A cooperative scheme for late leaf spot estimation in peanut using UAV multispectral images.

In Australia, peanuts are mainly grown in Queensland with tropical and subtropical climates. The most common foliar disease that poses a severe threat to quality peanut production is late leaf spot (LLS). Unmanned aerial vehicles (UAVs) have been widely investigated for various plant trait estimations. The existing works on UAV-based remote sensing have achieved promising results for crop disease estimation using a mean or a threshold value to represent the plot-level image data, but these methods might be insufficient to capture the distribution of pixels within a plot. This study proposes two new methods, namely measurement index (MI) and coefficient of variation (CV), for LLS disease estimation on peanuts. We first investigated the relationship between the UAV-based multispectral vegetation indices (VIs) and the LLS disease scores at the late growth stages of peanuts. We then compared the performances of the proposed MI and CV-based methods with the threshold and mean-based methods for LLS disease estimation. The results showed that the MI-based method achieved the highest coefficient of determination and the lowest error for five of the six chosen VIs whereas the CV-based method performed the best for simple ratio (SR) index among the four methods. By considering the strengths and weaknesses of each method, we finally proposed a cooperative scheme based on the MI, the CV and the mean-based methods for automatic disease estimation, demonstrated by applying this scheme to the LLS estimation in peanuts.

Legacy genetics of Arachis cardenasii in the peanut crop shows the profound benefits of international seed exchange.

The narrow genetics of most crops is a fundamental vulnerability to food security. This makes wild crop relatives a strategic resource of genetic diversity that can be used for crop improvement and adaptation to new agricultural challenges. Here, we uncover the contribution of one wild species accession, Arachis cardenasii GKP 10017, to the peanut crop (Arachis hypogaea) that was initiated by complex hybridizations in the 1960s and propagated by international seed exchange. However, until this study, the global scale of the dispersal of genetic contributions from this wild accession had been obscured by the multiple germplasm transfers, breeding cycles, and unrecorded genetic mixing between lineages that had occurred over the years. By genetic analysis and pedigree research, we identified A. cardenasii-enhanced, disease-resistant cultivars in Africa, Asia, Oceania, and the Americas. These cultivars provide widespread improved food security and environmental and economic benefits. This study emphasizes the importance of wild species and collaborative networks of international expertise for crop improvement. However, it also highlights the consequences of the implementation of a patchwork of restrictive national laws and sea changes in attitudes regarding germplasm that followed in the wake of the Convention on Biological Diversity. Today, the botanical collections and multiple seed exchanges which enable benefits such as those revealed by this study are drastically reduced. The research reported here underscores the vital importance of ready access to germplasm in ensuring long-term world food security.

Quantitative proteomics analysis of high and low polyphenol expressing recombinant inbred lines (RILs) of peanut (Arachis hypogaea L.).

To facilitate selective breeding of polyphenol-rich peanuts, we looked for mass spectrometry-based proteomic evidence, investigating a subset of recombinant inbred lines (RILs) developed by the Australian peanut breeding program. To do this, we used label-free shotgun proteomics for protein and peptide quantitation, statistically analyzed normalized spectral abundance factors using R-package, as well as assayed important antioxidants. Results revealed statistically significant protein expression changes in 82 proteins classified between high or low polyphenols expressing RILs. Metabolic changes in polyphenol-rich RIL p27-362 point towards increased enzymatic breakdown of sugars and phenylalanine biosynthesis. The study revealed phenylpropanoid pathway overexpression resulting in increased polyphenols biosynthesis. Overexpression of antioxidant enzymes such as catalase, by 73.4 fold was also observed. A strong metabolic correlation exists with the observed phenotypic traits. Peanut RIL p27-362 presents a superior nutritional composition with antioxidant-rich peanut phenotype and could yield commercial profits. Data are available via ProteomeXchange with identifierPXD015493.

Translational genomics for achieving higher genetic gains in groundnut.

