy of the parameters and to be able to construct a 95% confidence interval for the predicted sampling level. Finally, the paper provides the operational steps to improve the accuracy of the parameter estimation and an innovational way to estimate the sampling level.

  10. Two staged incentive contract focused on efficiency and innovation matching in critical chain project management

    Directory of Open Access Journals (Sweden)

    Min Zhang

    2014-09-01

    Full Text Available Purpose: The purpose of this paper is to define the relative optimal incentive contract to effectively encourage employees to improve work efficiency while actively implementing innovative behavior. Design/methodology/approach: This paper analyzes a two staged incentive contract coordinated with efficiency and innovation in Critical Chain Project Management using learning real options, based on principle-agent theory. The situational experiment is used to analyze the validity of the basic model. Finding: The two staged incentive scheme is more suitable for employees to create and implement learning real options, which will throw themselves into innovation process efficiently in Critical Chain Project Management. We prove that the combination of tolerance for early failure and reward for long-term success is effective in motivating innovation. Research limitations/implications: We do not include the individual characteristics of uncertain perception, which might affect the consistency of external validity. The basic model and the experiment design need to improve. Practical Implications: The project managers should pay closer attention to early innovation behavior and monitoring feedback of competition time in the implementation of Critical Chain Project Management. Originality/value: The central contribution of this paper is the theoretical and experimental analysis of incentive schemes for innovation in Critical Chain Project Management using the principal-agent theory, to encourage the completion of CCPM methods as well as imitative free-riding on the creative ideas of other members in the team.

  11. Selective capsulotomies of the expanded breast as a remodelling method in two-stage breast reconstruction.

    Science.gov (United States)

    Grimaldi, Luca; Campana, Matteo; Brandi, Cesare; Nisi, Giuseppe; Brafa, Anna; Calabrò, Massimiliano; D'Aniello, Carlo

    2013-06-01

    The two-stage breast reconstruction with tissue expander and prosthesis is nowadays a common method for achieving a satisfactory appearance in selected patients who had a mastectomy, but its most common aesthetic drawback is represented by an excessive volumetric increment of the superior half of the reconstructed breast, with a convexity of the profile in that area. A possible solution to limit this effect, and to fulfil the inferior pole, may be obtained by reducing the inferior tissue resistance by means of capsulotomies. This study reports the effects of various types of capsulotomies, performed in 72 patients after removal of the mammary expander, with the aim of emphasising the convexity of the inferior mammary aspect in the expanded breast. According to each kind of desired modification, possible solutions are described. On the basis of subjective and objective evaluations, an overall high degree of satisfaction has been evidenced. The described selective capsulotomies, when properly carried out, may significantly improve the aesthetic results in two-stage reconstructed breasts, with no additional scars, with minimal risks, and with little lengthening of the surgical time.

  12. Two-Stage Nerve Graft in Severe Scar: A Time-Course Study in a Rat Model

    Directory of Open Access Journals (Sweden)

    Shayan Zadegan

    2015-04-01

    According to the EPT and WRL, the two-stage nerve graft showed significant improvement (P=0.020 and P =0.017 respectively. The TOA showed no significant difference between the two groups. The total vascular index was significantly higher in the two-stage nerve graft group (P

  13. Bite force evaluation in subjects with cleft lip and palate

    Directory of Open Access Journals (Sweden)

    Carla Renata Sipert

    2009-04-01

    Full Text Available The purpose of this study was to evaluate the masticatory function of subjects with cleft lip and palate by analyzing the bite force developed by these individuals. Bite force was evaluated in a group of 27 individuals with repaired unilateral cleft lip and palate (14 males and 13 females - aged 18-26 years and compared to the data achieved from a group of 20 noncleft subjects (10 males and 10 females - aged 18-26 years. Measurement was achieved on three positions within the dental arch (incisors, right molars and left molars, three times at each position considering the highest value for each one. Statistical analysis was performed by ANOVA and Mann-Whitney test ( α = 5%. There was a significant deficit in bite force in male individuals with cleft lip and palate compared to the male control group (p=0.02, p=0.004, p=0.003 for incisors, right and left molars, respectively. For the female group, the difference was not statistically significant (p=0.79, p=0.06, p=0.47. In the group of individuals with clefts, 92.6% were under orthodontic treatment, which could be a reason for the present findings, since it can decrease the bite force more remarkably in males than in females. In conclusion, the bite force is significantly reduced in men when comparing the cleft group to the noncleft group. In females, this reduction was not significant in the same way. However, the main reason for this reduction and for the different behavior between genders should be further investigated.

