Successful Block Research Articles

Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as an adjunct to supraclavicular brachial plexus block for upper arm arteriovenous access procedures

BackgroundsUltrasound-guided proximal and distal approaches of the intercostobrachial nerve (ICBN) blocks facilitate analgesia for upper arm and axillary surgery, though success rates vary and lack clinical comparison. This study compared...

Safety and efficacy of high thoracic epidural analgesia for chest wall surgery in young adolescents: A retrospective cohort analysis and a new standardised definition for success rate.

Chest wall surgery for the correction of pectus excavatum or pectus carinatum has gained increased interest in recent years. Adequate pain treatment, respiratory physiotherapy and early ambulation are key to improving the outcomes. Although thoracic epidural analgesia is highly effective, its safety is controversial, leading to extensive scrutiny and questioning of its role. We hypothesise that thoracic epidural analgesia is effective and well tolerated to use in adolescents, with a high success rate and low pain scores. Observational retrospective cohort study. All adolescent cases in a high-volume academic tertiary chest wall surgery centre between March 1993 and December 2017 were included. A total of 1117 patients aged from 12 to 19 years of age and receiving either Ravvitch, Nuss or Abramson chest wall reconstruction for pectus excavatum were identified in our institutional chest wall surgery database. After applying selection and exclusion criteria, 532 patients were included in the current analysis. The primary endpoint of this study was the safety of epidural analgesia, assessed by the incidence of acute adverse events. Secondary endpoints were block success rates using a specific novel definition, and analgesic efficacy using recorded postoperative pain scores. More than 60% of patients experienced one or more adverse events. However, all events were minor and without consequences. No serious or long-term adverse events were detected. The success rate of thoracic epidural placement was 81%. Low postoperative pain scores were observed. Thoracic epidural analgesia is an extremely effective pain control technique, with a surprisingly high number of minor adverse events but safe with regard to serious adverse events. The local research ethics committee approved and registered this study on 16 May 2022 (registration number: S66594).

Stochastic stability of random stacking of blocks

The paper explores the stability of a tower obtained by stacking identical rectangular blocks on top of each other with an inherent randomness due to slight positional offsets between successive blocks. With probabilistic modeling techniques, the diffusive behavior of the stacking process is studied and the collapse is seen as a first passage time problem. In the considered model, alignment errors are idealized as independent Gaussian random variables with zero mean and given standard deviation. We derive expressions for the joint probability density functions of block positions, and analyze their correlation. The study extends to the stochastic stability of a stack of given height, by exploring the statistical characteristics of the center of gravity of the part of tower above each block. Eventually, the probabilistic analysis of collapse is developed to quantify the statistics of the number of blocks that can be heaped up before the tower topples. Although this problem may initially appear playful, it offers an illustrated introduction to first passage problems on a non homogenous process. From a practical standpoint, this analysis offers a simple understanding of the influence of alignment errors on the overall stability of a stack, which may find several fields of application.

Proof-of-Trusted-Work: A lightweight blockchain consensus for decentralized IoT networks

Traditional Internet of Things (IoT) architectures that rely on centralized servers for data management and decision-making are vulnerable to security threats and privacy leakage. To address this issue, blockchain has been advocated for decentralized data management in a tamper-resistance, traceable, and transparent manner. However, a major issue that hinders the integration of blockchain and IoT lies in that, it is rather challenging for resource-constrained IoT devices to perform computation-intensive blockchain consensuses such as Proof-of-Work (PoW). Furthermore, the incentive mechanism of PoW pushes lightweight IoT nodes to aggregate their computing power to increase the possibility of successful block generation. Nevertheless, this eventually leads to the formation of computing power alliances, and significantly compromises the decentralization and security of BlockChain-aided IoT (BC-IoT) networks. To cope with these issues, we propose a lightweight consensus protocol for BC-IoT, called Proof-of-Trusted-Work (PoTW). The goal of the proposed consensus is to disincentivize the centralization of computing power and encourage the independent participation of lightweight IoT nodes in blockchain consensus. First, we put forth an on-chain reputation evaluation rule and a reputation chain for PoTW to enable the verifiability and traceability of nodes' reputations based on their contributions of computing power to the blockchain consensus, and we incorporate the multi-level block generation difficulty as a rewards for nodes to accumulate reputations. Second, we model the block generation process of PoTW and analyze the block throughput using the continuous time Markov chain. Additionally, we define and optimize the relative throughput gain to quantify and maximize the capability of PoTW that suppresses the computing power centralization (i.e., centralization suppression). Furthermore, we investigate the impact of the computing power of the computing power alliance and the levels of block generation difficulty on the centralization suppression capability of PoTW. Finally, simulation results demonstrate the consistency of the analytical results in terms of block throughput. In particular, the results show that PoTW effectively reduces the block generation proportion of the computing power alliance compared with PoW, while simultaneously improving that of individual lightweight nodes. This indicates that PoTW is capable of suppressing the centralization of computing power to a certain degree. Moreover, as the levels of block generation difficulty in PoTW increase, its centralization suppression capability strengthens.

