Receptor binding motif surrounding sites in the Spike 1 protein of infectious bronchitis virus have high susceptibility to mutation related to selective pressure

Background@#To date, various genotypes of infectious bronchitis virus (IBV) have cocirculated and in Korea, GI-15 and GI-19 lineages were prevailing. The spike protein, particularly S1 subunit, is responsible for receptor binding, contains hypervariable regions and is also responsible for the emerging of novel variants. @*Objective@#This study aims to investigate the putative major amino acid substitutions for the variants in GI-19. @*Methods@#The S1 sequence data of IBV isolated from 1986 to 2021 in Korea (n = 188) were analyzed. Sequence alignments were carried out using Multiple alignment using Fast Fourier Transform of Geneious prime. The phylogenetic tree was generated using MEGA-11 (ver.11.0.10) and Bayesian analysis was performed by BEAST v1.10.4. Selective pressure was analyzed via online server Datamonkey. Highlights and visualization of putative critical amino acid were conducted by using PyMol software (version 2.3). @*Results@#Most (93.5%) belonged to the GI-19 lineage in Korea, and the GI-19 lineage was further divided into seven subgroups: KM91-like (Clade A and B), K40/09-like, QX-like (I-IV).Positive selection was identified at nine and six residues in S1 for KM91-like and QX-like IBVs, respectively. In addition, several positive selection sites of S1-NTD were indicated to have mutations at common locations even when new clades were generated. They were all located on the lateral surface of the quaternary structure of the S1 subunits in close proximity to the receptor-binding motif (RBM), putative RBM motif and neutralizing antigenic sites in S1. @*Conclusions@#Our results suggest RBM surrounding sites in the S1 subunit of IBV are highly susceptible to mutation by selective pressure during evolution.

Dexamethasone reduces infectious bursal disease mortality in chickens

Very virulent infectious bursal disease virus (vvIBDV) causes high mortality in chickens but measures to reduce the mortality have not been explored. Chickens (8–9 weeks) were treated with 3 agents before and during vvIBDV inoculation. Dexamethasone treatment reduced the mortality of infected chickens (40.7% vs. 3.7%; p < 0.001), but treatment with aspirin or vitamin E plus selenium did not affect the mortality. The bursa of Fabricius appeared to have shrunk in both dead and surviving chickens (p < 0.01). The results indicate that dexamethasone can reduce mortality in vvIBDV-infected chickens and may provide therapeutic clues for saving individual birds infected by the virus.

Dexamethasone reduces infectious bursal disease mortality in chickens

Very virulent infectious bursal disease virus (vvIBDV) causes high mortality in chickens but measures to reduce the mortality have not been explored. Chickens (8–9 weeks) were treated with 3 agents before and during vvIBDV inoculation. Dexamethasone treatment reduced the mortality of infected chickens (40.7% vs. 3.7%; p < 0.001), but treatment with aspirin or vitamin E plus selenium did not affect the mortality. The bursa of Fabricius appeared to have shrunk in both dead and surviving chickens (p < 0.01). The results indicate that dexamethasone can reduce mortality in vvIBDV-infected chickens and may provide therapeutic clues for saving individual birds infected by the virus.

Molecular prophage typing of Staphylococcus aureus isolates from bovine mastitis

Staphylococcus aureus is one of the major pathogens causing bovine mastitis and foodborne diseases associated with dairy products. To determine the genetic relationships between human and bovine or bovine isolates of S. aureus, various molecular methods have been used. Previously we developed an rpoB sequence typing (RSTing) method for molecular differentiation of S. aureus isolates and identification of RpoB-related antibiotic resistance. In this study, we performed spa typing and RSTing with 84 isolates from mastitic cows (22 farms, 72 cows, and 84 udders) and developed a molecular prophage typing (mPPTing) method for molecular epidemiological analysis of bovine mastitis. To compare the results, human isolates from patients (n = 14) and GenBank (n = 166) were used for real and in silico RSTing and mPPTing, respectively. Based on the results, RST10-2 and RST4-1 were the most common rpoB sequence types (RSTs) in cows and humans, respectively, and most isolates from cows and humans clearly differed. Antibiotic resistance-related RSTs were not detected in the cow isolates. A single dominant prophage type and gradual evolution through prophage acquisition were apparent in most of the tested farms. Thus, RSTing and mPPTing are informative, simple, and economic methods for molecular epidemiological analysis of S. aureus infections.