  14. Velopharyngeal valving during speech, in patients with velocardiofacial syndrome and patients with non-syndromic palatal clefts after surgical and speech pathology management.

    Science.gov (United States)

    Ysunza, Antonio; Carmen Pamplona, Maria; Santiago Morales, M A

    2011-10-01

    Velocardiofacial syndrome (VCFS) is the most common genetic syndrome associated with cleft palate. There are reports describing several anomalies associated with the palatal cleft in patients with VCFS, which can affect the characteristics of the velopharyngeal insufficiency (VPI) in these cases. The purpose of this study is to assess velopharyngeal sphincter function during speech, using videonasopharyngoscopy (VNP) and videofluoroscopy (VF), in patients with VCFS, as compared with patients with non-syndromic palatal clefts (NSCP). Twenty patients with VCFS corroborated by a FISH test were studied. All patients showed a palatal cleft. All patients had received previous management including speech therapy and palatal repair. These patients underwent a thorough clinical speech evaluation, including VNP and VF. Twenty patients with NSCP matched by sex, type of cleft and within the age range of the patients with VCFS were studied as controls. From the patients with VCFS, seventeen patients showed a submucous cleft palate. Three patients showed sub-total cleft of the secondary palate. Fourteen patients (70%) showed a coronal velopharyngeal closure pattern. Six patients (30%) showed a circular pattern. In contrast, 10 patients (50%) from the NSCP group showed a circular pattern, two of them showed a Passavant's ridge. Seven patients (35%) showed a coronal pattern and 3 patients (15%) showed a saggital pattern. Mean velum (V) and lateral pharyngeal wall (LPW) motion were significantly decreased in patients with VCFS (V=46% vs 71%; LPW=14% vs 30%; Pspeech was significantly increased in patients with VCFS (34.57% vs 67.37%; Pspeech is significantly different in patients with VCFS as compared with patients with NSCP. Several anomalies associated with the palatal cleft in patients with VCFS can explain these differences. Thus, the surgical approach for repairing a palatal cleft should consider these differences. Moreover, surgical planning should be performed according to

  15. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis†

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

    2013-01-01

    OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1–24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. PMID:23442937

  16. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis.

    Science.gov (United States)

    Ibrahim, Mohsen; Menna, Cecilia; Andreetti, Claudio; Ciccone, Anna Maria; D'Andrilli, Antonio; Maurizi, Giulio; Poggi, Camilla; Vanni, Camilla; Venuta, Federico; Rendina, Erino Angelo

    2013-06-01

    Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.

  17. A study of nasal cavity volume in patients with cleft lip and palate by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakano, Kenichi [Showa Univ., Tokyo (Japan). School of Medicine

    1996-02-01

    Nasal cavity volume was studied in 11 patients with cleft lip and palate by magnetic resonance imaging. The areas of horizontal sections of the nasal cavity on the cleft and non-cleft sides were measured with the help of a personal computer and image analyzing software. Nasal cavity volume was determined by integrated volume calculation. The volume of each side was measured before and after cleft lip repair. Before cleft lip repair nasal cavity volume on the non-cleft side was larger than on the cleft side. However there was no significant difference in the volume of the cleft and non-cleft sides after cleft lip repair. (author)

  18. Treatment of 4-5 year old patients with cleft lip and cleft palate in Tawanchai center.

    Science.gov (United States)

