Preclinical motor chunking and fine motor skill learning in fixed prosthodontics: Contribution of 3D printing and satisfaction of dental students.

INTRODUCTION: In fixed prosthodontics, simulators are essential to students for a progressive transition from preclinical to clinical condition. With the 3D printing technology, we developed resin bars allowing students to better visualise by motor chunking technique. Main objectives of this work were to describe this teaching methodology used in preclinic among different promotions of second, third and fourth dental years and to evaluate students' feedback. MATERIALS AND METHODS: Two hundred seventy resin strips were digitally designed and printed in resin. All participants from second, third and fourth had to fulfil a User Experience Questionnaire (UEQ) after the preclinical work. The scales of this questionnaire covered the complete impression of the user experience. Both classical aspects of usability (efficiency, insight and reliability) and aspects of user experience (originality, stimulation) were measured. RESULTS: For the second dental years, 'Attractiveness', 'Stimulation' and 'Novelty' were considered 'Excellent'. For the third dental year, novelty average was considered as 'Excellent'. For the fourth dental year, 'novelty' was considered as 'Good'. DISCUSSION: The resin plates used in this study are original and stimulating for the students, especially for the second-year dental students who found the exercises useful for their learning. This method can also be used by creating scenarios close to the clinical situations encountered in dentistry departments (more dilapidated teeth, preparation of inlays, post and core, etc.). This 3D printed simulation model is not intended to replace the Frasaco® models but is a complement to the learning process.

Efectos de la lecitina de soya en parámetros hematológicos y marcadores inflamatorios sistémicos de ratas / Effects of soy lecithin on hematological parameters and systemic inflammatory markers of rats

Introducción: El estudio de los efectos farmacológicos preclínicos de la lecitina de soya sobre parámetros hematológicos y marcadores inflamatorios sistémicos, contribuirá a sustentar las bases de su posible empleo como medicamento natural. Objetivo: Determinar los efectos de la lecitina de soya sobre parámetros hematológicos y marcadores inflamatorios sistémicos de ratas Wistar. Métodos: Se realizó un estudio de farmacología preclínica experimental, en el que se administró lecitina de soya en dosis máximas y mínimas a dos grupos experimentales de ratas Wistar. Se estimaron variables hematológicas para ser comparadas con el grupo control, se determinó recuento diferencial y el conteo global de leucocitos según fórmula avanzada como indicativo indirecto de inmunocompetencia. Se calcularon como marcadores inflamatorios sistémicos la relación neutrófilos-linfocitos (N/LR) y la relación plaquetas-linfocitos (P/LR). La existencia de diferencias de medianas y rangos de las diferentes variables entre los grupos se reveló mediante la Prueba de Kruskal-Wallis de muestras independientes con nivel de significancia de p <0.05. Resultados: Se observó leucopenia, aumento del recuento plaquetario y alteraciones de índices relacionados con la inflamación y la inmunidad en ambos grupos experimentales, relacionado con la dosis. La N/LR y P/LR se incrementaron de manera proporcional con la dosis y el índice de inmunidad e inflamación sistémica se incrementa con dosis mínima y tiende a decrecer con dosis máxima. Conclusiones: El producto modifica parámetros hematológicos en ratas, pero se requieren otros estudios controlados que corroboren el estado de inmunocompetencia, tomando en consideración lo que expresan los marcadores inflamatorios sistémicos.

Introduction: The study of the preclinical pharmacological effects of soy lecithin on hematological parameters and systemic inflammatory markers, will contribute to support the foundations of its possible use as a natural medication. Objective: To determine the effects of soy lecithin on hematological parameters and systemic inflammatory markers of Wistar rats. Methods: An experimental preclinical pharmacology study was conducted, in which soy lecithin was administered in maximum and minimum doses of two experimental Wistar rats. Hematological variables were estimated to be compared to the control group, differential counting and global leukocyte count according to advanced formula as an indirect indicative of immunocompetence was determined. The neutrophil-linfocyte (N/LR) and the platelet-linfocyte ratio (P/LR) were calculated as systemic inflammatory markers. The existence of medium and ranges differences of the different variables between the groups was revealed by the Kruskal-Wallis test of independent samples with a level of significance of p<0.05. Results: Leukopenia, increased platelet count and alterations of inflammation related to inflammation and immunity dose-related were observed in both experimental groups. The N/LR and P/LR were proportionally increased with the dose and the system of systemic immunity and inflammation is increased with minimal dose and tends to decrease with maximum dose. Conclusions: The product modifies hematological parameters in rats, but other controlled studies are required that corroborate the state of immunocompetence, taking into consideration what systemic inflammatory markers express.