KEY MESSAGE: Groundnut has entered now in post-genome era enriched with optimum genomic and genetic resources to facilitate faster trait dissection, gene discovery and accelerated genetic improvement for developing climate-smart varieties. Cultivated groundnut or peanut (Arachis hypogaea), an allopolyploid oilseed crop with a large and complex genome, is one of the most nutritious food. This crop is grown in more than 100 countries, and the low productivity has remained the biggest challenge in the semiarid tropics. Recently, the groundnut research community has witnessed fast progress and achieved several key milestones in genomics research including genome sequence assemblies of wild diploid progenitors, wild tetraploid and both the subspecies of cultivated tetraploids, resequencing of diverse germplasm lines, genome-wide transcriptome atlas and cost-effective high and low-density genotyping assays. These genomic resources have enabled high-resolution trait mapping by using germplasm diversity panels and multi-parent genetic populations leading to precise gene discovery and diagnostic marker development. Furthermore, development and deployment of diagnostic markers have facilitated screening early generation populations as well as marker-assisted backcrossing breeding leading to development and commercialization of some molecular breeding products in groundnut. Several new genomics applications/technologies such as genomic selection, speed breeding, mid-density genotyping assay and genome editing are in pipeline. The integration of these new technologies hold great promise for developing climate-smart, high yielding and more nutritious groundnut varieties in the post-genome era.

Aflatoxin levels in maize and peanut and blood in women and children: The case of Timor-Leste.

Aflatoxins are toxic fungal metabolites produced by Aspergillus sp. with carcinogenic properties that are a common food contaminant of many crops including maize and peanuts. In Timor-Leste malnutrition and children's stunting are frequent and maize and peanuts are staple foods. This study aimed to provide information on aflatoxin exposure nationally. The study measured levels of aflatoxin in locally-produced maize and peanuts (296 samples) and of aflatoxin-albumin conjugate in blood samples of women and young children (514 and 620 respectively) across all municipalities. The average concentration of aflatoxin in the grain samples was low with most maize (88%) and peanut (92%) samples - lower than European Commission tolerated aflatoxin level. Although aflatoxin-albumin conjugate was detected in more than 80% of blood samples, the average concentration in children and adults of 0.64 and 0.98 pg mg-1 alb, respectively, is much lower than in other similar rural-based countries. Although low in concentration, blood aflatoxin levels and aflatoxin contamination levels in maize across municipalities were correlated significantly for mothers (R2 = 37%, n = 495) but not for children (R2 = 10%). It is unlikely that the consumption of aflatoxin contaminated grain is a causative factor in the current level of malnutrition and stunting affecting Timor-Leste children.

Evaluation of linkage disequilibrium, population structure, and genetic diversity in the U.S. peanut mini core collection.

BACKGROUND: Due to the recent domestication of peanut from a single tetraploidization event, relatively little genetic diversity underlies the extensive morphological and agronomic diversity in peanut cultivars today. To broaden the genetic variation in future breeding programs, it is necessary to characterize germplasm accessions for new sources of variation and to leverage the power of genome-wide association studies (GWAS) to discover markers associated with traits of interest. We report an analysis of linkage disequilibrium (LD), population structure, and genetic diversity, and examine the ability of GWA to infer marker-trait associations in the U.S. peanut mini core collection genotyped with a 58 K SNP array. RESULTS: LD persists over long distances in the collection, decaying to r2 = half decay distance at 3.78 Mb. Structure within the collection is best explained when separated into four or five groups (K = 4 and K = 5). At K = 4 and 5, accessions loosely clustered according to market type and subspecies, though with numerous exceptions. Out of 107 accessions, 43 clustered in correspondence to the main market type subgroup whereas 34 did not. The remaining 30 accessions had either missing taxonomic classification or were classified as mixed. Phylogenetic network analysis also clustered accessions into approximately five groups based on their genotypes, with loose correspondence to subspecies and market type. Genome wide association analysis was performed on these lines for 12 seed composition and quality traits. Significant marker associations were identified for arachidic and behenic fatty acid compositions, which despite having low bioavailability in peanut, have been reported to raise cholesterol levels in humans. Other traits such as blanchability showed consistent associations in multiple tests, with plausible candidate genes. CONCLUSIONS: Based on GWA, population structure as well as additional simulation results, we find that the primary limitations of this collection for GWAS are a small collection size, significant remaining structure/genetic similarity and long LD blocks that limit the resolution of association mapping. These results can be used to improve GWAS in peanut in future studies - for example, by increasing the size and reducing structure in the collections used for GWAS.

Lower energy intake following consumption of Hi-oleic and regular peanuts compared with iso-energetic consumption of potato crisps.