    Pradubwong, Suteera; Volrathongchai, Kanittha; Chowchuen, Bowornsilp

    2013-09-01

    The occurrence of Cleft Lip/Palate condition in Thailand reaches a rate of 2.49% of child births, with estimates of 800 new cases per year in the Northeastern region. The healthcare process emphasizes interdisciplinary teamwork at each stage of the planning of treatment and services with the primary goal of achieving patient satisfaction and ability to live normally in society. The first 5 years are particularly important, with a focus on quality of care and ability to adapt to the environment before entering school. To study the treatment of patients with cleft lip and palate in Tawanchai center in the 4-5 year age range. A retrospective study of the clinical records was led, concerning the 123 cleft lip and cleft palate patients aged 4-5 years under treatment in Tawanchai center, Srinagarind Hospital. Data was collected during three months from October to December 2011, using the admission records of the interdisciplinary team. Percentages and mean values were calculated from these data. 120 of the 123 patients were operated, giving a ratio of 97.56%. 108 cases were under government universal health coverage regime, corresponding to 87.80% of cases. 74 cases (60.16%) presented both cleft lip and palate condition, and an average of 5-night stay in hospital per person. Medical services by the interdisciplinary team were provided as follows: (1) of 30 patients with cleft lip aged 3-4 months, 30 (100%) received pre and post-surgery care counseling, 29 (96.67%) received surgery; (2) of 19 patients with cleft palate aged 10-18 months, 17 (89.47%) received treatment information, pre and postsurgery counseling and were operated according to the protocols; (3) of 74 patients with cleft lip and palate, 53 (71.62%) received counseling for pre and post-surgery care for lip repair at the age of 3-4 months, 52 (70.27%) were operated following the protocols, while at the age of 10-18 months 63 patients (85.14%) received treatment information, pre and postsurgery care counseling

  19. Two-stage atlas subset selection in multi-atlas based image segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Tingting, E-mail: tingtingzhao@mednet.ucla.edu; Ruan, Dan, E-mail: druan@mednet.ucla.edu [The Department of Radiation Oncology, University of California, Los Angeles, California 90095 (United States)

    2015-06-15

    Purpose: Fast growing access to large databases and cloud stored data presents a unique opportunity for multi-atlas based image segmentation and also presents challenges in heterogeneous atlas quality and computation burden. This work aims to develop a novel two-stage method tailored to the special needs in the face of large atlas collection with varied quality, so that high-accuracy segmentation can be achieved with low computational cost. Methods: An atlas subset selection scheme is proposed to substitute a significant portion of the computationally expensive full-fledged registration in the conventional scheme with a low-cost alternative. More specifically, the authors introduce a two-stage atlas subset selection method. In the first stage, an augmented subset is obtained based on a low-cost registration configuration and a preliminary relevance metric; in the second stage, the subset is further narrowed down to a fusion set of desired size, based on full-fledged registration and a refined relevance metric. An inference model is developed to characterize the relationship between the preliminary and refined relevance metrics, and a proper augmented subset size is derived to ensure that the desired atlases survive the preliminary selection with high probability. Results: The performance of the proposed scheme has been assessed with cross validation based on two clinical datasets consisting of manually segmented prostate and brain magnetic resonance images, respectively. The proposed scheme demonstrates comparable end-to-end segmentation performance as the conventional single-stage selection method, but with significant computation reduction. Compared with the alternative computation reduction method, their scheme improves the mean and medium Dice similarity coefficient value from (0.74, 0.78) to (0.83, 0.85) and from (0.82, 0.84) to (0.95, 0.95) for prostate and corpus callosum segmentation, respectively, with statistical significance. Conclusions: The authors

  20. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Jiong Lu; Yao Cheng; Xian-Ze Xiong; Yi-Xin Lin; Si-Jia Wu; Nan-Sheng Cheng

