Medicine and Health Sciences Commons^™

Muc13- A Novel Cancer Biomarker For Early Pancreatic Cancer Diagnosis And Imaging, Sheema Khan, Anupam Dhasmana

Research Symposium

Pancreatic adenocarcinoma (PDAC) has a very poor survival rate due to late diagnosis. Therefore, identification approaches that aid in early diagnosis are highly desirable. MUC13 is a recently identified high molecular weight glycoprotein that is aberrantly expressed in PDAC and allows its progression via alterations of multiple tumor signaling pathways. Overexpression of MUC13 in PDAC cells leads to enhanced tumorigenic and metastatic phenotypes. These characteristics of PDAC cells are mediated by physical interactions between MUC13 and HER2/Neu. This study elucidates significance of MUC13, as a diagnostic and imaging marker of PDAC. Additionally, a collaborative effort has commenced to investigate the …

Interdisciplinary Integrated Primary And Behavioral Healthcare (I2pbh) Initiative, John Ronnau, Deepu George, Maria Hernandez, Salvador Arellano Iii, Myrna Ruiz

Research Symposium

Purpose: The Interdisciplinary Integrated Primary and Behavioral Healthcare (I2PBH) Initiative will train University of Texas Rio Grande Valley (UTRGV) mental health graduates to deliver high quality, evidence-based Integrated Behavioral Health (IBH) services in the Rio Grande Valley (RGV) – a high-need, high-demand, medically underserved Hispanic region along the US-Mexico border. Specifically, the I2PBH initiative will train 24 UTRGV mental health graduates annually to deliver high-quality IBH clinical services through the evidence based Primary Care Behavioral Health (PCBH) model. With a training emphasis on basic/advanced theory and clinical skills in the PCBH model, students will serve as Behavioral Health Consultants (BHC) …

Integrative Transcriptomics Data Analysis Of Trpv1 In Hepatocellular Carcinoma, Vivek Kumar Kashyap, Bhuvnesh Sharma, Himanshu Narayan Singh, Deepak Verma, Deepak Parashar, Murali M. Yallapu, Subhash C. Chauhan

Research Symposium

Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Transient receptor potential vanilloid 1 (TRPV1) is a nonselective Ca2+ channel protein that is widely expressed and plays a significant role in cancer initiation and progression. However, the biological significance of TRPV1 in HCC has not been systematically and comprehensively investigated. Using deep data mining and transcriptomics analyses, in this study, we described the significance of TRPV1 expression and its association with HCC prognosis.

Methods: TRPV1 mRNA expression in HCC was examined using the Cancer Genome Atlas (TCGA), the Genotype Tissue Expression Atlas (GTEx), the Tumor Immune Estimation …

Icg-Loaded Mesoporous Nanohybrid (Nd-Doped Hydroxyapatite/Fe3o4) For Photonic/Magnetic Hyperthermia And Photodynamic Therapy, Prakhar Sengar, K. Chauhan, A. G. Rodríguez-Hernández, G. A. Hirata

Research Symposium

Background: Multimodality nanoplatforms play a crucial role in advancing medical interventions by integrating multiple functionalities into a single system. However, issues like intricate production processes and biocompatibility persist. Herein, a facile synthesis of a biomaterial-based mesoporous nanocarrier, HAp:Nd+SPIONs@mSiO2, loaded with the near-infrared (NIR) emitting dye indocyanine green (ICG) is reported.

Methods: HAp:Nd nanoparticles were synthesized via combustion methods. Thereafter, commercial SPIONs and HAp:Nd were integrated within a mesoporous silica via a modified Stöber approach. HAp:Nd+SPIONs@mSiO2 nanoplatform was characterized for particle size, porosity, and luminescence using TEM, BET, and luminescence spectroscopy. The synthesized nanoplatform was further loaded with ICG dye and …

Integrated Cancer Research Core (Icrc) At The University Of Texas Rio Grande Valley, Iris Enriquez

Research Symposium

Background: The University of Texas Rio Grande Valley-School of Medicine (UTRGV-SOM) has founded the South Texas Centre of Excellence in Cancer Research to address disproportionate cancer related health issues in the Valley. UTRGV-SOM intends to establish an Integrated Cancer Research Core (ICRC) Facility at the UTRGV campus to provide cutting-edge technologies to support cancer research investigators of the Rio Grande Valley.

