Appreciation of cleft lip and palate treatment outcome by professionals and laypeople

The aim of the study was to analyse the aesthetic evaluation of head photographs of treated individuals with clefts by laypeople and professionals and to investigate how certain cephalometric variables could be related to their rating. A set of five standardized head photos (frontal, both laterals, three-quater right and left) of 12 Caucasian patients with treated unilateral cleft lip and palate were presented to 12 adult laypeople, 12 orthodontists, and 12 maxillofacial surgeons. For each set of photos the judges had to answer four questions on a visual analogue scale (VAS). The answers were analysed for intra- and inter-panel level of agreement and correlations of assessments with certain cephalometric parameters were determined. There was a high level of agreement for all assessments of each panel of raters. However, laypeople were less satisfied with lip and nose aesthetics compared to professionals. The three groups were similarly satisfied with the aesthetics of the jaws and the face. The anterior position of the maxilla (SNA) influenced positively professionals' ratings of facial aesthetics. Orthodontists were negatively influenced when the vertical dimension of the face or the distance of the lower lip to E-plane were relatively increased. The latter was the only cephalometric parameter correlated with lower aesthetic scores obtained from laypeople. Professionals report greater satisfaction from the treatment outcome and evaluate cleft consequences with less severity than laypeople. According to cephalometric findings, the relative positions of the lips seem to dominate facial aesthetics' appreciation by laypeople, while specialists appear to focus on different features of the face.

Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003-2007)

OBJECTIVE: To assess the utility of nasotracheal tubes in postoperative oxygen supplementation in dogs following corrective surgery for brachycephalic syndrome. DESIGN: Retrospective study 2003-2007. SETTING: University teaching hospital. ANIMALS: Thirty-six client-owned dogs that underwent corrective surgery for brachycephalic syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for animals that underwent surgical interventions for brachycephalic syndrome including palatoplasty, ventriculectomy, and rhinoplasty. Data collected included signalment, presenting complaints, analgesic and surgical interventions, type of supplemental oxygen therapy, complications and mortality occurring during hospitalization. A nasotracheal tube (NTT) was placed in 20 dogs at the end of surgery; 16 dogs received other forms of oxygen supplementation (8) or no oxygen supplementation (8) during recovery. The total number of postoperative complications was similar in both groups (8/20 dogs with NTTs and 7/16 in those without NTTs). However, respiratory distress was observed in 5 dogs without NTTs but was not observed in any dog while an NTT was in place. One dog in each group died postoperatively. CONCLUSION: Placement of an NTT was found to be easy and may offer benefit in dogs with brachycephalic syndrome as a noninvasive means of delivering oxygen. The use of NTT may minimize severe postoperative morbidity, in particular by reducing postoperative respiratory distress.

Trial history biases the spatial programming of antisaccades

The historical context in which saccades are made influences their latency and error rates, but less is known about how context influences their spatial parameters. We recently described a novel spatial bias for antisaccades, in which the endpoints of these responses deviate towards alternative goal locations used in the same experimental block, and showed that expectancy (prior probability) is at least partly responsible for this 'alternate-goal bias'. In this report we asked whether trial history also plays a role. Subjects performed antisaccades to a stimulus randomly located on the horizontal meridian, on a 40° angle downwards from the horizontal meridian, or on a 40° upward angle, with all three locations equally probable on any given trial. We found that the endpoints of antisaccades were significantly displaced towards the goal location of not only the immediately preceding trial (n - 1) but also the penultimate (n - 2) trial. Furthermore, this bias was mainly present for antisaccades with a short latency of <250 ms and was rapidly corrected by secondary saccades. We conclude that the location of recent antisaccades biases the spatial programming of upcoming antisaccades, that this historical effect persists over many seconds, and that it influences mainly rapidly generated eye movements. Because corrective saccades eliminate the historical bias, we suggest that the bias arises in processes generating the response vector, rather than processes generating the perceptual estimate of goal location.

