[Burden of disease and risk factors among children under 5 years in China from 1990 to 2019: a perspective of international comparison].

Based on the Global Burden of Disease study 2019, the standardized mortality rate and disability-adjusted life years (DALYs) rate of children under 5 years old were selected as evaluation indicators to compare and analyze the current situation and differences of disease burden of children under 5 years old between China and other regions from 1990 to 2019. The change trend and difference of disease burden of children under 5 years old in China were analyzed by sexes. From 1990 to 2019, the all-cause standardized mortality rate of children under 5 years old in China decreased from 1 153.81/100 000 to 160.39/100 000, and the all-cause standardized DALY rate decreased from 104 426.40/100 000 to 16 479.01/100 000. In 2019, neonatal preterm birth, congenital heart anomalies and lower respiratory infections ranked the top three disease burden of children under 5 years old in China. Except that the disease burden of neonatal preterm birth was lower than that in North America, they were much higher than that in Western Europe and North America in the same period. The burden of unintentional injury diseases, including pulmonary aspiration and foreign body in airway and drowning, was higher than that in Western Europe and North America. The standardized mortality and DALY rate of the top ten diseases and injuries in boys and girls under 5 years old in China showed a downward trend (P<0.05), and most of them were higher in boys than girls (P<0.05). From 1990 to 2019, the disease burden of children under 5 years old in China decreased significantly. However, compared other regions, it is still necessary to strengthen the prevention and control of neonatal premature birth, birth defects and unintentional injuries, and take different sex-specific interventions to improve the overall health of children.

[Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancreatic head].

Objective: To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR) for benign and pre-malignant lesions of pancreatic head. Methods: The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People's Hospital. Thirty-three patients were enrolled with 10 males and 23 females. The age(M(IQR)) was 54(32) years old(range: 11 to 77 years old) and the body mass index was 21.9(2.9)kg/m2(range: 18.1 to 30.1 kg/m2). The presenting symptoms included abdominal pain(n=12), Whipple triad(n=2), and asymptomatic(n=19). There were 7 patients with hypertension and 1 patient with diabetes mellitus. There were 19 patients who were diagnosed as American Society of Anesthesiologists class Ⅰ and 14 patients who were diagnosed as class Ⅱ. The student t test,U test, χ2 test or Fisher exact test was used to compare continuous data or categorized data,respectively. All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded. Results: Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR. Indocyanine green fluorescence imaging was used in 19 patients to guide operation. Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy. Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms, 9 intraductal papillary mucinous neoplasms, 7 serous cystic neoplasms, 6 pancreatic neuroendocrine tumors, 1 mucous cystic neoplasm, 1 chronic pancreatitis. The operative time was (309.4±50.3) minutes(range:180 to 420 minutes),and the blood loss was (97.9±48.3)ml(range:20 to 200 ml). Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade ≥Ⅲ). Pancreatic fistula occurred in 16 patients,including 8 patients with biochemical leak,7 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula. No one suffered from the duodenal necrosis and none perioperative death was occurred. The length of hospital stay was 14(7) days (range:6 to 87 days). The follow-up was 22.6(24.5)months(range:2 to 74 months). None suffered from recurrence or metastasis. During the follow-up,all the patients were free of refractory cholangitis. Moreover,in the term of endocrine dysfunction,no postoperative new onset of diabetes mellitus were observed in the long-term follow-up. However,in the view of exocrine insufficiency,pancreatic exocrine insufficiency and non-alcoholic fatty liver disease (NAFLD) was complicated in 2 and 1 patient,respectively,with the supplement of pancreatic enzyme,steatorrhea and weight loss relieved,but NAFLD was awaited to be seen. Conclusions: Minimally invasive DPPHR is feasible and safe for benign or pre-malignant lesions of pancreatic head. Moreover,it is oncological equivalent to pancreaticoduodenectomy with preservation of metabolic function without refractory cholangitis.

Study on the relationship between the structure and functions of anti-human cervical cancer single-chain antibody and the lengths of linkers.