Methods: The ICRC will house most recent technologies (Flow Cytometry, Image Stream Flow, Droplet Digital PCR, molecular imaging, microPET/CT imaging, etc) to support flow cytometric analyses in cell suspension and tissues, cell sorting, analysis of tumor immune components, microbiome …

Graphene Nanoparticles For Microrna Delivery, Eswara Naga Hanuma Kumar Ghali

Research Symposium

Background: Graphene (G) has been established as an exciting prospect for a broad range of applications owing to its remarkable properties. As the molecular structure of G itself is achiral thus introducing chirality in G by simple attachment of a functional group (a chiral ligand) on the G nanosheet may result in more diverse applications. The recent innovations of G chiral nanosystems have been extended to drug delivery. Herein, we have developed a novel and facile synthesis method for producing chiral G for its application in chirality-dependent microRNA delivery.

Methods: L-graphene and D-graphene were produced in a single step by …

Exploring The Role Of Mucin 13 In Hepatocellular Carcinoma, Shabnam Malik, Mohammed Sikander, Daniel Zubieta

Research Symposium

Background: Hepatocellular carcinoma (HCC) has a poor prognosis due to ineffective therapeutic modality and lack of early diagnostic marker. Accumulating studies have shown that elevated expression of mucin 13 as potential oncogene and predictive biomarker for various cancer. However, very little is known about its expression and function for development and progression of HCC.

Objective: To investigate mucin 13 expression in chemically induced hepatocellular carcinoma model.

Methodology: Diethyl nitrosamine (DEN) and 2-Acetylaminofluorene (2-AAF) induced method was employed for the development of hepatocellular carcinoma in Male Wistar rats. Serum and tissues were collected at regular intervals of time and routinely validated …

Evaluating Who, Cci, And Cfs Performance In Predicting Non-Small Cell Lung Cancer Survival In Finland: Insights Beyond Concord-3, Ville Paappanen

Research Symposium

Background: Set against the backdrop of the 2018 CONCORD-3 study, our research focuses on Finland's lung cancer survival rates. Despite similar tax-funded and public healthcare systems, these rates lag behind those of other Nordic countries, prompting an investigation into the underlying causes. This research aims to unravel these disparities, particularly in the context of Finland's success in other cancer domains, contributing to broader efforts to elevate lung cancer outcomes to the level of other Nordic cancer success stories.

Study objective: Our study focuses on evaluating clinical performance classification systems like WHO Score, Charlson Comorbidity Index (CCI), and Clinical Frailty Scale …

Embolic Protection During Radical Nephrectomy With Inferior Vena Cava Thrombectomy Using The Protrieve Sheath, Mia Rose Schmolze

Research Symposium

Renal Cell Carcinoma (RCC) is complicated by inferior vena cava (IVC) involvement in 4-10% of cases with intraoperative tumor embolization associated with 60-75% mortality. Currently, there is no high-level evidence demonstrating which surgical techniques provide optimal outcomes. The Protrieve SheathTM (Inari Medical®) has been used in the vascular setting for complex deep vein thrombosis(DVT) and non-tumor IVC thrombectomy cases. We aim to describe its first use in the setting of RCC with IVC thrombectomy to help prevent intraoperative tumor embolization. The Protrieve SheathTM successfully provided potentially life-saving protection from clot embolization when performing radical nephrectomy with IVC thrombectomy.

Development Of Mirna Therapeutics Targeting Atp Citrate Lyase (Acly) For The Treatment Of Oral Cancer, Uzini Devi Daimary

Research Symposium

Background: The global incidence of oral cancer (OC) has seen a consistent rise, with India accounting for nearly one-third of reported cases. Thus, there is an urgent need to gain a comprehensive understanding of the underlying pathophysiology of OC and develop effective and novel therapeutic interventions for the prevention and treatment of this deadly disease. Lipogenesis, a primary metabolic alteration in cancer cells, is linked to ACLY, a key enzyme in lipid biogenesis making it a promising target for OC treatment. Aberrant expression of ACLY regulates vital signaling pathways in tumorigenesis, indicating its potential as a novel therapeutic strategy against …

Development Of Mirna Mimics Targeting Tumor Necrosis Factor-Α Induced Protein Eight (Tnfaip8/Tipe) In Oral Cancer, Aviral Kumar