Snack foods can contribute a high proportion of energy intake to the diet. Peanuts are a snack food rich in unsaturated fatty acids, protein and fibre which have demonstrated satiety effects and may reduce total energy intake, despite their high energy density. This study examined the effects of consuming Hi-oleic (oleic acid ~75% of total fatty acids) peanuts and regular peanuts (oleic acid ~50% and higher in polyunsaturated fatty acids) compared with a high carbohydrate snack (potato crisps) on satiety and subsequent energy intake. Using a triple crossover study design, 24 participants (61 ± 1 years) consumed iso-energetic amounts (56-84 g) of Hi-oleic or regular peanuts or (60-90 g) potato crisps after an overnight fast. Hunger and satiety were assessed at baseline, 30, 60, 120 and 180 minutes following snack consumption using visual analogue scales, after which a cold buffet meal was freely consumed and energy intake measured. The same snack was consumed on 3 subsequent days with energy intake assessed from dietary records. This protocol was repeated weekly with each snack food. Total energy intake was lower following consumption of Hi-oleic and regular peanuts compared with crisps, both acutely during the buffet meal (-21%; p<.001 and -17%; p< .01) and over the 4 days (-11%; p< .001 and -9%; p< .01). Despite these reductions in energy intake, no differences in perceived satiety were observed. The findings suggest peanuts may be a preferred snack food to include in the diet for maintaining a healthy weight.

Sexuality generates diversity in the aflatoxin gene cluster: evidence on a global scale.

Aflatoxins are produced by Aspergillus flavus and A. parasiticus in oil-rich seed and grain crops and are a serious problem in agriculture, with aflatoxin B1 being the most carcinogenic natural compound known. Sexual reproduction in these species occurs between individuals belonging to different vegetative compatibility groups (VCGs). We examined natural genetic variation in 758 isolates of A. flavus, A. parasiticus and A. minisclerotigenes sampled from single peanut fields in the United States (Georgia), Africa (Benin), Argentina (Córdoba), Australia (Queensland) and India (Karnataka). Analysis of DNA sequence variation across multiple intergenic regions in the aflatoxin gene clusters of A. flavus, A. parasiticus and A. minisclerotigenes revealed significant linkage disequilibrium (LD) organized into distinct blocks that are conserved across different localities, suggesting that genetic recombination is nonrandom and a global occurrence. To assess the contributions of asexual and sexual reproduction to fixation and maintenance of toxin chemotype diversity in populations from each locality/species, we tested the null hypothesis of an equal number of MAT1-1 and MAT1-2 mating-type individuals, which is indicative of a sexually recombining population. All samples were clone-corrected using multi-locus sequence typing which associates closely with VCG. For both A. flavus and A. parasiticus, when the proportions of MAT1-1 and MAT1-2 were significantly different, there was more extensive LD in the aflatoxin cluster and populations were fixed for specific toxin chemotype classes, either the non-aflatoxigenic class in A. flavus or the B1-dominant and G1-dominant classes in A. parasiticus. A mating type ratio close to 1∶1 in A. flavus, A. parasiticus and A. minisclerotigenes was associated with higher recombination rates in the aflatoxin cluster and less pronounced chemotype differences in populations. This work shows that the reproductive nature of the population (more sexual versus more asexual) is predictive of aflatoxin chemotype diversity in these agriculturally important fungi.

Analysis of crude protein and allergen abundance in peanuts (Arachis hypogaea cv. Walter) from three growing regions in Australia.

The effects of plant growth conditions on concentrations of proteins, including allergens, in peanut ( Arachis hypogaea L.) kernels are largely unknown. Peanuts (cv. Walter) were grown at five sites (Taabinga, Redvale, Childers, Bundaberg, and Kairi) covering three commercial growing regions in Queensland, Australia. Differences in temperature, rainfall, and solar radiation during the growing season were evaluated. Kernel yield varied from 2.3 t/ha (Kairi) to 3.9 t/ha (Childers), probably due to differences in solar radiation. Crude protein appeared to vary only between Kairi and Childers, whereas Ara h 1 and 2 concentrations were similar in all locations. 2D-DIGE revealed significant differences in spot volumes for only two minor protein spots from peanuts grown in the five locations. Western blotting using peanut-allergic serum revealed no qualitative differences in recognition of antigens. It was concluded that peanuts grown in different growing regions in Queensland, Australia, had similar protein compositions and therefore were unlikely to show differences in allergenicity.