BACKGROUND: This study aimed to find the linker with minimal impact among chains to fight against the structure and function of cervical cancer (CC) single-chain antibody. MATERIALS AND METHODS: The original variable region of heavy chain (VH) and variable region of light chain (VL), and the single-chain antibody with linkers of different lengths (n = 1-8) were modeling by homologous modeling, while the peptide chain structure of (Gly4Ser)n was utilized by the linkers. Comparison of the similarity of original VH/VL and VHn/VLn was carried out by applying the algorithm of spatial hierarchical alignment based on the spherical coordinates. The fore and aft distance and diffusion radius of alpha (α) were also calculated. The stability of antibody with different linker length was then compared. ELISA method was adopted to evaluate the immunological activity of single-chain antibody with different linkers. MTT assay was used to analyze the inhibition effect of ScFv-n on CC cells. RESULTS: When n = 4, the structures were the most similar between ScFv and the original VH/VL. When n = 3, the influence of adding connecting peptide on the stability of single-chain antibody was the least. The result of ELISA and MTT methods indicated that when n = 3, single-chain antibody gained the highest activity. CONCLUSION: The optimum length of linker of anti-human CC single-chain antibody was n = 3 from the point of mathematical modeling and biology experiments. This study provided new ideas for the design and constructions of single-chain antibody, and theoretical basis for the treatment of CC.

[Introduction and application of European Academy of Paediatric Dentistry judgment criteria and scoring system for molar-incisor hypomineralization].

Molar-incisor hypomineralization (MIH) is defined as an enamel mineralization defect caused by systemic factors, which is characterized by demarcated opacities. These opacities are liable to result in brittle hypomineralized enamel breakdown, which expediting the eventual development of cavities, even tooth loss. Early diagnosis and prompt intervention are essential. The MIH scoring system based on the diagnostic criteria of the European Academy of Paediatric Dentistry (EAPD) is internationally recognized. This system is particularly helpful to diagnose and evaluate the MIH, as well as conductive to the performance of epidemiological investigations. This paper gives a presentation on the EAPD judgment criteria and scoring system as well as their applications, based on the current situation of MIH studies and our findings of MIH epidemiological investigation.

Cryptanshinone extract of Salvia miltiorrhiza stimulates pediatric acute myeloid leukemia stem cell apoptosis and the anti-inflammatory mechanism via accelerating microRNA-211-5p to supress Janus kinase 2/signal transducer and activator of transcription 3 signaling pathway activation.

This study was designed to explore cryptanshinone (CPT) extract of Salvia miltiorrhiza stimulating pediatric acute myeloid leukemia (AML) stem cell (LSC) apoptosis and anti-inflammatory mechanism via accelerating microRNA (miR)-211-5p to restrain Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway activation. Obtaining blood samples from pediatric acute myeloid leukemia patients and healthy volunteers and detecting miR-211-5p and JAK2 were performed. Purchase of the human AML cell line KG1a was conducted, and sorting of KG1a cells was to gain LSC. Test of miR-211-5p and JAK2, the phosphorylation of JAK2/STAT3 was implemented. Pretreatment of LSCs was with CPT. Variation of miR-211-5p and JAK2 in LSCs was via plasmid transfection to explore their actions in cell advancement with apoptosis and inflammation. Identification of the targeting of miR-211-5p with JAK2 was implemented. In results: MiR-211-5p was declined in endometrial cancer, while JAK2 was elevated; CPT was available to boost LSC apoptosis and restrain the inflammation; elevated miR-211-5p or repressive JAK2 was available to strengthen the acceleration of CPT on LSCs apoptosis and the repression of inflammation; MiR-211-5p targeted JAK2; augmented JAK2 was available to turn around the action of elevated miR-211-5p. We conclude that CPT extract of Salvia miltiorrhiza stimulated pediatric LSC apoptosis and restrained the inflammation via accelerating microRNA (miR)-211-5p to suppress JAK2/STAT3 pathway activation.

Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms.