Research Symposium

Background: The prevalence of oral cancer worldwide is on the rise, with India accounting for almost a third of all documented cases. Despite significant progress in therapeutic approaches, elevated mortality rates and recurrent disease incidences pose a considerable challenge to India’s emerging healthcare sector. Hence, there is an urgent need to comprehend the underlying pathophysiology of oral cancer and devise innovative and effective therapeutic interventions for both prevention and treatment of this lethal ailment. TNFAIP8 is an apoptosis regulator proven to have an important function in the proliferation, invasion, metastasis, and progression of various malignancies. Therefore, targeting TNFAIP8 protein might …

Cucurbitacin B: A Novel Agent For Inducing Tumor-Immune Response., Sahir S. Alvi, Emmanuel Anning, Mudassier Ahmad, Carlos Perez, Mehdi Chaib, Subhash C. Chuahan, Taha Merghoub, Bilal B. Hafeez

Research Symposium

Despite the emergence of immunotherapy as a potential breakthrough in cancer treatment, it showed only a marginal response in pancreatic and liver cancers. Thus, novel strategies are highly desirable to take full advantage of immunotherapy in the treatment of these cancers. One of the critical factors that influence the efficacy of immunotherapy is the increased infiltration of myeloid-derived suppressor cells (MDSCs) and tumor-associated macrophages (TAM) into tumors that alter the immune landscape and serve as facilitators of tumor proliferation, metastatic growth, and immunotherapy resistance. Thus, we believe that selecting a potent molecule that has the ability to suppress the function …

Assessment Of Cytochrome P450 Isoforms In Colorectal Cancer And Utilization Of Phytochemicals For Their Modulation., Sudha Gahlawat

Research Symposium

Cytochrome P450 (CYPs) belongs to Phase I enzymes and exists in multiple isoforms. CYPs are present in all tissues with the highest concentrations in the liver and small intestine. These are mainly involved in drug detoxification, cellular homeostasis, metabolism of endogenous & exogenous substrates and in the inactivation/ activation of several anticancer drugs. As these CYPs are selectively and differentially expressed in CRC, which could not only provide a mechanism for drug resistance, but also insights into future therapies that may use these enzymes as therapeutic targets. This study is designed to evaluate the differential expression of various CYPs isoforms …

Assessment Of Anti-Cancerous Properties Of Nyctanthes Arbor-Tristis Linn Natural Compounds, Qazi Mohammad Sajid Jamal, Varish Ahmad

Research Symposium

Purpose: Nyctanthes arbor-tristis Linn., the lovely and fragrant flowering tree, sometimes called night-blooming jasmine or parijat, is native to Southeast and South Asia. For ages, this has been utilized in traditional medicine. There are claims that its leaves and blossoms have anti-inflammatory, antimicrobial, and anti-diabetic qualities. Plants contain anti-cancer capabilities; however, this has not yet been investigated. Therefore, we propose to explore mechanistic interaction with different cancer targets and active chemicals of this plant through computational methods, which will be further subjected to in vitro/in vivo experimental validation to show its anti-cancerous potentialities.

Description: Nyctanthes arbor-tristis Linn. plant contains several …

A Translational Approach Towards More Cost-Effective Lung Cancer Treatments, Tuula Klaavuniemi, Subhash C. Chauhan, Ville Paappanen, Artturi Mäkinen, Tuomas Rauramaa, Juha Väyrynen, Arja Jukkola, Hanne Kuitunen, Outi Kuittinen

Research Symposium

Lung cancer, globally the second most common cancer, causes 1.8 million deaths annually with 2 million new cases. It's also one of Finland's deadliest cancers. Chemotherapeutic agents, targeted drugs and radiation therapy have been the mainstay in oncologic treatment for lung cancer patients for decades. Checkpoint inhibitors (e.g. nivolumab, pembrolizumab, atezolizumab) have changed the landscape also in lung cancer. These drugs awake patients own immune system to attack cancer cells. These drugs are widely used in different cancers and they have efficacy also in lung cancer, but only in a minority of patients. Checkpoint inhibitors also induce autoimmune side effects. …

A Novel Exo-Glow Nano-System For Bioimaging, Nycol Cotto, Benilde Adriano, Neeraj Chauhan, Deepak S. Chauhan, Meena Jaggi, Subhash C. Chauhan, Murali M. Yallapu