Molecular identification of coagulase-negative staphylococci by rpoB sequence typing / 대한수의학회지

Bovine mastitis (BM) has resulted in enormous economic loss in the dairy industry and coagulase-negative staphylococci (CNS) have caused subclinical BM. Although VITEK 2 GP ID card (VITEK 2) has been used for CNS identification, the probability of identification varies. The rpoB sequence typing (RSTing) method has been used for molecular diagnosis and epidemiology of bacterial infections. In this study, we undertook RSTing of CNS and compared the results with those of VITEK2 and 16S rRNA gene sequencing. As compared VITEK2, the molecular-based methods were more reliable for species identification; moreover, RSTing provided more molecular epidemiological information than that from 16S rRNA gene sequencing.

Molecular identification of coagulase-negative staphylococci by rpoB sequence typing

Bovine mastitis (BM) has resulted in enormous economic loss in the dairy industry and coagulase-negative staphylococci (CNS) have caused subclinical BM. Although VITEK 2 GP ID card (VITEK 2) has been used for CNS identification, the probability of identification varies. The rpoB sequence typing (RSTing) method has been used for molecular diagnosis and epidemiology of bacterial infections. In this study, we undertook RSTing of CNS and compared the results with those of VITEK2 and 16S rRNA gene sequencing. As compared VITEK2, the molecular-based methods were more reliable for species identification; moreover, RSTing provided more molecular epidemiological information than that from 16S rRNA gene sequencing.

Optimized clade 2.3.2.1c H5N1 recombinant-vaccine strains against highly pathogenic avian influenza

A/Puerto Rico/8/34 (PR8)-derived recombinant viruses have been used for seasonal flu vaccines; however, they are insufficient for vaccines against some human-fatal H5N1 highly pathogenic avian influenza (HPAI) viruses (HPAIV) due to low productivity. Additionally, the polymerase basic 2 (PB2) protein, an important mammalian-pathogenicity determinant, of PR8 possesses several mammalian-pathogenic mutations. We previously reported two avian PB2 genes (01310 and 0028) related to efficient replication in embryonated chicken eggs (ECEs) and nonpathogenicity in BALB/c mice. In this study, we generated PR8-derived H5N1 recombinant viruses harboring hemagglutinin (attenuated) and neuraminidase genes of a clade 2.3.2.1c H5N1 HPAIV (K10-483), as well as the 01310 or 0028 PB2 genes, and investigated their replication and immunogenicity. Compared with a control virus harboring six internal PR8 genes (rK10-483), the recombinant viruses possessing the 01310 and 0028 PB2 genes showed significantly higher replication efficiency in ECEs and higher antibody titers in chickens. In contrast to rK10-483, none of the viruses replicated in BALB/c mice, and all showed low titers in Madin-Darby canine kidney cells. Additionally, the recombinant viruses did not induce a neutralization antibody but elicited decreased protective immune responses against K10-483 in mice. Thus, the highly replicative and mammalian nonpathogenic recombinant H5N1 strains might be promising vaccine candidates against HPAI in poultry.

Identification of microbiome with 16S rRNA gene pyrosequencing and antimicrobial effect of egg white in bovine mastitis