It is important for dental care professionals to reliably assess carbon dioxide (CO2) levels and ventilation rates in their offices in the era of frequent infectious disease pandemics. This study was to evaluate CO2 levels in dental operatories and determine the accuracy of using CO2 levels to assess ventilation rate in dental clinics. Mechanical ventilation rate in air change per hour (ACHVENT) was measured with an air velocity sensor and airflow balancing hood. CO2 levels were measured in these rooms to analyze factors that contributed to CO2 accumulation. Ventilation rates were estimated using natural steady-state CO2 levels during dental treatments and experimental CO2 concentration decays by dry ice or mixing baking soda and vinegar. We compared the differences and assessed the correlations between ACHVENT and ventilation rates estimated by the steady-state CO2 model with low (0.3 L/min, ACHSS30) or high (0.46 L/min, ACHSS46) CO2 generation rates, by CO2 decay constants using dry ice (ACHDI) or baking soda (ACHBV), and by time needed to remove 63% of excess CO2 generated by dry ice (ACHDI63%) or baking soda (ACHBV63%). We found that ACHVENT varied from 3.9 to 35.0 in dental operatories. CO2 accumulation occurred in rooms with low ventilation (ACHVENT ≤6) and overcrowding but not in those with higher ventilation. ACHSS30 and ACHSS46 correlated well with ACHVENT (r = 0.83, P = 0.003), but ACHSS30 was more accurate for rooms with low ACHVENT. Ventilation rates could be reliably estimated using CO2 released from dry ice or baking soda. ACHVENT was highly correlated with ACHDI (r = 0.99), ACHBV (r = 0.98), ACHDI63% (r = 0.98), and ACHBV63% (r = 0.98). There were no statistically significant differences between ACHVENT and ACHDI63% or ACHBV63%. We conclude that ventilation rates could be conveniently and accurately assessed by observing the changes in CO2 levels after a simple mixing of household baking soda and vinegar in dental settings.

Dental Care and Oral Health under the Clouds of COVID-19.

KNOWLEDGE TRANSFER STATEMENT: This commentary provides a timely evidence-based overview on the impact of COVID-19 on dental care and oral health and identifies gaps in protection of patients and staff in dental settings. Oral symptoms are prominent before fever and cough occur. Dental professionals may play an important role in early identification and diagnosis of patients with COVID-19.

Characterization of cadmium uptake and translocation in a cadmium-sensitive mutant of rice (Oryza sativa L. ssp. japonica).

To understand the physiological mechanism that confers Cd sensitivity/tolerance, Cd uptake and translocation by Cd-sensitive mutant and wild-type rice seedlings were characterized using radioactive tracer. Time-dependent Cd accumulation during 210 min was 1.8-fold higher in roots of the mutant than of wild-type rice. The kinetics of Cd uptake showed that two processes were involved: a first, fast, probably passive process and a second, slower, possibly physiological process. After 96 h, more Cd was translocated to the shoot of mutant compared with wild-type rice. Low temperature (2 degrees C), carbonyl cyanide m-chlorophenylhydrazone, and dicyclohexylcarbodiimide inhibited Cd accumulation to a greater extent in mutant than wild-type rice, suggesting that metabolism plays a more important role in Cd uptake for the rice mutant. Cd uptake into the symplasm is linked to Ca2+ transport, as revealed by the inhibition of Cd accumulation by La and high Ca by equal percentages in both mutant and wild-type rice. Cd uptake and root-to-shoot translocation in the mutant were inhibited more markedly by Zn and Mn than in wild-type rice. This indicates that transport sites other than entry into the root symplasm are also stimulated in the mutant. The results suggest that enhanced absorption into the root and further accumulation in the shoot is one of the mechanisms involved in Cd accumulation and sensitivity, and the difference in Cd uptake and root-to-shoot translocation between mutant and wild-type rice may be mediated partly by energy supply and transporters for Zn and Mn.

[Homosexual behavior and related factors among married men who have sex with men in Mianyang city, Sichuan province].

Objective: To understand the homosexual behavior and related factors among married MSM in Mianyang city. Methods: Between January and October in 2017, a snowball sampling method was adopted to carry out cross-sectional survey through questionnaires plus HIV testing among those MSM in Mianyang city. Logistic regression model was used to analyze homosexual behaviors and related factors among married MSM under study. Statistical analysis was used by EpiData 3.1 and SPSS 19.0 software. Results: A total of 234 MSM participated in this survey. The overall rate of homosexual behavior in these married MSM appeared as 94.9% (222/234). Rate of having anal sex behavior was 94.4% (221/234) in the past 6 months, with rate of condom use as 57.9% (128/221). HIV positive rate was 8.1% (18/222). As for the motives for homosexual behavior after marriage, 87.8% (195/222) were driven by feelings of love, 12.2% (27/222) due to 'releasing pressure'. Proportion of male sex partners would include occasional sex partners (62.2%, 138/222), stable male sex partners (26.1%, 58/222) and stable boyfriends (11.7%, 26/222). Factors from logistic regression analysis showed that homosexual behaviors were related to the factors including education level of senior high school or above vs. education level of junior middle school or below (OR=3.65, 95%CI: 1.33-9.98); local residency over one year vs. the ones having local residency less than one year (OR=23.28, 95%CI:1.67-324.89); having 10 or more friends in the MSM community vs. having below 10 friends in MSM community (OR=4.15, 95%CI: 1.28-13.43); without sex pleasure with spouse vs. having sex pleasure with spouse (OR=3.25, 95%CI: 1.22-8.62); having 2 or more anal sex partners in the past 6 months vs. having less than 2 anal sex partners in the past 6 months (OR=0.28,95%CI: 0.09-0.81). Conclusions: The rate of homosexual behavior and HIV positive rate were high among MSM in Mianyang city. Homosexual behaviors after marriage were influenced by multiple factors among MSM. The motives of homosexual behavior after marriage were driven by feelings of love, the related factors were education level of senior high school or above, local residency over one year, having 10 or more friends in the MSM community and without sex pleasure with spouse. As for the motives of these behaviors was caused by releasing pressure, the related factors was having more than 2 anal sex partners.