Central nervous system activity of a Tabernaemontana arborea alkaloid extract involves serotonergic and opioidergic neurotransmission in murine models.

Tabernaemontana arborea (Apocynaceae) is a Mexican tree species known to contain ibogan type alkaloids. This study aimed at determining central nervous system-related activities of an alkaloid extract obtained from the root bark of T. arborea. A gas chromatography-mass spectrometry (GC-MS) analysis was performed to describe the alkaloid profile of the extract. A wide dosing range (0.1 to 56.2 mg/kg) of this extract was evaluated in different murine models. Electrical brain activity was examined by electroencephalography (EEG). The extract's effects on motor coordination, ambulatory activity, and memory were analyzed based on the rotarod, open field (OFT), and object recognition tests (ORT), respectively. Antidepressant and antinociceptive activities were determined using the forced swimming test (FST) and the formalin assay, respectively. In order to elucidate the underlying mechanisms of action, the 5-HT1A receptor antagonist WAY100635 (1 mg/kg) or the opioid receptor antagonist naloxone (1 mg/kg) was included in the latter experiments. GC-MS analysis (µg/mg extract) confirmed the presence of the monoterpenoid indole alkaloids (MIAs) voacangine (207.00), ibogaine (106.33), vobasine (72.81), coronaridine (30.72), and ibogamine (24.2) as principal constituents of the extract, which exhibited dose- and receptor-dependent antidepressant (0.1 to 1 mg/kg; 5-HT1A) and antinociceptive (30 and 56.2 mg/kg; opioid) effects, without altering motor coordination, ambulatory activity, and memory. EEG indicated CNS depressant activity at high doses (30 and 56.2 mg/kg). The root bark of T. arborea contains a mixture of alkaloids that may hold therapeutic value in pain relief and the treatment of psychiatric diseases without causing neurotoxic activity at effective doses.

Delivering Biopsychosocial Health Care Within Routine Care: Spotlight-AQ Pivotal Multicenter Randomized Controlled Trial Results.

BACKGROUND: Annual national diabetes audit data consistently shows most people with diabetes do not consistently achieve blood glucose targets for optimal health, despite the large range of treatment options available. AIM: To explore the efficacy of a novel clinical intervention to address physical and mental health needs within routine diabetes consultations across health care settings. METHODS: A multicenter, parallel group, individually randomized trial comparing consultation duration in adults diagnosed with T1D or T2D for ≥6 months using the Spotlight-AQ platform versus usual care. Secondary outcomes were HbA1c, depression, diabetes distress, anxiety, functional health status, and healthcare professional burnout. Machine learning models were utilized to analyze the data collected from the Spotlight-AQ platform to validate the reliability of question-concern association; as well as to identify key features that distinguish people with type 1 and type 2 diabetes, as well as important features that distinguish different levels of HbA1c. RESULTS: n = 98 adults with T1D or T2D; any HbA1c and receiving any diabetes treatment participated (n = 49 intervention). Consultation duration for intervention participants was reduced in intervention consultations by 0.5 to 4.1 minutes (3%-14%) versus no change in the control group (-0.9 to +1.28 minutes). HbA1c improved in the intervention group by 6 mmol/mol (range 0-30) versus control group 3 mmol/mol (range 0-8). Moderate improvements in psychosocial outcomes were seen in the intervention group for functional health status; reduced anxiety, depression, and diabetes distress and improved well-being. None were statistically significant. HCPs reported improved communication and greater focus on patient priorities in consultations. Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels. The Natural Language Processing semantic analysis confirmed the mapping relationship between questions and their corresponding concerns. Machine learning model revealed type 1 and type 2 patients have different concerns regarding psychological burden and knowledge. Moreover, the machine learning model emphasized that individuals with varying levels of HbA1c exhibit diverse levels of psychological burden and therapy-related concerns. CONCLUSION: Spotlight-AQ was associated with shorter, more useful consultations; with improved HbA1c and moderate benefits on psychosocial outcomes. Results reflect the importance of a biopsychosocial approach to routine care visits. Spotlight-AQ is viable across health care settings for improved outcomes.