    2012-01-01

    AIM:To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.METHODS:Four databases,including PubMed,Embase,the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011,were searched to identify all randomized controlled trials (RCTs).Data were extracted from the studies by two independent reviewers.The primary outcomes were stone clearance from the common bile duct,postoperative morbidity and mortality.The secondary outcomes were conversion to other procedures,number of procedures per patient,length of hospital stay,total operative time,hospitalization charges,patient acceptance and quality of life scores.RESULTS:Seven eligible RCTs [five trials (n =621)comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC +laparoscopic common bile duct exploration (LCBDE);two trials (n =166) comparing postoperative ERCP/EST + LC with LC + LCBDE],composed of 787 patients in total,were included in the final analysis.The metaanalysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) =-0.10,95% confidence intervals (CI):-0.24 to 0.04,P =0.17],postoperative morbidity (RR =0.79,95% CI:0.58 to 1.10,P =0.16),mortality (RR =2.19,95% CI:0.33 to 14.67,P =0.42),conversion to other procedures (RR =1.21,95% CI:0.54 to 2.70,P =0.39),length of hospital stay (MD =0.99,95% CI:-1.59 to 3.57,P =0.45),total operative time (MD =12.14,95% CI:-1.83 to 26.10,P =0.09).Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.CONCLUSION:Single-stage management is equivalent to two-stage management but requires fewer procedures.However,patient's condition,operator's expertise and local resources should be taken into account in

  1. Feeding methods for children with cleft lip and/or palate: a systematic review.

    Science.gov (United States)

    Duarte, Giesse Albeche; Ramos, Ramon Bossardi; Cardoso, Maria Cristina de Almeida Freitas

    2016-01-01

    Feeding difficulties in children with cleft lip and palate (CLP) are frequent and appear at birth due to impairment of sucking and swallowing functions. The use of appropriate feeding methods for the different types of cleft and the period of the child's life is of utmost importance for their full development. Review studies comparing feeding methods for children with CLP, pre- and postoperatively. The search covered the period between January 1990 and August 2015 in the PubMed, LILACS, SciELO, and Google Scholar databases using the terms: cleft lip or cleft palate and feeding methods or breastfeeding or swallowing disorders and their synonyms. This systematic review was recorded in PROSPERO under number CRD42014015011. Publications that compared feeding methods and published in Portuguese, English, and Spanish were included in the review. Studies with associated syndromes, orthopedic methods, or comparing surgical techniques were not included. The three reviewed studies on the period prior to surgical repair showed better feeding performance with three different methods: squeezable bottle, syringe, and paladai bottle. Only one study addressed the postoperative period of cleft lip and/or palate repair, with positive results for the feeding method with suction. Likewise, the post-lip repair studies showed better results with suction methods. After palatoplasty, two studies showed better performance with alternative feeding routes, one study with suction method, and one study that compared methods with no suction showed better results with spoon. The studies show that prior to surgical repair, the use of alternative methods can be beneficial. In the postoperative period following lip repair, methods with suction are more beneficial. However, in the postoperative period of palatoplasty, there are divergences of opinion regarding the most appropriate feeding methods. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published

  2. Submucous cleft palate and the general practitioner

    Science.gov (United States)

    Lowry, R. B.; Courtemanche, A. D.; MacDonald, C.

    1973-01-01

    Submucous cleft palate refers to a situation where the soft palate is largely composed of mucosa with little or no muscle. The defect is often not obvious on inspection of the mouth and pharynx. There is considerable clinical variation, with speech ranging from normal or minimal nasality to severe nasality and defective articulation. Many patients who have latent submucous cleft palate have the condition unmasked by an adenoidectomy because the adenoid pad had served as a compensatory factor in effecting palatopharyngeal closure. All physicians who perform tonsillectomy and adenoidectomy should be aware of the signs and symptoms which may suggest the diagnosis. ImagesFIG. 2 PMID:4758872

  3. Tendon repair

    Science.gov (United States)

    Repair of tendon ... Tendon repair can be performed using: Local anesthesia (the immediate area of the surgery is pain-free) ... a cut on the skin over the injured tendon. The damaged or torn ends of the tendon ...

  4. Two-stage dilute-acid and organic-solvent lignocellulosic pretreatment for enhanced bioprocessing

    Energy Technology Data Exchange (ETDEWEB)

    Brodeur, G.; Telotte, J.; Stickel, J. J.; Ramakrishnan, S.