Modes of Diversification in Bulgarian Higher Education: Case Studies in four Disciplines

This project was stimulated by the unprecedented speed and scope of changes in Bulgarian higher education since 1989. The rapid growth of the student population and the emergence of a new private sector in higher education led to tightening governmental control and a growing criticism of autonomy and academic freedom. This raised questions about the need for diversification in the field, about the importance of recent innovations in terms of strategic choices for future development and so of how higher education governance could maintain diversity without the system deteriorating. The group first traced the extent of spontaneous processes of innovation at the level of content, of institutions, and the organisation of teaching and learning processes. They then identified the different parties in the struggle for institutionalisation and against diversification, and promising mechanisms for maintaining diversity in higher education. On this basis they outlined a basis for a wide-ranging public discussion of the issue which may serve as a corrective to the mechanisms of state control. Their work included analysis of the legislative framework laid down in the Higher Education Act, which effectively dispenses with the autonomy of universities. They then surveyed the views of both high-level executives in the field and the academics actually involved in the process, as well as of the "consumers" of the educational product, i.e. the students. In considering diversification, they focused on four different types of programmes, including those where diversification is largely limited to content level (e.g. Law), those where it operates mainly on structural levels (e.g. Industrial Management), those where it is often feigned (e.g. Social Work), and those where it is at best formal and sporadic (e.g. Mechanical Engineering). They conclude that the educational system in Bulgaria has considerable internal resources for development. The greatest need is for adequate statutory regulation of academic life which will provide incentives for responsible academic development of higher education institutions and create conditions for the institutionalisation of academic self-organisation and self-control, which will in turn limit the pathological trends in the diversification processes.

Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation

BACKGROUND: Breast reconstruction by latissimus dorsi myocutaneous flap in combination with a prosthesis is a widely used, well-established procedure. Short- and medium-term evaluation after this procedure is well described in the literature, but there have been no evaluations of the late course (over 10 years) published until now. METHODS: In a retrospective study, 68 patients operated on by means of this technique at the authors' institution from 1981 to 1993 resulting in a minimal follow-up of 10 years were included. Patients were invited to an interrogation, clinical examination, and photographic documentation (n = 51). Incidence of late flap or prosthesis-related complications, number of and indications for corrective procedures, and the correlation of the patients' subjective judgment and objective results in the late course have been the main interest of the authors' survey. RESULTS: The authors found that 50 percent of the patients needed a late reoperation for change or removal of the prosthesis. Seven (10 percent) of 68 patients needed a definitive removal of the implant in the late course. Assessment of the photographic documentation of the late result by four nonprofessionals showed that the objective aesthetic results of a considerable number of the authors' reconstructions were not sufficient. CONCLUSION: The procedure combines two basic techniques of reconstructive surgery, the soft-tissue restoration by a pedicled flap as the autologous reconstructive component and the volume reconstruction by prosthesis. Therefore, these patients are subject to a cumulation of the basic morbidity of the two techniques. The authors conclude that the indication for this procedure should be restricted to patients not qualifying for "pure" reconstructive techniques.

Reduced atrial connexin43 expression after pediatric heart surgery

Myocardial dysfunction and arrhythmias may be induced by congenital heart defects, but also be the result of heart surgery with cardiopulmonary bypass (CPB), potentially caused by differential expression of connexin40 (Cx40) and connexin43 (Cx43). In 16 pediatric patients undergoing corrective heart surgery, connexin mRNA expression was studied in volume overloaded (VO group, n=8) and not overloaded (NO group, n=8) right atrial myocardium, excised before and after CPB. Additionally, in eight of these patients ventricular specimens were investigated. The atrial Cx43 expression decreased during CPB, which was restricted to the VO group (p=0.008). In contrast, atrial Cx40 mRNA did not change during CPB. In ventricular myocardium compared to atrial mRNA levels, Cx40 was lower (p=0.006) and Cx43 higher (p=0.017) expressed, without significant change during CPB. This study revealed a significant influence of CPB and the underlying heart defect on Cx43 expression.