Protocol paper: multi-Centre randomised controlled trial evaluating a pre-clinic diabetes assessment and mapped care planning intervention amongst adults with type 1, type 2 or pre-diabetes.

BACKGROUND: Existing therapeutic interventions to treat diabetes are well known, yet the majority of people with diabetes do not consistently achieve blood glucose targets (even individual therapy targets) for optimal health, despite the large range of treatment options available. Such outcomes have remained stubbornly poor for decades with <25% adults with diabetes achieving glycaemic targets. Patient behaviour, individually supported in routine clinical care, is an important missing component to improved outcomes, in a medical healthcare model not ideally suited to supporting successful diabetes management. METHODS: A multi-centre, parallel group, individually randomised trial comparing consultation duration in adults with type 1, type 2 or pre-diabetes using the Spotlight Consultations pre-clinic assessment compared to usual care in the Spotlight-AQ study. Two hundred adults with type 1, type 2 or pre-diabetes attending routine care outpatient appointments across up to ten participating sites will be invited to participate. INTERVENTION: An outpatient pre-clinic intervention delivered within 1 week prior to scheduled routine outpatient appointment. PRIMARY OUTCOME MEASURE: Duration of routine outpatient consultation. SECONDARY OUTCOME MEASURES: Functional health status Diabetes distress Depression Treatment satisfaction Impact on self-care behaviours HCP burnout HCP treatment satisfaction and burden Hypoglycaemia (time less than 70mg/dL) Hyperglycaemia (time above 180 mg/dL) Change in weight Change in HbA1c Cost effectiveness of intervention DISCUSSION: Results from the study will provide valuable insights into patient-professional communication practices within routine care and recommendations will be made, as necessary, for improvements to that. If the intervention is shown to be clinically and cost-effective, the feedback from participants and healthcare professionals will be used to make any improvements prior to its deployment to support improved communication and associated health outcomes. ETHICS AND DISSEMINATION: The trial was approved by the Wales REC7 Research Ethics Committee (21/WA/0020). Results will be disseminated through national and international conferences, scientific journals, newsletters, magazines and social media. Target audiences include consultants and other clinicians in diabetes, and medical professionals or scientists overall. TRIAL REGISTRATION: ISRCTN15511689 . Registered on 10 November 2021.

Lessons from mouse models of MPN.

Over the past decades, a variety of MPN mouse models have been developed to express in HSC the main mutations identified in patients: JAK2V617F, CALRdel52 or ins5 and MPLW515L. These models mimic quite faithfully human PV or ET with their natural evolutions into MF and their hemostasis complications, demonstrating the driver function of these mutations in MPN. Here, we review these models and show how they have improved our general understanding of MPN regarding (1) the mechanisms of fibrosis, thrombosis/hemorrhages and disease initiation, (2) the roles of additional mutations and signaling pathways in disease progression and (3) the preclinical development of novel therapies. We also address controversial results between these models and remind how these models may differ from human MPN onset and also how basically mice are not humans, encouraging caution when one draw lessons from mice to humans. Furthermore, the contribution of germline genetic predisposition, HSC and niche aging, metabolic, oxidative, replicative or genotoxic stress, inflammation, immune escape and additional mutations need to be considered in further investigations to encompass the full complexity of human MPN in mice.

FDG PET Imaging of the Pain Matrix in Neuropathic Pain Model Rats.

