Persistent Widening Research Articles

Three-dimensional Assessment of Longitudinal Surgical Outcome in Patients with Unilateral Cleft Lip and Palate: A Modified Rotation Advancement Technique.

Optimization of a modified rotation advancement technique is hampered by lack of objective measures to quantify the longitudinal surgical outcome. We collected and assessed facial 3D images of 115 consecutive patients who underwent primary repair between 2017 and 2019. Photogrammetry was performed preoperatively, immediately postoperatively and at a first and second follow-up interval, occurring at an average year of 0.6 and 5.3 years, respectively. 10 additional age-matched noncleft control subjects were also included. Growth lag in cleft side lateral lip and gradual elongation of medial lip height on the cleft side caused continuous deviation of philtrum towards the cleft side. The columellar length on the cleft side continued to grow slower, accompanied by a persistent widening of alar base width on the cleft side, leading to in the gradual deviation of columella towards the cleft side. The pre-operative and post-operative nasolabial asymmetry would increase with greater degree of postoperative deficiencies. Right clefts presented with greater degrees of deficiencies in lateral lip height in preoperative measurement, but this discrepancy of the laterality of clefts was not observed in the two follow-up periods. The surgical outcome of this modified rotational advancement technique in unilateral cleft lip primary repair is promising. Growth lag in lateral lip and lateral displacement of alar base cause continuous deviation of philtrum towards the cleft side. Pre-operative severity does predict post-operative outcomes. Laterality of oral clefts does not significantly affect the long-term outcomes of surgery. This surgical technique meets the current trend of cleft lip and palate primary repair and is worth promoting.

Labor market outcomes during opposite resource shocks: the 2009 and 2012 earthquakes in Italy

The 2009 and 2012 earthquakes in Italy occurred in a close-knit region and time horizon but differed substantially on both the initial shock to the stock and the subsequent flow of resources. This paper considers the short run impact on the dynamic response of labor market outcomes. Both earthquakes lowered employment and labor force participation by more than 0.5%. With its negative effect on the resources available, the 2009 shock led to a drop in real wages of 1.3% and a sharp—but short-lived—widening of the wage gap generated by the skill premium. The 2012 earthquake, which led firms to upgrade their technology, increased wages by 2.2% and led to a more balanced—but persistent—widening of the wage gap. The predictions of a model developed in this paper are consistent with these results.

Sovereign risk and financial risk

In this paper, we study the interplay between sovereign risk and global financial risk. We show that a substantial portion of the comovement among sovereign spreads is accounted for by changes in global financial risk. We construct bond-level sovereign spreads for dollar-denominated bonds issued by over 50 countries from 1995 to 2020 and use various indicators to measure global financial risk. Through panel regressions and local projection analysis, we find that an increase in global financial risk causes a large and persistent widening of sovereign bond spreads. These effects are strongest when measuring global risk using the excess bond premium – a measure of the risk-bearing capacity of U.S. financial intermediaries. The spillover effects of global financial risk are more pronounced for speculative-grade sovereign bonds.

Persistent widening in racial disparities between black and white women undergoing art over the last 10 years

Persistent widening in racial disparities between black and white women undergoing art over the last 10 years

Treatment of Deltoid Injuries Associated With Ankle Fractures

Complete avulsion of the superficial deltoid complex off the medial malleolus can occur during high-energy ankle fractures in young patients. Partial deltoid ligament injuries can also occur with avulsion fractures off the tip of the medial malleolus in low-energy ankle fractures in the elderly. Infolding and retraction of the avulsed deltoid complex can cause persistent widening of the medial clear space and lead to ankle fracture malreduction, postoperative medial gutter pain, and medial ankle instability. It is important for physicians to recognize and repair superficial deltoid ligament injuries in the setting of ankle fractures in order to restore ankle collateral ligament anatomy and help improve clinical outcomes. The deep deltoid ligament is generally difficult to repair in the acute setting and reconstructed later on if chronic ankle instability and valgus deformity develop in the future. Level of Evidence: Level V—Expert Opinion.