[Oral and maxillofacial surgery residency training in the United States: what can we learn].

China is currently in the process of establishing formal residency training programs in oral and maxillofacial surgery and other medical and dental specialties. Regulatory agencies, and educational and academic institutions in China are exploring mechanisms, goals and standards of residency training that meet the needs of the Chinese healthcare system. This article provides an introduction of residency training in oral and maxillofacial surgery in the United States, with emphasis on the accreditation standard by the Commission on Dental Accreditation. As there are fundamental differences in the medical and dental education systems between China and United States, the training standards in the United States may not be entirely applicable in China. A competency-based training model that focus on overall competencies in medical knowledge, clinical skills and values at the time of graduation should be taken into consideration in a Chinese residency training program in oral and maxillofacial surgery.

Surface Properties and Color Stability of Resin-Infiltrated Enamel Lesions.

OBJECTIVES: To examine the surface topographies, microhardness, and color stability of resin-infiltrated enamel lesions before and after aging challenges in vitro using three-dimensional laser scanning profilometry, surface microhardness testing, spectrophotometry, and scanning electron microscopy. METHODS: Forty human third molars were embedded in epoxy resin, and each tooth was prepared to have two white spot lesions and one sound enamel area. One white spot lesion received resin infiltration and the other was untreated. Ten specimens were subjected to thermocycling for 10,000 cycles, 10 specimens were immersed in coffee solutions, and 10 specimens were placed in water storage. Surface area roughness (Sa), Vickers microhardness (VHN), and CIE L*a*b* color values were measured on sound enamel, resin-infiltrated lesions, and untreated lesions before and after aging. The surface morphology of resin-infiltrated lesions was observed after aging under scanning electron microscopy and compared with 10 specimens that were not subjected to aging challenge. RESULTS: Resin infiltration increased the surface microhardness of the enamel lesions from 89.3 to 212.0 VHN. The surface microhardness of resin-infiltrated enamel lesions was not significantly affected by aging. The surface roughness of resin-infiltrated lesions (0.32-0.37 µm) was greater than that of sound enamel (0.05-0.06 µm) and untreated lesions (0.12-0.13 µm). Thermocycling and water storage further increased surface roughness of resin-infiltrated surfaces. Resin-infiltrated enamel lesions showed greater discoloration than sound enamel surfaces. Surface microfissures and microcracks were observed on resin-infiltrated enamel lesions after thermocycling. CONCLUSIONS: Surface hardness of enamel lesions increased significantly after resin infiltration and remained stable following thermocycling. Surface roughness and color stability of resin-infiltrated enamel lesions were less than ideal and might further deteriorate after aging in the oral environment.

External Dentin Stimulation Induces ATP Release in Human Teeth.

ATP is involved in neurosensory processing, including nociceptive transduction. Thus, ATP signaling may participate in dentin hypersensitivity and dental pain. In this study, we investigated whether pannexins, which can form mechanosensitive ATP-permeable channels, are present in human dental pulp. We also assessed the existence and functional activity of ecto-ATPase for extracellular ATP degradation. We further tested if ATP is released from dental pulp upon dentin mechanical or thermal stimulation that induces dentin hypersensitivity and dental pain and if pannexin or pannexin/gap junction channel blockers reduce stimulation-dependent ATP release. Using immunofluorescence staining, we demonstrated immunoreactivity of pannexin 1 and 2 in odontoblasts and their processes extending into the dentin tubules. Using enzymatic histochemistry staining, we also demonstrated functional ecto-ATPase activity within the odontoblast layer, subodontoblast layer, dental pulp nerve bundles, and blood vessels. Using an ATP bioluminescence assay, we found that mechanical or cold stimulation to the exposed dentin induced ATP release in an in vitro human tooth perfusion model. We further demonstrated that blocking pannexin/gap junction channels with probenecid or carbenoxolone significantly reduced external dentin stimulation-induced ATP release. Our results provide evidence for the existence of functional machinery required for ATP release and degradation in human dental pulp and that pannexin channels are involved in external dentin stimulation-induced ATP release. These findings support a plausible role for ATP signaling in dentin hypersensitivity and dental pain.