Pain is an unpleasant subjective experience that is usually modified by complex multidimensional neuropsychological processes. Increasing numbers of neuroimaging studies in humans have characterized the hierarchical brain areas forming a pain matrix, which is involved in the different dimensions of pain components. Although mechanistic investigations have been performed extensively in rodents, the homologous brain regions involved in the multidimensional pain components have not been fully understood in the rodent brain. Herein, we successfully identified several brain regions activated in response to mechanical allodynia in neuropathic pain rat models using an alternative neuroimaging method based on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography (FDG PET) scanning. Regions such as the medial prefrontal cortex, primary somatosensory cortex hindlimb region, and the centrolateral thalamic nucleus were identified. Moreover, brain activity in these regions was positively correlated with mechanical allodynia-related behavioral changes. These results suggest that FDG PET imaging in neuropathic pain model rats enables the evaluation of regional brain activity encoding the multidimensional pain aspect. It could thus be a fascinating tool to bridge the gap between preclinical and clinical investigations.

Patient feedback identifies "Rheum" to improve clinic visit preparedness.

Healthcare providers and administrators are incorporating patient feedback to drive local health system improvement. Improvement interventions, including patient feedback, guided a novel approach for rheumatology patient appointment preparedness. We tested the interventions in a single rheumatology clinic. A comprehensive patient questionnaire was developed by assessing patients' clinic access using patient journey mapping. The questionnaire was administered to a random cohort of 125 rheumatology patients about their feedback on pre-clinic practices. From the responses, modifications were made to existing administrative practices within the clinic. The modified practices were tested with an additional cohort of 10 patients aligned to one rheumatologist, assessing overall patients' preparedness and clinic visit cycle time. It was identified from the questionnaire that during appointment booking, inconsistent pre-clinic planning information was communicated to patients and the appointment package did not support patient preparedness, resulting in extending clinic visits. Standardization of the appointment phone call script, updating the appointment package, and inclusion of a clinic visit preparation checklist, reduced the clinic visit cycle time by 10 minutes for new patients, and 5 minutes for existing patients. The participating clinic rheumatologist also perceived improved patient preparedness and clinic visit flow based on the modified practices. In this study, patient feedback was used to identify patient-centred interventions to improve patient preparedness at clinic visits. The interventions developed were simple and easy to incorporate into practice. Systematic collection of and strategies based on patient feedback was determined to be a valid, meaningful method for incorporating clinical quality improvement. KEY POINTS : • Structured patient feedback can inform quality improvement practices in a rheumatological clinic setting. • A patient journey map outlining healthcare clinic access can help to understand patient experiences and needs. • Simple, patient-centred interventions, such as an appointment package and a consistent telephone reminder script, improved patient preparedness and reduced average clinic cycle time.

[Metrological assessment of the averaged phase cardiocycle in solving problems of rehabilitation and sports medicine]. / Metrologicheskaya otsenka fazovogo usrednennogo kardiotsikla v reshenii zadach vosstanovitel'noi i sportivnoi meditsiny.

Electrocardiography is one of the leading and most common methods of instrumental research of heart biorhythms in primary medical and social care. The development of information and digital technologies, robotics for the purpose of preclinical assessment and ranking of myocardial status in different categories of the population for preventive purposes has allowed us to create highly sensitive methods for recording and processing biosignals. Converting and displaying a cardiosignal on the phase plane to obtain a averaged phase cardiocycle (APC) is a demostrative instrumental method of research. AIM OF STUDY: To determine the possibility of measuring the myocardial biosignal using the averaged cardiocycle of a single-channel ECG in the phase space. MATERIALS AND METHODS: Registration and analysis of the averaged biosignal obtained by converting a single-channel ECG in phase space, taking into account age and gender characteristics, was carried out using the FAZAGRAF software and hardware complex, which implements the original information technology for processing an electrocardiogram in phase space using computer graphics ideas and automatic pattern recognition methods. The parameters of the phase averaged cycle were subject to an analytical assessment: duration and amplitude characteristics of the P, Q, R, S, T waves (ms). The construction of a nonlinear mathematical model is carried out using an algebraic model of constructive logic based on predicate logic, followed by a multivariate assessment of the influence of each factor. The massive of verified data is represented by 58 016 values of indicators of the cardiovascular system in 1568 study participants aged 20 to 65 years. All subjects were divided into 2 groups: group 1 - 1087 conditionally healthy patients, group 2 - 471 patients with a verified diagnosis of pathology of the cardiovascular system. The information content of the QTc indicator was determined using ROC analysis. The age-related features of some parameters of the averaged phase cycle were examined in a cohort of 218 conditionally healthy schoolchildren aged 6-17 in Simferopol. The study of the adaptive features of the circulatory system was carried out in 40 sportsmen aged 14-15 with different profile orientation of training activity, which was divided into 2 cohorts. The first cohort included 20 wrestlers, the second - amounted to 20 football players. The gender characteristics of the reaction to natural aroma effects were studied in 30 conditionally healthy young people aged 17-18 (15 boys and 15 girls). RESULTS AND CONCLUSION: The most significant parameters of the averaged phase cardiocycle for assessing the states and characteristics of their values were revealed. The obtained parameters of the averaged phase cardiocycle with a quantitative assessment of ranges with a significant number of subjects were used to solve preventive (predictive) problems of rehabilitation and sports medicine.