Disparities in the Prevalence of Diagnosed Diabetes - United States, 1999-2002 and 2011-2014.

The prevalence of diabetes mellitus has increased rapidly in the United States since the mid-1990s. By 2014, an estimated 29.1 million persons, or 9.3% of the total population, had received a diagnosis of diabetes (1). Recent evidence indicates that the prevalence of diagnosed diabetes among non-Hispanic black (black), Hispanic, and poorly educated adults continues to increase but has leveled off among non-Hispanic whites (whites) and persons with higher education (2). During 2004-2010, CDC reported marked racial/ethnic and socioeconomic position disparities in diabetes prevalence and increases in the magnitude of these disparities over time (3). However, the magnitude and extent of temporal change in socioeconomic position disparities in diagnosed diabetes among racial/ethnic populations are unknown. CDC used data from the National Health Interview Survey (NHIS) for the periods 1999-2002 and 2011-2014 to assess the magnitude of and change in socioeconomic position disparities in the age-standardized prevalence of diagnosed diabetes in the overall population and among blacks, whites, and Hispanics. During each period, significant socioeconomic position disparities existed in the overall population and among the assessed racial/ethnic populations. Disparities in prevalence increased with increasing socioeconomic disadvantage and widened over time among Hispanics and whites but not among blacks. The persistent widening of the socioeconomic position gap in prevalence suggests that interventions to reduce the risk for diabetes might have a different impact according to socioeconomic position.

Use of β-tricalcium phosphate grafts for Airway reconstruction in rabbits: A pilot study

To assess the safety and feasibility of using β-tricalcium phosphate grafts in airway reconstruction in rabbits. Interventional animal study. Ten New Zealand White rabbits underwent division of the anterior cricoid cartilage with interposition of a graft sculpted from β-tricalcium phosphate blocks. Grafts were secured with sutures or were self-retaining. Rabbit larynges were harvested according to the following schedule: one at 1 week, one at 3 months, and two each at 2 weeks, 4 weeks, 6 months, and 1 year after graft implantation. Specimens were evaluated grossly for overall graft incorporation. Sections through the graft substance were prepared for histology. All sections were reviewed by a pathologist for evidence of vascular ingrowth, granulation tissue, inflammation, epithelialization, and graft resorption. There were no major postoperative complications. Gross examination revealed persistent widening of the airway at the level of graft placement. Histologic evaluation of the larynges showed growth of new blood vessels within all specimens and absence of significant granulation tissue near the airway lumen. The graft was at least partially covered by an epithelium in seven of the 10 specimens. Evidence of graft resorption was present as early as 4 weeks after implantation, with replacement of the graft substance by fibrous tissue, fatty tissue, bone, or cartilage. β-tricalcium phosphate grafts can be used safely in airway reconstruction procedures in rabbits. Further research is necessary to demonstrate its safety in human airway reconstruction in addition to further clarifying the processes of graft resorption and integration. NA Laryngoscope, 126:E255-E260, 2016.

Ligamentous advancement for the treatment of subacute syndesmotic injuries. Report of a new technique in 5 cases.

Integrity and optimum functioning of the syndesmotic ligament complex is of paramount importance for stability of the ankle joint during various ankle movements. Persistent widening and chronic isolated instability of the distal tibio-fibular syndesmosis leads to poor functional outcome and the development of osteoarthritis. In subacute total ruptures the focus of treatment is to restore the normal anatomy by repair of the ruptured ligament and to protect the reconstruction for a period of time. Various techniques have been previously reported with good results but associated with donor site morbidity and multiple incisions. Ligamentous advancement allows repair of the syndesmosis when the AITFL is dysfunctional but intact. The lax AITFL was mobilised with periosteum from the tibia leaving the fibular side intact. The Syndesmosis was cleared, reduced with a clamp, and held with two syndesmotic screws inserted transversely between the distal fibular and tibial shafts. The tibial surface was roughened to receive the new attachment of AITFL. The sleeve of tissue was then secured to the roughened tibial surface under tension using suture anchors with the ankle in neutral position. The repair was protected with a two hole plate and screws. The functional outcome scores showed excellent outcome at the end of 6 months. Ligamentous advancement technique obviates the need of any bony procedure and does not involve the use of any material which will lead to any sort of foreign body reaction or donor site morbidity while providing anatomical reconstruction of the syndesmosis with excellent functional outcome.

