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1.
J Minim Access Surg ; 19(1): 57-61, 2023.
Article in English | MEDLINE | ID: mdl-36722531

ABSTRACT

Context: While laparoscopy has been the standard procedure for gallstone treatment, recent advances including the use of indocyanine green (ICG) in laparoscopic cholecystectomy have made it easier to understand the biliary tree and reduce the risk of bile duct injury. Aims: In this retrospective study, we aim to determine the efficacy of ICG in near-infrared fluorescence cholangiography (NIRFC) for visualising biliary anatomy. Settings and Design: A total of 90 patients with the symptoms of cholelithiasis were enrolled for this retrospective study. Subjects and Methods: All the patients underwent cholecystectomy approximately 53.8 min (40-90 min) after the intravenous administration of mean volume 1.6 ml (1-2 ml) ICG. The surgeons used NIRFC along with ICG for real-time visualisation of biliary anatomy. Results: The mean operative time for the surgery was 65.7 min (25-120 min) with no post-surgical complications observed in the patients. The average length of stay was 2 days (1-3 days). ICG usage with NIRFC enabled identification of cystic duct, common hepatic and common bile duct, the junction between common hepatic and bile duct, right and left hepatic duct in 87.7%, 94.4%, 80% and 14.4% of cases, respectively. Conclusions: ICG fluorescence allowed successful visualisation of at least 1 biliary structure in 100% of cases.

2.
Appl Biochem Biotechnol ; 2022 Sep 23.
Article in English | MEDLINE | ID: mdl-36149583

ABSTRACT

Bombyx mori is an agriculturally important insect used extensively for silk production. India, especially the eastern regions, is mostly dependent on the multivoltine breeds of silkworm Bombyx mori and their hybrids/crossbreeds. The multivoltine breeds are indigenous and superior in survival and hardiness but are relatively inferior in terms of qualitative traits, typically the silk quality. Therefore, it is highly relevant to understand the mechanism of silk production in the multivoltine breeds to decipher the reasons for the inferior quality of silk produced by the multivoltine breeds and thus gain leads to improve the quality of silk production in multivoltine breeds. With this background, study was carried to identify differential expression of the major genes associated with silk proteins in the silk gland region of the popular multivoltine breeds. Our results indicated that although fib-L, fib-H, Sericins, and P25 are the major genes associated with silk filament, a few other genes associated with silk assembly, transport, and protection in the silk glands are the ones that largely contribute towards efficient silk production. The differential expression of these genes had a major effect on the movement of silk proteins within the silk gland and the efficiency of silk production as well. The Pearson correlation revealed a positive correlation amongst the genes dealt with in this study, indicating that the concurrent increase in expression of both the types of genes in the silk glands, significantly improves the silk production.

3.
J Minim Access Surg ; 2022 May 27.
Article in English | MEDLINE | ID: mdl-35661009

ABSTRACT

Context: While laparoscopy has been the standard procedure for gallstone treatment, recent advances including the use of indocyanine green (ICG) in laparoscopic cholecystectomy have made it easier to understand the biliary tree and reduce the risk of bile duct injury. Aims: In this retrospective study, we aim to determine the efficacy of ICG in near-infrared fluorescence cholangiography (NIRFC) for visualising biliary anatomy. Settings and Design: A total of 90 patients with the symptoms of cholelithiasis were enrolled for this retrospective study. Subjects and Methods: All the patients underwent cholecystectomy approximately 53.8 min (40-90 min) after the intravenous administration of mean volume 1.6 ml (1-2 ml) ICG. The surgeons used NIRFC along with ICG for real-time visualisation of biliary anatomy. Results: The mean operative time for the surgery was 65.7 min (25-120 min) with no post-surgical complications observed in the patients. The average length of stay was 2 days (1-3 days). ICG usage with NIRFC enabled identification of cystic duct, common hepatic and common bile duct, the junction between common hepatic and bile duct, right and left hepatic duct in 87.7%, 94.4%, 80% and 14.4% of cases, respectively. Conclusions: ICG fluorescence allowed successful visualisation of at least 1 biliary structure in 100% of cases.

