Cross-Domain Bilateral Access Control on Blockchain-Cloud Based Data Trading System

Data trading enables data owners and data requesters to sell and purchase data.With the emergence of blockchain technology,research on blockchain-based data trading systems is receiving a lot of attention.Particularly,to reduce the on-chain storage cost,a novel paradigm of blockchain and cloud fusion has been widely considered as a promising data trading platform.Moreover,the fact that data can be used for commercial purposes will encourage users and organizations from various fields to participate in the data marketplace.In the data marketplace,it is a challenge how to trade the data securely outsourced to the external cloud in a way that restricts access to the data only to authorized users across multiple domains.In this paper,we propose a cross-domain bilateral access control protocol for blockchain-cloud based data trading systems.We consider a system model that consists of domain authorities,data senders,data receivers,a blockchain layer,and a cloud provider.The proposed protocol enables access control and source identification of the outsourced data by leveraging identity-based cryptographic techniques.In the proposed protocol,the outsourced data of the sender is encrypted under the target receiver’s identity,and the cloud provider performs policy-match verification on the authorization tags of the sender and receiver generated by the identity-based signature scheme.Therefore,data trading can be achieved only if the identities of the data sender and receiver simultaneously meet the policies specified by each other.To demonstrate efficiency,we evaluate the performance of the proposed protocol and compare it with existing studies.

Low-frequency oscillation of train-network system considering traction power supply mode

The low-frequency oscillation(LFO)has occurred in the train-network system due to the introduction of the power electronics of the trains.The modeling and analyzing method in current researches based on electrified railway unilateral power supply system are not suitable for the LFO analysis in a bilateral power supply system,where the trains are supplied by two traction substations.In this work,based on the single-input and single-output impedance model of China CRH5 trains,the node admittance matrices of the train-network system both in unilateral and bilateral power supply modes are established,including three-phase power grid,traction transformers and traction network.Then the modal analysis is used to study the oscillation modes and propagation characteristics of the unilateral and bilateral power supply systems.Moreover,the influence of the equivalent inductance of the power grid,the length of the transmission line,and the length of the traction network are analyzed on the critical oscillation mode of the bilateral power supply system.Finally,the theoretical analysis results are verified by the time-domain simulation model in MATLAB/Simulink.

Bilateral adrenal histoplasmosis in a Malaysian tertiary hospital:Report of four cases

Rationale:Adrenal histoplasmosis can present as bilateral adrenal enlargement with constitutional symptoms and/or adrenal insufficiency.Often these patients are initially investigated as secondary adrenal metastases before eventually their diagnosis established by histopathological examination of the adrenal tissues.Patients concerns:We report 4 cases of patients aged 55-78 who presented with hypocortisolism and bilateral adrenal masses.Diagnoses:Bilateral adrenal histoplasmosis.Interventions:Three patients received antifungal treatment for at least one year while 1 patient passed away before the initiation of antifungal treatment.Outcomes:Two patients’adrenal function recovered not requiring any steroid replacement,while 1 patient still requires long-term steroid replacement.Lessons:Adrenal histoplasmosis should be excluded in patients from endemic areas presenting with bilateral adrenal masses and adrenal insufficiency.Usually patients have an exposure to bird droppings,bat guano or soil contaminated with histoplasmosis fungi.Histopathological examination of biopsied adrenal tissues is still the gold standard investigation as serology and molecular diagnostic methods are still not widely available in most centers in Malaysia.