Development Strategy, Urbanization and the Urban-Rural Income Gap in China

Analyzing the reasons for the lag in urbanization and the persistent widening of the urban- rural income gap in China from the viewpoint of government development strategy, we find that the government’s strategy of encouraging the development of capital-intensive sectors has resulted in a relative fall in labor demand in urban areas and thus delayed the progress of urbanization, hampered the effective transfer of the rural population into urban areas and widened the urban-rural income gap. Using the technology choice index (TCI) to measure the degree to which government policy is biased towards capital-intensive sectors, this paper conducts empirical tests of a series of theoretical hypotheses on the basis of Chinese provincial panel data for 1978-2008. We further find that changes in China’s urban-rural income gap conform to a U-curve pattern, i.e. in the course of economic development, the income gap first decreases then increases.

Modeling of Interest Rate Term Structures Under Collateralization and its Implications

In recent years, we have observed dramatic increase of collateralization as an important credit risk mitigation tool in over the counter (OTC) market [6]. Combined with the significant and persistent widening of various basis spreads, such as Libor-OIS and cross currency basis, the practitioners have started to notice the importance of difference between the funding cost of contracts and Libors of the relevant currencies. In this article, we integrate the series of our recent works [1, 2, 4] and explain the consistent construction of term structures of interest rates in the presence of collateralization and all the relevant basis spreads, their no-arbitrage dynamics as well as their implications for derivative pricing and risk management. Particularly, we have shown the importance of the choice of collateral currency and embedded cheapest-to-deliver (CTD) option in a collateral agreement.

The importance of decoupling between freight transport and economic growth

In France and Europe, mobility and economic activity have developed with the same growth rate for several decades. This trend has to be prolonged with short – medium terms. The correlation observed between transport demand, in particular of goods, and economic growth throws light on the concepts of coupling / uncoupling which have been proposed in literature for a few years. In September 2001, the decoupling notion leaves the narrow world of the economists of transport where it had appeared a few years earlier, to be revealed with a widened public, with the favour of the publication of the European Commission’s white paper « European transport policy for 2010: time to decide ». Here, the coupling means that freight transport demand is correlated with economic growth. This perception permits to analyse underlying freight transport logics and to suggest different means for reducing negative externalities. The growth of freight transport demand, usually expressed in ton kilometres, is more easily explained by the rise of the consumption of physical distances than by transported tonnes. The spatial dimension is thus in the centre of our problems. In fact, freight transport demand is function of distances, themselves defined by the modes of interaction between manufacturing units. The approach of decoupling is based on the links between industrial and logistic organisations, location of activities and planning of freight transport systems. The hypothetical close link between industrial and spatial organisations and supply chain management has been confirmed by several scientific works (David Banister, Peter Nijkamp, Dominic Stead, Roger Vickerman). This validation rests on the analysis of industry location drivers. We can then explain the logistic organisations that govern their interactions. The aim of this research is to improve the sustainable mobility reflexion from current behaviour of freight mobility and their determinants. How is explained the trend and regular lengthening distances covered, the higher frequency of forwardings? How is explained the continuous and persistent widening of surfaces of provisioning and distribution? Several scientists defend the thesis which spatial spreading out of industrial units permits the reduction of production costs, scope economy and the improvement of wellbeing. Our work is focused on the variable “distance” like a component of the overall consumption of transport. So, we are interested in the capacity of industrial and distribution organisations to adopt another spatial behaviour. The aim is to reduce the consumption of physical distances and/or to improve the transfer of merchandises from road to other means of transport like rail, inland waterways or short sea shipping. This approach is deliberately registered in the field of economic geography, then complementary of the economic entry of the thesis of decoupling.