    2016-11-01

    A two stage pretreatment approach for biomass is developed in the current work in which dilute acid (DA) pretreatment is followed by a solvent based pretreatment (N-methyl morpholine N oxide -- NMMO). When the combined pretreatment (DAWNT) is applied to sugarcane bagasse and corn stover, the rates of hydrolysis and overall yields (>90%) are seen to dramatically improve and under certain conditions 48 h can be taken off the time of hydrolysis with the additional NMMO step to reach similar conversions. DAWNT shows a 2-fold increase in characteristic rates and also fractionates different components of biomass -- DA treatment removes the hemicellulose while the remaining cellulose is broken down by enzymatic hydrolysis after NMMO treatment to simple sugars. The remaining residual solid is high purity lignin. Future work will focus on developing a full scale economic analysis of DAWNT for use in biomass fractionation.

  5. Reconstruction of Gene Regulatory Networks Based on Two-Stage Bayesian Network Structure Learning Algorithm

    Institute of Scientific and Technical Information of China (English)

    Gui-xia Liu; Wei Feng; Han Wang; Lei Liu; Chun-guang Zhou

    2009-01-01

    In the post-genomic biology era, the reconstruction of gene regulatory networks from microarray gene expression data is very important to understand the underlying biological system, and it has been a challenging task in bioinformatics. The Bayesian network model has been used in reconstructing the gene regulatory network for its advantages, but how to determine the network structure and parameters is still important to be explored. This paper proposes a two-stage structure learning algorithm which integrates immune evolution algorithm to build a Bayesian network .The new algorithm is evaluated with the use of both simulated and yeast cell cycle data. The experimental results indicate that the proposed algorithm can find many of the known real regulatory relationships from literature and predict the others unknown with high validity and accuracy.

  6. The Application of Two-stage Structure Decomposition Technique to the Study of Industrial Carbon Emissions

    Institute of Scientific and Technical Information of China (English)

    Yanqiu HE

    2015-01-01

    The total carbon emissions control is the ultimate goal of carbon emission reduction, while industrial carbon emissions are the basic units of the total carbon emission. On the basis of existing research results, in this paper, a two-stage input-output structure decomposition method is creatively proposed for fully combining the input-output method with the structure decomposition technique. In this study, more comprehensive technical progress indicators were chosen in comparison with the previous studies and included the utilization efficiency of all kinds of intermediate inputs such as energy and non-energy products, and finally were positioned at the factors affecting the carbon emissions of different industries. Through analysis, the affecting rate of each factor on industrial carbon emissions was acquired. Thus, a theory basis and data support is provided for the total carbon emissions control of China from the perspective of industrial emissions.

  7. A two-stage metal valorisation process from electric arc furnace dust (EAFD

    Directory of Open Access Journals (Sweden)

    H. Issa

    2016-04-01

    Full Text Available This paper demonstrates possibility of separate zinc and lead recovery from coal composite pellets, composed of EAFD with other synergetic iron-bearing wastes and by-products (mill scale, pyrite-cinder, magnetite concentrate, through a two-stage process. The results show that in the first, low temp erature stage performed in electro-resistant furnace, removal of lead is enabled due to presence of chlorides in the system. In the second stage, performed at higher temperatures in Direct Current (DC plasma furnace, valorisation of zinc is conducted. Using this process, several final products were obtained, including a higher purity zinc oxide, which, by its properties, corresponds washed Waelz oxide.

  8. A wavelet-based two-stage near-lossless coder.

    Science.gov (United States)

    Yea, Sehoon; Pearlman, William A

    2006-11-01

    In this paper, we present a two-stage near-lossless compression scheme. It belongs to the class of "lossy plus residual coding" and consists of a wavelet-based lossy layer followed by arithmetic coding of the quantized residual to guarantee a given L(infinity) error bound in the pixel domain. We focus on the selection of the optimum bit rate for the lossy layer to achieve the minimum total bit rate. Unlike other similar lossy plus lossless approaches using a wavelet-based lossy layer, the proposed method does not require iteration of decoding and inverse discrete wavelet transform in succession to locate the optimum bit rate. We propose a simple method to estimate the optimal bit rate, with a theoretical justification based on the critical rate argument from the rate-distortion theory and the independence of the residual error.