Spatiotemporal Control Over Protein Release from Artificial Cells via a Light-Activatable Protease.

The regulation of protein uptake and secretion by cells is paramount for intercellular signaling and complex multicellular behavior. Mimicking protein-mediated communication in artificial cells holds great promise to elucidate the underlying working principles, but remains challenging without the stimulus-responsive regulatory machinery of living cells. Therefore, systems to precisely control when and where protein release occurs should be incorporated in artificial cells. Here, a light-activatable TEV protease (LaTEV) is presented that enables spatiotemporal control over protein release from a coacervate-based artificial cell platform. Due to the presence of Ni2+-nitrilotriacetic acid moieties within the coacervates, His-tagged proteins are effectively sequestered into the coacervates. LaTEV is first photocaged, effectively blocking its activity. Upon activation by irradiation with 365nm light, LaTEV cleaves the His-tags from sequestered cargo proteins, resulting in their release. The successful blocking and activation of LaTEV provides control over protein release rate and triggerable protein release from specific coacervates via selective irradiation. Furthermore, light-activated directional transfer of proteins between two artificial cell populations is demonstrated. Overall, this system opens up avenues to engineer light-responsive protein-mediated communication in artificial cell context, which can advance the probing of intercellular signaling and the development of protein delivery platforms.

Supraclavicular versus infraclavicular brachial plexus block in upper limb orthopaedic surgery: a systematic review and meta-analysis of randomised controlled trials.

Clavicular brachial plexus blocks are a popular method to provide analgesia in upper limb surgery. Two common approaches include the infraclavicular (IC) and supraclavicular (SC) blocks. These two techniques have been compared previously; however, it is still being determined from the current literature whether one should be favoured. A search was performed on the following databases: Ovid Medline, EMBASE and the Web of Science from inception until 30.04.2023. All RCTs comparing SC and IC approaches in upper limb orthopaedic surgery were included. The primary outcome was block success rate. Eighteen RCTs comprising 1389 patients were included. The success rate of IC blocks was higher than SC blocks, odds ratio 0.61 (95% CI 0.41-0.91, p = 0.01). A small number of studies reported on secondary outcomes. A reduced rate of Horner's syndrome was observed in the IC group. Otherwise, no difference was noted between the approaches in terms of procedure time, sensory onset time, patient satisfaction, pain and vascular puncture. IC blocks demonstrate a higher success rate over SC blocks. Across all studies a large variance in outcome reporting and definitions was observed. Future studies should conform to an agreed definition set to facilitate comparison.

The Success of Treatment for Osteoarthritis with a Genicular Nerve Block is Associated with Patients’ Body Mass Index

Background: While the mainstay of treatment for severe osteoarthritis of the knee has been total knee arthroplasty, a prognostic genicular nerve block (GNB) followed by cooled radiofrequency ablation (CRFA) has been shown to provide long term relief of osteoarthritic knee pain and its disability. The goal of this study is to determine if there is a difference in the demographic makeup of those who had a successful prognostic genicular nerve block compared to those who did not. Methods: A retrospective chart review of 224 genicular nerve blocks was completed. The nerve block was considered successful if the patient reported a 50% or greater pain reduction for a week or more at follow up. Demographic cohorts that were compared include sex, age, race, and BMI. Results: Those who were categorized as non-obese, 36 out of 69 (52.2%) had unsuccessful blocks while 33 out of 69 (47.8%) in this BMI category had successful blocks. Of those who were categorized as obese, 25 out of 75 (33.3%) had unsuccessful blocks while 50 out of 75 (66.7%) in this BMI category had successful blocks. Of those who were deemed morbidly obese, 22 out of 75 (29.3%) had unsuccessful blocks while 53 out of 75 (70.7%) in this BMI category had successful blocks. These results were found to be statistically significant with a p-value of .011. Furthermore, GNB success was not found to be significantly impacted by patient age, race, or gender. Conclusions: These findings demonstrate the utility of prognostic genicular nerve blocks in all patients with osteoarthritis of the knee, but, in particular, the obese patient, who experiences a greater chance of pain relief on average.