The homeoprotein engrailed 1 has pleiotropic functions in calvarial intramembranous bone formation and remodeling

The membranous bones of the mammalian skull vault arise from discrete condensations of neural crest- and mesodermally-derived cells. Recently, a number of homeodomain transcription factors have been identified as critical regulators of this process. Here, we show that the homeoprotein engrailed 1 (EN1) is expressed during embryonic and perinatal craniofacial bone development, where it localizes to the skeletogenic mesenchyme, and, subsequently, to calvarial osteoblasts and osteoprogenitors. Mice lacking En1 exhibit generalized calvarial bone hypoplasia and persistent widening of the sutural joints. A reduction in calvarial membranous bone deposition and mineralization (osteopenia) is coupled to enhanced osteolytic resorption in En1 mutants. Consistent with these observations, expression of established osteoblast differentiation markers reveals that En1 function is required for both early and late phases of calvarial osteogenesis. Further analysis shows that EN1 regulates FGF signaling in calvarial osteoblasts. Moreover, EN1 indirectly influences calvarial osteoclast recruitment and bone resorption by regulating the expression of receptor activator of NFkappaB ligand (RANKL) in osteoblasts. Thus, during intramembranous bone formation, EN1 acts both cell autonomously and non-cell autonomously. In summary, this study identifies EN1 as a novel modulator of calvarial osteoblast differentiation and proliferation, processes that must be exquisitely balanced to ensure proper skull vault formation.

Ankle Stress Test for Predicting the Need for Surgical Fixation of Isolated Fibular Fractures

The purpose of this study was to confirm the prevalence of medial ankle widening among patients with an isolated fibular fracture and to determine the functional outcome of nonoperative treatment despite a diagnosis of a supination-external rotation stage-IV injury based on stress radiography. One hundred and one patients with evidence of an isolated fibular fracture and an intact mortise seen on a standard ankle trauma radiograph series were evaluated with stress radiographs. Clinical signs were recorded at the time of presentation. A positive stress test was defined as > or =4 mm of widening of the medial clear space. Patients with a negative stress test were treated nonoperatively, those with a positive stress test and clinical signs of medial injury were treated surgically, and those with a positive stress test and no signs of medial injury were treated according to the preference of the surgeon and patient. The patients were followed prospectively with radiographs and ankle outcome scores. Sixty-six (65%) of the 101 patients had a positive stress radiograph. Thirty-six of them had signs of medial injury, and thirty had no medial injury. With regard to predicting a positive stress radiograph, medial tenderness had a sensitivity of 56% and a specificity of 80%, swelling had a sensitivity of 55% and a specificity of 71%, and ecchymosis had a sensitivity of 26% and a specificity of 91%. Of the subset of patients without signs of medial injury, twenty were treated nonoperatively (group I) and ten were treated operatively (group II). Two of the twenty patients in group I had evidence of persistent widening of the medial clear space at the time of the latest follow-up (mean, 7.4 months); only one of those patients was symptomatic. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 94 points in group I and 93 points in group II. We found a high rate of positive stress radiographs for patients who presented with an isolated fibular fracture and an intact ankle mortise on the initial radiographs. Medial tenderness, swelling, and ecchymosis were not sensitive with regard to predicting widening of the medial clear space on stress radiographs. All of the patients with a positive stress radiograph and no clinical symptoms who were treated without surgery had a good or excellent clinical result.

Wrist kinetics after scapholunate dissociation: the effect of scapholunate interosseous ligament injury and persistent scapholunate gaps

