Attitudes of robotic surgery educators and learners: challenges, advantages, tips and tricks of teaching and learning robotic surgery.

As the application of robotic surgical technology grows, so does the need to instruct surgical residents in robotic techniques. To better understand the challenges and benefits unique to robotic surgery education, this study explored the attitudes of teachers and learners. A 43-item questionnaire was developed with five domains: challenges and benefits of robotic education, training methodologies, trainees' readiness for learning, and education tips. This was delivered to surgeons and surgical fellows at a high-volume surgical department. 31 surgeons and 25 fellows from 7 specialties responded (response rate 70% and 43%). The teaching and learning of robotic surgery were perceived as superior to traditional minimally invasive surgery by both surgeons (in 7/9 factors studied) and fellows (7/9), but was seen as mostly disadvantageous compared to open surgery by both surgeons (in 6/9 factors studied) and fellows (8/9). Surgeons frequently stated the greatest challenge to teaching robotics was the need to relinquish total control to the trainee. Robotic surgery education is generally well received and offers several advantages. However, teaching robotic surgery presents unique challenges, especially when compared to open surgery. Understanding the benefits of, and barriers to, robotic surgery education may help develop more effective training paradigms that are responsive to educational needs while maintaining patient safety.

Identification of the seasonal conditions required for dormancy break of Persoonia longifolia (Proteaceae), a species with a woody indehiscent endocarp.

BACKGROUND AND AIMS: The mechanisms involved in breaking seed dormancy in species with woody endocarps are poorly understood. In a landmark study examining the role of endocarps in regulating germination, our aim was to investigate the effects of the natural sequence of environmental conditions on dormancy break of a species with a woody endocarp (Persoonia longifolia). METHODS: The role of the endocarp in germination was investigated through imbibition and endocarp removal germination tests. The use of burial to break dormancy was examined and results from these experiments were used to guide laboratory investigations into the use of wet/dry cycling and stratification to break dormancy. KEY RESULTS: Endocarps were water-permeable. Germination increased from 0 to 92·5 % when endocarps were removed. During burial in the field and nursery, 41·6 and 63·7 % of the endocarps germinated, respectively, after 36 months. Ex situ post-burial germination was cyclical and highest after 30 months of burial (45·4 % nursery and 31·8 % field). Highest germination occurred in wet/dry trials when the dry summer was long (20 weeks), had fluctuating temperatures (30/50 °C) and two long (7 d) wet cycles and was followed by moist winters at 10/20 °C. A stratification trial found that highest germination occurred following incubation for 12 weeks at 30 °C (including 2 weeks moist) + 6 weeks moist at 8 °C then placement at 20/10 °C for germination. CONCLUSIONS: Summer conditions break physiological dormancy of the embryo and promote opening of the endocarp, allowing seeds to germinate during winter conditions. By closely monitoring the environment that endocarps are exposed to in nature, dormancy breaking mechanisms can be identified and used to improve germination. These results outline for the first time how dormancy and germination are regulated in a species with a hard woody endocarp, insights which will significantly improve our understanding of other species with similar reproductive features.

The contribution of protein kinase C and CPI-17 signaling pathways to hypercontractility in murine experimental colitis.

BACKGROUND: Colonic smooth muscle contractility is altered in colitis, and several protein kinase pathways can mediate colonic smooth muscle contraction. In the present study, we investigated whether protein kinase C (PKC) pathways also play a role in colonic hypercontractility observed during T(H) 2 colitis in BALB/c mice. METHODS: Colitis was induced in BALB/c mice by provision of 5% dextran sodium sulfate (DSS) for 7 days. Changes in smooth muscle contractility were examined using dissected circular smooth muscle preparations from the distal colon. The contribution of conventional and novel PKC isozymes to the hypercontractile response was examined with pharmacological PKC inhibitors. Western blot analyses were used to examine protein expression and phosphorylation changes. KEY RESULTS: Colonic smooth muscle was associated with inflammation-induced hypercontractility and altered PKC expression. Carbachol-induced peak (phasic) and sustained (tonic) contractions were increased. Chelerythrine was the most effective PKC inhibitor of both phasic and tonic contractions. There was no general difference in the percent contribution of conventional and novel PKC isozymes toward the DSS-induced hypercontractility, but inhibition of sustained force with GF109203x was higher for inflamed muscle. The CPI-17 phosphorylation was equally suppressed in both normal and DSS conditions by Gö6976 and chelerythrine, but only for the phasic component of contraction. CONCLUSIONS & INFERENCES: The outcomes suggest that both conventional and novel PKC isozymes contribute to the phasic and tonic contractile components of BALB/c colonic circular smooth muscle under normal conditions, with novel PKC isozymes having a greater contribution to the tonic contraction. However, no effect of inflammation was observed on the relative contribution of PKC and CPI-17 toward the observed hypercontractility.