Resource allocation in RISs-assisted UAV-enabled MEC network with computation capacity improvement

Unmanned aerial vehicle (UAV)-enabled mobile edge computing (MEC) networks have recently been considered to be a support for ground MEC networks to enhance their computation capability. However, the line-of-sight (LOS) channels between the UAV and Internet of Things (IoT) devices can be interfered by various obstacles, such as trees and buildings, resulting in a considerable reduction in the capacity of MEC networks. To solve this issue, a system that combines multiple reconfigurable intelligence surfaces (RISs) with a UAV-enabled MEC network is proposed in this study. A UAV equipped with edge servers is treated as an aerial computing platform for IoT devices, and multi-RISs are utilized to simultaneously improve the communication quality between enhanced UAV and IoT devices. To maximize the sum computation bits of the system, a problem that jointly optimizes the time slot partition, local computation frequency, transmit power of the devices, UAV receive beamforming vectors, phase shifts of the RISs, and the trajectory of the UAV is formulated. The problem is a typical nonconvex optimization problem; therefore, we propose a recursive algorithm based on the successive convex approximation (SCA) and block coordinate descent (BCD) technology to find an approximate optimal solution. Simulation results demonstrate the effectiveness of the proposed algorithm compared with various benchmark schemes.

Direct numerical simulations of turbulent channel flow with wall transpiration using Lattice Boltzmann method

Abstract Direct numerical simulations of turbulent channel flow with wall transpiration are conducted using the multi-relaxation time lattice Boltzmann method for the first time. Flows with two friction Reynolds numbers, Reτ=150 and 250, are investigated, and the explored transpiration rates based on the friction velocity range from 0.05 to 0.26. A successive block mesh-refinement strategy is adopted to resolve the near-wall structure, where the grid sizes are Δ+ ∼1, 2, and 4. Under such resolution, the size of the maximum grid density employed is 775 × 106. At the low transpiration rate (V+ = 0.05), the turbulence level at the suction side is damped relative to the less altered values along the injection side. However, at the high level of wall transpiration, i.e., V+ = 0.26, turbulence levels are severely retarded on both the injection and suction sides. The predicted mean and turbulence quantities show good agreements with the available DNS data, indicating the effectiveness of LBM combined with mesh refinement in reproducing the correct physics of turbulent channel flows with different levels of wall transpiration.

Factors associated with stellate ganglion block success in recurrent ventricular arrhythmias.

One treatment option for refractory ventricular arrythmias is stellate ganglion block (SGB). We examined differences in SGB success by patient and arrhythmia characteristics and predictors of successful SGB. This was a multicenter analysis of patients treated for refractory ventricular arrythmias in the Czech Republic and the United States. The primary outcome was absence of ventricular arrythmias at 24h post SGB. SGB effectiveness was examined according to aetiology of cardiomyopathy, arrhythmia type, laterality of SGB, presence of inotropes, and presence of mechanical circulatory support. Binary logistic regression was used to examine variables associated with the primary outcome. In total there were 117 patients with refractory ventricular arrythmias treated with SGB. Overall, the mean age was 63.5±11.0years, majority of patients were male (94.0%), White (87.2%), and had an implantable cardioverter defibrillator in situ (70.1%). There were no differences in efficacy of SGB based on aetiology of cardiomyopathy (P=0.623), arrhythmia type (0.852), laterality of block (P=0.131), and presence of inotropes (P=0.083). Multivariable analysis demonstrated that increased age was associated with decreased odds of SGB success (odds ratio: 0.96, confidence interval: 0.92-0.99, P=0.039) whereas increased left ventricular ejection fraction trended towards increased odds of SGB success (odds ratio: 1.05, confidence interval: 0.995-1.11, P=0.077). In this multicentre experience, SGB was similarly effective despite the aetiology of cardiomyopathy, type of arrhythmia, laterality, and inotropic or mechanical support. SGB was less effective for the suppression of ventricular arrythmias at 24h for the elderly.

