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Purpose Trans-sutural distraction osteogenesis (TSDO) is an alternative method for the early treatment of midfacial hypoplasia in growing patients with cleft lip and palate (CLP). The purpose of this study was to analyze three-dimensional (3D) midfacial skeletal changes after TSDO and to explore the mechanism in this process. Material and methods All patients with nonsyndromic CLP who underwent bone-borne TSDO for midfacial hypoplasia from 2005 to 2014 were reviewed in this retrospective study. 3D morphological and quantitative measurement analyses were performed to evaluate midfacial skeletal changes by superimposition of preoperative and postoperative computed tomographic images. Results Twenty-six patients with mean age of 11.5 years met the inclusion criteria. The 3D morphological findings exhibited the most significant suture stress changes at the pterygomaxillary suture area, with obvious bone generation in all patients. The whole midfacial skeleton had progressively increased advancement in a craniocaudal direction along the midface segment, associated with morphological changes in skeleton itself. The 3D quantitative measurement findings showed differential advancement of each landmark at the maxillary alveolar, zygomatic bone, orbital rim, and nasal bone, which was consistent with morphological findings. Conclusions TSDO allows rotation advancement of the midfacial skeleton to achieve occlusal correction and facial harmony through the mechanism of both suture remodeling and bone remodeling. [ABSTRACT FROM AUTHOR]

• A novel passive knee exoskeleton with inclusivity in uncertainties • Propose a method for analysis human-exoskeleton with uncertainties • Propose an indicator to quantify the exoskeletons' motion transmission smoothness • Smoothness indicator consider only configuration variables It is suggested that exoskeletons may present challenges in terms of wearability due to unexpected human-machine interaction forces, usually caused by wearing uncertainties such as wearing slips, geometric differences in individual knees, and variable-axis knee movements. Additionally, the forces caused by drastic changes in velocity during exoskeleton locomotion may also be a contributing factor. To address these issues, this paper introduces a new passive knee exoskeleton and its human-machine wearing parallel (HMWP) research prototype to compensate and accommodate these uncertainties. Subsequently, a response interval analysis method based on Chebyshev functions is proposed to investigate the effect of uncertainties on the HMWP system's kinematic performance. In order to enhance the motion transmission smoothness, a new kinematic performance evaluation indicator is proposed, which considers solely the exoskeleton-configuration parameters. The response interval analysis method and new indicator are applied together in kinematic dimensional synthesis, resulting in significant improvements in the exoskeleton's kinematic performance. Furthermore, a parameter sensitivity analysis is conducted to facilitate more effective improvements to the exoskeleton's comfort. This research can also be used to improve the wearability of other wearable devices. [ABSTRACT FROM AUTHOR]