Cortical activity in patients with high-functioning ischemic stroke during the Purdue Pegboard Test:insights into bimanual coordinated fine motor skills with functional near-infrared spectroscopy

After stroke,even high-functioning individuals may experience compromised bimanual coordination and fine motor dexterity,leading to reduced functional independence.Bilateral arm training has been proposed as a promising intervention to address these deficits.However,the neural basis of the impairment of functional fine motor skills and their relationship to bimanual coordination performance in stroke patients remains unclear,limiting the development of more targeted interventions.To address this gap,our study employed functional near-infrared spectroscopy to investigate cortical responses in patients after stroke as they perform functional tasks that engage fine motor control and coordination.Twenty-four high-functioning patients with ischemic stroke(7 women,17 men;mean age 64.75±10.84 years)participated in this cross-sectional observational study and completed four subtasks from the Purdue Pegboard Test,which measures unimanual and bimanual finger and hand dexterity.We found significant bilateral activation of the sensorimotor cortices during all Purdue Pegboard Test subtasks,with bimanual tasks inducing higher cortical activation than the assembly subtask.Importantly,patients with better bimanual coordination exhibited lower cortical activation during the other three Purdue Pegboard Test subtasks.Notably,the observed neural response patterns varied depending on the specific subtask.In the unaffected hand task,the differences were primarily observed in the ipsilesional hemisphere.In contrast,the bilateral sensorimotor cortices and the contralesional hemisphere played a more prominent role in the bimanual task and assembly task,respectively.While significant correlations were found between cortical activation and unimanual tasks,no significant correlations were observed with bimanual tasks.This study provides insights into the neural basis of bimanual coordination and fine motor skills in high-functioning patients after stroke,highlighting task-dependent neural responses.The findings also suggest that patients who exhibit better bimanual performance demonstrate more efficient cortical activation.Therefore,incorporating bilateral arm training in post-stroke rehabilitation is important for better outcomes.The combination of functional near-infrared spectroscopy with functional motor paradigms is valuable for assessing skills and developing targeted interventions in stroke rehabilitation.

Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions:A case report

BACKGROUND In addition to the non-specific symptomatology of ocular rosacea,currently,there are no reliable diagnostic tests for the disease,which may lead to its misdiagnosis.Here,we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids.CASE SUMMARY A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes,with no facial erythema.Initial management done were application of steroid eye ointment on both eyelids,hot compresses,and eyelid margin cleaning;noting that there was no relief of symptoms.Surgical excision of the chalazion was done on both eyes,however,bilateral recurrence occurred post-operatively.The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells.Immunohistochemistry studies were positive for LL-37.Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin.CONCLUSION Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

The burden of upper motor neuron involvement is correlated with the bilateral limb involvement interval in patients with amyotrophic lateral sclerosis:a retrospective observational study

Amyotrophic lateral sclerosis is a rare neurodegenerative disease characterized by the involvement of both upper and lower motor neurons.Early bilateral limb involvement significantly affects patients'daily lives and may lead them to be confined to bed.However,the effect of upper and lower motor neuron impairment and other risk factors on bilateral limb involvement is unclear.To address this issue,we retrospectively collected data from 586 amyotrophic lateral sclerosis patients with limb onset diagnosed at Peking University Third Hospital between January 2020 and May 2022.A univariate analysis revealed no significant differences in the time intervals of spread in different directions between individuals with upper motor neuron-dominant amyotrophic lateral sclerosis and those with classic amyotrophic lateral sclerosis.We used causal directed acyclic graphs for risk factor determination and Cox proportional hazards models to investigate the association between the duration of bilateral limb involvement and clinical baseline characteristics in amyotrophic lateral sclerosis patients.Multiple factor analyses revealed that higher upper motor neuron scores(hazard ratio[HR]=1.05,95%confidence interval[CI]=1.01–1.09,P=0.018),onset in the left limb(HR=0.72,95%CI=0.58–0.89,P=0.002),and a horizontal pattern of progression(HR=0.46,95%CI=0.37–0.58,P<0.001)were risk factors for a shorter interval until bilateral limb involvement.The results demonstrated that a greater degree of upper motor neuron involvement might cause contralateral limb involvement to progress more quickly in limb-onset amyotrophic lateral sclerosis patients.These findings may improve the management of amyotrophic lateral sclerosis patients with limb onset and the prediction of patient prognosis.

