Should prospective dental students be screened for colour vision deficits?

A perennial question in dental education is: what skills and aptitudes should be assessed in prospective dental students? Intellectual capacity and manual dexterity understandably rank highly, but are there minimum thresholds for visual perception that applicants need be able to demonstrate before they enter the profession? We have recently flagged this issue with regard to the thresholds of stereoscopic acuity required for a dentist when operating on teeth. In the present article, we highlight the issue of identifying a minimum acceptable level of colour vision.

In vitro investigations on the effects of semi-synthetic, sulphated carbohydrates on the immune status of cultured common carp (Cyprinus carpio) leucocytes

The rapid emergence of drug resistance, unfavourable immunosuppression and mounting evidence to suggest the deleterious accumulation of drug breakdown residues within animal tissues has driven a strong desire to move away from these current methods of disease control. Some natural products such as β-glucan, which are extracted from, for example, plants and fungi, are able to modulate the immune system and increase protection against diseases. However, these products are heterogeneous and their effects can be variable thus limiting their applicability and reliability. Carbohydrates were modified via chemical sulphation and these semi-synthetic, sulphated carbohydrates analysed for their immunological activity utilising carp pronephric cells and a carp leucocyte cell line (CLC). A sulphated β(1,4)-glucan, methyl hydroxyethyl cellulose sulphate (MHCS), demonstrated a stimulatory effect on fish immune cells. MHCS induced a range of bioactive effects in carp leucocyte cells whilst not affecting cell viability when cells were exposed for 24 h at concentrations of 1-150 μgml^-1. MHCS stimulated the innate immune system where a significant increase in respiratory burst activity was observed at concentrations 25-250 μgml^-1 in comparison to control (sterile water), cellulose ether, MacroGard^® and zymosan. Also, under in mock bacterial and viral infection conditions i.e. Lipopolysaccharide (LPS) and polyinosinic:polycytidylic acid (Poly(I:C)), MHCS enhanced the immune responses of pronephric cells by stimulating the respiratory burst activity at concentrations 50 and 150 μgml^-1. MHCS also enhanced the expression of cytokines including interleukin 1 beta (IL1β), tumor necrosis factor alpha 1 and 2 (TNFα 1,2), interferons alpha 2 (IFN α2) and inducible nitric oxide synthase (iNOS) in carp pronephric cells. It is proposed that this new semi-synthetic carbohydrate is a potential candidate for the development of a new generation of immunostimulants and adjuvants for use in vaccination strategies in aquaculture.

Feedback and motor skill acquisition using a haptic dental simulator

AIM

To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator.

METHODS

Sixty-three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device-only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post-test.

RESULTS

Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks.

CONCLUSION

These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education.

Subscapularis and deltoid preserving anterior approach for reverse shoulder arthroplasty

HYPOTHESIS

We hypothesize that performing a RSA using an anterior approach without cutting the subscapularis tendon and the deltoid muscle could provide patients with superior short-term clinical outcomes and immediate active range of motion (ROM) without immobilization.

METHODS

Between August 2013 and June 2015, all patients who had a primary RSA were considered potentially eligible for inclusion in this prospective study.

RESULTS

No immediate intra- or postoperative complications were noted. A statistically significant improvement of VAS (from 6.7 to 1; P<.001), SANE (from 34 to 80; P<.001), and elevation (from 103° to 128°; P=.02) was observed. In some cases, patients who had pseudoparalysis preoperative were able to achieve full anterior elevation few days after the operation.

DISCUSSION

Using a subscapularis and deltoid preserving anterior approach is an option for patients requiring RSA. Leaving this tendon intact and preserving the deltoid minimize the need for immediate postoperative immobilization and allow for faster recovery of shoulder ROM, without risking the concern of humeral anterior dislocation. Overall duration of hospital stay as well as length of postoperative physical therapy may be minimized, with substantial long-term economic gain. Longer follow-up and comparison with standard approaches is necessary in the future.

LEVEL OF EVIDENCE OF THE STUDY

Level IV, case series with no comparative group.

A critical evaluation of the Incapacity Status Scale

The Incapacity State Scale (ISS) of the research version of the Minimal Record of Disability in Multiple Sclerosis has been tested in parallel with Assessment of the Activities of Daily Living (ADL) Index. Reliance of the ISS scoring on the use of aids and adaptive devices was found to be a major source of variation. It is suggested that the general scoring of the proposed ISS scale should be modified so that it employs that of the ADL method, i.e. measuring only independence (irrespective of the use of side and adaptive devices), partial and total dependence.