Research Symposium

Background: Milk exosomes are widely used to improve the performance of various small macromolecules, oligonucleotides, and imaging agents for delivery and imaging applications. Indocyanine green (ICG) based Near-Infrared (NIR) fluorescent imaging is an attractive and safer technique used for number of clinical applications. However, ICG tend to have poor photostability, short half-life, non-specific proteins binding, and concentration-dependent aggregation. Therefore, there is an unmet clinical need to develop newer modalities to package and deliver ICG. Bovine milk exosomes are natural, biocompatible, safe, and feasible nanocarriers that facilitate the delivery of micro and macro molecules. Herein, we developed a novel exosomes based …

Near-Neutral Balanced Selection Theory (Nnbst): Implication On The Molecular Evolution Of Sars-Cov-2 And Zika Virus, Nicholas J. Paradis

Graduate Student and Postdoctoral Fellow Symposium

Virus pandemics have significantly impacted human welfare and development. Understanding the true molecular evolution of viruses is critical for preventing future pandemics and developing the next-generation drugs and vaccines. Unfortunately, viruses exhibiting constant genomic substitution rates (GSRs) despite increasing vaccinations and human infections (SARS-CoV-2) and viruses under seemingly extreme conservation (ZIKV) paints a confusing picture of viral evolution, and the main evolutionary theories (Selectionist Theory, Kimura’s Neutral Theory) cannot explain their molecular evolution. Here, we developed a first-principle model, c/u, to characterize reproductive fitness changes in viruses based on variations in the nucleotide/codon mutation rate (c) with respect to the …

Black Boys Om: A Case Study Of The Impacts Of Community And Culture On Wellness Practices, Khanh Pham

Graduate Student and Postdoctoral Fellow Symposium

Black men continue to face health disparities due to systemic oppression. Research indicates that mind-body-spirit practices (MBSPs) can effectively improve mental and physical health, thereby reducing health disparities among Black men. However, MBSPs are often White-female-dominated practices, thus putting Black male practitioners at continued risks of under-representation and marginalization in MBSP spaces. The culturally specific nature of MBSP spaces may then be an important factor in MBSPs’ influence on Black men’s health. Therefore, we aimed to explore how culturally specific MBSP spaces impact Black male practitioners’ MBSPs. We collaborated with Black Boys OM (BBO), a global community of Black male …

Repetitive Negative Thinking As A Prospective Predictor Of Depression And Anxiety Symptoms In Autistic And Non-Autistic Incoming College Students, Erin Kckenney

Graduate Student and Postdoctoral Fellow Symposium

Background: Improving the understanding and treatment of mental health concerns, including depression and anxiety, are significant priorities for autistic adults (Benevides et al., 2020; Crane et al., 2019; Pellicano et al., 2014). While several theories have been proposed to explain the high prevalence of internalizing symptoms in autistic people, little longitudinal research has been done to investigate potential causal mechanisms. One potentially fruitful area of investigation is to explore how well-known contributors to depression/anxiety in the general population predict and/or moderate the development of internalizing symptoms in autistic individuals. Objectives: The current study investigates the relation of one established risk …

The Imitation Game: Drug Reaction Presenting As Autoimmunity Presenting As Syphilis, Victoria W. Murray, Liam Courtney, Judith Lightfoot

Graduate Student and Postdoctoral Fellow Symposium

Introduction: Syphilis screening, a common medical test in the US, is recommended annually in sexually active women younger than 25, annually for women older than 25, and annually for men(1). Standard tests include rapid reagin tests and Venereal Disease Research Laboratory tests, which react to membrane antigens of Treponema pallidum(2). Case reports of patients with autoimmune conditions have been described (3) but rarely considered in clinical practice. Additionally, patients may be underdiagnosed with autoimmune conditions with clinically relevant antibodies (4). Here, we describe one such case where a patient received delay in care prior to referral to our service. Case …

Lstm-Based Recurrent Neural Network Predicts Influenza-Like-Illness In Variable Climate Zones, Alfred Amendolara, Christopher Gowans, Joshua Barton, David Sant, Andrew Payne