A comparative study of root canal shaping using protaper universal and protaper next rotary files in preclinical dental education.

BACKGROUND: Dentistry has undergone an evolution in endodontics practice caused by the advancement of rotary techniques for root canal preparation and their subsequent incorporation into the teaching of dentistry undergraduates. This research aimed to evaluate the shaping ability of third-year dental students as their first experience in rotary instrumentation using ProTaper Universal (PTU) and ProTaper Next (PTN) (Dentsply Maillefer) rotary instruments in simulated curved canals. METHODS: Forty students instrumented 200 simulated canals with a 40° curvature in resin blocks according to the manufacturer's instructions with PTU and 39 students and 195 canals with PTN files. The canals were prepared at a speed of 300 rpm using a 16:1 reduction hand-piece powered by an electric motor (Xsmart; Dentsply Maillefer). The final apical preparation was set to F2 for the PTU and X2 for the PTN group. The change in canal curvature was evaluated based on Schneider technique using the AutoCAD 2007 software on post-digital photographs. The incidence of instrument fracture and deformation, the incidence of ledge, the change in working length (WL), and the working time were noted. The data were analyzed with Student's t-test and Chi-Square test at a significance level of 0.05 using SPSS. RESULTS: PTN maintained the original canal curvature better, resulting in fewer fractures and ledges, and shaped the canals faster than the PTU (P < 0.05). The mean curves of the resin canals after the instrumentation for the PTU and PTN groups were 24.03° ± 3.14° and 25.64° ± 2.72°, respectively. Thirty-three (17.4%) PTU and 18 (9.3%) PTN files fractured (p < 0.05). Nine (4.5%) PTU and 2 (2.6%) PTN deformed (p > 0.05). The change in WL after instrumentation was 0.97 mm ± 0.95 mm in PTU and 0.96 mm ± 0.80 mm in PTN (p < 0.05). The mean times were 627 s ± 18 s for PTU and 379 s ± 18 s for PTN (p < 0.000). DISCUSSION: PTN can be recommended in severely curved root canals in terms of maintenance of the original canal curvature, superior instrument fracture and fewer ledges. Even if training before preparation provides an acceptable level of canal shaping for preclinical students, the use of NiTi rotary instruments should be included in the undergraduate dental curriculum, contributing to an increase in the quality of root canal shaping and, consequently, to an improvement of the clinical experience of students.

Factors influencing the National License Examination step 1 score in preclinical medical students.