Success rate and efficiency of activator treatment

In a retrospective multicentre study, the success rate and efficiency of activator treatment were analysed. All patients from two University clinics (Giessen, Germany and Berne, Switzerland) that fulfilled the selection criteria (Class II division 1 malocclusion, activator treatment, no aplasia, no extraction of permanent teeth, no syndromes, no previous orthodontic treatment except transverse maxillary expansion, full available records) were included in the study. The subject material amounted to 222 patients with a mean age of 10.6 years. Patient records, lateral head films, and dental casts were evaluated. Treatment was classified as successful if the molar relationship improved by at least half to three-fourths cusp width depending on whether or not the leeway space was used during treatment. Group comparisons were carried out using Wilcoxon two-sample and Kruskal-Wallis tests. For discrete data, chi-square analysis was used and Fisher's exact test when the sample size was small. Stepwise logistic regression was also employed. The success rate was 64 per cent in Giessen and 66 per cent in Berne. The only factor that significantly (P < 0.001) influenced treatment success was the level of co-operation. In approximately 27 per cent of the patients at both centres, the post-treatment occlusion was an 'ideal' Class I. In an additional 38 per cent of the patients, marked improvements in occlusal relationships were found. In subjects with Class II division 1 malocclusions, in which orthodontic treatment is performed by means of activators, a marked improvement of the Class II dental arch relationships can be expected in approximately 65 per cent of subjects. Activator treatment is more efficient in the late than in the early mixed dentition.

Stability of the hard and soft tissue profile after mandibular advancement in sagittal split osteotomies: a longitudinal and long-term follow-up study

The aim of the study was to conduct a long-term follow-up investigation of the stability of hard and soft tissues after bilateral sagittal split osteotomy (BSSO) with rigid internal (RIF) fixation to advance the mandible. Sixteen consecutive patients (12 females and 4 males, mean age 21.4 years) were available for re-examination 12.7 years (T5) after surgery. The preceding follow-ups were before (T1), and 5 days (T2), 7.3 months (T3), and 13.9 months (T4) after surgery. Lateral cephalograms were traced by hand, digitized, and evaluated with the Dentofacial Planner program. The x-axis for the system of co-ordinates ran through sella (point zero) and the line NSL -7 degrees. Thus, the program determined the x- and y-values of each variable and the usual angles and distances. Statistical analysis was carried out using Wilcoxon's matched-pair signed-ranks test with Bonferroni adjustments. The relationships between the examined variables were analysed by Spearman rank correlation coefficients. The backward relapse at point B (T5) was 2.42 mm, or 50 per cent, and at pogonion 3.21 mm, or 60 per cent of the initial advancement. The mean net effect at T5 on the labial fold (soft tissue point B) was 94 per cent of the advancement at point B. For the soft tissue chin (soft tissue pogonion), it was 119 per cent of the advancement at pogonion. The net effect on the lower lip (labrale inferior) was 55 per cent of the advancement at incision inferior. The amount of the surgical advancement of the mandible was correlated with the long-term relapse in point B. Among possible reasons for this relapse are the initial soft tissue profile, the initial growth direction, and the remodelling processes of the hard tissue.

Stability of hard tissue profile after mandibular setback in sagittal split osteotomies: a longitudinal and long-term follow-up study