  9. Two-Stage Over-the-Air (OTA Test Method for LTE MIMO Device Performance Evaluation

    Directory of Open Access Journals (Sweden)

    Ya Jing

    2012-01-01

    Full Text Available With MIMO technology being adopted by the wireless communication standards LTE and HSPA+, MIMO OTA research has attracted wide interest from both industry and academia. Parallel studies are underway in COST2100, CTIA, and 3GPP RAN WG4. The major test challenge for MIMO OTA is how to create a repeatable scenario which accurately reflects the MIMO antenna radiation performance in a realistic wireless propagation environment. Different MIMO OTA methods differ in the way to reproduce a specified MIMO channel model. This paper introduces a novel, flexible, and cost-effective method for measuring MIMO OTA using a two-stage approach. In the first stage, the antenna pattern is measured in an anechoic chamber using a nonintrusive approach, that is without cabled connections or modifying the device. In the second stage, the antenna pattern is convolved with the chosen channel model in a channel emulator to measure throughput using a cabled connection.

  10. Two stages of parafoveal processing during reading: Evidence from a display change detection task.

    Science.gov (United States)

    Angele, Bernhard; Slattery, Timothy J; Rayner, Keith

    2016-08-01

    We used a display change detection paradigm (Slattery, Angele, & Rayner Human Perception and Performance, 37, 1924-1938 2011) to investigate whether display change detection uses orthographic regularity and whether detection is affected by the processing difficulty of the word preceding the boundary that triggers the display change. Subjects were significantly more sensitive to display changes when the change was from a nonwordlike preview than when the change was from a wordlike preview, but the preview benefit effect on the target word was not affected by whether the preview was wordlike or nonwordlike. Additionally, we did not find any influence of preboundary word frequency on display change detection performance. Our results suggest that display change detection and lexical processing do not use the same cognitive mechanisms. We propose that parafoveal processing takes place in two stages: an early, orthography-based, preattentional stage, and a late, attention-dependent lexical access stage.

  11. Enhanced biodiesel production in Neochloris oleoabundans by a semi-continuous process in two stage photobioreactors.

    Science.gov (United States)

    Yoon, Se Young; Hong, Min Eui; Chang, Won Seok; Sim, Sang Jun

    2015-07-01

    Under autotrophic conditions, highly productive biodiesel production was achieved using a semi-continuous culture system in Neochloris oleoabundans. In particular, the flue gas generated by combustion of liquefied natural gas and natural solar radiation were used for cost-effective microalgal culture system. In semi-continuous culture, the greater part (~80%) of the culture volume containing vegetative cells grown under nitrogen-replete conditions in a first photobioreactor (PBR) was directly transferred to a second PBR and cultured sequentially under nitrogen-deplete conditions for accelerating oil accumulation. As a result, in semi-continuous culture, the productivities of biomass and biodiesel in the cells were increased by 58% (growth phase) and 51% (induction phase) compared to the cells in batch culture, respectively. The semi-continuous culture system using two stage photobioreactors is a very efficient strategy to further improve biodiesel production from microalgae under photoautotrophic conditions.

  12. The Sources of Efficiency of the Nigerian Banking Industry: A Two- Stage Approach

    Directory of Open Access Journals (Sweden)

    Frances Obafemi

    2013-11-01

    Full Text Available The paper employed a two-stage Data Envelopment Analysis (DEA approach to examine the sources oftechnical efficiency in the Nigerian banking sub-sector. Using a cross sectionof commercial and merchant banks, the study showed that the Nigerian bankingindustry was not efficient both in the pre-and-post-liberalization era. Thestudy further revealed that market share was the strongest determinant oftechnical efficiency in the Nigerian banking Industry. Thus, appropriatemacroeconomic policy, institutional development and structural reforms mustaccompany financial liberalization to create the stable environment requiredfor it to succeed. Hence, the present bank consolidation and reforms by theCentral Bank of Nigeria, which started with Soludo and continued with Sanusi,are considered necessary, especially in the areas of e banking and reorganizingthe management of banks.