Labelling heparan sulphate saccharides with chromophore, fluorescence and mass tags for HPLC and MS separations

The analysis of heparin/HS saccharides derived from small amounts of tissue or cells is a considerable technical challenge and the development of methods to characterise these carbohydrates has progressed comparatively slowly. A number of procedures have been devised to tag glycans selectively at the reducing end with a group that will enhance the sensitivity of detection and facilitate chromatographic separations. Outlined in this chapter are two useful strategies designed specifically for the analysis of heparin/HS saccharides. The first involves a fluorophore label, Bodipy-FL-hydrazide, which permits highly sensitive (fmol level) detection of saccharides utilising high performance strong anion exchange chromatography. The second facilitates oligosaccharide separation by gel-permeation chromatography and reverse phase high performance ion-pairing chromatography (RP-HPIPC) through the use of a phenylsemicarbazide tag. The latter also serves as an effective mass tag for electrospray mass spectrometry, permitting enhanced analysis of HS saccharides. These methods provide new opportunities for the development of glycomics approaches to study the structure and function of the heparan sulfate family of glycans.

In a medium containing glucose, lactate carbon is incorporated by gonococci predominantly into fatty acids and glucose carbon incorporation is increased: implications regarding lactate stimulation of metabolism

The reason for stimulation by lactate of metabolism of gonococci growing in a medium containing glucose, which enhances pathogenicity by increasing growth rate, lipopolysaccharide (LPS) synthesis and protein formation, has been investigated. Tricine dodecylpolyacrylamide gel electrophoresis (SDS-PAGE) and thin layer chromatography (TLC) on homogenates of gonococci grown in this medium with [14C]lactate showed that lactate carbon was preferentially incorporated into lipid and LPS. Nuclear magnetic resonance (NMR) spectroscopy on lipid extracted from gonococci grown in the glucose containing medium with [13C]lactate showed that lactate carbon was incorporated into fatty acid moieties and not into ethanolamine or glycerol moieties. In contrast, NMR on lipid from gonococci grown with [13C]glucose indicated glucose carbon in both moieties. When unlabelled lactate was added, lipid synthesis from [l3C]glucose was stimulated and small amounts of different fatty acids were formed. The NMR data shows that gluconeogenesis from lactate carbon does not occur in the presence of glucose, suggesting that lactate is used solely for rapid production, via pyruvate, of acetyl CoA, the precursor not only for fatty acid synthesis but also for the constituents and products of the citric acid cycle, including ATP. The rapid formation of a high level of acetyl CoA is the probable reason for the stimulation of metabolism and oxygen uptake by lactate. 14C label on LPS was detected in its fatty acids. Most proteins that stained with silver in tricine SDS-PAGE were not significantly labelled by [14C]lactate in the glucose-containing medium. Two of three appreciably labelled proteins were identified by N-terminal sequencing as GroEL and porin 1B, and one of the two less labelled proteins was similar to peroxiredoxin type proteins. There were no signs of specific induction of these proteins by lactate and their labelling was consistent with fatty acids in attached lipid.

Child and adolescent nortriptyline single dose kinetics predict steady state plasma levels and suggested dose: preliminary data

The use of nortriptyline single dose kinetics to predict steady state plasma levels and suggested dose was investigated in 33 pediatric subjects who were diagnosed as having major depressive disorder. The data were analyzed separately for the 11 subjects 5 to 9 years old who received a single dose of 25 mg and a fixed daily dose of 20 mg of nortriptyline, and for the 22 subjects 10 to 16 years old who received a single dose of 50 mg and a fixed daily dose of 50 mg of nortriptyline (N = 17) or a fixed daily dose of 20 mg (N = 5) because of a very slow rate of metabolism of the drug. Correlations within the group of 5 to 9 years olds between the steady state plasma levels and the five sampling points after the single dose were all highly significant. Correlations between the steady state plasma levels within the group of 10 to 16 year olds and the five sampling points after the single dose and a fixed daily dose of 50 mg (N = 17) were also highly significant. Similar correlations for the total group of 10 to 16 year olds (N = 22) were performed (prorating the steady state plasma levels of the slow metabolizers), and these too were highly significant. Suggested dose schedules for each age group were developed from the regression equations of nortriptyline steady state plasma levels versus 24-hour nortriptyline plasma levels after the single dose. The regression equation for the group of 5 to 9 year olds was highly significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary data on DSM-III associated features of major depressive disorder in children and adolescents

Fifty-nine subjects 5-16 years old with major depressive disorder were assessed for the presence of separation anxiety and antisocial behavior, mentioned in DSM-III as associated features of the disorder in children and adolescents. The findings of the study support the existence of these associated features.

Symposium--forensic psychiatry. Civil commitment and the danger mandate

This paper examines the practice of involuntary mental hospitalization from the viewpoint of factors constituting effective, operating definitions of ‘dangerous’ mental disorder, as contrasted with the more narrow criteria which sanction commitment under Canadian law.

A sorting and analysis of a large sample of commitment certificates indicated that few contained evidence of involuntarily hospitalized patients as being dangerous, nor did the present sample of certificates indicate clearly that operating commitment criteria have been altered with the new and liberalized legislative formulations of such criteria. Independent of the need to commit certain people in society, possible incongruities between ideal and operating criteria for civil commitment deserve to be scrutinized by responsible professionals in mental health and law.