Cadaver corneoscleral model for angle surgery training.

PURPOSE: To assess a new training model (Tackdriver) for new-generation microinvasive glaucoma surgeries (MIGS). SETTING: Resident training centers in Canada. DESIGN: Evaluation of technology. METHODS: Human cadaver corneoscleral rims recovered after Descemet-stripping endothelial keratoplasty or not suitable for transplantation were acquired from an eye bank. The tissue was fixated with a single tack through the center of the cornea, which was inverted in a concave fashion. A water-based medical lubricant was used for placement of a goniolens after visualization of the anterior chamber and the trabecular meshwork. Microbypass stent (iStent) insertion and gonioscopy-assisted transluminal trabeculotomy (GATT) were practiced on this model. The model was qualitatively assessed for ease of preparation, accuracy of surgical simulation, and the number and variety of MIGS procedures that can be performed. RESULTS: Efficient high-volume training was performed for microbypass stent insertion using first-generation and second-generation microbypass stents. The GATT procedure was also performed as a final step in a titratable fashion in 90-, 180-, or 270-degree segments or a complete 360-degree treatment. The model simulated bimanual angle surgery with good fidelity. CONCLUSIONS: The training model allowed for high-volume bimanual MIGS training for techniques such as microbypass stent insertion and removal as well as GATT. Preparation was relatively simple, efficient, and cost-effective compared with other models. Inverting the specimen allowed the trainee to practice MIGS techniques independent of the tissue's corneal clarity. Other MIGS techniques and angle training procedures can be adopted to this model.

Identification of two thaumatin-like proteins (TLPs) in the pollination drop of hybrid yew that may play a role in pathogen defence during pollen collection.

We describe the proteomic identification of two pathogenesis-related group 5 (PR-5) proteins, an acidic thaumatin-like protein (TLP) and a basic TLP isolated from the pollination drop of hybrid yew (Taxus x media Rehder). The basic TLP (TxmTLPb) was the most abundant protein in the yew pollination drop based on protein spot size after two-dimensional electrophoresis. The acidic TLP (TxmTLPa) is also a major protein component of the yew ovular secretion and appears to be encoded by a number of mRNAs transcribed from a TLP gene family that has undergone limited sequence divergence. We have sequenced five acidic TLP-encoding cDNAs (TxmTLPa-1,2,3,4 and 5) isolated from the yew ovule that vary from each other by no more than five out of 233 amino acid residues in their predicted protein sequences. All of the cDNA variants encode TLPs possessing the 16 conserved cysteine residues and five charged amino acid side chains associated with antifungal activity. Amplification of genomic DNA with TxmTLPa primers indicated that at least 11 acidic TLPs with highly similar amino acid sequences may be expressed in yew tissues. Antibodies against TLPs confirmed the identity of TxmTLPa and TxmTLPb in the yew pollination drop and detected TLPs in the ovular secretions of four other species from three other conifer families. Our results suggest that TLPs are a conserved component of conifer ovular secretions and are involved in broad spectrum pathogen defence of ovules.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada.

OBJECTIVE: In the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). METHODS: Data regarding speciality surgeons' adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. RESULTS: Compared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: "no suitable product for my practice" (p = 0.01), "too costly" (p = 0.0006), "too time consuming" (p < 0.0001), and "planning to retire soon" (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. CONCLUSIONS: The barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.