In Search of the Optimal Surgical Treatment for Velopharyngeal Dysfunction in 22q11.2 Deletion Syndrome: A Systematic Review

<div><h3>Background</h3><p>Patients with the 22q11.2 deletion syndrome (22qDS) and velopharyngeal dysfunction (VPD) tend to have residual VPD following surgery. This systematic review seeks to determine whether a particular surgical procedure results in superior speech outcome or less morbidity.</p> <h3>Methodology/ Principal Findings</h3><p>A combined computerized and hand-search yielded 70 studies, of which 27 were deemed relevant for this review, reporting on a total of 525 patients with 22qDS and VPD undergoing surgery for VPD. All studies were levels 2c or 4 evidence. The methodological quality of these studies was assessed using criteria based on the Cochrane Collaboration's tool for assessing risk of bias. Heterogeneous groups of patients were reported on in the studies. The surgical procedure was often tailored to findings on preoperative imaging. Overall, 50% of patients attained normal resonance, 48% attained normal nasal emissions scores, and 83% had understandable speech postoperatively. However, 5% became hyponasal, 1% had obstructive sleep apnea (OSA), and 17% required further surgery. There were no significant differences in speech outcome between patients who underwent a fat injection, Furlow or intravelar veloplasty, pharyngeal flap pharyngoplasty, Honig pharyngoplasty, or sphincter pharyngoplasty or Hynes procedures. There was a trend that a lower percentage of patients attained normal resonance after a fat injection or palatoplasty than after the more obstructive pharyngoplasties (11–18% versus 44–62%, p = 0.08). Only patients who underwent pharyngeal flaps or sphincter pharyngoplasties incurred OSA, yet this was not statistically significantly more often than after other procedures (p = 0.25). More patients who underwent a palatoplasty needed further surgery than those who underwent a pharyngoplasty (50% versus 7–13%, p = 0.03).</p> <h3>Conclusions/ Significance</h3><p>In the heterogeneous group of patients with 22qDS and VPD, a grade C recommendation can be made to minimize the morbidity of further surgery by choosing to perform a pharyngoplasty directly instead of only a palatoplasty.</p> </div

The heel-induced sway force and yaw moment of a high-speed craft in following regular waves

The coupling between heel and the loads in the horizontal plane is usually neglected in manoeuvrability studies. However, the heel-sway and heel-yaw coupling can play an important role in potentially unsafe conditions, such as in a following sea. In these conditions, small fast vessels experience dynamic instabilities which threaten their ability to maintain a straight course. In this study, the coupling between the static heel and the sway force and yaw moment was investigated for a high-speed craft. The objective of this work is to understand the effect of heel on the manoeuvring in following waves, and to predict this effect by means of numerical tools for different combinations of wave characteristics and vessel speeds. A dedicated captive model test campaign was conducted to evaluate the manoeuvring loads in sway and yaw when the craft has a heel angle in following regular waves. The tests were performed in the towing tank of Delft University of Technology. The heel-induced loads depend strongly on the longitudinal position of the vessel in the wave, and they significantly differ from the heel-induced loads in calm water at the respective speed. The data carried out in the model tests were used to describe empirically the heel-induced loads for several combinations of ship speeds and wave characteristics. This empirical description was meant to correct a 3D potential flow boundary element method (BEM), with the objective of being able to predict these loads on a wide range of conditions. The corrected 3D BEM was used to simulate the behaviour of the high-speed craft in following regular waves. This analysis showed that the heel-induced loads have the effect of stabilizing the ship to the inception of dynamic instabilities in the following sea

The fauna of hydrothermal vents on the Mohn Ridge (North Atlantic)

The macrofauna of the newly discovered hydrothermal vent field on the Mohn Ridge at 71 degrees N was investigated. Samples were collected during the cruise BIODEEP 2006 using the ROV 'Bathysaurus'. A total of 180 species-level taxa were identified. The region contains very few vent-endemic species, but some species of Porifera, Crustacea and Mollusca may be vent-associated. Dense aggregations of motile non-vent species such as Heliometra glacialis and Gorgonocephalus eucnemis surrounded the vent area, but the area in general only held small numbers of sedentary animals. Calcareous sponges comprised an unusually high portion of the sponge species found and they constitute one of the first pioneers among the sessile invertebrates settling on these vents. Possible explanations for the structure of the fauna in the region are discussed