Childhood dental trauma and socioeconomic status.

DATA SOURCES: Brazilian Bibliography of Dentistry (BBO), Scientific Electronic Library online (SciELO), Latin American and Caribbean Health Sciences (LILACS), The Cochrane Library, ISI Web of Knowledge, International Database for Medical Literature (MEDLINE) and PubMed Central. The database of the Brazilian Coordination of Higher Education Personnel Improvement (CAPES) was searched as well as reference lists from included articles. STUDY SELECTION: Articles providing information on the correlation between traumatic injuries in permanent teeth and socioeconomic indicators were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted by two reviewers and disagreements resolved through discussion and a qualitative synthesis conducted. RESULTS: Nine studies were included (1 cohort, 8 cross-sectional). Seven of the surveys were carried out in Brazil and two in Thailand. The age of children was 9-14 years. Statistically significant associations between permanent tooth injuries and high economic status were found in four studies. CONCLUSIONS: There were few studies correlating traumatic injuries in permanent teeth and socioeconomic indicators and the majority found no such association. It is suggested that the association between traumatic dental injuries and socioeconomic factors may be related to the indicators used, considering differences in their individual components. Furthermore, the heterogeneity of the methodologies hinders the comparison of the studies.

The initial management of dento-alveolar trauma in general dental practice.

UNLABELLED: Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. CLINICAL RELEVANCE: The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Impact of compliance on weight loss and health profile in a very low energy diet program.

BACKGROUND: Although intuitive, little data links program compliance with weight loss and health profile changes in obese Australians. METHODS: Obese males (n=308) and females (n=734) from one clinic using a very low energy diet intervention were studied over 26 weeks. Physical and health profiles were assessed. Low compliance completed 1-12 weeks, medium 13-20 weeks and high 21-26 weeks. OBJECTIVE: Overall, 52% achieved high compliance (females: 53%, males: 49%). Greater compliance was associated with greater weight loss and health profile changes in both genders. Mean male weight loss approximated 12 kg, 21 kg and 26 kg with low, medium and high compliance; mean female values were 8 kg, 15 kg and 20 kg. Body mass index, waist-hip ratios, and blood pressure, cholesterol, triglyceride and glucose changes were all more marked with high compliance. DISCUSSION: Unsuprisingly, high compliance in both genders was consistently associated with more substantial reductions (>15%) of body weight and greater health profile improvements.

Genotype-by-environment interaction affects the essential mineral composition of peanut (Arachis hypogaea L.) kernels.

The concentrations of 15 essential minerals (B, Ca, Co, Cr, Cu, Fe, K, Mg, Mn, Mo, Na, Ni, P, Se, and Zn) in kernels of nine diverse peanut genotypes, which were cultivated in five distinct growing environments, were analyzed by inductively coupled plasma-optical emission spectroscopy (ICP-OES) and -mass spectrometry (ICP-MS). The effects of genotype, environment, and genotype-by-environment (G × E) interactions were significant (P < 0.05) for all elements excluding Cr. Genetic control of mineral composition was demonstrated by large (P < 0.05) genotypic differences in Ca, Mo, K, Na, and P contents, and clustering of some genotypes in environment-centered principal components analysis (PCA) along axes comprising both macro (Ca, Mg, P, and K)- and microelements (Co, Cu, Fe, Mn, and Zn). Mo and Na concentrations were strongly influenced (P < 0.05) by the growing environment, with very high levels measured in samples from Bundaberg. The results confirm that that there is breeding potential for several important minerals in peanuts, although significant G × E interactions will complicate the response to selection. From a practical viewpoint, combining genetic improvement with agronomic management may be a useful strategy to consistently achieve desirable mineral concentrations in peanut kernels.

Disease surveillance using a hidden Markov model.