  13. Two-stage triolein breath test differentiates pancreatic insufficiency from other causes of malabsorption

    Energy Technology Data Exchange (ETDEWEB)

    Goff, J.S.

    1982-07-01

    In 24 patients with malabsorption, (/sup 14/C)triolein breath tests were conducted before and together with the administration of pancreatic enzymes (Pancrease, Johnson and Johnson, Skillman, N.J.). Eleven patients with pancreatic insufficiency had a significant rise in peak percent dose per hour /sup 14/CO/sub 2/ excretion after Pancrease, whereas 13 patients with other causes of malabsorption had no increase in /sup 14/CO/sub 2/ excretion (2.61 +/- 0.96 vs. 0.15 +/- 0.45, p less than 0.001). The two-stage (/sup 14/C)triolein breath test appears to be an accurate and simple noninvasive test of fat malabsorption that differentiates steatorrhea secondary to pancreatic insufficiency from other causes of steatorrhea.

  14. Heuristic for Critical Machine Based a Lot Streaming for Two-Stage Hybrid Production Environment

    Science.gov (United States)

    Vivek, P.; Saravanan, R.; Chandrasekaran, M.; Pugazhenthi, R.

    2017-03-01

    Lot streaming in Hybrid flowshop [HFS] is encountered in many real world problems. This paper deals with a heuristic approach for Lot streaming based on critical machine consideration for a two stage Hybrid Flowshop. The first stage has two identical parallel machines and the second stage has only one machine. In the second stage machine is considered as a critical by valid reasons these kind of problems is known as NP hard. A mathematical model developed for the selected problem. The simulation modelling and analysis were carried out in Extend V6 software. The heuristic developed for obtaining optimal lot streaming schedule. The eleven cases of lot streaming were considered. The proposed heuristic was verified and validated by real time simulation experiments. All possible lot streaming strategies and possible sequence under each lot streaming strategy were simulated and examined. The heuristic consistently yielded optimal schedule consistently in all eleven cases. The identification procedure for select best lot streaming strategy was suggested.

  15. Product prioritization in a two-stage food production system with intermediate storage

    DEFF Research Database (Denmark)

    Akkerman, Renzo; van Donk, Dirk Pieter

    2007-01-01

    In the food-processing industry, usually a limited number of storage tanks for intermediate storage is available, which are used for different products. The market sometimes requires extremely short lead times for some products, leading to prioritization of these products, partly through the dedi......In the food-processing industry, usually a limited number of storage tanks for intermediate storage is available, which are used for different products. The market sometimes requires extremely short lead times for some products, leading to prioritization of these products, partly through...... the dedication of a storage tank. This type of situation has hardly been investigated, although planners struggle with it in practice. This paper aims at investigating the fundamental effect of prioritization and dedicated storage in a two-stage production system, for various product mixes. We show...

  16. Experimental and modeling study of a two-stage pilot scale high solid anaerobic digester system.

    Science.gov (United States)

    Yu, Liang; Zhao, Quanbao; Ma, Jingwei; Frear, Craig; Chen, Shulin

    2012-11-01

    This study established a comprehensive model to configure a new two-stage high solid anaerobic digester (HSAD) system designed for highly degradable organic fraction of municipal solid wastes (OFMSW). The HSAD reactor as the first stage was naturally separated into two zones due to biogas floatation and low specific gravity of solid waste. The solid waste was retained in the upper zone while only the liquid leachate resided in the lower zone of the HSAD reactor. Continuous stirred-tank reactor (CSTR) and advective-diffusive reactor (ADR) models were constructed in series to describe the whole system. Anaerobic digestion model No. 1 (ADM1) was used as reaction kinetics and incorporated into each reactor module. Compared with the experimental data, the simulation results indicated that the model was able to well predict the pH, volatile fatty acid (VFA) and biogas production.