The aim of the study was to conduct a long-term follow-up on the stability of the hard tissues after bilateral sagittal split osteotomy (BSSO) with rigid internal fixation (RIF)to set back the mandible and to compare it with that of mandibular advancement performed by the same team of surgeons and with the same examination protocol. Seventeen consecutive patients (6 females and 11 males) could be re-examined 12.7 years (T5) after surgery. The previous examinations were before surgery (T1), 5 days (T2), and 6.6 (T3) and 14.4 (T4) months after surgery. Lateral cephalograms were traced by hand, digitized, and evaluated with the Dentofacial Planner software program. The x-axis for the system of co-ordinates ran through sella (point zero) and the line nasion-sella-line minus 7 degrees. The program determined the x- and y-values of each variable and the usual angles and distances. The effects of treatment were determined with Wilcoxon matched pairs, signed ranks test, with Bonferroni adjustment, and the relationship between variables with Spearman rank correlation coefficient. Relapse at point B was 0.94 mm or 15 per cent and at pogonion 1.46 mm or 21 per cent of the initial setback at T5. Relapse was mainly short-term (T4-T2), 13 per cent for point B and 17 per cent for pogonion. Gender correlated significantly with relapse (T5-T2) at point B (P = 0.002) and pogonion (P = 0.021), i.e. females in contrast to males showed further distalization of the mandible instead of relapse. No correlations were seen for age or the amount of surgical setback. The long-term results in mandibular setback patients were more stable when compared with the mandibular advancement patients examined previously. The initial soft tissue profile, the initial growth direction, and the remodelling processes of the hard tissues must be considered as reasons for long-term relapse. Growth direction positively influenced the long-term results in females: further distalization of the mandible occurred.

Stability after bilateral sagittal split osteotomy setback surgery with rigid internal fixation: a systematic review

PURPOSE: The purpose of this systematic review was to evaluate relapse and its causes in bilateral sagittal split setback osteotomy with rigid internal fixation. MATERIALS AND METHODS: Literature research was done in databases such as PubMed, Ovid, the Cochrane Library, and Google Scholar Beta. From the original 488 articles identified, 14 articles were finally included. Only 5 studies were prospective and 9 retrospective. The range of postoperative study records was from 6 weeks to 12.7 years. RESULTS: The horizontal short-term relapse was between 9.9% and 62.1% at point B and between 15.7% and 91.3% at pogonion. Long-term relapse was between 14.9% and 28.0% at point B and between 11.5% and 25.4% at pogonion. CONCLUSIONS: Neither large increase nor decrease of relapse was seen when short-term values were compared with long-term. Bilateral sagittal split osteotomy for mandibular setback in combination with orthodontics is an effective treatment of skeletal Class III and a stable procedure in the short- and long-term. The etiology of relapse is multifactorial: the proper seating of the condyles, the amount of setback, the soft tissue and muscles, remaining growth and remodeling, and gender were identified. Age did not show any correlations. To obtain reliable scientific evidence, further short- and long-term research of bilateral sagittal split osteotomy setback with rigid internal fixation should exclude additional surgery, ie, genioplasty or maxillary surgery, and include correlation statistics.

Assessment of vertical facial and dentoalveolar changes using panoramic radiography

The purpose of the study was to analyse longitudinal vertical facial and dentoalveolar changes using panoramic radiographs (PRs) and to compare the results with measurements on lateral cephalometric radiographs (LCRs) in order to determine whether, under certain circumstances, the radiation dose for a patient may be reduced by taking only a PR instead of a PR and a LCR. Pre- and post-treatment PRs and LCRs of 30 (15 females and 15 males) orthodontically treated adolescents (mean age pre-treatment 10.9 years, post-treatment 13.4 years) were analysed using Pearson's correlation coefficients and gender differences using Fisher's z-transformation. The results revealed that most variables exhibited larger absolute values on PRs than on LCRs. Comparison of dentoskeletal morphology between the LCRs and the PRs revealed moderate to high, mostly statistically significant, interrelations both before and after orthodontic treatment. The lowest correlations were found for the maxillary jaw base angle (NL/H; r= 0.35***) and the highest for the gonial angle (ML/RL; r = 0.90***). However, when assessing the combined growth and treatment changes from before to after treatment, only weak to moderate, not statistically significant, interrelations were found between LCRs and PRs. Anterior face height (AFH; r = 0.43***), the mandibular plane angle (ML/H; r = 0.06*), and the distance of the incisal tip of the most extruded mandibular incisor to the ML-line (ii-ML; r = -0.21*) were the only statistically significant parameters. The average group differences for growth and treatment changes, however, were small for most parameters. Analysis of vertical facial and dentoalveolar parameters on PRs delivers a moderate approximation to the situation depicted on LCRs. However, PRs cannot be recommended for the analysis of individual longitudinal changes in vertical facial and dentoalveolar parameters.