Bovine mastitis is an important microbial disease in the dairy industry. We investigated the frequencies of bacterial pathogens in 62 farms and pathogen antibiotic resistance from mastitis samples (n = 748). We tested the antimicrobial activity of chicken and duck egg white and lysozyme purified from chicken egg white. Moreover, we compared the microbiomes of normal and mastitic raw milk obtained by 16S rRNA gene pyrosequencing and culture methods. The results showed that the frequencies of Gram-positive pathogens (Enterococcus faecalis 37% and Staphylococcus aureus 36%) were higher than that of a Gram-negative pathogen (Escherichia coli 15%). Resistance frequencies to ampicillin and norfloxacin were lowest in Staphylococcus aureus (21%), Enterococcus faecalis (23%), and Escherichia coli (33%), and the antimicrobial activity of chicken egg white was higher than those of lysozyme and duck egg white. Pyrosequencing results revealed clear differences between the microbiomes of mastitic and normal raw milk samples and revealed a slightly similar, but clearly different, composition of pathogens compared to that from the culture method. Thus, pyrosequencing may be useful for elucidating changes in microbiomes during mastitis progression and treatment. A chicken egg white and antibiotic combination may help with mastitis treatment; however, further studies are needed.

Effect of the fourth nucleotide at the 3′ end of neuraminidase and matrix viral genomic RNA on the pathogenicity of influenza virus A/PR/8/34

Twelve nucleotides located at the 3′ end of viral genomic RNA (vRNA) are conserved among influenza A viruses (IAV) and have a promoter function. Hoffmann's 8-plasmid reverse genetics vector system introduced mutations at position 4, C nucleotide (C4) to U nucleotide (U4), of the 3′ ends of neuraminidase (NA) and matrix (M) vRNAs of wild-type A/PR/8/34 (PR8). This resulted in a constellation of C4 and U4 vRNAs coding for low (polymerases) and relatively high (all others) copy number proteins, respectively. U4 has been reported to increase promoter activity in comparison to C4, but the constellation effect on the replication efficiency and pathogenicity of reverse genetics PR8 (rgPR8) has not been fully elucidated. In the present study, we generated 3 recombinant viruses with C4 in the NA and/or M vRNAs and rgPR8 by using reverse genetics and compared their pathobiological traits. The mutant viruses showed lower replication efficiency than rgPR8 due to the low transcription levels of NA and/or M genes. Furthermore, C4 in the NA and/or M vRNAs induced lower PR8 virus pathogenicity in BALB/c mice. The results suggest that the constellation of C4 and U4 among vRNAs may be one of the multigenic determinants of IAV pathogenicity.

Establishment of a live vaccine strain against fowl typhoid and paratyphoid / 대한수의학회지

To develop a live vaccine strain against fowl typhoid and paratyphoid caused by Salmonella serovar Gallinarum biovar Gallinarum (Salmonella Gallinarum) and Salmonella serovar Enteritidis (Salmonella Enteritidis), respectively, several nalidixic acid resistant mutants were selected from lipopolysaccharide (LPS) rough strains of Salmonella Gallinarum that escaped from fatal infection of a LPS-binding lytic bacteriophage. A non-virulent and immunogenic vaccine strain of Salmonella Gallinarum, SR2-N6, was established through in vivo pathogenicity and protection efficacy tests. SR2-N6 was highly protective against Salmonella Gallinarum and Salmonella Enteritidis and safer than Salmonella Gallinarum vaccine strain SG 9R in the condition of protein-energy malnutrition. Thus, SR2-N6 may be a safe and efficacious vaccine strain to prevent both fowl typhoid and paratyphoid.

rpoB gene sequencing for phylogenetic analysis of avian pathogenic Escherichia coli / 대한수의학회지

The present study was conducted to determine the full rpoB and eight house-keeping gene sequences of 78 and 35, respectively, avian pathogenic E. coli (APEC) strains. Phylogenetic comparison with 66 E. coli and Shigella strains from GenBank and EMBL was also conducted. Based on the full rpoB sequence, 50 different rpoB sequence types (RSTs) were identified. RST 1 was assigned to a major RST that included 34.7% (50/144) of the analyzed strains. RST 2 to RST 50 were then assigned to other strains with higher nucleotide sequence similarity to RST 1 in order. RST 1, 11, and 23 were mixed with APEC along with human commensal and pathogenic strains while RST 2, 6, 9, 13-15, 22, 24, 25, 33, 34, 36, and 41 were unique to APEC strains. Only five APEC strains grouped into RST 32 and 47, which contained human pathogenic E. coli (HPEC). Thus, most of the APEC strains had genetic backgrounds different from HPEC strains. However, the minor APEC strains similar to HPEC should be considered potential zoonotic risks. The resolution power of multi-locus sequence typing (MLST) was better than RST testing. Nevertheless, phylogenetic analysis of rpoB was simpler and more economic than MLST.