Anti-fertility and other actions of gossypol analogues.

From a series of gossypol derivatives studied, we conclude that the carbonyl groups of gossypol are needed for inhibition of erythrocyte anion transport and the hydroxy groups affect but are not essential to that inhibition. In an in vitro mouse erythroleukemia cytocidal assay, the most active compounds were gossypol and apogossypol. The latter was not active in the inhibition of erythrocyte anion transport or in a spermicidal assay. Of the more simple structures related to gossypol, those that were active in the cytocidal and spermicidal assays were bi-aromatic, linked by a 1- and not a 4-carbon chain and had free phenolic hydroxyl groups. These results are included in a discussion of the specificity and mechanism of action of gossypol.

PIP: The analysis of multiple biological assays of gossypol and its derivatives suggests that the carbonyl groups of gossypol are required for inhibition of erythrocyte anion transport and the hydroxy groups affect but are not essential to that inhibition. In an in vitro mouse erythroleukemia cytocidal assay, the most active compounds were gossypol and apogossypol. The latter was not active in the inhibition of erythrocyte anion transport or in a spermicidal assay. Of the more simple structures related to gossypol, those that were active in the cytocidal and spermicidal assays were biaromatic, linked by a 1- and not a 4-carbon chain, and had free phenolic hydroxyl groups. When gossypol inhibits the anion transporter, the carbonyl group does not seem to form a Schiff base. Gossypol is a unique compound since it alone, but not any of its derivatives, has in vivo as well as in vitro antifertility activity. It remains unknown, however, whether similar mechanisms are involved in gossypol's in vivo and in vitro effects. In whatever manner gossypol exerts its toxic effects, the selectivity for testicular tissue must be explained.

[3H]-forskolin binding sites in rat submandibular salivary glands.

Specific [3H]-forskolin binding was linear as a function of the membrane protein concentration and reached steady-state by 30-40 min of incubation at 37 degrees C. Such binding was saturable and the bound radioligand could be readily dissociated by an excess of unlabelled forskolin. There was only one type of binding site, with a dissociation constant (Kd) of 0.16 microM. The concentration of the binding sites (Bmax) was 0.73 pmol/mg protein. There was no significant difference in the [3H]-forskolin binding characteristics in membranes of rats fed for 6 weeks on diets containing 10% corn oil, 8% coconut oil + 2% corn oil, or 10% menhaden fish oil.

[3H]forskolin- and [3H]dihydroalprenolol-binding sites and adenylate cyclase activity in heart of rats fed diets containing different oils.

The characteristics of the cardiac adenylate cyclase system were studied in rats fed diets containing fish oil (menhaden oil) and other oils. Adenylate cyclase activity generally was higher in cardiac homogenates and membranes of rats fed diet containing 10% menhaden oil than in the other oils. The increase in enzyme activity, especially in forskolin-stimulated activity, was associated with an increase in the concentration of the [3H] forskolin-binding sites in cardiac membranes of rats fed menhaden oil. The beta-adrenergic receptor concentration was not significantly altered although the affinity for [3H]dihydroalprenolol-binding was lower in membranes of rats fed menhaden oil than those fed the other oils. omega-3 fatty acids from menhaden oil were incorporated into the cardiac membrane phospholipids. The results suggest that the observed increase in myocardial adenylate cyclase activity of rats fed menhaden oil may be due to an increase in the number of the catalytic subunits of the enzyme or due to a greater availability of the forskolin-binding sites.

Effect of dietary trans fatty acids on some membrane-associated enzymes and receptors in rat heart.