4.
RSC Adv ; 11(35): 21323-21331, 2021 Jun 15.
Article in English | MEDLINE | ID: mdl-35478782

ABSTRACT

Due to the long half-life of 137Cs (t 1/2 ∼ 30 years), the selective extraction of cesium (Cs) from high level liquid waste is of paramount importance in the back end of the nuclear fuel cycle to avoid long term surveillance of high radiotoxic waste. As 1,3-di-octyloxycalix[4]arene-crown-6 (CC6) is suggested to be a promising candidate for selective Cs extraction, the improvement in the Cs extraction efficiency by CC6 has been investigated through the optimization of the effect of dielectric media on the extraction process. The effects of the feed acid (HNO3, HCl, and HClO4) and the composition of the diluents for the ligand in the organic phase on the extraction efficiency of Cs have been investigated systematically. In 100% n-octanol medium, Cs is found to form a 1 : 1 ion-pair complex with CC6 (0.03 M) providing a very high distribution ratio of D Cs ∼ 22, suggesting n-octanol as the most suitable diluent for Cs extraction. No significant interference of other relevant cations such as Na, Mg and Sr was observed on the D Cs value in the optimized solvent system. Density functional theory (DFT) based calculations have been carried out to elucidate the reason of ionic selectivity and enhanced Cs extraction efficiency of CC6 in the studied diluent systems. In addition to the ionic size-based selectivity of the crown-6 cavity, the polarity of the organic solvent system, the hydration energy of the ion, and the relative reorganization of CC6 upon complexation with Cs are understood to have roles in achieving the enhanced efficiency for the extraction of Cs by the CC6 extractant in nitrobenzene medium.

5.
Environ Res ; 206: 112546, 2022 04 15.
Article in English | MEDLINE | ID: mdl-34902377

ABSTRACT

The global environmental changes owing to natural and anthropogenic influences are challenging the structure and functioning of the ocean ecosystem. The complex processes interacting within the physical, chemical, and biological environment at different spatio-temporal scales and their impact on the ocean ecosystem processes are yet to be investigated. A long term trend on phytoplankton biomass in terms of Chlorophyll-a concentration (Chl-a), phytoplankton compositions and the processes that control the variability is required for understanding the ocean ecosystem. This study investigated decadal trends (2002-2015) of phytoplankton composition and biogeochemical parameters over the Global Ocean (GO), Southern Ocean (SO), and the Arctic Ocean (AO) using ocean color remote sensing and assimilated data from the National Aeronautics and Space Administration (NASA) Ocean biogeochemical model. The results revealed the dominance of larger cell phytoplankton mainly diatoms throughout the SO and AO; however, the coccolithophores dominate in the remaining part of the GO. Analysis of nutrients showed that nitrate is not a limiting factor for the variability of phytoplankton biomass in the SO and AO. The low nitrate concentration influenced in the rest of the GO. The photosynthetically available radiation (PAR) limiting the phytoplankton biomass and composition in the SO and AO. Although the SO is known as the high nutrient low chlorophyll (HNLC) region of the GO, the low iron concentration along with the PAR co-limits the growth of phytoplankton biomass. Trend analysis showed that an increase in Chl-a and diatoms in the SO and AO. In contrast, it declined significantly in the other regions of the GO, in response to the consistent increase in sea surface temperature. The results indicated that, shifting of phytoplankton community from regional to global scale have a greater implication for climate change and marine ecosystem.


Subject(s)
Ecosystem , Phytoplankton , Biomass , Chlorophyll A/metabolism , Climate Change , Oceans and Seas , Phytoplankton/metabolism , Seawater/chemistry
6.
Environ Pollut ; 283: 117070, 2021 Aug 15.
Article in English | MEDLINE | ID: mdl-33839622

ABSTRACT

Ballast water transport is considered as one of the major vectors for dispersal of microplastics around the global oceans. In this commentary, a simple, inexpensive solution has been proposed to reduce microplastic pollution and its mobility via ballast water. A screening chamber (with stainless steel three layered mesh) is proposed to be attached to the existing Ballast Water Treatment Systems (BWTSs) in cargo ships to filter back-flushed sea water from BWTSs. The three layered screens (500, 300 and 100 µm) will not only avoid clogging and easy separation of different size groups of microplastic particles but also help in smooth discharge of water to the sea. This technique is expected to remove a large number of microplastic particles (ranging from 0.0015 to 1020 million) from a single voyage. The proposed chamber may help to collect 0.0003-204 metric tons of particles/day, depending upon the geographical location of ballast intake in the global ocean. These estimations were made by considering a daily turnover of 0.033 billion tonnes of ballast water globally. This proposed screening chamber attached to the existing BWTSs in cargo ships, along with other region-specific ocean cleaning initiatives, will help in mitigating microplastic pollution in the global ocean.