The National License Examination step 1 (NLE1), which tests basic medical sciences knowledge in Thailand, is considered to be tough and stressful for medical students due to the large amount of content. This study aimed to determine factors influencing the NLE1 score (NLE1S). The NLE1S, academic achievement, and class attendance were obtained officially. Other factors, including study habits, were obtained via a questionnaire, with 81.97% (241/294) being returned. Students were divided into four groups according to the central passing score and Z-score of the NLE1S, including the fail (<52%; n = 13), low-pass (52 to <70%; n = 121), high-pass (70 to <80%; n = 89), and excellent (≥80%; n = 18) groups. Men had higher NLE1S (P < 0.001) and comprehensive examination scores (P < 0.001) than women. Students with high motivation to study medicine had higher NLE1S. Daily preparation time (h/day) was lower, but stress was higher, in the fail group. In the excellent group, internet for academic use and achievement of study targets were higher; internet for nonacademic use, instance of absence, and stress were lower; and check-in time was earlier. The NLE1S had strong positive correlations with the comprehensive examination score and academic achievement during preclinical studies. By setting the NLE1S as a dependent variable in multivariate regression analyses, models of significant interactions were observed by setting behavioral factors, the comprehensive examination score, and academic achievement during a regular class as independent variables. Thus exhibiting good study habits and showing good academic performance throughout preclinical studies should be encouraged among students to achieve a good NLE1S.

Impact of an early clinical exposure project conducted by senior clinical students compared between participating and nonparticipating students.

An early clinical exposure project conducted by clinical students aimed to promote direct clinical experience to preclinical students. The aim of this study was to determine the effects of the project on academic achievement and study attitudes and habits between participating and nonparticipating students before ( test 1) and after the project ( test 2) in the second preclinical year and at the end of the first semester of the first clinical year ( test 3), with a subgroup analysis of the first (lowest) to third (highest) tertile of the score. Questionnaires were sent to the first clinical year students at test 3 and asked the information retrospectively at test 1 and test 2 in second year preclinical and currently at test 3, with 83.86% (265/316) being returned. Mean percentile of scores was higher at test 2 compared with test 1 in the first tertile group of participating students. Motivation to study medicine (motivation), realization of application of preclinical knowledge to clinical study (application), understanding of clinical environment (environment), and lesson review after class (review) were higher for participating than nonparticipating students at test 2 and/or test 3. Searching additional study information was higher at test 2 compared with test 1 only for participating students. This project could effectively promote application, motivation, environment, and review for participating vs. nonparticipating students at test 2 and/or test 3. Effortless, intimate, and effective communication between clinical and preclinical students and a direct experience in early clinical exposure might be key success factors.

Life unlocking card game in death and dying classroom for medical students.

This article was migrated. The article was marked as recommended. Introduction: Advance Care Planning (ACP) is a part of comprehensive palliative care but there are challeges for its implementation. In Thailand, undergraduate medical curriculum also has not implemented palliative care and ACP as a core teaching topic for the medical students yet. Life Unlocking Card Game is an end-of-life conversation card game that aims to bridge this gap. Objective: To assess second year medical students' attitude of death by using Life Unlocking Card Game and its effectiveness to teach about death and dying. Methods: Non-equivalent quasi-experimental design with convenience sampling method. All (48) of second year medical students participated in an end-of-life conversation game (8 games in total with one facilitator within each group). After that, each group formed an after-game focus group interview. Seven students also joined individual semi-structured interviews. We used content analysis approach along with investigator triangulation and methodological triangulation methods for the qualitative analysis. Results: Participants (n = 48) were second-year preclinical medical students. 26 of them were male (54.2%), 22 were female (45.8%), with the mean age of 20 years (SD 0.6). Five primary themes regarding the card game emerged: 1) Safe space to disclose personal issues 2) Seeing the world through different views 3) Surprise elements 4) Death distant closure 5) Changed behaviour. Conclusions: Life Unlocking Card Game proves to be an effective tool to teach death and dying issues and also ACP in second year medical students. Further study in clinical year students or postgraduate students are recommended.

Macromolecular Drug Carriers for Targeted Glioblastoma Therapy: Preclinical Studies, Challenges, and Future Perspectives.