Rare Bilateral Radius and Ulna Fractures: A Case Report

Introduction: Forearm fractures involving both the radius and ulna, present distinctive challenges in orthopedic trauma management. This case report explores the complexities of a rare case of bilateral fractures, emphasizing the importance of a comprehensive approach for optimal outcomes. Case Presentation: This report presents the case of a 40-year-old motorcyclist who was involved in a road accident and arrived at the emergency department shortly after the incident. Clinical examination revealed closed fractures in both forearms with mild swelling and severe tenderness. Fortunately, no neurovascular issues or compartment syndrome were detected. The patient was administered intravenous fluids and effective pain relief. Forearm splints were applied and the arms were elevated using pillows. Radiographs showed fractures in the right distal radius and ulna, as well as the left mid-shaft radius and ulna. Under general anesthesia, open reduction and internal fixation were per-formed using plates and screws for all four fractures. Postoperatively, the patient’s arms were immobilized and elevated, with gradual recovery during follow-up appointments over six months, eventually achieving full function without complaints. Conclusion: This article highlights the possibility, although infrequent, of bilateral shaft fractures of the ulna and radius. With thorough clinical assessment and radiological investigation, such fractures can be well-defined. The required definitive treatment, which usually involves open reduction and internal fixation, can be performed.

Paraneoplastic retinopathies: an update on pathogenesis, diagnosis and management

The paraneoplastic retinopathies are a heterogeneous group of disorders with significant visual consequences occuring in the setting of a systemic malignancy.These conditions may be characterized by the presence of antiretinal antibodies and may predate or follow the diagnosis of an underlying malignancy.Herein I review the clinical findings,pathophysiology,laboratory testing and management of the paraneoplastic retinopathies:cancer-associated retinopathy(CAR),melanoma-associated retinopathy(MAR),bilateral diffuse uveal melanocytic proliferation(BDUMP)and paraneoplastic vitelliform maculopathy(PVM).The pathophysiology of the paraneoplastic retinopathies varies from molecular mimicry resulting in anti-retinal antibody production(CAR,MAR)to relases of soluble factors either by the primary tumor(BDUMP)and/or immune system in response to the primary tumor(PVM)which result in retinal and/or retinal pigment epithelium dysfunction.For each condition,structural and functional multimodal retinal testing can be helpful in establishing the diagnosis.Treatment for the paraneoplastic retinopathies involves a combination of treating the underlying malignancy plus additional local and/or systemic immunosuppressive agents though no systemic therapeutic protocols exist.Despite these interventions,the retinopathy may be progressive or the retinopathy may be a harbinger of poor survival.Nevertheless,prompt diagnosis may help identify an underlying malignancy earlier and may thus improve cancer-related survival.

Klippel Trenaunay Syndrome with Angiokeratoma Circumscriptum Naeviforme and Bilateral Congenital Anorchia: A Rare Association

Klippel-Trenaunay syndrome (KTS) is not a common congenital vascular abnormality. A trio of capillary malformation, venous varicosities, and bony or soft-tissue hypertrophy define this syndrome. Significant morbidities associated with this illness include bleeding, deep vein thrombosis, and embolic consequences. Angiokeratoma circumscriptum naeviforme (ACN) is indeed a congenital variant of angiokeratoma that appears as a hyperkeratotic plaque on the lower extremity. Bilateral congenital anorchia (BCA) is the total lack of testicular tissue in a male with a normal phenotype and karyotype. KTS has been linked to ACN. Here we presented an 8-year-old male child who came with a swollen left thigh and the right side of his face with overlying blackish nodules on his left thigh and scrotum. The patient was diagnosed as KTS with angiokeratoma circumscriptum naeviforme and bilateral congenital anorchia based on his history, imaging studies and the typical clinical features of the disease.