Subject(s)
Microplastics , Water Pollutants, Chemical , Environmental Monitoring , Environmental Pollution , Oceans and Seas , Plastics/analysis , Ships , Water , Water Pollutants, Chemical/analysis
7.
Diabet Med ; 37(9): 1611-1613, 2020 09.
Article in English | MEDLINE | ID: mdl-31872458
8.
Dokl Biochem Biophys ; 488(1): 293-295, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31768843

ABSTRACT

The interaction of the GAF protein with the promoters of neuron-specific genes during activation and repression of transcription was studied. We showed that, while the Su(Hw) protein remains stably associated with the promoters of these genes at different transcriptional state, the GAF protein level is significantly higher when transcription is activated.


Subject(s)
DNA-Binding Proteins/biosynthesis , Drosophila Proteins/biosynthesis , Drosophila Proteins/metabolism , Gene Expression Regulation , Promoter Regions, Genetic , Repressor Proteins/metabolism , Transcription Factors/biosynthesis , Transcription, Genetic , Animals , DNA-Binding Proteins/genetics , Drosophila Proteins/genetics , Drosophila melanogaster , Repressor Proteins/genetics , Transcription Factors/genetics
9.
Med J Armed Forces India ; 56(3): 231-232, 2000 Jul.
Article in English | MEDLINE | ID: mdl-28790715
10.
J Appl Genet ; 58(3): 307-319, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28577124

ABSTRACT

Pigeonpea production is severely constrained by wilt disease caused by Fusarium udum. In the current study, we discover the putative genomic regions that control resistance response to variant 2 of fusarium wilt using association mapping approach. The association panel comprised of 89 diverse pigeonpea genotypes including seven varieties, three landraces and 79 germplasm lines. The panel was screened rigorously for 3 consecutive years (2013-14, 2014-15 and 2015-2016) against variant 2 in a wilt-sick field. A total of 65 pigeonpea specific hypervariable SSR markers (HASSRs) were screened representing seven linkage groups and 29 scaffolds of the pigeonpea genome. A total of 181 alleles were detected, with average values of gene diversity and polymorphism information content (PIC) of 0.55 and 0.47, respectively. Further analysis using model based (STRUCTURE) and distance based (clustering) approaches separated the entire pigeonpea collection into two distinct subgroups (K = 2). The marker trait associations (MTAs) were established based on three-year wilt incidence data and SSR dataset using a unified mixed linear model. Consequently, six SSR markers were identified, which were significantly associated with wilt resistance and explained up to 6% phenotypic variance (PV) across the years. Among these SSRs, HASSR18 was found to be the most stable and significant, accounting for 5-6% PV across the years. To the best of our knowledge, this is the first report of identification of favourable alleles for resistance to variant 2 of Fusarium udum in pigeonpea using association mapping. The SSR markers identified here will greatly facilitate marker assisted resistance breeding against fusarium wilt in pigeonpea.


Subject(s)
Cajanus/genetics , Disease Resistance/genetics , Microsatellite Repeats , Plant Diseases/genetics , Alleles , Cajanus/microbiology , Chromosome Mapping , Fusarium , Genetic Linkage , Genetic Markers , Genotype , Phenotype , Plant Diseases/microbiology , Polymorphism, Genetic
11.
Front Plant Sci ; 8: 377, 2017.
Article in English | MEDLINE | ID: mdl-28408910