BMP2 Binds Non-Specifically to PEG-Passivated Biomaterials and Induces pSMAD 1/5/9 Signalling.

Biomaterials are widely employed across diverse biomedical applications and represent an attractive strategy to explore how extracellular matrix components influence cellular response. In this study, the previously developed streptavidin platforms is aimed to use to investigate the role of glycosaminoglycans (GAGs) in bone morphogenetic protein 2 (BMP2) signaling. However, it is observed that the interpretation of findings is skewed due to the GAG-unrelated, non-specific binding of BMP2 on components of biomaterials. Non-specific adsorption of proteins is a recurrent and challenging issue for biomaterial studies. Despite the initial incorporation of anti-fouling polyethylene glycol (PEG) chains within biomaterials, the residual non-specific BMP2 adsorption still triggered BMP2 signaling within the same range as conditions of interest. The various options are explored to prevent BMP2 non-specific adsorption and a successful blocking condition involving a combination of bovine serum albumin and trehalose are identified. Furthermore, the effect of this blocking step improved when using gold platforms instead of glass, particularly with Chinese hamster ovary (CHO) cells. With this specific example, it is suggested that non-specific adsorption of BMPs on biomaterials may be a general concern - often undetected by classical surface-sensitive techniques - that needs to be addressed to better interpret cellular responses.

Deflection of Needles, Used for Local Anesthesia in the Dental Practice – Comparative Study

The mandibular nerve blocks prove to be one of the most challenging anesthetic techniques for the dental practitioner. Many factors have a role in the success of these nerve blocks and one of them is the accuracy of the deposition of the anesthetic which can be influenced to a certain degree by the deflection of the injection needle. In this study, three types of injection needles (Septoject XL 30G, Septoject XL 27G and Medoject 23G) were tested for deflection in a reversible hydrocolloid (agar-agar). They were divided into three groups of 30 needles each and were all inserted in the agar-agar at a depth of 20 mm with the help of a dental surveyor. Two mutually perpendicular radiographs were made for each needle in order to calculate the deviation in mm. The results were analyzed and showed that the mean deflection in the 30G needles group was 5.32±1.91 mm, the deviation in the 27G group – 3.37±0.67 mm and none of the needles in the 23G group showed a deviation upon insertion in the hydrocolloid. The results in this study showed that dentists should always prefer needles with a smaller gauge, because they provide smaller deflection figures and therefore better accuracy in the deposition of the anesthetic.

The median effective concentration of ropivacaine for ultrasound-guided anterior iliopsoas muscle space block in the elderly undergoing hip surgery: a dose-finding study.

In order to improve perioperative pain and reduce the adverse outcome of severe pain in elderly hip fractures, anterior iliopsoas muscle space block (AIMSB) can be used clinically to reduce pain. The aim of the study is to investigate the 50% effective concentration (EC50) of ropivacaine for ultrasound-guided anterior iliopsoas space block in elderly with hip fracture. A total of 27 patients were enrolled with aged ≥65 years, American society of Anesthesiologists (ASA) physical status classification II-III and undergoing Total Hip Arthroplasty (THA). We measured the EC50 using Dixon's up-and-down method. Ultrasound-guided AIMSB was performed preoperatively with an initial concentration of 0.2% in the first patient. After a successful or unsuccessful postoperative analgesia, the concentration of local anesthetic was decreased or increased 0.05%, respectively in the next patient. The successful block effect was defined as no sensation to pinprick in the area with femoral nerve, obturator nerve, and lateral femoral cutaneous nerve in 30 min. Meanwhile, the EC50 of ropivacaine was determined by using linear model, linear-logarithmic model, probit regression model, and centered isotonic regression. A total of 12 patients (48%) had a successful block. All patients with a successful block had a postoperative visual analog scale score of <4 in the 12 h. The estimated EC50 values in linear model, linear-logarithmic model, probit regression model, and centered isotonic regression (a nonparametric method) were 0.268%, 0.259%, 0.277%, and 0.289%. The residual standard error of linear model was the smallest (0.1245). The EC50 of ropivacaine in anterior iliopsoas space block under ultrasound guidance is 0.259-0.289%.