Clinico-pathological Features of Chlamydophila psittaci Infection in Parrots and Genetic Characterization of the Isolates / 대한수의학회지

Avian chlamydiosis is caused by Chlamydophila psittaci and considered as one of an important zoonotic disease throughout the world. Among more than 400 avian species including poultry and pet birds susceptible to the disease, psittacine birds were known to be mostly susceptible hosts. In Korea, no outbreak of the disease and genetic analysis of the agent in poultry and pet birds have been reported. With histopathological findings and genetic identification of a causative agent, avian chlamydiosis was identified in parrots submitted from the same pet bird farm in 2006 and 2009 for the diagnosis. Based on genetic sequences and phylogenetic analysis of ompA gene, the two isolates of Chlamydophila psittaci showed 100% of genetic similarity and belonged to genotype A, suggesting that the same agent might be continuously circulated in the farm. This result indicates that serological survey of the disease in pet bird farms and impact of the disease on significance in public health may be further studied.

Pathotyping avian pathogenic Escherichia coli strains in Korea

To examine the genetic background of avian pathogenic Escherichia coli (APEC) that affects virulence of this microorganism, we characterized the virulence genes of 101 APEC strains isolated from infected chickens between 1985~2005. Serotypes were determined with available anti-sera and median lethal doses were determined in subcutaneously inoculated chicks. The virulence genes we tested included ones encoding type 1 fimbriae (fimC), iron uptake-related (iroN, irp2, iucD, and fyuA), toxins (lt, st, stx1, stx2, and vat), and other factors (tsh, hlyF, ompT, and iss). Twenty-eight strains were found to be O1 (2.0%), O18 (3.0%), O20 (1.0%), O78 (19.8%), and O115 (2.0%) serotypes. The iroN (100%) gene was observed most frequently followed by ompT (94.1%), fimC (90.1%), hlyF (87.1%), iss (78.2%), iucD (73.3%), tsh (61.4%), fyuA (44.6%), and irp2 (43.6%). The strains were negative for all toxin genes except for vat (10.9%). All the strains were classified into 27 molecular pathotypes (MPs). The MP25, MP19, and MP10 pathotypes possessing iroN-fimC-ompT-hlyF-iucD-tsh-iss-irp2-fyuA (22.8%), iroN-fimC-ompT-hlyF-iucD-tsh-iss (21.8%), and iroN-fimC-ompT-hlyF-iss (11.9%) genotypes, respectively, were predominant. Redundancy of iron uptake-related genes was clearly observed and some strains were associated with higher mortality than others. Therefore, strains with the predominant genotypes can be used for diagnosis and vaccine.

Genetic and biological characteristics of recent Korean isolates of avian influenza virus subtype H9N2 / 대한수의학회지

The worldwide distribution and continuing genetic mutation of avian influenza virus (AIV) has been posed a great threat to human and animal health. A comparison of 3 isolates of AIV H9N2, A/chicken/Korea/KBNP-0028/00 (H9N2) (KBNP-0028), A/chicken/Korea/SNU8011/08 (H9N2) (SNU 8011) and an inactivated oil vaccine strain A/chicken/Korea/01310/01 (H9N2) (01310), was performed. The former 2 AIVs were isolated from field cases before and after the application of an inactivated H9N2 vaccine in 2007, respectively. The antigenic relationship, viral shedding, tissue tropism and genetic analysis were examined. The comparison of virus shedding from the cloaca and the oropharynx revealed that both isolates were more frequently isolated from the upper respiratory tract (90~100%) 1 day post inoculation (DPI) compared with isolation 5 DPI from gastrointestinal tracts (10~60%). Moreover, the isolate KBNP-0028 were recovered from all organs including bone marrow, brain and kidneys, indicating higher ability for broad tissue dissemination than that of SNU 8011. KBNP-0028 replicated earlier than other strains and with a higher titer than SNU 8011. In full-length nucleotide sequences of the NA gene and a partial sequence of the HA gene of SNU 8011, we found that there might be significant changes in tissue tropism, virus replication and genetic mutation in AIV H9N2 isolates.