Writing center handbooks and travel guidebooks : redesigning instructional texts for multicultural, multilingual, and multinational contexts

In an increasingly interconnected world characterized by the accelerating interplay of cultural, linguistic, and national difference, the ability to negotiate that difference in an equitable and ethical manner is a crucial skill for both individuals and larger social groups. This dissertation, Writing Center Handbooks and Travel Guidebooks: Redesigning Instructional Texts for Multicultural, Multilingual, and Multinational Contexts, considers how instructional texts that ostensibly support the negotiation of difference (i.e., accepting and learning from difference) actually promote the management of difference (i.e., rejecting, assimilating, and erasing difference). As a corrective to this focus on managing difference, chapter two constructs a theoretical framework that facilitates the redesign of handbooks, guidebooks, and similar instructional texts. This framework centers on reflexive design practices and is informed by literacy theory (Gee; New London Group; Street), social learning theory (Wenger), globalization theory (Nederveen Pieterse), and composition theory (Canagarajah; Horner and Trimbur; Lu; Matsuda; Pratt). By implementing reflexive design practices in the redesign of instructional texts, this dissertation argues that instructional texts can promote the negotiation of difference and a multicultural/multilingual sensibility that accounts for twenty-first century linguistic and cultural realities. Informed by the theoretical framework of chapter two, chapters three and four conduct a rhetorical analysis of two forms of instructional text that are representative of the larger genre: writing center coach handbooks and travel guidebooks to Hong Kong. This rhetorical analysis reveals how both forms of text employ rhetorical strategies that uphold dominant monolingual and monocultural assumptions. Alternative rhetorical strategies are then proposed that can be used to redesign these two forms of instructional texts in a manner that aligns with multicultural and multilingual assumptions. These chapters draw on the work of scholars in Writing Center Studies (Boquet and Lerner; Carino; DiPardo; Grimm; North; Severino) and Technical Communication (Barton and Barton; Dilger; Johnson; Kimball; Slack), respectively. Chapter five explores how the redesign of coach handbooks and travel guidebooks proposed in this dissertation can be conceptualized as a political act. Ultimately, this dissertation argues that instructional texts are powerful heuristic tools that can enact social change if they are redesigned to foster the negotiation of difference and to promote multicultural/multilingual world views.

How to avoid clean intermittent catheterization in men with ileal bladder substitution

PURPOSE: In male patients with ileal bladder substitute we ascertained the likelihood of spontaneous voiding failure, the corrective procedures required and the eventual outcomes. MATERIALS AND METHODS: Following cystectomy and ileal bladder substitution for urothelial cancer between April 1985 and September 2002 male patients were identified and analyzed from the prospective departmental database. Four patients underwent ileum conduit conversion following urethral recurrence or pouch necrosis and were excluded from study. Funnel-shaped outlets were avoided during bladder substitute surgery after the first 4 patients with this configuration experienced voiding failure and required corrective procedures. Only patients with a minimum 5-year followup were assessed for voiding failure, corrective procedures and final outcomes. RESULTS: Of 354 patients with a median age of 65 years (range 36 to 84) treated with bladder substitute 180 (51%) were alive at 5 years. All 180 of these patients spontaneously voided within 3 months of surgery. During this 5-year observation period 22 (12%) patients experienced voiding problems requiring de-obstructive procedures. Following intervention 177 (98%) patients were spontaneously voiding by 5 years. Of 237 patients 77 (32%) were alive at 10 years. Of these 77 patients followed for another 5 years 10 (13%) had similar voiding problems requiring de-obstructive procedures. Subsequently 74 (96%) were voiding spontaneously by 10 years. CONCLUSIONS: Patients often fail to void spontaneously after ileal bladder substitution. However, if a funnel-shaped outlet is avoided and de-obstructive surgery is appropriately implemented, excellent long-term results are seen with spontaneous voiding and clean intermittent catheterization can be avoided.