BACKGROUND: Routine surveillance of disease notification data can enable the early detection of localised disease outbreaks. Although hidden Markov models (HMMs) have been recognised as an appropriate method to model disease surveillance data, they have been rarely applied in public health practice. We aimed to develop and evaluate a simple flexible HMM for disease surveillance which is suitable for use with sparse small area count data and requires little baseline data. METHODS: A Bayesian HMM was designed to monitor routinely collected notifiable disease data that are aggregated by residential postcode. Semi-synthetic data were used to evaluate the algorithm and compare outbreak detection performance with the established Early Aberration Reporting System (EARS) algorithms and a negative binomial cusum. RESULTS: Algorithm performance varied according to the desired false alarm rate for surveillance. At false alarm rates around 0.05, the cusum-based algorithms provided the best overall outbreak detection performance, having similar sensitivity to the HMMs and a shorter average time to detection. At false alarm rates around 0.01, the HMM algorithms provided the best overall outbreak detection performance, having higher sensitivity than the cusum-based Methods and a generally shorter time to detection for larger outbreaks. Overall, the 14-day HMM had a significantly greater area under the receiver operator characteristic curve than the EARS C3 and 7-day negative binomial cusum algorithms. CONCLUSION: Our findings suggest that the HMM provides an effective method for the surveillance of sparse small area notifiable disease data at low false alarm rates. Further investigations are required to evaluation algorithm performance across other diseases and surveillance contexts.

Applying cusum-based methods for the detection of outbreaks of Ross River virus disease in Western Australia.

BACKGROUND: The automated monitoring of routinely collected disease surveillance data has the potential to ensure that important changes in disease incidence are promptly recognised. However, few studies have established whether the signals produced by automated monitoring methods correspond with events considered by epidemiologists to be of public health importance. This study investigates the correspondence between retrospective epidemiological evaluation of notifications of Ross River virus (RRv) disease in Western Australia, and the signals produced by two cumulative sum (cusum)-based automated monitoring methods. METHODS: RRv disease case notification data between 1991 and 2004 were assessed retrospectively by two experienced epidemiologists, and the timing of identified outbreaks was compared with signals generated from two different types of cusum-based automated monitoring algorithms; the three Early Aberration Reporting System (EARS) cusum algorithms (C1, C2 and C3), and a negative binomial cusum. RESULTS: We found the negative binomial cusum to have a significantly greater area under the receiver operator characteristic curve when compared with the EARS algorithms, suggesting that the negative binomial cusum has a greater level of agreement with epidemiological opinion than the EARS algorithms with respect to the existence of outbreaks of RRv disease, particularly at low false alarm rates. However, the performance of individual EARS and negative binomial cusum algorithms were not significantly different when timeliness was also incorporated into the area under the curve analyses. CONCLUSION: Our retrospective analysis of historical data suggests that, compared with the EARS algorithms, the negative binomial cusum provides greater sensitivity for the detection of outbreaks of RRv disease at low false alarm levels, and decreased timeliness early in the outbreak period. Prospective studies are required to investigate the potential usefulness of these algorithms in practice.

Dentoalveolar trauma in Glasgow: an audit of mechanism and injury.

Traumatic dental injuries in children often require multiple follow-up visits to the dentist and may have long-term consequences for the developing dentition. The aim of this audit was to examine age, gender, location, time of year, mechanism of injury and type of injury sustained in relation to dentoalveolar trauma in children attending the paediatric dental trauma clinic at Glasgow Dental Hospital from 2002 to 2004, and to compare our findings with data in the published literature. Males suffered 60% of all dental trauma, 79% of sporting injuries and 85% of assaults. The injuries in males were more severe, representing 65% of enamel dentine and pulp fractures, 100% of crown root fractures and 66% of crown root and pulp fractures. A peak for trauma was seen in the 8-11-year-old group (43%). The majority of injuries in the under four age group resulted from falls (87%). Taken as a whole, falls accounted for 49%, sports related injuries 18%, bicycle and scooter 13%, assault 7%, and road traffic accidents 1.5% of all injuries. They also accounted for a far higher percentage of intrusive luxations (67%). The largest proportion of injuries occurred during the summer months (33%). Sixty-four percent of children suffered trauma to more than one tooth. Fifty-eight percent of injuries involved the dental hard tissues and pulp and the majority of these (82%) were crown fractures. Most subjects (82%) suffered trauma to their periodontal tissues, (26% concussion or subluxation, 26% lateral luxation and 23% avulsion). Injuries to the supporting bone were uncommon. Sixty-six percent of all injuries occurred outdoors. Our findings were similar to a number of published studies, but in contrast to several others. More consistency is required in the collection and reporting of trauma data to be able to draw meaningful conclusions by comparison.