Surveillance and molecular epidemiology of avian influenza viruses from birds in zoos, backyard flocks and live bird markets in Korea / 대한수의학회지

The circulation and infection of avian influenza virus (AIV) in zoos and backyard flocks has not been systematically investigated. In the present study, we surveyed the birds including those in live bird markets (LBMs) and evaluated co-circulation of AIVs among them. Overall, 26 H9N2 AIVs and one H6N2 AIV were isolated from backyard flocks and LBMs, but no AIVs were isolated from zoo birds. Genetic analysis of the HA and NA genes indicated that most of the H9N2 AIVs showed higher similarities to AIVs circulating in domestic poultry than to those in wild birds, while the H6N2 AIV isolate from an LBM did to AIVs circulating in migratory wild birds. In serological tests, 15% (391/2619) of the collected sera tested positive for AIVs by competitive-ELISA. Among them, 34% (131/391) of the sera tested positive for AIV H9 antigen by HI test, but only one zoo sample was H9 positive. Although AIVs were not isolated from zoo birds, the serological results indicated that infection of AIVs might occur in zoos. It was also confirmed that H9N2 AIVs continue to circulate and evolve between backyard flocks and LBMs. Therefore, continuous surveillance and monitoring of these flocks should be conducted to control further epidemics.

Correction of Secondary Cleft Lip Deformities by Scar Excision and Abbe Flap Coverage: Photogrammetric Analysis

PURPOSE: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. METHODS: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom- shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. RESULTS: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. CONCLUSION: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

Photogrammetry Based on Standardized Clinical Photography using Cephalostat: Comparison with Anthropometric Analysis

PURPOSE: Direct anthropometry is an ideal method for preoperative planning and postoperative evaluation in plastic surgery, but it requires highly skilled specialty. Indirect anthropometry, especially photogrammetry, is an alternative method. In photogrammetry, standardized clinical photography is essential. Photogrammetry-based standardized clinical photography has several advantages over direct anthropometry. It is easier to measure and has less chance to make errors during measurement. Furthermore, it is possible to repeat measurements, and available for follow up study based on permanent custody. But, it is still different from actual measurement, and inherently less accurate than anthropometry. METHODS: The authors revised the standardized clinical photography and then, carried out photogrammetry using Photoshop(Adobe, U.S.A.), and compared each data with those of anthropometry. The subjects were 50 males and 50 females, undergraduate medical students in twenties. Standard head position was obtained from the wire, fixed to cephalostat which indicates the Frankfort horizontal plane. All photographs were taken at the same situation such as fixed position of light, subject and camera, etc. RESULTS: Total 96 measurements, based on 40 landmarks, consist of linear measurements, angular measurements and inclinations include 3 measurements in head, 22 in face, 15 in orbit, 28 in nose, 16 in lip and mouth, and 12 in ear. CONCLUSION: Normal photogrammetric data of face of Korean in twenties was obtained. Reliable photogrammetric measurements, not significantly different from anthropometric measurement statistically, accounted for 44 in 96 measurements(45.8%). Anthropometric values different from those of photogrammetric values were obtained by multiplying coefficient by photogrammetric value.

Photogrammetry Based on Standardized Clinical Photography using Cephalostat: Comparison with Anthropometric Analysis

