摘要： Purpose: Inferior alveolar nerve block (IANB) is a frequently used anesthetic technique for restorative and surgical procedures in the mandible and its success rate usually ranges from 80 to 85%. Thus, this study aimed to compare the anesthetic efficacy of an alternative technique named superficial nerve block (SNB)-which consists of a modified approach using an extra-short needle inserted 10 mm deep and on a higher injection site to the conventional technique (CT) for IANB in healthy individuals. Methods: About 20 participants received both SNB and CT with 1.8 mL of 2% lidocaine and 1:100,000 epinephrine. Thermal tests were performed 6 times, every 2 min, on the inferior canine and first molar to determine the success rate and anesthesia onset. Assessments were repeated at 20, 40, and 60 min to determine anesthesia duration. Sensitivity of lips and tongue was tested by clamp pressure. Pain perception during injection was assessed by a 100 mm visual analog scale (VAS). Results: The success rate in accordance with anatomical location was molars (SNB = 90%;CT = 85%), canines (SNB = 25%;CT = 70%), lips (SNB = 45%;CT = 95%), and tongue (SNB = 85%;CT = 95%). Significant differences were found for canines (P =.012) and lips (P <.002). Moreover, median anesthesia onset was: molars (SNB = 6 min;CT = 4 min), canines (SNB = 6 min;CT = 6 min), lips (SNB = 10 min;CT = 6 min), and tongue (SNB = 8 min;CT = 4 min), whereas median duration was molars (SNB = 60 min;CT = 60 min), canines (SNB = 20 min;CT = 60 min), lips (SNB = 60 min;CT = 60 min), and tongue (SNB = 60 min;CT = 60 min). A significant difference was found for anesthesia onset on molars (P =.024) and lips (P =.009). Pain scores on VAS were SNB (median = 8.5 mm) and CT (median = 10.0 mm) (P =.398). Conclusions: In healthy individuals, the anesthetic effects of SNB were noninferior to CT in molars and tongue, although efficacy was considerably inferior in anterior teeth and lips. (C) 2020 American Association of Oral and

摘要： These are challenging times for physicians. Extensive changes in the practice environment have altered the nature of physicians' interactions with patients and their role in the health care delivery system. Many physicians feel as if they are "cogs in the wheel" of austere corporations that care more about productivity and finances than compassion or quality. They often do not see how the strategy and plan of their organization align with the values of the profession. Despite their expertise, they frequently do not feel they have a voice or input in the operational plan of their work unit, department, or organization. At their core, the authors believe all of these factors represent leadership issues. Many models of leadership have been proposed, and there are a number of effective philosophies and approaches. Here, the authors propose a new integrative model of Wellness-Centered Leadership (WCL). WCL includes core skills and qualities from the foremost leadership philosophies along with evidence on the relationship between leadership and physician well-being and distills them into a single framework designed to cultivate leadership behaviors that promote engagement and professional fulfillment. The 3 elements of WCL are: care about people always, cultivate individual and team relationships, and inspire change. A summary of the mindset, behaviors, and outcomes of the elements of the WCL model is presented, and the application of the elements for physician leaders is discussed. The authors believe that learning and developing the skills that advance these elements should be the aspiration of all health care leaders and a foundational focus of leadership development programs. If cultivated, the authors believe that WCL will empower individual and team performance to address the current problems faced by health care organizations as well as the iterative innovation needed to address challenges that may arise in the decades to come.