ABSTRACT

Draft genome sequence in pigeonpea offers unprecedented opportunities for genomics assisted crop improvement via enabling access to genome-wide genetic markers. In the present study, 421 hypervariable simple sequence repeat (SSR) markers from the pigeonpea genome were screened on a panel of eight pigeonpea genotypes yielding marker validation and polymorphism percentages of 95.24 and 54.11%, respectively. The SSR marker assay uncovered a total of 570 alleles with three as an average number of alleles per marker. Similarly, the mean values for gene diversity and PIC were 0.44 and 0.37, respectively. The number of polymorphic markers ranged from 39 to 89 for different parental combinations. Further, 60 of these SSRs were assayed on 94 genotypes, and model based clustering using STRUCTURE resulted in the identification of the two subpopulations (K = 2). This remained in close agreement with the clustering patterns inferred from genetic distance (GD)-based approaches i.e., dendrogram, factorial and principal coordinate analysis (PCoA). The AMOVA accounted majority of the genetic variation within groups (89%) in comparison to the variation existing between the groups (11%). A subset of these markers was implicated for hybrid purity testing. We also demonstrated utility of these SSR markers in trait mapping through association and bi-parental linkage analyses. The general linear (GLM) and mixed linear (MLM) models both detected a single SSR marker (CcGM03681) with R2 = 16.4 as associated with the resistance to Fusarium wilt variant 2. Similarly, by using SSR data in a segregating backcross population, the corresponding restorer-of-fertility (Rf) locus was putatively mapped at 39 cM with the marker CcGM08896. However, The marker-trait associations (MTAs) detected here represent a very preliminary type and hence demand deeper investigations for conclusive evidence. Given their ability to reveal polymorphism in simple agarose gels, the hypervariable SSRs are valuable genomic resource for pigeonpea research community, particularly in South Asia and East Africa where pigeonpea is primarily grown.

12.
Insect Mol Biol ; 26(2): 127-139, 2017 04.
Article in English | MEDLINE | ID: mdl-27991710

ABSTRACT

RNA interference (RNAi) refers to the process of post-transcriptional silencing of cellular mRNA by the application of double-stranded RNA (dsRNA). RNAi strategies have been widely employed to regulate gene expression in plants and animals including insects. With the availability of the full genome sequences of major vector mosquitoes, RNAi has been increasingly used to conduct genetic studies of human pathogens in mosquito vectors and to study the evolution of insecticide resistance in mosquitoes. This review summarizes the recent progress in our understanding of mosquito-pathogen interactions using RNAi and various methods of dsRNA delivery in mosquitoes at different stages. We also discuss potential applications of this technology to develop novel tools for vector control.


Subject(s)
Mosquito Control , RNA Interference , RNA, Double-Stranded/administration & dosage , Animals , Nanotechnology
13.
Saudi J Anaesth ; 10(4): 449-452, 2016.
Article in English | MEDLINE | ID: mdl-27833493

ABSTRACT

Postoperative visual loss (POVL) is a rare but grave postoperative complication. It has been mainly reported in patients undergoing cardiac and spinal surgeries. Dorsal root entry zone (DREZ) is pain relieving procedure performed in patients with refractory neuropathic pain with minimal complication rate. We present a case of unilateral POVL following DREZ rhizotomy in prone position in a patient having brachial plexus neuropathy. Exact etiology of vision loss was though not clear; hypotension, use of vasopressors and hemodilution may have led to vision loss in this patient. This case report highlights the associated risk factors for development of this hazardous complication.

14.
Vet World ; 8(2): 225-31, 2015 Feb.
Article in English | MEDLINE | ID: mdl-27047078

ABSTRACT

BACKGROUND AND AIM: In today era, broiler industry facing a problem of price hiking of feed of broiler, also in competitive era there should be lower feed cost, lower feed conversion ratio, low feed consumption yet good body weight at marketable age. MATERIALS AND METHODS: Day-old commercial broiler chicks (n=200) were distributed randomly into 5 dietary treatment groups viz. control (T1), probiotic in the feed @ 100 g/tonne of feed (T2), prebiotic in the feed @ 500 g/tonne of feed (T3), probiotic + prebiotic @ 100 g/tonne and 500 g/tonne of feed, respectively (T4) and probiotic + prebiotic @ 50 g/tonne and 250 g/tonne of feed (T5). The growth of broilers and dressing weight along with the weight of giblet (liver without gall bladder, gizzard without serous layer, and heart without pericardium), Kidney, Abdominal fat, Length of Intestine and dressing percentage were measured. Economics in terms of Return Over Feed Cost (ROFC) and European Performance Efficiency Index (EPEI) was calculated. RESULTS: Among all carcass traits, dressing percentage, abdominal fat weight and abdominal fat percentage (as a percentage of dressed weight) were recorded significant (p<0.05) difference among different treatment groups. The income from selling of the birds was significantly (p<0.05) higher in all treatment groups than the control group but there was a non-significant difference between supplemented groups. Feed cost during whole experimental period was significantly (p<0.05) lower in synbiotic supplemented groups (T4 and T5) than other groups. ROFC of all treatment group found significantly (p<0.05) higher than the control group. CONCLUSION: It can be concluded that the diet supplemented with synbiotic (100% level) was most efficient in terms of EPEI and synbiotic (50% level) in terms of ROFC. Hence, as feed supplement, synbiotic has a beneficial effect over probiotic and prebiotic when used alone.