PURPOSE: Direct anthropometry is an ideal method for preoperative planning and postoperative evaluation in plastic surgery, but it requires highly skilled specialty. Indirect anthropometry, especially photogrammetry, is an alternative method. In photogrammetry, standardized clinical photography is essential. Photogrammetry-based standardized clinical photography has several advantages over direct anthropometry. It is easier to measure and has less chance to make errors during measurement. Furthermore, it is possible to repeat measurements, and available for follow up study based on permanent custody. But, it is still different from actual measurement, and inherently less accurate than anthropometry. METHODS: The authors revised the standardized clinical photography and then, carried out photogrammetry using Photoshop(Adobe, U.S.A.), and compared each data with those of anthropometry. The subjects were 50 males and 50 females, undergraduate medical students in twenties. Standard head position was obtained from the wire, fixed to cephalostat which indicates the Frankfort horizontal plane. All photographs were taken at the same situation such as fixed position of light, subject and camera, etc. RESULTS: Total 96 measurements, based on 40 landmarks, consist of linear measurements, angular measurements and inclinations include 3 measurements in head, 22 in face, 15 in orbit, 28 in nose, 16 in lip and mouth, and 12 in ear. CONCLUSION: Normal photogrammetric data of face of Korean in twenties was obtained. Reliable photogrammetric measurements, not significantly different from anthropometric measurement statistically, accounted for 44 in 96 measurements(45.8%). Anthropometric values different from those of photogrammetric values were obtained by multiplying coefficient by photogrammetric value.

Clinical Epidemiologic Study of Facial Bone Fractures in Daegu

PURPOSE: There are many reports about facial bone fractures, but limited to retrospective data of a single hospital. Etiology and severity of the facial bone fracture have been changed and treatment method and materials have been advanced. In order to reflect those changes and provide up-to-date data of the facial bone fractures in Daegu, we gathered the data and analyzed the epidemiologic study. METHODS: The medical records of 1058 fractures in 895 patients were gathered from 5 general hospitals in Daegu during last year and these data were analyzed by following parameters: age, sex, place of residence, occupation, cause of injury, time of injury, location of fracture, length of in-hospital stay, time of operation, treatment method, associated injury, complication. Statistical analysis was performed using the Chi-square test. RESULTS: Most commonly involved age group was 20s(26%) and the sex ratio was 3.4:1(male predominance). Fractures were occurred more in unban and white-color workers. Among variable etiology of injury, traffic accident was the most common cause. Time of injury was heighest at 6 to 7 P.M., on Sunday, in July. Locations of fractures were following sequence: nasal, zygoma, mandible, orbit, maxilla. Mean length of in- hospital stay and time of operation after injury were 6.3 and 3.2 days, respectively. In treatment methods, operative methods were dominant than conservative management and general anesthesia were favored than local anesthesia. Associated injuries were noticed in 188 cases(21.2%) and complications were in 94 cases(8.9%) and among them, ocular problem were common. CONCLUSION: Compared to previous studies, mean age of occurrence was lowered and the etiologies showed age-specific pattern and reflected the change of lifestyle. In young age groups, sports injury, violence were more dominant and the other hand, traffic accident and fall were dominant in older groups.

Acoustic Rhinometric Comparison of Cleft Side with Non-cleft Side after Repair of Unilateral Cleft Lip Nose Deformity

The upper and lower lateral cartilages provide the key to the lower cartilaginous portion of the nose. Lifting the cartilages is essential procedure for correction of unilateral cleft lip nose deformity. After correction of cleft lip nose deformity, authors used acoustic rhinometry (AR) to compare the lower nasal cavity of cleft side with non-cleft side. AR is a well known new, non-invasive diagnostic technique in which nasal geometry is assessed by means of acoustic reflection. From June 1996 to January 2004, we performed acoustic rhinometric analysis after correction of unilateral cleft lip nose deformity. This study involved 40 children of age ranged from 3 months to 8 years. Subjects were divided into the group of incomplete unilateral cleft lip nose deformity(20 subjects), and the group of complete unilateral cleft lip nose deformity(20 subjects). Results show that lower nasal cavity volume between non-cleft side and cleft side has no difference, and better results were obtained when nasal molding prong was applied at cleft side nostril. The results between incomplete type and complete type have no significant difference. In conclusion, AR is an effective method to calibrate cross sectional area and nasal cavity volume of unilateral cleft lip nose deformity, and furthermore effective in comparing the volume of cleft side with non-cleft side after unilateral cleft lip nose deformity correction with lifting the lower lateral cartilages to the upper lateral cartilages.