ABSTRACTSkeletofacial reconstruction in skeletally mature patients with cleft lip/palate can be challenging because of multifaceted condition-specific anatomical features in addition to several ...repercussions from surgical intervention during the growing period. This surgical report presents the history and evolving philosophy of cleft-skeletofacial reconstruction at the Chang Gung Craniofacial Center, a referral center for cleft care in Taiwan. The maximization of satisfactory function and the appearance outcome-burden ratio have been the fundamental aims for this team to develop and upgrade cleft-skeletofacial reconstruction over the past 4 decades, with more than 10,000 mature patients treated. The study highlights key lessons learned in outcome-based and patient-oriented changes over time until the current approach, which focuses on patient-centered care with a comprehensive, multidisciplinary, and team-based model. Substantial advances in surgical, orthodontic, anesthetic, and computer imaging aspects have contributed to improving and optimizing the correction of a broad spectrum of facial and occlusal deformities while ensuring safety, predictability, efficiency, and stability in outcomes. Understanding the development and refinement of cleft-skeletofacial reconstruction over the time and transferring these time-tested and scientifically validated protocols and principles to clinical practice may serve as a reliable foundation to continue the advancement and enhancement of the delivery of surgical cleft care worldwide.
Three-dimensional computer-assisted orthognathic surgery allows to simulate the space between the mandibular ramus segments, i.e. intersegmental gap, for the correction of facial asymmetry. The ...purposes of the study were to estimate the screws- and mandible bone-related changes from the early postoperative period to the period after the debonding and to measure the association between the intersegmental gap volume and the screws- and mandible bone-related changes.
This cone-beam computed tomography (CBCT)-assisted retrospective study assessed the stability of the bicortical positional screw fixations in maintaining the space between the mandibular ramus segments after bilateral sagittal split osteotomy in correction of 31 patients with malocclusion and facial asymmetry. The primary predictor variable was the CBCT-based intersegmental gap volume at early postoperative period (T1). The primary outcome variables were CBCT-based screws- and bone-related measurement changes between the T1 and T2 (at debonding) periods.
No significant differences were observed in screws-related linear and angular measurements between T1 and T2 virtual models. Some of mandible bone-related linear and angular measurements had significant differences (P < 0.05) between the T1 and T2 images, but with no clinical repercussion such as need of revisionary surgery. The gap volume and the screws- and bone-related changes had no significant correlations.
This study contributes to the multidisciplinary-related literature by demonstrating that the bicortical positional screws-based fixation technique in maintaining the three-dimensional-simulated space between the mandibular ramus segments is a stable and clinically acceptable option for correction of facial asymmetry associated with malocclusion, regardless of intersegmental gap size.
Mobile mapping technologies, for example multi-sensor integration and multi-platform mapping technology, have developed and improved over recent decades, various applications such as conventional ...mapping scenarios, rapid disaster response, smart city, and autonomous vehicle application arise synchronously. Especially, autonomous driving vehicles have made enormous progress. High-definition (HD) maps are key for autonomous driving because of their high accuracy and rich information of road scenes. However, how to make sure that HD maps are suitable for autonomous vehicle requirement is an important topic. The HD maps guidelines and standards in Taiwan are released since 2018 and mainly focus on point cloud and shape file format. In this paper, a procedure for the verification and validation of HD maps for OpenDRIVE and Autoware (Lanelet2) is proposed. It discusses about the verification strategies, suggestion review item, recommendation tools, and process. As shown by our preliminary results, the proposed process can conform not only in closed area but also public road. These issues can help reducing HD maps production costs. When the foundation of HD maps accomplishes, the autonomous driving techniques can naturally complement. The vision of full automation vehicle will come true rapidly in the future.
A precise volumetric assessment of maxillary alveolar defects in patients with cleft lip and palate can reduce donor site morbidity or allow accurate preparation of bone substitutes in future ...applications. However, there is a lack of agreement regarding the optimal volumetric technique to adopt. This study measured the alveolar bone defects by using two cone-beam computed tomography (CBCT)-based surgical simulation methods. Presurgical CBCT scans from 32 patients with unilateral or bilateral clefts undergoing alveolar bone graft surgery were analyzed. Two hands-on CBCT-based volumetric measurement methods were compared: the 3D real-scale printed model-based surgical method and the virtual surgical method. Different densities of CBCT were compared. Intra- and inter-examiner reliability was assessed. For patients with unilateral clefts, the average alveolar defect volumes were 1.09 ± 0.24 and 1.09 ± 0.25 mL (
> 0.05) for 3D printing- and virtual-based models, respectively; for patients with bilateral clefts, they were 2.05 ± 0.22 and 2.02 ± 0.27 mL (
> 0.05), respectively. Bland-Altman analysis revealed that the methods were equivalent for unilateral and bilateral alveolar cleft defect assessment. No significant differences or linear relationships were observed between adjacent different densities of CBCT for model production to obtain the measured volumes. Intra- and inter-examiner reliability was moderate to good (intraclass correlation coefficient (ICC) > 0.6) for all measurements. This study revealed that the volume of unilateral and bilateral alveolar cleft defects can be equally quantified by 3D-printed and virtual surgical simulation methods and provides alveolar defect-specific volumes which can serve as a reference for planning and execution of alveolar bone graft surgery.