15.
Indian J Plast Surg ; 48(3): 236-48, 2015.
Article in English | MEDLINE | ID: mdl-26933277

ABSTRACT

Fibrous dysplasia (FD) is a non-malignant fibro-osseous bony lesion in which the involved bone/bones gradually get converted into expanding cystic and fibrous tissue. The underlying defect in FD is post-natal mutation of GNAS1 gene, which leads to the proliferation and activation of undifferentiated mesenchymal cells arresting the bone development in woven phase and ultimately converting them into fibro-osseous cystic tissue. Cherubism is a hereditary form of fibrous dysplasia in which the causative factor is transmission of autosomal dominant SH3BP2 gene mutation. The disease may present in two distinct forms, a less severe and limited monostotic form, and a more aggressive and more widespread polyostotic form. Polyostotic form may be associated with various endocrine abnormalities, which require active management apart from the management of FD. Management of FD is not free from controversies. While total surgical excision of the involved area and reconstruction using newer micro-vascular technique is the only definitive treatment available from the curative point of view, but this can be only offered to monostotic and very few polyostotic lesions. In polyostotic varieties on many occasions these radical surgeries are very deforming in these slow growing lesions and so their indication is highly debated. The treatment of cranio-facial fibrous dysplasia should be highly individualized, depending on the fact that the clinical behavior of lesion is variable at various ages and in individual patients. A more conservative approach in the form of aesthetic recontouring of deformed bone, orthodontic occlusal correction, and watchful expectancy may be the more accepted form of treatment in young patients. Newer generation real-time imaging guidance during recontouring surgery adds to accuracy and safety of these procedures. Regular clinical and radiological follow up is required to watch for quiescence, regression or reactivation of the disease process. Patients must be warned and watched for any sign of nerve compression, especially visual impairment due to optic nerve compression. Rather than going for prophylactic optic canal decompression (which does more harm than good), optic nerve decompression should be done in symptomatic patients only, and preferably be done via minimal invasive endoscopic neuro-surgical approach than the conventional more morbid open craniotomy approach. There is growing research and possibilities that newer generation bisphosphonate medication may change the management scenario, as these medications show encouraging response in not only reducing the osteoclastic activity, but simultaneously also stimulating the osteoblastic and osteocytic activities. The explosion of genetic research and stem cell therapy may lead to better understanding and subsequently better treatment of FD in future.

16.
West Afr J Med ; 34(1): 44-9, 2015.
Article in English | MEDLINE | ID: mdl-26902816

ABSTRACT

BACKGROUND: The establishment of minimal access surgery (MAS) in the last three decades brought new dimensions to surgical training. The sole role of traditional apprenticeship training model was challenged and adjunctive surgical simulation models were introduced. Knowledge of the trainees' educational needs is important in designing MAS training curriculum. OBJECTIVES: To study the MAS educational needs of trainees from Africa, review MAS training models and offer recommendations for MAS training. METHODOLOGY: Data was obtained from questionnaires filled by trainees from Africa who attended the monthly MAS training at the World Laparoscopy Hospital, India from October 2013 to May 2014 about their MAS educational needs. RESULTS: There were 38 trainees from different parts of Africa (Central, East, North, South and West Africa) with average age of 41.92 ± 8.67 years (minimum-28 years and maximum 63 years) and majority were males (92%). General surgeons constituted 57% while Gynaecologists were 41%. Only a quarter have MAS training integrated in their training curriculum. Box trainers, Animal models, live human surgeries and virtual reality simulation were the commonest models used in previous trainings and favoured in the educational needs for MAS training. Using cadaveric models and self sponsorship were deemphasised. CONCLUSION: Widespread application of MAS, globalisation and trainees educational needs call for establishing training programmes. Box trainers, animal models, live human surgeries and virtual reality simulators should be adopted and a synergy between Postgraduate surgical programmes, biomedical industry, universities and trainees will facilitate the setting of MAS skills laboratories and programmes.