Comparing the Efficacy of Landmark-Based Fascia Iliaca Compartment Block and Pericapsular Nerve Group Block for Preoperative Positioning and Postoperative Analgesia in Patients Undergoing Surgery for Hip Fractures: A Randomized Controlled Trial.

Subarachnoid block is the most common anesthetic technique for patients having corrective hip surgeries. However, adequate positioning for a successful subarachnoid block is a major challenge in this particular population of patients, owing to the site of fracture. Regional anesthesia, in the form of nerve blocks, is an effective means of alleviating such constraints and gives an added benefit of prolonged postoperative analgesia. The pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB), under ultrasonography guidance, are a few examples of the commonly performed peripheral nerve blocks in such settings. However, the landmark-based techniques of nerve blockade still hold good in many resource poor settings, given the lack of ultrasonography facilities. To compare the ease of spinal positioning using the patient sitting satisfaction score between the landmark-guided FICBand PENG block. This study was done on 80 patients of the American Society of Anesthesiology (ASA) grade I or II with intertrochantericfractures of the hip joint scheduled for proximal femoral nailing. Patients were allocated into two groups of 40 each through computer generated random numbers, to receive 30 ml of 0.5% ropivacaine via the landmark-guided technique of FICB in Group F and peripheral nerve stimulator assisted landmark-guided PENG block in Group P, 30 minutes prior to spinal positioning. Time to passive leg raise (PLR) to 15 degrees and time to PLR to 30 degrees with a standard goniometer guidance at visual analogue scale (VAS) score < 4 and ease of spinal positioning through the sitting satisfaction score at the 30th minute were assessed. Any adverse effects and events of failure were noted. The duration of postoperative analgesia was measured through the time to the first dose of paracetamol on arrival at the post-anesthesia care unit. Statistical analysis was done using JASP version (0.18.3.0) using the independent samples t-test and significance was taken when p value was < 0.001. The time to PLR to 15 degrees and 30 degrees were achieved faster in the patients who received the PENG block in comparison to the patients who received the FICB, and the average patient sitting satisfaction score was significantly higher in Group P as compared to Group F (p < 0.001). While the overall amount of analgesics used in both groups was similar, the overall period of postoperative analgesia was prolonged in Group F compared to Group P (p < 0.001). The landmark guided PENG block is feasible and superior to the landmark-guided FICB for preoperative positioning and analgesia. The FICB provides a longer duration of postoperative analgesia for patients with intertrochanteric fractures.

Feasibility and safety of ultrasound-guided supra-clavicular block in children

BackgroundUltrasound-guided supra-clavicular nerve block (SCNB) has regained interest in adults but remains underutilized in pediatrics. This case series aims to evaluate the efficacy and safety of ultrasound-guided SCNB in children undergoing upper-extremity surgery. MethodsProspective observational case series, the inclusion criteria were children over one year old who were scheduled for elective upper-extremity surgery. After induction of general anesthesia, an ultrasound-guided SCNB was performed. A dose of 0.2–0.5 ml/kg of bupivacaine 0.25 % or ropivacaine 0.2 % was administered all around the brachial plexus. In case of postoperative pain, 15 mg kg-1 of paracetamol + 10 mg kg-1 of ibuprofen were administered. The primary outcome measure was the success and safety of the block. Secondary outcomes were time to first analgesia administration and duration of motor blockade. ResultsThirty-three patients were included. Median age and weight were 6 [2.75,9.75] years and 24 [16,35] kg, respectively with a sex ratio of 3.1. Bupivacaine 0.25 % was used in the majority of cases (N = 24). The overall duration to complete block performance was 170 [120,300] seconds. A single attempt was sufficient for the majority of children, with a block success rate of 100 %. No incidents were reported during block performance. Postoperatively, time to the first analgesic request was 10 [8,12.5] hours. Twenty-five patients developed a motor block, with a duration of 4 [0.5,5] hours. Bupivacaine 0.25 % was associated with higher incidence of motor blockade (p = 0.002). ConclusionsUltrasound-guided SCNB appears to be an effective and safe technique in children. Further studies using lower doses of bupivacaine could help reduce the incidence of motor block.

Determination of the Optimal Volume of 0.5% Ropivacaine in Single-Injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial.