The purpose of this study was to investigate the effects of cutting of the scapholunate interosseous ligament (SLIL) and persistent widening of the scapholunate (SL) joint on changes in moment arms of the principal wrist motor tendons. In seven fresh frozen cadaveric upper extremities, excursions of the extensor carpi radialis longus (ECRL) and brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) were recorded simultaneously with wrist joint angulation during wrist flexion–extension and radioulnar deviation. Tendon excursions were measured in intact wrists, then in the wrists with complete SLIL sectioning and in those with moderate or severe persistent SL joint widening. The data were converted to moment arms of the tendons. The results showed that moment arms of the ECRL and ECRB tendons after SLIL sectioning were, respectively, 110±6% and 105±3% of those in the intact wrist. In the wrists with moderate or severe SL joint widening, moment arms of the flexors significantly increased ( P<0.01 and P<0.001, respectively). During radioulnar deviation, moment arms of the ECRL, ECRB, ECU, and FCU tendons decreased after SLIL sectioning and the SL joint widening. However, moment arms of the FCR tendon significantly increased 122±23% after the SLIL section, 133±28% after the moderate SL joint widening, and 138±24% after the severe SL joint widening compared with those of the intact wrists. This study demonstrated that integrity of the SLIL and appropriate SL joint space are important for mechanics of wrist motor tendons. Loss of integrity of the SLIL and persistent SL joint widening increase mechanical effects of the radial side wrist motor tendons, which may contribute to the pathomechanics of scaphoid malrotation, scapholunate advanced collapse, and early osteoarthritis in the radioscaphoid joint interface seen in SL dissociation. The results also suggest that reduction of the displaced SL joint is imperative to the recovery of wrist kinetics after SL dissociation.

Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre- and postnatal sonographic screening.

Pre- and postnatal pyelectasis detected by sonographic screening is of questionable pathologic importance. Therefore, we defined the natural course and diagnostic value of renal pelvis diameter (RPD) during fetal life and the neonatal period as such dilatation was revealed on routine sonography. Routine sonography in pregnant women was obtained between gestational weeks 22 and 30. Sonograms were obtained for 1021 fetuses, of which 15 could not be followed up as neonates. The remaining 1006 fetuses also underwent neonatal sonography. All neonates with an RPD larger than 5 mm were followed up sonographically. Neonates with an RPD larger than 9 mm or persistent widening (> 5-9 mm) were examined by voiding cystourethrogram, radionuclide renogram, or both. Thirty fetuses (3%) had an RPD larger than 5 mm. Nine of these fetuses also had an RPD larger than 5 mm as neonates. Of these nine neonates, one had bilateral grade II vesicoureteric reflux (VUR) and two had urinary tract obstructions (one posterior urethral valve and one ureteropelvic junction obstruction). Forty-nine neonates whose results on fetal sonograms had been normal showed an RPD larger than 5 mm on neonatal sonograms. Grade III VUR was found in one boy, and ureteropelvic junction obstruction was found in two boys. The kidneys of 54 neonates who showed an RPD larger than 5 mm without urinary tract obstruction were followed up until an RPD of 0-5 mm was evident. RPD normalized within 1 year of birth, whether VUR was present or not. Symptomatic urinary tract infection was diagnosed in 17 infants who had no renal pelvis dilatation seen on pre-or postnatal screening during the observation period. Seven of the 17 neonates had VUR. Conversely, none of the infants with pre- postnatal dilatation presented with symptomatic urinary tract infection. However, in one neonate an asymptomatic urinary tract infection without VUR was diagnosed by routine urinalysis. In our study, we linked renal pelvis dilatation on pre- and postnatal sonograms to obstructive uropathies rather than to vesicoureteric reflux. Prenatal sonography proved less sensitive than postnatal sonography in revealing obstructive uropathies. An RPD smaller than 10 mm on neonatal sonography was of no pathologic significance because renal collecting systems normalized spontaneously in all infants within 1 year of birth. These neonates and infants had no significant risk for urinary tract infection and did not need further evaluation.

Long-Term Trends in the Saving-Investment Balance and Persistent Current Account Surpluses in a Small Open Economy: The Case of the Netherlands

This paper explores, from an investment-saving perspective, the factors underlying the persistent widening of the current account surplus in the Netherlands since the early 1980s. Standard intertemporal models, even appropriately extended to incorporate specific features of the Dutch economy, do not appear to fully account for this development. Accordingly, the paper focusses attention on the production side of the economy to gain further insight into the trends of the current account. Empirical evidence suggests that changes in relative factor prices and a relative demand shift toward non-tradable goods account for the bulk of the observed widening of the current account surplus. In turn, the impact of these factors on the current account appears to reflect both changes in factor proportions and deviations from perfect competition in the Dutch sheltered sector.