17.
Med J Armed Forces India ; 71(Suppl 2): S586-9, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26858499
18.
Andrologia ; 48(9): 923-932, 2016 Nov.
Article in English | MEDLINE | ID: mdl-26840772

ABSTRACT

The flower buds of Syzygium aromaticum (clove) have been used for the treatment of male sexual disorders in indigenous medicines of Indian subcontinent. Therefore to evaluate the efficacy of Syzygium aromaticum on the male reproductive health, chronic oral exposure of aqueous extract of flower buds of Syzygium in three doses (15 mg, 30 mg and 60 mg kg-1 BW) were studied for a single spermatogenic cycle (35 days) in Parkes (P) strain mice. Lower dose (15 mg) of Syzygium aromaticum flower buds increased serum testosterone level and testicular hydroxysteroid dehydrogenase (HSD) activities and improved sperm motility, sperm morphology, secretory activity of epididymis and seminal vesicle, and number of litters per female. On the other hand, higher doses (30 and 60 mg) of the treatment adversely affected above parameters. Further, higher doses of the extract also had adverse effects on daily sperm production, 1C cell population and on histology of testis. In conclusion, Syzygium aromaticum flower buds extract exhibits biphasic effect on reproductive physiology of male mice. Lower dose of Syzygium aromaticum flower bud extract is androgenic in nature and may have a viable future as an indigenous sexual rejuvenator, while higher doses adversely affected functional physiology of reproductive organs.


Subject(s)
Reproduction/drug effects , Syzygium , Androgens/administration & dosage , Androgens/adverse effects , Androgens/pharmacology , Animals , Dose-Response Relationship, Drug , Female , Fertility/drug effects , Fertility/physiology , Flowers , Genitalia, Male/drug effects , Genitalia, Male/metabolism , Genitalia, Male/pathology , Humans , India , Male , Medicine, Traditional , Mice , Plant Extracts/administration & dosage , Plant Extracts/adverse effects , Plant Extracts/pharmacology , Pregnancy , Reproduction/physiology , Spermatogenesis/drug effects , Testosterone/blood
19.
Rev Sci Instrum ; 86(11): 116107, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26628188

ABSTRACT

A novel circuit scheme is presented to improve timing jitter performance of high voltage pulse power supply utilizing semiconductor switches and magnetic pulse compressors, for pumping pulsed copper vapor lasers. The circuit effectively handles reflected energy from the laser load and achieves better jitter performance. The proposed circuit scheme had typical jitter value of ±2 ns whereas the standard circuit used earlier had jitter of more than ±10 ns under similar conditions. Performance of the circuit scheme is studied on a copper vapor laser operating at average laser power of 40 W.

20.
Indian J Plast Surg ; 48(2): 178-84, 2015.
Article in English | MEDLINE | ID: mdl-26424983

ABSTRACT

AIM: Numerous modifications of Millard's technique of rotation - advancement repair have been described in literature. This article envisions a new modification in Millard's technique of primary unilateral chieloplasty. MATERIAL AND METHODS: Eliminating or reducing the secondary deformities in children with cleft lip has been a motivating factor for the continual refinement of cleft lip surgical techniques through the years. Vermilion notching, visibility of paramedian scars and scar contracture along the white roll are quite noticeable in close-up view even in good repairs. Any scar is less noticeable if it is in midline or along the lines of embryological closure. White Roll Vermilion turn down Flap (WRV Flap), a modification in the Millard's repair is an attempt to prevent these secondary deformities during the primary cleft lip sugery. This entails the use of white roll and the vermilion from the lateral lip segment for augmenting the medial lip vermilion with the final scar in midline at the vermilion. RESULT: With an experience of more than 100 cases of primary cleft lip repair with this technique, we have achieved a good symmetry and peaking of cupid's bow with no vermilion notching of the lips. CONCLUSION: WRV flap aims to high light the importance of achieving a near normal look of the cleft patient with the only drawback of associated learning curve with this technique.

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