A brachial plexus block plays an important role in providing perioperative analgesia for shoulder surgery; however, the inherent risk of phrenic nerve block and resulting hemidiaphragmatic paralysis may limit its use in patients with compromised pulmonary function. This study aimed to evaluate safety, efficacy, the maximum tolerated volume, and the optimal biological volume of 0.5% ropivacaine used in a single-injection retroclavicular brachial plexus block for arthroscopic shoulder surgery. In this seamless single-arm exploratory phase I/II trial, a novel Bayesian optimal interval design was used to guide volume escalation for determination of the maximum tolerated volume, followed by sequential volume expansion using Bayesian optimal phase 2 design to establish the optimal biological volume. Fifty-four patients who underwent arthroscopic shoulder surgery received a single-injection retroclavicular brachial plexus block with 0.5% ropivacaine ranging from 15 mL to 40 mL. The primary outcomes were complete or partial hemidiaphragmatic paralysis in phase I, measured using ultrasound 30 min after block completion, and the block success in phase II, defined as achieving a total sensorimotor score ≥12 points and the total sensory score ≥3, measured through manual sensorimotor testing. The maximum tolerated volume for the single-injection retroclavicular brachial plexus block was determined to be 35 mL of 0.5% ropivacaine, with a hemidiaphragmatic paralysis rate of 0.09 (95% credible interval, 0 to 0.29). The optimal biological volume was found to be 25 mL, with a block success rate of 1.0 (95% credible interval, 0.95 to 1.0) and a negligible hemidiaphragmatic paralysis rate of 0.01 (95% credible interval, 0 to 0.06). A single-injection retroclavicular brachial plexus block using 25 mL of 0.5% ropivacaine produced consistent block success with a minimal HDP rate, suggesting the need for further studies to confirm this result in arthroscopic shoulder surgery.

Comparison of Outcomes of Intravenous Dexamethasone Versus Placebo as Adjunct to Local Anaesthetic Brachial Plexus Block for Upper Limb Surgery

Introduction: Dexamethasone has been tested in combination with different local anesthetics with varying degree of results including increase in intensity and duration of block. Objectives: To compare the outcomes of intravenous dexamethasone versus placebo as adjunct to local anesthetic brachial plexus block for upper limb surgery. Study design: Randomized controlled trial Setting: Department of Anesthesia, pain management and intensive care Holy Family Hospital, Rawalpindi. Study duration: 7th November 2019 till 6th May 2020. Materials &amp; Methods: A total of 10 0 patients of either gender aged 18 to 60 years admitted for upper limb surgery were included. Patients with pregnancy, DM, block failure and contraindication to brachial plexus block were excluded. Patients in group A received a block injection with 30ml of 0.5% bupivacaine along with 2ml of intravenous dexamethasone. Group B patients received 30ml of 0.5% bupivacaine for block injection and 2ml of normal saline intravenously. Block success was confirmed using the sensory and motor examination of the upper limb. Block duration was recorded in hours, opioid consumption was recorded in intravenous morphine equivalents in first 24 hours, visual analogue scores for pain on scale of 0-10 at upper limb at rest was recorded at 8 and 24 hours. Results: In our study, duration of local anesthetic brachial plexus block in dexamethasone and placebo group were 16.12 ± 1.33 hrs and 9.77 ± 1.26 hrs respectively with p-value = 0.0001. Opioid consumption in Morphine Equivalents at 24 hrs in local anesthetic brachial plexus block and placebo group were 16.48 ± 2.60 vs 22.68 ± 3.78 with p-value &lt; 0.0001 respectively. Conclusion: This study concluded that intravenous dexamethasone has better outcomes as compared to intravenous saline as adjunct to local anesthetic brachial plexus block for upper limb surgery.

Evaluation of lavender and rose aromatherapies on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized clinical trial