  17. Study of a two-stage photobase generator for photolithography in microelectronics.

    Science.gov (United States)

    Turro, Nicholas J; Li, Yongjun; Jockusch, Steffen; Hagiwara, Yuji; Okazaki, Masahiro; Mesch, Ryan A; Schuster, David I; Willson, C Grant

    2013-03-01

    The investigation of the photochemistry of a two-stage photobase generator (PBG) is described. Absorption of a photon by a latent PBG (1) (first step) produces a PBG (2). Irradiation of 2 in the presence of water produces a base (second step). This two-photon sequence (1 + hν → 2 + hν → base) is an important component in the design of photoresists for pitch division technology, a method that doubles the resolution of projection photolithography for the production of microelectronic chips. In the present system, the excitation of 1 results in a Norrish type II intramolecular hydrogen abstraction to generate a 1,4-biradiacal that undergoes cleavage to form 2 and acetophenone (Φ ∼ 0.04). In the second step, excitation of 2 causes cleavage of the oxime ester (Φ = 0.56) followed by base generation after reaction with water.

  18. ADM1-based modeling of methane production from acidified sweet sorghum extractin a two stage process

    DEFF Research Database (Denmark)

    Antonopoulou, Georgia; Gavala, Hariklia N.; Skiadas, Ioannis

    2012-01-01

    The present study focused on the application of the Anaerobic Digestion Model 1 οn the methane production from acidified sorghum extract generated from a hydrogen producing bioreactor in a two-stage anaerobic process. The kinetic parameters for hydrogen and volatile fatty acids consumption were...... estimated through fitting of the model equations to the data obtained from batch experiments. The simulation of the continuous reactor performance at all HRTs tested (20, 15 and 10d) was very satisfactory. Specifically, the largest deviation of the theoretical predictions against the experimental data...... was 12% for the methane production rate at the HRT of 20d while the deviation values for the 15 and 10 d HRT were 1.9% and 1.1%, respectively. The model predictions regarding pH, methane percentage in the gas phase and COD removal were in very good agreement with the experimental data with a deviation...

  19. A Two-Stage Diagnosis Framework for Wind Turbine Gearbox Condition Monitoring

    Directory of Open Access Journals (Sweden)

    Janet M. Twomey

    2013-01-01

    Full Text Available Advances in high performance sensing technologies enable the development of wind turbine condition monitoring system to diagnose and predict the system-wide effects of failure events. This paper presents a vibration-based two stage fault detection framework for failure diagnosis of rotating components in wind turbines. The proposed framework integrates an analytical defect detection method and a graphical verification method together to ensure the diagnosis efficiency and accuracy. The efficacy of the proposed methodology is demonstrated with a case study with the gearbox condition monitoring Round Robin study dataset provided by the National Renewable Energy Laboratory (NREL. The developed methodology successfully picked five faults out of seven in total with accurate severity levels without producing any false alarm in the blind analysis. The case study results indicated that the developed fault detection framework is effective for analyzing gear and bearing faults in wind turbine drive train system based upon system vibration characteristics.

  20. Nitrification and microalgae cultivation for two-stage biological nutrient valorization from source separated urine.

    Science.gov (United States)

    Coppens, Joeri; Lindeboom, Ralph; Muys, Maarten; Coessens, Wout; Alloul, Abbas; Meerbergen, Ken; Lievens, Bart; Clauwaert, Peter; Boon, Nico; Vlaeminck, Siegfried E

    2016-07-01

    Urine contains the majority of nutrients in urban wastewaters and is an ideal nutrient recovery target. In this study, stabilization of real undiluted urine through nitrification and subsequent microalgae cultivation were explored as strategy for biological nutrient recovery. A nitrifying inoculum screening revealed a commercial aquaculture inoculum to have the highest halotolerance. This inoculum was compared with municipal activated sludge for the start-up of two nitrification membrane bioreactors. Complete nitrification of undiluted urine was achieved in both systems at a conductivity of 75mScm(-1) and loading rate above 450mgNL(-1)d(-1). The halotolerant inoculum shortened the start-up time with 54%. Nitrite oxidizers showed faster salt adaptation and Nitrobacter spp. became the dominant nitrite oxidizers. Nitrified urine as growth medium for Arthrospira platensis demonstrated superior growth compared to untreated urine and resulted in a high protein content of 62%. This two-stage strategy is therefore a promising approach for biological nutrient recovery.