Research Spotlight

Wells, K. and J. W. Fleshman (2020). “Women in Leadership.” Clin Colon Rectal Surg 33(4): 238-242.

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The role of a surgeon is inherently that of a leader and as women become a larger minority in surgical specialties, the next step becomes greater representation of women in positions of surgical leadership. Leadership is a relationship of granting and claiming wherein society must accept that women are deserving of leadership and women must realize their rightfulness to lead. Implicit gender bias undermines this relationship by perpetuating traditional gender norms of women as followers and not as leaders. Though female representation in academia and leadership has increased over the past few decades, this process is unacceptably slow, in part due to manifestations of implicit bias including discrimination within academia, pay inequality, and lack of societal support for childbearing and childcare. The women who have achieved leadership roles are testament to woman’s rightfulness to lead and their presence serves to encourage other young professional women that success is possible despite these challenges.

Cavaness, K., A. Picchioni and J. W. Fleshman (2020). “Linking Emotional Intelligence to Successful Health Care Leadership: The Big Five Model of Personality.” Clin Colon Rectal Surg 33(4): 195-203.

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Research has identified emotional intelligence as the ability to understand and manage emotions. This is especially important for surgical leaders who must interact constructively with teams, administrators, patients, colleagues, and the community. Conventional intelligence emphasizes the rational and analytical brain. When one becomes aware of emotional intelligence, it adds to the repertoire of the surgical leader. It gives them insight into the dynamics of interpersonal relationships. This will allow the surgeon to control the emotional side of communication. Specifically, emotional intelligence focuses on self-awareness, self-management, social skills, and resiliency. With these skills, they are able to modulate their leadership style, allowing for increased conflict management and persuasiveness, more effective change management, and consensus-building. Emotional intelligence is not innate; these are learned skills. With practice and attention, it is possible to acquire the skills to enhance relationships.

Arnold, D. and J. W. Fleshman (2020). “Leadership in the Setting of the Operating Room Surgical Team.” Clin Colon Rectal Surg 33(4): 191-194.

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Leadership in the operating room requires the ability to adopt different styles under specific circumstances. Transformational leadership grows the team. The style used to guide the team can vary; coercive, visionary, affiliative, democratic, pacesetting, and coaching are all important styles in team leadership. The ability to adapt to different needs in the operating room by using the appropriate style is leadership.

Hatzke, M. W., F. C. Daigle, R. A. Augsburger, M. J. Kesterke and P. Jalali (2020). “Retrograde Instrumentation of Surgically Resected Roots Using Controlled Memory Files: A Human Cadaver Study.” J Endod Jun 15;S0099-2399(20)30386-1. [Epub ahead of print.].

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INTRODUCTION: The purpose of this study is to evaluate the amount of residual obturation material of retroinstrumented surgically resected roots using controlled memory (CM) files and to evaluate the incidence of adverse treatment outcomes. METHODS: Thirty maxillary anterior teeth in human cadavers were selected and non-surgical root canal treatment was performed on these teeth. A standardized 4-mm osteotomy and a 3-mm root resection with as close to a zero-degree bevel as possible was made on each tooth. A microsurgical diamond tip was used to create a 1-2 mm starting point for each retropreparation. A 25/06 and 30/06 VTaper 2H (SS White, Lakewood, NJ) were bent at a about 90-degree angle to mimic the clinical and anatomical restrictions and used to create a retropreparation to a depth of 14-mm. Micro-CT scans were taken and analyzed for volume and percentage of residual obturation material at 5- and 10-mm. Additionally, the incidence of instrument separation and crack and ledge formation in the teeth were recorded. RESULTS: The median volume of residual obturation at 5- and 10-mm was 0.18 mm(3) (interquartile range of 0.36 mm(3)), and 1.97 mm(3) (interquartile range of 1.99 mm(3)) respectively. The overall incidence of file separation during retropreparation was 13.33% (4/30). Among the cases analyzed with micro-CT, none showed crack or ledge formation. CONCLUSIONS: Retroinstrumentation of surgically resected roots using controlled memory files cleans the canal effectively with relatively low adverse treatment outcomes. This novel technique, while limited in application, is a safe and effective way to achieve a deep, clean retropreparation.

Liang, J., P. Yi, X. Wang, F. Huang, X. Luan, Z. Zhao and C. Liu (2020). “Acellular matrix hydrogel for repair of the temporomandibular joint disc.” J Biomed Mater Res B Appl Biomater Jun 29. [Epub ahead of print.].

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Application of tissue-derived extracellular matrix (ECM) biomaterials in the repair of the temporomandibular joint (TMJ) disc is a promising approach for the treatment of disc abrasion and perforation, particularly for the young patient population. Although decellularized ECM (dECM) scaffolds preserve tissue-specific structures as well as biological and biomechanical properties, they require surgical implantation. To address this issue, we prepared porcine TMJ discs into decellularized ECM with serial detergent and enzyme treatments, and the TMJ disc-derived ECM was then processed into hydrogels via pepsin digestion. The decellularization efficiency was assessed by quantification of the DNA and matrix component contents. The fibrous ultrastructure of the hydrogel was observed by scanning electron microscopy (SEM). Rheological characterization and mechanical properties were measured. in vitro experiments with costal chondrocytes ensured the cellular proliferative capacity and compatibility in the injectable disc-derived ECM hydrogel. The results showed that a large amount of DNA (>95%) was removed after decellularization; but, the collagen was retained. SEM of the hydrogels demonstrated a multiaperture fiber ultrastructure. Rheological studies revealed a rapid gelation temperature (37°C) and injectable properties. The mechanical properties of the hydrogels were adjusted by changing the ECM concentration. The in vitro studies revealed that the hydrogels are not cytotoxic, but instead showed good cytocompatibility. The hydrogel also showed good injectability and degradability through an in vivo study. Overall, these results suggest the great potential of injectable disc-derived hydrogels for TMJ disc repair and regeneration applications.