Using GIS to create synthetic disease outbreaks.

BACKGROUND: The ability to detect disease outbreaks in their early stages is a key component of efficient disease control and prevention. With the increased availability of electronic health-care data and spatio-temporal analysis techniques, there is great potential to develop algorithms to enable more effective disease surveillance. However, to ensure that the algorithms are effective they need to be evaluated. The objective of this research was to develop a transparent user-friendly method to simulate spatial-temporal disease outbreak data for outbreak detection algorithm evaluation. A state-transition model which simulates disease outbreaks in daily time steps using specified disease-specific parameters was developed to model the spread of infectious diseases transmitted by person-to-person contact. The software was developed using the MapBasic programming language for the MapInfo Professional geographic information system environment. RESULTS: The simulation model developed is a generalised and flexible model which utilises the underlying distribution of the population and incorporates patterns of disease spread that can be customised to represent a range of infectious diseases and geographic locations. This model provides a means to explore the ability of outbreak detection algorithms to detect a variety of events across a large number of stochastic replications where the influence of uncertainty can be controlled. The software also allows historical data which is free from known outbreaks to be combined with simulated outbreak data to produce files for algorithm performance assessment. CONCLUSION: This simulation model provides a flexible method to generate data which may be useful for the evaluation and comparison of outbreak detection algorithm performance.

A retrospective comparison of two very low energy diets on weight loss and health status in obese women completing a 26-week program.

AIM: To retrospectively compare the effects of two very low energy diets (VLED) on weight, girths, and health status by auditing clinic database. METHODS: Obese women (n = 150) who consumed either 420 kcal/day (n = 75) or 800 kcal/day (n = 75) were retrospectively matched for age, height and entry weight. The 26-week program comprised 12 weeks of 420 or 800 kcal/day energy intake then 12 weeks of reintroduction of normal food, with behavioural management. Pre-post measures of weight, BMI, girths, blood pressure (BP) and blood glucose, cholesterol and triglycerides were made. RESULTS: Within groups, all variables significantly improved at 26 weeks, except fasting glucose (420 group only). In the 420 and 800 groups, mean weight loss was 18.7 and 19.0 kg, BMI reduced by 7.7 and 7.0 kg/m(2), waist girth by 15.6 and 16.2 cm and hip girth by 16.5 and 14.1 cm (all p < 0.001). With weight loss expressed as % of entry weight, 58.7% of the 420 and 42.6% of the 800 groups lost >20% weight (p = 0.05). The only post-between group differences were in decreases in systolic BP (14 mmHg in 420 vs. 7 mmHg in 800; p < 0.05) and fasting glucose (0.1 mmol/L in 420 vs. 0.4 mmo1/L in 800; p < 0.05). CONCLUSIONS: Both levels of VLED with behavioural management produced similar improvements in weight and health status in obese women after 26 weeks. A VLED of 800 kcal/day (instead of 420) might be recommended for calorie control programs, to minimise health risks, while producing similar improvements in weight and health.

LeFort III internal distraction in syndromic craniosynostosis.

Distraction osteogenesis of the mid-face alleviates the requirements of substantial autogenous bone grafts and donor site morbidity and alleviates the restriction of the soft-tissue envelope in gaining advancement of the mid-face. A prospective study, over a 14-month period, was initiated to evaluate the results of seven consecutive patients undergoing mid-facial advancement who were treated with Le Fort III internal distraction using the MID device. All patients had syndromic craniosynostoses and six patients had previously undergone fronto-orbital advancement. Four patients had symptoms of airway obstruction and one patient was tracheostomy dependent. Six of the patients completed the distraction as planned. Lateral cephalograms were analyzed and the mean linear distraction was 18 mm with a range of 8 mm to 23 mm. Complications included infection (one patient), mechanical failure (one patient), intraoperative fragment dysjunction (three patients), velopharyngeal insufficiency (one patient), conjunctivitis (two patients), trismus (six patients), and bony irregularities. It was concluded that in our Unit's future protocol for managing infant syndromic synostoses, synostectomies and cranial vault remodeling will be undertaken in infants as before, but that in early childhood, patients with severe mid-facial hypoplasia and/or respiratory compromise will be offered distraction osteogenesis as a substitute for the traditional Le Fort III advancement and bone grafting.