Trial designThis is a prospective, block-randomized, blinded, multiple arm and parallel-group superiority clinical trial. MethodsSeventy-eight patients satisfying the recruitment standards, were randomly allocated into three groups as follows: Group I (n = 26) – Inferior alveolar nerve block (IANB) devoid of aromatherapy (AT); Group II (n = 26) - IANB with lavender AT and Group III - IANB with rose AT (n = 26) with the help of the ultrasonic aroma diffuser (with respective oils)for 20 min/2 h in operatories 1,2 and 3 respectively. For AT, 3–4 drops of lavender and rose-conditioned oils were added from a 100 ml solution containing 100 mg of these medicinal plants. The pre-operative (PRO) and access opening (AO) pain as well as the anxiety of patients were recorded using the Visual Analog Scale (VAS) and Modified Dental Anxiety Scale (MDAS) respectively. Data thus obtained was entered into the Excel sheet and subjected to statistical tests (analysis of variance and paired t-test). The p-value less than 0.05 was considered statistically significant. ResultsGroup I showed non-significant disparity between PRO and AO for both VAS as well as MDAS (p = 0.62, p = 0.71). However, group II (p = 0.04, p = 0.02) and group III (p = 0.03, p = 0.01) revealed significant differences between PO - AO VAS and MDAS. MDAS and VAS intergroup comparison revealed a significant difference among groups I and II (p = 0.03, p = 0.04), and groups I and III (p = 0.02, p = 0.03). However non-significant disparity was observed among groups II and III (p = 0.85, 0.34). Moreover, there was a statistically significant reduction in anxiety levels in females compared to males after rose AT (p = 0.02). Nevertheless, groups I and II did not show any gender predilection for anxiety as well as pain. ConclusionAlleviation of dental anxiety as well as reduction in pain during AO of teeth with SIP can be achieved using Lavender and rose AT. In female patients, rose AT can be preferred over lavender AT.

Quantitative investigation of acute lesions created by ethanol infusion into the vein of Marshall

BackgroundEthanol infusion into the vein of Marshall (EIVOM) has been performed as an adjunctive atrial fibrillation therapy. However, the time course change, quantitative lesion investigation, and effects on epicardial fat pads and fractionated atrial electrograms created by EIVOM have never been investigated. ObjectiveThis study aimed to perform a quantitative analysis of lesions created by EIVOM. MethodsWe created voltage maps using a 3-dimensional mapping system immediately before and 30 minutes and 60 minutes after performing EIVOM to study the time course change in the lesions. We compared differences in the average contact force value required for successful conduction block in the Marshall vein area of patients with and without EIVOM. We also investigated effects of EIVOM on the area of complex fractionated atrial electrograms before and after EIVOM. We measured the total epicardial fat pad volume before and after EIVOM by computed tomography. ResultsVoltage was significantly reduced after EIVOM, and there were significant differences in voltage reduction between the control status and 30 minutes and 60 minutes after EIVOM (P < .05). The average contact force value was significantly lower with vs without EIVOM (P < .05). The total epicardial fat volume and complex fractionated atrial electrogram area also significantly decreased after EIVOM (P < .05). ConclusionEIVOM provided significant therapeutic effects on the left atrial tissue perpetuating atrial fibrillation, which was demonstrated by a quantitative analysis.

Unraveling the building blocks of success: exploring the nexus between school structure and effectiveness in Israeli primary schools

PurposeFirst, to analyze the relationships between school effectiveness, as expressed in the improvement gained in academic achievements, and school structure; and second, to analyze the relationships between school effectiveness and school features (e.g. ethnicity, SES, rural vs. central location, class size, prior achievements, and per-student allocation) and to measure their contribution to the explained variation in school effectiveness.Design/methodology/approachResearch on school effectiveness emphasizes the examination of school characteristics that have been found to contribute more to promoting school outcomes. Therefore, by using regression models the purpose of the research is twofold.FindingsThe research findings reveal positive significant relationships between school effectiveness, and students' prior achievements, and SES. However, school effectiveness is less related to school structure.Research limitations/implicationsFuture research in the field of school effectiveness should extend beyond solely focusing on academic achievements and include the evaluation of broader aspects of students' development, such as values and self-esteem. Recognizing the multifaceted nature of schools, it is crucial to incorporate additional variables into ongoing research efforts to provide a more comprehensive understanding of overall school effectiveness. Moreover, considering the diverse stakeholders involved in the educational process, including parents, teachers, principals, and the community, future studies should strive to examine the collective impact of these factors on school effectiveness. However, it is important to acknowledge the limitations of our study. Our research is constrained by a specific sample size, which may limit the generalizability of our findings. We assert that future studies with larger and more diverse sample sizes would strengthen the validity and significance of our results, allowing for broader implications and insights into enhancing school effectiveness.Originality/valueThis research holds significant importance in understanding the relationships between school effectiveness, school structure, and various school features in the context of Israeli primary schools. By examining the impact of school structure on academic achievements and exploring the contributions of other school-related factors, this study provides insights into the dynamics of educational effectiveness for educational stakeholders.