Annual Research Symposium

Purpose: Influenza virus is responsible for a recurrent, yearly epidemic in most temperate regions of the world. For the 2021-2022 season the CDC reports 5000 deaths and 100,000 hospitalizations, a significant number despite the confounding presence of SARS-CoV-2. The mechanisms behind seasonal variance in flu burden are not well understood. Based on a previously validated model, this study seeks to expand understanding of the impact of variable climate regions on seasonal flu trends. To that end, three climate regions have been selected. Each region represents a different ecological region and provides different weather patterns showing how the climate variables impact …

What Time Is It? It Is 8-And-A-1/2 Time. A Rare Case About Right Medial Pontine Stroke, Right Ino, Right Facial Colliculus Ischemic Stroke Consistent With Eight-And-A-Half Syndrome., Jessica Marcela Daza, Eunbee Cho, Celia Patricia Daza, Shakirat Ganiyu, Francisco Gomez

Research Symposium

Eight-and-a-half syndrome (EHS) is a rare neuro-ophthalmologic condition characterized by conjugated horizontal gaze palsy, internuclear ophthalmoplegia (INO), and ipsilateral fascicular seventh cranial nerve palsy. Clinical features are attributed to the involvement of the lower pontine, including the abducens nucleus, ipsilateral medial longitudinal fasciculus (MLF), and adjacent facial colliculus. Etiology includes vascular diseases such as pontine infarction or ischemia, demyelinating conditions at the level of the pons, and rarely space-occupying lesions.

Β-Cyclodextrin-Enzalutamide Self-Assembly Complexes For Prostate Cancer Therapy, Meghana Kolli, Rahul Tiwari, Subhash C. Chauhan, Yonghong Zhang, Neeraj Chauhan, Alba C. M, Murali Yallapu

Research Symposium

Background:Castrate circumstances brought on by therapy give rise to castrationresistant prostate cancer (CRPC), which thereafter develops androgen receptor (AR) resistance. AR inhibitors are frequently used to obstruct AR translocation in cells that overexpress AR and slow the progression of cancer by reducing the number of AR receptors that are accessible. In comparison to Bicalutamide, a first-generation AR inhibitor, the hydrophobic drug Enzalutamide has demonstrated higher effectiveness. We investigate Enzalutamide as a viable option for the formation of self-assembly complexes because AR downregulation is still the major treatment for CRPC.

Methods:Enz-loaded self-assembly complexes (enz-β-CD) formulation was developed using solvent …

Update On The Role Of Muc13 In Pancreatic Cancer: A Promising Early Detection Biomarker, Anupam Dhasmana, Swati Dhasmana, Sheema Khan, Meena Jaggi, Murali M. Yallapu, Subhash C. Chauhan

Research Symposium

Background: With the rise in pancreatic cancer (PanCa) prevalence and mortality rate, by 2030 it will secure second position among leading causes of cancer-related deaths. Due to poor prognosis of PanCa only 11% of PanCa patients have a 5-year survival rate, resulting in an equal mortality rate and incidence rate. 85% of PanCa are Pancreatic ductal adenocarcinoma (PDAC). The main clinical challenge with PanCa is poor treatment outcomes due the late diagnosis. Currently, there are traditional biomarkers panels available for diagnosis, however, these biomarkers do not have optimal sensitivity and specificity for PanCa. Considering this alarming unmet clinic need, our …

Unveiling The Influence Of Transcription Factor Yb1 In Hepatocellular Carcinoma Cell Lines, Yamile Abuchard, Sophia Leslie, Dennis Kwabiah, Ricardo Pequeno Bracho, Ana Ayala Pazzi, Mohammad Hussain, Manish Tripathi

Research Symposium

Background: In the Rio Grande Valley (RGV), Hispanics constitute the predominant ethnic group, accounting for over 94% of the population. Projections for 2023 indicate liver cancer to rank fifth in male and seventh in female mortality. Hepatocellular carcinoma (HCC) manifests as a significant concern within the Hispanic community, influenced by a spectrum of factors—biogenetic, social, and cultural—that intertwine with genetic predispositions and dietary practices. The incidence of HCC is intertwined with various illnesses like hepatitis, liver cirrhosis, drug-induced liver injury (DILI), adding to the burden of cancer. Over the years, HCC prevalence in the RGV has surged by over 35%. …

Unraveling Sorafenib Resistance In Hepatocellular Carcinoma: Exploring Key Facets, Dennis Kwabiah, Kyle Doxtater, Yamile Abuchard, Sophia Leslie, Ricardo Pequeno Bracho, Shaibir Hussain, Manish K. Tripathi