Three groups of male weanling Sprague-Dawley rats were fed diets containing 20% corn oil, 20% partially hydrogenated soybean oil (PHSBO) or 18% PHSBO + 2% corn oil. PHSBO contained about 48% of its total fatty acids as trans-octadecenoate. Rats were killed after 16-18 weeks of feeding the various diets, hearts were dissected and crude sarcolemma was prepared by differential centrifugation. The activities of ouabain-sensitive (Na+ + K+)ATPase were significantly lower in membranes of rats fed 20% PHSBO than the control rats fed 20% corn oil. The feeding of 2% corn oil with 18% PHSBO resulted in partial restoration of the enzyme activity. The maximum number of [3H]ouabain-binding sites (Bmax) was also lower in cardiac membranes of rats fed 20% PHSBO than those fed 20% corn oil. Similar to (Na+ + K+)-ATPase activity, some restoration of the number of [3H]ouabain-binding sites was observed when 2% corn oil was fed with 18% PHSBO-containing diet. There was no difference in the binding affinity of the radioligand for the receptor among the 3 dietary groups. Adenylate cyclase activities (fluoride-, isoproterenol- and forskolin-stimulated) were lower in membranes of rats fed 20% PHSBO or 18% PHSBO + 2% corn oil than in the control group fed 20% corn oil. Density of the beta-adrenergic receptor was the lowest in cardiac membranes of rats fed 20% PHSBO. The feeding of 2% corn oil with 18% PHSBO resulted in partial restoration of the maximum number of [3H]dihydroalprenolol (DHA)-binding sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylate cyclase and beta-receptors in salivary glands of rats fed diets containing trans fatty acids.

The effects of trans fatty acids on adenylate cyclase were determined in the submandibular salivary glands (SMSG) of rats fed diets containing 20% corn oil, 20% partially hydrogenated soybean oil (PHSBO) or 18% PHSBO + 2% corn oil. The fluoride- and isoproterenol-stimulated adenylate cyclase activities were higher in the SMSG from rats fed 20% PHSBO than in the control group fed 20% corn oil. The feeding of 2% corn oil with the diet containing 18% PHSBO resulted in a complete restoration of isoproterenol-stimulated and a partial restoration of fluoride-stimulated adenylate cyclase activity. There was no significant difference in the concentration of the beta-adrenergic receptor or in the receptor-binding affinity constants among the three dietary groups as measured by [3H]dihydroalprenolol (DHA)-binding. Higher fluorescence polarization of diphenyl hexatriene (DPH) was observed in SMSG membranes of rats fed diet containing 20% PHSBO than in the other two oils, suggesting that membrane fluidity may play a role in adenylate cyclase activity.

A modified palatopharyngeous flap operation and its application in the correction of velopharyngeal incompetence.

The conventional sphincteric pharyngoplasty does not achieve velopharyngeal competence in certain cases because of the intrinsic deficiency of the technique. A modified palatopharyngeous flap operation was introduced and used as a secondary procedure for the correction of velopharyngeal incompetence in 15 cleft palate patients. The results showed that the lateral-to-lateral connection and the high attachment of the palatopharyngeal flaps can form a new velopharyngeal port that is easily closed by velar movement. The surgical result is satisfactory, as revealed by the speech intelligibility test, videofluoroscopy, and nasopharyngoscopy. The surgical technique is described and the importance of presurgical identification of velopharyngeal movements is stressed in this paper.

Magnetic resonance imaging of the temporomandibular joint: value of pseudodynamic images.

Magnetic resonance fast scanning technique (gradient recalled acquisition at steady state) has been reported to be useful when evaluating the dynamics of the temporomandibular joint and also to be accurate for determining the disk position. Yet in our clinical experience gradient recalled acquisition at steady state images have frequently been inferior to proton density images for diagnosis of temporomandibular joint internal derangement. The first aim of this study was to compare gradient recalled acquisition at steady state images with proton density images for diagnosis of disk position. The second aim was to identify what additional information could be gathered from gradient recalled acquisition at steady state images when compared with static proton density images. We obtained unilateral images from 20 patients with signs and symptoms of temporomandibular joint internal derangement and from 20 asymptomatic volunteers. Multiple gradient recalled acquisition at steady state images were obtained during mouth opening and closing and proton density images were obtained at the closed and open mouth positions. The results showed that the gradient recalled acquisition at steady state images were in accordance with the proton density images in 32 joints (80%) and were false negative in 8 joints (20%). Six of the joints with false-negative gradient recalled acquisition at steady state images showed sideways disk displacement, and two showed partial anterior disk displacement. Gradient recalled acquisition at steady state images, on the other hand, provided information about movement pattern and also demonstrated impingement of the joint structures on the muscles anterior to the joint at maximal mouth opening. It was concluded that gradient recalled acquisition at steady state images cannot replace proton density images for diagnosis of disk position but they can provide supplementary information for evaluation of joint function.