Glioblastoma, the most common, aggressive brain tumor, ranks among the least curable cancers-owing to its strong tendency for intracranial dissemination, high proliferation potential, and inherent tumor resistance to radiation and chemotherapy. Current glioblastoma treatment strategies are further hampered by a critical challenge: adverse, non-specific treatment effects in normal tissue combined with the inability of drugs to penetrate the blood brain barrier and reach the tumor microenvironment. Thus, the creation of effective therapies for glioblastoma requires development of targeted drug-delivery systems that increase accumulation of the drug in the tumor tissue while minimizing systemic toxicity in healthy tissues. As demonstrated in various preclinical glioblastoma models, macromolecular drug carriers have the potential to improve delivery of small molecule drugs, therapeutic peptides, proteins, and genes to brain tumors. Currently used macromolecular drug delivery systems, such as liposomes and polymers, passively target solid tumors, including glioblastoma, by capitalizing on abnormalities of the tumor vasculature, its lack of lymphatic drainage, and the enhanced permeation and retention (EPR) effect. In addition to passive targeting, active targeting approaches include the incorporation of various ligands on the surface of macromolecules that bind to cell surface receptors expressed on specific cancer cells. Active targeting approaches also utilize stimulus responsive macromolecules which further improve tumor accumulation by triggering changes in the physical properties of the macromolecular carrier. The stimulus can be an intrinsic property of the tumor tissue, such as low pH, or extrinsic, such as local application of ultrasound or heat. This review article explores current preclinical studies and future perspectives of targeted drug delivery to glioblastoma by macromolecular carrier systems, including polymeric micelles, nanoparticles, and biopolymers. We highlight key aspects of the design of diverse macromolecular drug delivery systems through a review of their preclinical applications in various glioblastoma animal models. We also review the principles and advantages of passive and active targeting based on various macromolecular carriers. Additionally, we discuss the potential disadvantages that may prevent clinical application of these carriers in targeting glioblastoma, as well as approaches to overcoming these obstacles.

Dental Anatomy and Occlusion: Mandibular Incisors-Flipped Classroom Learning Module.

INTRODUCTION: This dental anatomy module is the second in a series that develops skills in analyzing the morphology, function, anomalies, and development of human teeth. Learning the visual details associated with teeth has often proven difficult using the lecture format; thus, we have utilized computer-assisted flipped learning, which has been shown to be just as effective as lectures and frees up class time for active learning. METHODS: In a flipped classroom approach, students learn basic knowledge with a self-paced, interactive tutorial prior to class. In class, students are assigned to small groups and start with a readiness assessment quiz, administered first individually and then to each team. This is followed by a review for the whole class. The teams then practice critical thinking through practical application scenarios; a laboratory exercise follows where students wax tooth #25 and tooth #26. RESULTS: Students rated faculty members who used team-based learning higher than those who used lecture format for similar morphology lectures. For the first 3 years that this flipped classroom technique was used, students consistently scored it higher than the lecture format on a 5-point Likert scale. Multiple positive comments indicated their preference for this method. DISCUSSION: Teaching students to see the subtle variations in tooth morphology takes time and attention. In a lecture, each key point is covered only once, and images appear fleetingly. A key advantage of the self-paced interactive tutorial coupled with flipped classroom activities is that each learner can take the time needed with each image in a tutorial.

Performance of two different digital evaluation systems used for assessing pre-clinical dental students' prosthodontic technical skills.

INTRODUCTION: Proper integration of newly emerging digital assessment tools is a central issue in dental education in an effort to provide more accurate and objective feedback to students. The study examined how the outcomes of students' tooth preparation were correlated when evaluated using traditional faculty assessment and two types of digital assessment approaches. Specifically, incorporation of the Romexis Compare 2.0 (Compare) and Sirona prepCheck 1.1 (prepCheck) systems was evaluated. Additionally, satisfaction of students based on the type of software was evaluated through a survey. MATERIAL AND METHODS: Students in a second-year pre-clinical prosthodontics course were allocated to either Compare (n = 42) or prepCheck (n = 37) systems. All students received conventional instruction and used their assigned digital system as an additional evaluation tool to aid in assessing their work. Examinations assessed crown preparations of the maxillary right central incisor (#8) and the mandibular left first molar (#19). All submissions were graded by faculty, Compare and prepCheck. RESULTS: Technical scores did not differ between student groups for any of the assessment approaches. Compare and prepCheck had modest, statistically significant correlations with faculty scores with a minimum correlation of 0.3944 (P = 0.0011) and strong, statistically significant correlations with each other with a minimum correlation of 0.8203 (P < 0.0001). A post-course student survey found that 55.26% of the students felt unfavourably about learning the digital evaluation protocols. A total of 62.31% felt favourably about the integration of these digital tools into the curriculum. CONCLUSIONS: Comparison of Compare and prepCheck showed no evidence of significant difference in students' prosthodontics technical performance and perception.