Research Symposium

Hepatocellular carcinoma (HCC) stands as the prevalent form of primary liver cancer worldwide, diagnosing over half a million new cases annually. Surgical interventions like hepatectomy and liver transplantation offer a potential cure for early-stage HCC. However, the prognosis for advanced stages remains grim due to drug resistance, particularly with high refractoriness rates. Sorafenib, a tyrosine kinase inhibitor, is an approved treatment for advanced HCC. Despite its use, the overall survival extension for these patients remains limited due to the drug's ineffectiveness, and the mechanism behind advanced HCC's resistance to sorafenib remains elusive. TCGA analysis of HCC patient cohorts reveals elevated …

Too Yellow: An Idiopathic Case Of Autoimmune Hemolytic Anemia, Shreel Patel, Kashif Ali, Donnel Dockery-Joseph, Eunbee Cho, Sriharsha Koneru, Taha Al Hassan, Aramide Tijani, Elimar Gonzalez Morales

Research Symposium

Background: Autoimmune hemolytic anemia is caused by autoantibodies that react with self red blood cells and cause them to be destroyed. Warm AIHA, due to antibodies that are active at body temperature, is the most common type of the AIHA. It is mostly caused by the underlying disease like infections, autoimmune disorders, lymphoproliferative disorders, immunodeficiency or physiologic state like pregnancy. Rarely it happens that there is no underlying cause. Therefore, here we present a case of idiopathic autoimmune hemolytic anemia without any underlying cause.

Case Discussion: A 77 year old lady with known history of the diabetes mellitus type 2, …

Trimeric Antp-Tbp Complexes With Tfiieβ And Exd Modulated The Transcriptional Activity Of Antp, Norma C. Hernández-Bautista, Claudia A. Altamirano-Torres, Ruben Montalvo Mendez, Gustavo Jiménez-Mejía, Diana Reséndez-Pérez

Research Symposium

Homeoproteins are transcription factors that bind to DNA through a highly conserved binding domain known as the homeodomain (HD), which recognizes short regions rich in A-T. This DNA binding triggers the modulation of multiple target genes responsible for identity in various structures along the A-P axis of D. melanogaster. However, the high similarity of homeodomains and their affinity for widely distributed sites in the genome poses the "Hox paradox," which seeks to explain how homeoproteins acquire functional specificity so precisely. Previous evidence shows that homeoproteins like Antennapedia (Antp) form dimers with cofactors and other transcription factors to modulate their …

The Role Of Oral Microbiota In Periodontitis And Alzheimer's Disease, Noah Al-Hassan, Taha Al Hassan, Juan C. Lopez-Alvarenga, Maria Quinones, Seratna Guadarrama

Research Symposium

Background: Periodontal disease (PD), affecting 20-50% of the global population is marked by biofilm-induced inflammation in oral tissues. Chronic PD results in systemic complications such as heart disease, stroke, and Alzheimer's. The red complex microbes, Porphyromonas gingivalis and Treponema denticola, play a pivotal role, penetrating the blood-brain barrier and contributing to neurodegeneration. Alzheimer's disease (AD), an irreversible neurodegenerative disorder, is linked to abnormal protein cleavage and potentially involves microbiologic components, including gram-positive cocci. Research suggests the presence of bacteria such as Porphyromonas, Actinomyces, and Treponema in autopsied AD brains. Investigating the microbiologic connection between PD and AD is crucial, considering …

The Increasing Prevalence Of Cleft Lip With Or Without Cleft Palate In The Rio Grande Valley Of Texas, Yossef Alsabawi, Aaron I. Dadzie, Tyler Torres, Elias Arellano, Paul A. Berry

Research Symposium

Background: Orofacial clefts are a subset of birth defects that include cleft lip with or without cleft palate (CLP) and cleft palate alone (CP). The treatment for orofacial clefts is surgical repair, ideally within the first six months of life. Their impacts on patients and families are various and substantial. Babies with orofacial clefts can have trouble with breastfeeding, speech, recurrent ear infections, and hearing loss as they age. Additionally, there is a significant economic burden, with the average repair costing nearly $20,000, not including the costs of medical devices, postoperative care, and rehabilitation. Additionally, children with orofacial clefts face …