关键词： spine growth   early-onset scoliosis   growth friendly   rib-based implants   spine-based implants   sagittal spine length   SSL   3-dimensional true spine length  

摘要： Background: It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSL-curved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distraction-based surgeries will affect final spine length. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5 y follow-up, 5 lengthenings) were identified from 2 EOS registries. Radiographic analysis preoperative, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with the primary outcome of T1-S1 SSL. Results: We identified 126 patients-70 had rib-based implants (52 congenital, 9 syndromic, 9 neuromuscular) and 56 had spine-based implants (15 congenital, 29 syndromic, 12 neuromuscular) with preoperative age 4.6 years, scoliosis 75 degrees, and kyphosis 48 degrees. After initial correction (P<0.05), scoliosis remained constant [58 degrees (13 to 104 degrees) at L11-L15] and kyphosis increased over time [38 degrees (9 to 108 degrees) at L1 to 60 degrees (17 to 134 degrees) at L11-L15] (P<0.05). Preoperative SSL was higher in the spine-based group (29.6 cm) when compared with the rib-based group (25.2 cm) (P<0.05). This difference was maintained after initial implantation (spine-based: 32.2 cm vs. rib-based: 26.7 cm, P<0.05) and at final follow-up (spine-based: 37.0 cm vs. rib-based: 34.4 cm, P<0.05). As preoperative SSL differed between groups, maximum SSL gains per interval were also normalized to preoperative SSL. There was no statistically significant difference between groups at L1, L2-L5, and L6-L10. However, at L11-L15, the rib-based group achieved a more relative increase in spine length compared with the spine-based group (45% vs. 31%, P<0.05). Conclusion:

关键词： Ozaki procedure   conduit   Bentall operation   RV-to   PA conduit  

摘要： The modified Ozaki technique within a conduit is reproducible and is an alternative to the use of homografts and commercially available conduits which may have special appeal in a low resource setting.

关键词： patellar tendon imbrication   crouch gait   distal femoral extension osteotomy   patellar tendon advancement   cerebral palsy   motion analysis   gait analysis  

摘要： Background: Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO. Methods: After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical, radiographic, and instrumented gait analysis data were analyzed preoperatively and at 1 year following surgery. Results: Twenty-eight patients (54 extremities) with a diagnosis of cerebral palsy and crouch gait were included. Significant improvements were appreciated in the degree of knee flexion contracture, quadriceps strength, knee extensor lag, and popliteal angle (P<0.01). Knee flexion at initial contact and during mid-stance improved significantly (P<0.0001), and knee moments in late stance were significantly reduced (P<0.01). The anterior pelvic tilt, however, significantly increased postoperatively (P<0.0001). Radiographic improvements were seen in the knee flexion angle and patellar station as assessed by the Koshino Sugimoto Index (P<0.0001). Four patients (14.2%) developed a recurrence of knee flexion contracture requiring further intervention. Conclusions: PTI is a simplified and safe technique to address quadriceps insufficiency when performing DFEO. The short-term results of patients who underwent DFEO with PTI demonstrated improvements in clinical, radiographic, and gait analysis variables of the knee. Investigating long-term outcomes, comparing techniques, and assessing quality of life measures are important next steps in research.

关键词： adolescent   clavicle   fracture   surgery   non-operative   plate   intramedullary nail   PROMS   Quick-DASH   complications  

摘要： Introduction: Traditionally, midshaft clavicular fractures in adolescents are treated nonoperatively. In later years, a trend toward operative treatment can be observed. Documentation of the benefit of surgery in this group is scarce. The purpose of this study is to evaluate the long-term patient reported functional outcomes and complications for patients treated operatively and nonoperatively for displaced midshaft clavicular fractures. Using the same outcomes we also compared the operative methods. Methods: One hundred nine adolescents aged 12 to 18 years sustaining displaced midshaft clavicular fractures in the period 2010 to 2016 were identified in our computerized files. Sixty-one were treated nonoperatively, 48 operatively (22 plate and 26 intramedullary nail). Their radiographs and patient journals were examined for fracture classification, wound infection, sensory affection, surgery duration, hardware removal, and nonunion (n=109). Long-term function, pain, and satisfaction were measured with Quick Disability of Arm, Shoulder, and Hand (QuickDASH), Oxford Shoulder Score and Visual Analogue Scale (n=87). Results: Operative treatment: We could find no difference in functional score outcomes. The main outcome QuickDASH was excellent in both groups (median 0 nail vs. 2.26 plate). Surgery duration was shorter with intramedullary nail. We found 2 infections and 2 sensory affections in the plate group, and 1 infection and 1 sensory affection in the intramedullary nail group. There were 2 refractures in the nail group. Operative versus nonoperative treatment: there were no differences in functional outcomes between the operative and nonoperative groups. For the main outcome QuickDASH both groups scored excellently (median 1.12 operative vs. 0 nonoperative). The nonoperative group was more satisfied with the cosmetic result. There was 1 nonunion in the nonoperative group that later was operated. Conclusions: Adolescents aged 12 to 18 years with displaced midshaft cla

关键词： Epigenetics   Interleukins  

摘要： Histone lysine demethylase 6a (Kdm6a) mediates the removal of repressive trimethylation from histone H3 lysine 27 (H3K27me3) to activate target gene expression. Obesity is associated with metabolic inflammation, and adipose tissue macrophages (ATMs) are key players orchestrating metabolic inflammation. However, it is still unclear whether the Kdm6a pathway in ATMs regulates energy homeostasis. Here, we identified Kdm6a as a critical epigenetic switch that modulates macrophage polarisation and further disrupts energy balance. Myeloid-specific Kdm6a knockout in Kdm6a(F/Y);Lyz2-Cre mice significantly reversed the high-fat diet (HFD)-induced M1-M2 imbalance in white adipose tissue (WAT) and blocked HFD-induced obesity. The brown adipose tissue (BAT) activity, WAT browning and energy expenditure were significantly increased in Kdm6a(F/Y);Lyz2-Cre mice. Furthermore, Kdm6a regulated the Ire1 alpha expression in a demethylase activity-dependent manner and augmented the M2 polarisation of macrophages. Macrophage with higher Kdm6a significantly promotes adipogenesis in white adipocyte and inhibits thermogenesis in beige adipocytes. These results suggest that the Kdm6a in macrophages drives obesity and metabolic syndrome by impairing BAT activity and WAT differentiation.

关键词： aqueous biphasic systems   hydrolysate   Lupinus mutabilis   proteases   Pseudomonas sp  

摘要： Aqueous biphasic systems (ABSs) are an interesting alternative for separating industrial enzymes due to easy scale-up and low operational cost. The proteases of Pseudomonas sp. M211 were purified through ABS platforms formed by polyethylene glycol (PEG) and citrate buffer salt. Two experimental designs 2(3) + 4 were performed to evaluate the following parameters: molar mass of PEG (M-PEG), concentration of PEG (C-PEG), concentration of citrate buffer (C-Cit), and pH. The partition coefficient (K), activity yield (Y), and purification factor (PF) were the responses analyzed. The best purification performance was obtained with the system composed of M-PEG = 10,000 g/mol, C-PEG = 22 wt%, C-Cit = 12 wt%, pH = 8.0;the responses obtained were K = 4.9, Y = 84.5%, PF = 15.1, and tie-line length = 52.74%. The purified proteases of Pseudomonas sp. (PPP) were used to obtain hydrolysates of Lupinus mutabilis (Peruvian lupin cultivar) seed protein in comparison with the commercial protease Alcalase (R) 2.4L. A strong correlation between hydrolysis degree and radical scavenging activity was observed, and the highest antioxidant activity was obtained with Alcalase (R) (1.40 and 3.47 mu mol Trolox equivalent/mg protein, for 2,2 '-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) and oxygen radical absorbance capacity, respectively) compared with PPP (0.55 and 1.03 mu mol Trolox/mg protein). Nevertheless, the IC50 values were lower than those often observed for antioxidant hydrolysates from plant proteins. PEG/citrate buffer system is valuable to purify Pseudomonas proteases from the fermented broth, and the purified protease could be promising to produce antioxidant protein hydrolysates.