Does a Brief Educational Session Produce Positive Change for Individuals Waiting for Tertiary Chronic Pain Services?

OBJECTIVES: To examine: 1) whether a single brief pre-clinic educational session improved the well-being and quality of life of individuals entering the wait-list for a tertiary chronic pain (CP) service; and 2) the impact of waiting for services on these outcomes. METHODS: Participants were 346 adults, with basic English skills and non-urgent triage codes, who were recruited on referral to a tertiary Australian metropolitan CP unit. Participants were randomized across two conditions: "treatment as usual" (normal wait-list) and "experimental" (normal wait-list plus a 3-hour CP educational session). The educational session encouraged self-management and life engagement despite pain. Multiple outcomes (pain acceptance, pain-related interference, psychological distress, health care utilization [frequency, types], quality of life, health knowledge/beliefs), as well as pain severity and symptom exaggeration, were assessed at intake and again at 2 weeks and 6 months post-educational session (or equivalent for the wait-list group). RESULTS: Satisfaction with the educational session was moderate-to-high, but attendance was not associated with improved outcomes. At 2 weeks, all study participants reported significant improvements in pain acceptance (willingness, overall acceptance), health care utilization (frequency) and quality of life (physical), which were maintained/enhanced at 6 months. Use of psychological and physical therapies increased significantly by 6 months. There was no functional deterioration while wait-listed. CONCLUSIONS: Attending a brief pre-clinic education session did not improve function. There was no deterioration in wait-listed participants who agreed to be involved in research and who completed study measures at 2 and 6 months, but referral was associated with short-term functional improvements. This is the first study to link positive change with referral to, rather than treatment by, a tertiary CP service.

Highlights from the 1st Latin American meeting on metronomic chemotherapy and drug repositioning in oncology, 27-28 May, 2016, Rosario, Argentina.

Following previous metronomic meetings in Marseille (2011), Milano (2014), and Mumbai (2016), the first Latin American metronomic meeting was held in the School of Medical Sciences, National University of Rosario, Rosario, Argentina on 27 and 28 of May, 2016. For the first time, clinicians and researchers with experience in the field of metronomics, coming from different countries in Latin America, had the opportunity of presenting and discussing their work. The talks were organised in three main sessions related to experience in the pre-clinical, and clinical (paediatric and adult) areas. The different presentations demonstrated that the fields of metronomic chemotherapy and repurposing drugs in oncology, known as metronomics, constitute a branch of cancer therapy in permanent evolution, which have strong groups working in Latin America, both in the preclinical and the clinical settings including large, adequately designed randomised studies. It was shown that metronomics offers treatments, which, whether they are combined or not with the standard therapeutic approaches, are not only effective but also minimally toxic, with the consequent improvement of the patient's quality of life, and inexpensive, a feature very important in low resource clinical settings. The potential use of metronomic chemotherapy was proposed as a cost/effective treatment in low-/middle-income countries, for adjuvant therapy in selected tumours. The fundamental role of the governmental agencies and non-governmental alliances, as the Metronomic Global Health Initiative, in supporting this research with public interest was underlined.

Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma.

INTRODUCTION: Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment. PRESENTATION OF CASE: Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed circulatory insufficiency so that cardiopulmonary resuscitation was necessary. Considering the preclinical and clinical course it was decided to proceed with thrombolysis. Despite consistently sufficient resuscitation measures circulatory function was not restored and the patient remained in asystole and passed away. DISCUSSION: The initial assessment showed cardiopulmonary instability. After applying thrombolysis a therapeutic point of no return was reached because surgical intervention was impossible but autopsy findings showed severe myocardial and pulmonary contusions likely due to shear forces. CONCLUSION: This case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion.