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Abstract Background Nasopharyngoscopy is a common method to evaluate velopharyngeal closure in patients with cleft palate. However, insertion of a fiberoptic nasopharyngoscope causes discomfort in patients. The aim of this study was to estimate the reliability of short-time exposure images obtained using 320-row area detector computed tomography (320-ADCT) as a novel evaluation method for the assessment of velopharyngeal function. Methods We evaluated five healthy adult volunteers and five postoperative adult patients with cleft palate. During a 3.3-s imaging exposure, the participants were asked to perform two tasks: nasal inspiration and subsequent oral expiration through a catheter into a water-filled cup. The movement of the velopharyngeal structures was recorded during each examination, and the presence of velopharyngeal insufficiency (VPI) and velopharyngeal closure (VPC) patterns were estimated. If VPI was detected, the cross-sectional area was also calculated. Cohen’s kappa and weighted kappa coefficients were used to evaluate the concordance of nasopharyngoscopy and 320-ADCT evaluation. Results Speech pathology evaluation did not reveal hypernasality in any study participant. Micro-VPI was detected by nasopharyngoscopy in one healthy volunteer and two patients. 320-ADCT detected micro-VPI in two more patients. The cross-sectional area of the VPI in these subjects ranged from 2.53 to 16.28 mm2. Nasopharyngoscopy and 320-ADCT were concordant in detecting VPI in eight participants (κ = 0.6) and in assessing VPC patterns in nine (κ = 0.82). Moreover, images obtained using 320-ADCT allowed for reduced dead angle and, thus, easy detection of micro-VPI and Passavant’s ridges. Conclusion Although the radiation exposure cannot be ignored, our novel evaluation method using 320-ADCT enables more detailed evaluation of VPC than nasopharyngoscopy. Future studies should investigate the relationship between 320-ADCT findings and speech pathology evaluations.

Persistent interstitial pulmonary emphysema (PIPE) is rare and usually related to mechanical ventilation-induced lung damage in premature infants with respiratory distress syndrome (RDS). When conservative treatments for PIPE, such as surfactant treatment, steroid therapy, or selective intubation, are ineffective, surgical intervention should be considered. Although PIPE localized in one lobe has the potential for curative resection, diffuse PIPE (DPIPE) affecting both lungs usually carries a poor prognosis.Tension pneumatocele by ipsilateral expanded cyst in DPIPE may need surgical treatment in case of emergency. We present a rare case of an extremely low birth weight infant who required surgical intervention for tension pneumatocele due to DPIPE and propose the indications for surgery of tension pneumatocele with DPIPE. Keywords: Interstitial pulmonary emphysema, Tension pneumatocele, Extremely low birth weight infant, Surgical resection

The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA) branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding.

Two tests related to a new safety system for a pressurized water reactor were performed with the ROSA/LSTF (rig of safety assessment/large scale test facility). The tests simulated cold leg small-break loss-of-coolant accidents with 2-inch diameter break using an early steam generator (SG) secondary-side depressurization with or without release of nitrogen gas dissolved in accumulator (ACC) water. The SG depressurization was initiated by fully opening the depressurization valves in both SGs immediately after a safety injection signal. The pressure difference between the primary and SG secondary sides after the actuation of ACC system was larger in the test with the dissolved gas release than that in the test without the dissolved gas release. No core uncovery and heatup took place because of the ACC coolant injection and two-phase natural circulation. Long-term core cooling was ensured by the actuation of low-pressure injection system. The RELAP5 code predicted most of the overall trends of the major thermal-hydraulic responses after adjusting a break discharge coefficient for two-phase discharge flow under the assumption of releasing all the dissolved gas at the vessel upper plenum.