Minimally Invasive Total Arterial Coronary Artery Bypass Grafting in Left Main Stem Disease

Objective: The aim was to show that Minimally Invasive total arterial revascularization for left main stem coronary artery disease, via a left anterior Mini thoracotomy using bilateral internal thoracic arteries is feasible, reproducible and safe. Further, there has been no exclusive data or experience with minimally invasive coronary artery bypass grafting in left main stem disease. Methods: From April 2019 to March 2024, 41 patients with left main stem stenosis, left main equivalent disease and unprotected left main with triple vessel disease underwent off pump minimally invasive multivessel coronary artery bypass grafting using either in situ pedicled Bilateral Internal Thoracic arteries or Left and Right Internal Thoracic artery Y composite conduits at three centers. Bilateral Internal Thoracic arteries were harvested under direct vision. All patients had an Intra-Aortic Balloon Pump inserted via the femoral artery prior to induction of anesthesia, to prevent any hemodynamic instability, arrhythmias, and was removed following completion of the procedure in the operating room without any complications. Efficacy and outcomes were evaluated by i) Primary (MACCE)-Major Adverse Cardiac and Cardiovascular events and ii) Secondary outcome measures including total length of stay, return to full physical activity and quality of life. Mean follow-up was 1.4 years (Maximum was 2.5 years). Results: 41 patients with left main stem coronary artery stenosis, underwent total arterial revascularization using bilateral internal thoracic arteries. Left main stem stenosis was present in 29 patients, Unprotected left main stem stenosis with triple vessel disease in 7 and left main equivalence in 5 patients. In this cohort, 29 patients with only left main stem stenosis had 2 grafts each, 7 patients with left main and triple vessel disease had 3 grafts and 5 patients with left main equivalent disease had 2 grafts respectively. The average number of grafts was 2.2. One patient was converted to open sternotomy as an emergency because of hemodynamic instability and myocardial revascularization was done on cardiopulmonary bypass (2.2%). The average hospital stay was 3.7 days. Ejection fraction was 45% ± 5%. There was one mortality (2.2%) but no major morbidity. The average ICU and hospital stay was 24 ± 4 hours and 3.7 days. All patients were free from major adverse cardiac and cerebrovascular events at follow-up. Conclusions: Multivessel total arterial revascularization using left and right internal thoracic arteries, was performed via a left anterior Mini thoracotomy on patients with left main stem disease and showed that it was safe, reproducible and will help extend the armamentarium of the surgeon in minimally invasive Coronary artery bypass grafting. Concomitantly it helped enhance the potential for shorter hospital stay, increased survival, decreased morbidity, and earlier return to full activity. Furthermore, the safety, efficacy, and outcomes of minimally invasive coronary artery bypass grafting in this high-risk group evaluated by primary and secondary outcome measures have been good in this study.

Inked Impressions

Chinese Ambassador to Burundi Zhao Jiangping has successfully organised the writing competition entitled China and Me for the fourth consecutive year.The award ceremony was held on 1 February at the Chinese embassy in Burundi in the presence of Zhao,Ernest Niyokindi,director general in charge of bilateral relations at the Ministry of Foreign Affairs and Development Cooperation,members of the Chinese community living in Burundi,and several distinguished guests.

Effectiveness of Low-Temperature Plasma Adenoidectomy Combined with Bilateral Tonsillectomy in the Treatment of Snoring in Children and Its Effect on Sleep Quality

Objective:To evaluate the therapeutic effect of low-temperature plasma adenoidectomy(abbreviation:adenoid low-temperature plasma excision)coupled with tonsillectomy(bilateral)on snoring in children.Methods:Seventy-six cases of snoring children treated in the hospital between November 2020 and November 2023 were selected.38 cases of children in Group A agreed to surgery and were admitted to the hospital for surgical treatment and were treated with adenoid cryo-plasma excision combined with tonsillectomy(bilaterally),and 38 cases of children in Group B did not agree to outpatient conservative treatment for surgery,and the results of the treatment were compared.Results:Before treatment,there was no difference between the ventilation function indexes,sleep quality scores,and quality of life scores of the two groups compared with each other(P>0.05).After treatment,the ventilation function indexes of Group A were better than Group B,and the sleep quality score and quality of life score were higher than that of Group B.The total effective rate of Group A was higher than that of Group B(P<0.05).Conclusion:Adenoid cryo-plasma excision combined with tonsillectomy(bilateral)can improve the quality of life,ventilation function,and sleep quality of children with snoring,and can enhance the efficacy.

Rare uterine serosal pregnancy after in vitro fertilization in a woman with bilateral salpingectomy

Objective:To improve the understanding of ectopic pregnancy after bilateral salpingectomy through case analysis and literature review.Method:A case of uterine serosal pregnancy after in vitro fertilization and embryo transfer(IVF-ET)in a woman with bilateral salpingectomy was reported in detail and summarized,and relevant literatures searched in Pubmed were analyzed.Results:The patient had a sudden abdominal pain 18 days after transplantation.Ultrasound showed no pregnancy sac in the intrauterine cavity and bilateral adnexal areas,but there was a large amount of fluid in the Pouch of Douglas,which was an indication for surgical exploration.During the operation,the pregnancy tissue was found on the uterine serosal and cleared in time.And the patient recovered well after surgery.Review of the literatures showed that most of ectopic pregnancies after bilateral salpingectomy were treated surgically and had a good prognosis.Conclusion:Ectopic pregnancy after bilateral salpingectomy is extremely rare and should be early judged by the patients’signs.Surgical treatment timely can achieve good outcome.

Blockchain-Based Secure and Fair IoT Data Trading System with Bilateral Authorization

These days,data is regarded as a valuable asset in the era of the data economy,which demands a trading platform for buying and selling data.However,online data trading poses challenges in terms of security and fairness because the seller and the buyer may not fully trust each other.Therefore,in this paper,a blockchain-based secure and fair data trading system is proposed by taking advantage of the smart contract and matchmaking encryption.The proposed system enables bilateral authorization,where data trading between a seller and a buyer is accomplished only if their policies,required by each other,are satisfied simultaneously.This can be achieved by exploiting the security features of the matchmaking encryption.To guarantee non-repudiation and fairness between trading parties,the proposed system leverages a smart contract to ensure that the parties honestly carry out the data trading protocol.However,the smart contract in the proposed system does not include complex cryptographic operations for the efficiency of onchain processes.Instead,these operations are carried out by off-chain parties and their results are used as input for the on-chain procedure.The system also uses an arbitration protocol to resolve disputes based on the trading proof recorded on the blockchain.The performance of the protocol is evaluated in terms of off-chain computation overhead and on-chain gas consumption.The results of the experiments demonstrate that the proposed protocols can enable the implementation of a cost-effective data trading system.

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block(TAPB)in gastric cancer patients undergoing laparoscopic radical gastrectomy.METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group(n=45)and epidural anesthesia group(n=40)according to the different anesthesia and analgesia programs used.The TAPB group received general anesthesia combined with TAPB,and the epidural anesthesia group received general anesthesia combined with epidural anesthesia.The pain status,cognitive status,intestinal barrier indicators,recovery quality,and incidence of complications were compared between the two groups.RESULTS Compared with the epidural anesthesia group,the TAPB group’s visual analog scale scores were significantly lower 6 h,12 h,24 h and 48 h after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)in the TAPB group was significantly lower than that in the epidural anesthesia group,and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group(P<0.05).The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery(P<0.05).The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group(P<0.05).The total incidence of postoperative complications in the TAPB group was 4.44%,significantly lower than the 20.00%in the epidural anesthesia group(P<0.05).CONCLUSION Compared with epidural anesthesia combined with general anesthesia,TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications,improve the levels of intestinal barrier indicators,and improve postoperative recovery quality.

Position Measurement Based Slave Torque Feedback Control for Teleoperation Systems With Time-Varying Communication Delays

Bilateral teleoperation system is referred to as a promising technology to extend human actions and intelligence to manipulating objects remotely.For the tracking control of teleoperation systems,velocity measurements are necessary to provide feedback information.However,due to hardware technology and cost constraints,the velocity measurements are not always available.In addition,the time-varying communication delay makes it challenging to achieve tracking task.This paper provides a solution to the issue of real-time tracking for teleoperation systems,subjected to unavailable velocity signals and time-varying communication delays.In order to estimate the velocity information,immersion and invariance(I&I)technique is employed to develop an exponential stability velocity observer.For the proposed velocity observer,a linear relationship between position and observation state is constructed,through which the need of solving partial differential and certain integral equations can be avoided.Meanwhile,the mean value theorem is exploited to separate the observation error terms,and hence,all functions in our observer can be analytically expressed.With the estimated velocity information,a slave-torque feedback control law is presented.A novel Lyapunov-Krasovskii functional is constructed to establish asymptotic tracking conditions.In particular,the relationship between the controller design parameters and the allowable maximum delay values is provided.Finally,simulation and experimental results reveal that the proposed velocity observer and controller can guarantee that the observation errors and tracking error converge to zero.

A Hybrid Regularization-Based Multi-Frame Super-Resolution Using Bayesian Framework

The prime purpose for the image reconstruction of a multi-frame super-resolution is to reconstruct a higher-resolution image through incorporating the knowledge obtained from a series of relevant low-resolution images,which is useful in numerousfields.Nevertheless,super-resolution image reconstruction methods are usually damaged by undesirable restorative artifacts,which include blurring distortion,noises,and stair-casing effects.Consequently,it is always challenging to achieve balancing between image smoothness and preservation of the edges inside the image.In this research work,we seek to increase the effectiveness of multi-frame super-resolution image reconstruction by increasing the visual information and improving the automated machine perception,which improves human analysis and interpretation processes.Accordingly,we propose a new approach to the image reconstruction of multi-frame super-resolution,so that it is created through the use of the regularization framework.In the proposed approach,the bilateral edge preserving and bilateral total variation regularizations are employed to approximate a high-resolution image generated from a sequence of corresponding images with low-resolution to protect significant features of an image,including sharp image edges and texture details while preventing artifacts.The experimental results of the synthesized image demonstrate that the new proposed approach has improved efficacy both visually and numerically more than other approaches.

Robust fault detection for delta operator switched fuzzy systems with bilateral packet losses

Considering packet losses, time-varying delay, and parameter uncertainty in the switched fuzzy system, this paper designs a robust fault detection filter at any switching rate and analyzes the H∞ performance of the system. Firstly, the Takagi-Sugeno(T-S) fuzzy model is used to establish a global fuzzy model for the uncertain nonlinear time-delay switched system,and the packet loss process is modeled as a mathematical model satisfying Bernoulli distribution. Secondly, through the average dwell time method and multiple Lyapunov functions, the exponentially stable condition of the nonlinear network switched system is given. Finally, specific parameters of the robust fault detection filter can be obtained by solving linear matrix inequalities(LMIs). The effectiveness of the method is verified by simulation results.

Ochronotic arthropathy of bilateral hip joints:A case report

BACKGROUND Ochronosis,also known as alkaptonuria,is a rare autosomal recessive selfmetabolic disease arising from deficiency of homogentisate 1,2 dioxygenase enzyme.It affects several organs and muscoskeletal structures.We herein report a case of a patient who presented with severe hip arthropathy complicated with late stage ochronosis.CASE SUMMARY A 56-year-old male patient was admitted in our department in 2019 with complaints of chronic low backache and left hip pain.After the required investigations were done,lumbar disc herniation and severe hip arthritis were the initial diagnosis.A total left hip arthroplasty was performed.Ochronotic osteoarthritis was only obtained post-surgery as confirmatory diagnosis.He was again admitted mid 2022 with the same complaints on the right hip.Subsequently,he underwent a total right hip arthroplasty.Post-operative recovery and follow-ups were deemed very satisfactory.CONCLUSION Ochronosis is an unusual diagnosis for a patient who presents with typical hip arthritis.Thus,unless meticulous history taking and advanced laboratory tests,the diagnosis can easily be missed by surgeons.

Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings

Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.