Repair of complete bilateral cleft lip with protruding premaxilla is challenging, and postoperative dehiscence was common. Re-repair is usually suggested for the dehisced lip, but other methods might ...be needed in unique situations. Evaluation was performed to check the presence of prolabial skin, wound scarring, and the position of premaxilla. Reconstruction plan was made to restore the anatomical components as possible and to repair under minimal tension. Two patients with major dehiscence were reported. In the first case, separation from the columella base and tissue destruction in central lip were noted. Repeated complete dehiscence on one side was reported in the second case before he was referred to our center. The premaxilla was protruding in both cases. Abbe flap was performed as delayed procedure in the first case. Reposition of the premaxilla in conjunction with lip repair was required in the second case. In both cases, adequate muscle approximation plus subcutaneous retention sutures were used to cope with the tension, and satisfactory healing was achieved. It is concluded that additional methods could be required for the reconstruction of major dehiscence after bilateral cleft lip repair. Careful planning and surgical execution ensured successful outcome.
In this study, the heat transfer characteristics of water-based suspensions of phase-change nanocapsules were investigated in a natural circulation loop with a mini-channel heat sink and heat source. ...A total of 23 and 34 rectangular mini-channels, each with a width of 0.8 mm, a depth of 1.2 mm, a length of 50 mm, and a hydraulic diameter of 0.96 mm, were evenly placed on the copper blocks as the heat source and heat sink, respectively. Adiabatic sections of the circulation loop were constructed using polymethylmethacrylate tubes with an outer diameter of 6 mm and an inner diameter of 4 mm, which were fabricated and assembled to construct a rectangular loop with a height of 630 mm and a width of 220 mm. Using a core material of eicosane and a shell of urea-formaldehyde resin, phase-change nanocapsules with a mean particle size of 150 nm were successfully fabricated and then dispersed in pure water as the working fluid to form water-based suspensions with nanocapsule mass fractions in the range of 0.1–1 wt.%. The results clearly indicate that water-based suspensions of phase-change nanocapsules can markedly enhance the heat-transfer performance of the natural circulation loop considered.
•Phase-change nanocapsule suspensions can enhance the heat-transfer performance of the loop.•The 0.5% suspension was most prominent in the hot wall temperature reduction.•High viscosity of the suspension at low temperature affects the heat transfer.•Nusselt numbers at the inlets increased with increases in the Rayleigh number.
Active power filters (APFs) have been developed to solve the problems of harmonic suppression and reactive power compensation simultaneously, In this paper, a three-phase four-wire power filter ...comprising a three-phase three-wire APF and a Zig-Zag transformer is developed. A hardware prototype is implemented and tested to verify the performance of the proposed power filter under various ideal and non-ideal power conditions. Experimental results show that this three-phase four-wire power filter has the desired performance under limited zero sequence utility voltage.
Calcineurin is a calcium/calmodulin-dependent protein phosphatase composed of two subunits, a regulatory subunit of calcineurin B (CNB) and a catalytic subunit of calcineurin A (CNA). PPP3CC is the ...gamma isoform of CNA located at the chromosome 8p21.3 region. To evaluate the association between PPP3CC and schizophrenia in the Taiwanese population, 10 single nucleotide polymorphism (SNP) markers across the gene were genotyped by the method of MALDI-TOF in 218 schizophrenia families with at least two affected siblings. One SNP (rs2272080) located around the exon 1 untranslated region was nominally associated with schizophrenia (P=0.024) and significantly associated with the expression of PPP3CC in lymphoblast cell line; the TT and TG genotype had significantly higher relative expression levels than the GG genotype (P=0.0012 and 0.015, respectively). In further endophenotype stratification, the single locus of rs2272080 and the haplotypes of both two-SNP haplotype (rs7833266-rs2272080) and seven-SNP haplotype (rs2461491-rs2469758-rs2461489-rs2469770-rs2449340-rs1482337-rs2252471) showed significant associations with the subgroup of schizophrenia with deficits of the sustained attention as tested by the continuous performance test (CPT, P<0.05) and the executive functioning as tested by the Wisconsin Card Sorting Test (WCST, P<0.05). The results suggest that PPP3CC gene may be a true susceptibility gene for schizophrenia.
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