Long-Term Trends in the Saving-Investment Balance and Persistent Current Account Surpluses in a Small Open Economy: The Case of the Netherlands

This paper explores, from an investment-saving perspective, the factors underlying the persistent widening of the current account surplus in the Netherlands since the early 1980s. Standard intertemporal models, even appropriately extended to incorporate specific features of the Dutch economy, do not appear to fully account for this development. Accordingly, the paper focusses attention on the production side of the economy to gain further insight into the trends of the current account. Empirical evidence suggests that changes in relative factor prices and a relative demand shift toward non-tradable goods account for the bulk of the observed widening of the current account surplus. In turn, the impact of these factors on the current account appears to reflect both changes in factor proportions and deviations from perfect competition in the Dutch sheltered sector.

The Value of the Acetabular Teardrop Figure in Assessing Pediatric Hip Disorders

We have observed that the acetabular teardrop figure provides extremely useful information about the development of the hip in young children. Normal development of the acetabulum is associated with progressive narrowing of the teardrop figure and development of a concave shape to its acetabular line. Anatomic and functional abnormalities of the hip can cause abnormalities of the teardrop figure, including absence of the acetabular line, persistent widening, and a V-shaped teardrop figure. In young children, these abnormalities can be reversed to some degree by stabilizing operations, but it is unusual to observe substantial change in appearance of the teardrop figure after a child is aged 8 years.

Calcaneal fractures: three-dimensional treatment.

A series of 22 calcaneal fractures operated over 4 yr is presented. Radiographic evaluation of these fractures using axial, lateral, anteroposterior, and oblique medial projection (Broden's view) with varying tube angulation toward the head and computerized axial tomography in two planes, coronal and transverse, were done. This repeatedly demonstrated intra-articular splitting fractures along the axis of the os calcis through the posterior facet, extending to the calcaneocuboid joint. These fractures were surgically reduced as described by McReynolds with sequential medial and lateral approaches. Intraoperative X-rays demonstrate the three-dimensional nature of this injury. Bohler's angle may be reconstituted with apparent reduction of the posterior facet when projected laterally; however, Broden's and axial views show persistent widening and split of the posterior facet. The 22 patients have been followed from 12 to 46 mo. All have heels of normal width and wear standard shoes. The first two cases, done only medially, have less than anatomic reconstruction of the subtalar joint. Functional results have been encouraging. Of six active duty members so treated, three returned to full duty, a second who was medically retired as a result of other injuries had minimal heel problems, and fifth had a contralateral open pilon fracture which hampers him, and the sixth patient is now 4 mo postbilateral calcaneal fractures with return to duty anticipated. Most of the 22 have some decrease in subtalar motion without apparent gait abnormality. No cases of medial or lateral impingement or tendinitis are present. Fractures of the calcaneus are amendable to open reduction and internal fixation. Sequential medial and anterolateral exposure allow anatomic reconstruction in three dimensions, avoiding pitfalls of two-dimensional analysis and treatment.

Commissural mechanisms of restoration of visual function

The effect of cordarone on the ultrastructure of cardiomyocytes of the periinfarction zone was studied in experiments on 30 cats. Cordarone was injected intramuscularly daily for 3.7 and 15 days in a dose of 10 mg/kg. Experimental myocardial infarction was induced by ligation of the left coronary artery at the border of its medium and inferior thirds. As compared with control, cordarone produced a more demonstrable reduction in the intracellular edema, more rapid recovery of the structure of myofibrils and greater accumulation of glycogen granules by the cytoplasm of cardiomyocytes. At the same time the structure of the mitochondria returned to normal more slowly as compared with control, with persistent widening of the cisternae of the sarcoplasmic reticulum being observed in addition. The changes described indicate that cordarone exerts different actions on the ultrastructure of cardiomyocytes, which is probably based on the drug influence on adrenergic processes and calcium turnover in the myocardium.