Protection against nerve agent poisoning by a noncompetitive nicotinic antagonist.

The acute toxicity of organophosphorus (OP) nerve agents arises from accumulation of acetylcholine (ACh) and overstimulation of ACh receptors. The mainstay of current pharmacotherapy is the competitive muscarinic antagonist, atropine. Nicotinic antagonists have not been used due to the difficulties of administering a dose of a competitive neuromuscular blocker sufficient to antagonise the effects of excessive ACh, but not so much that it paralyses the muscles. An alternative approach would be to use a noncompetitive antagonist whose effects would not be overcome by increasing ACh concentrations. This study demonstrates that the compound 1,1'-(propane-1,3-diyl)bis(4-tert-butylpyridinium), which blocks open nicotinic ion channels noncompetitively, is able to reverse the neuromuscular paralysis after nerve agent poisoning in vitro and to protect guinea pigs against poisoning by nerve agents when used as part of a therapeutic drug combination including a muscarinic antagonist. In contrast to the oxime HI-6, this compound was equally effective in protecting against poisoning by sarin or tabun. Further studies should identify more effective compounds with this action and optimise doses for protection against nerve agent poisoning in vivo.

Identification and characterization of the water gap in the physically dormant seeds of Dodonaea petiolaris: a first report for Sapindaceae.

BACKGROUND AND AIMS: The Sapindaceae is one of 17 plant families in which seed dormancy is caused by a water-impermeable seed or fruit coat (physical dormancy, PY). However, until now the water gap in Sapindaceae had not been identified. The primary aim of this study was to identify the water gap in Dodonaea petiolaris (Sapindaceae) seeds and to describe its basic morphology and anatomy. METHODS: Seed fill, viability, water-uptake (imbibition) and other characteristics were assessed for D. petiolaris seeds. The location and structure of the water gap were investigated using a blocking experiment, time series photography, scanning electron microscopy and light microscopy. Dodonaea petiolaris seeds with PY also were assessed for loss of PY at four ecologically significant temperatures under moist and dry conditions. Seeds of three other species of Sapindaceae were examined for presence of a water gap. KEY RESULTS: The water gap in D. petiolaris seeds was identified as a small plug in the seed coat adjacent to the hilum and opposite the area where the radicle emerges. The plug was dislodged (i.e. water gap opened = dormancy break) by dipping seeds in boiling water for 2.5 min or by incubating seeds on a moist substrate at 20/35 degrees C for 24 weeks. Layers of cells in the plug, including palisade and subpalisade, are similar to those in the rest of the seed coat. The same kind of water gap was found in three other species of Sapindaceae, Diplopeltis huegelii, Distichostemon hispidulus and Dodonaea aptera. CONCLUSIONS: Following dormancy break (opening of water gap), initial uptake of water by the seed occurs only through the water gap. Thus, the plug must be dislodged before the otherwise intact seed can germinate. The anatomy of the plug is similar to water gaps in some of the other plant families with PY.

Occurrence of physical dormancy in seeds of Australian Sapindaceae: a survey of 14 species in nine genera.

BACKGROUND AND AIMS: Sapindaceae is one of 16 angiosperm families whose seeds have physical dormancy (PY). However, the extent and nature of PY within this family is poorly known. The primary aims of this study were: (1) to evaluate seed characteristics and determine presence (or not) of PY within nine genera of Australian Sapindaceae; and (2) to compare the frequency of PY across the phylogenetic tree within Australian Sapindaceae. METHODS: Viability, imbibition and seed characteristics were assessed for 14 taxa from nine genera of Sapindaceae. For five species of Dodonaea, optimal conditions for germination and dormancy break were evaluated. An in situ burial experiment was performed on D. hackettiana seeds to identify the factor(s) responsible for overcoming PY. Classes of dormancy and of non-dormancy for 26 genera of Sapindaceae were mapped onto a phylogenetic tree for the family. KEY RESULTS: Mean seed viability across all taxa was 69.7 %. Embryos were fully developed and folded (seven genera) or bent (two genera); no endosperm was present. Seeds of all five Dodonaea spp. and of Distichostemon hispidulus had PY. Hot-water treatment released PY in these six species. Optimal germination temperature for seeds of the four Dodonaea spp. that germinated was 15-20 degrees C. Following 5 months burial in soil, 36.4 % of D. hackettiana seeds had lost PY and germinated by the beginning of the winter wet season (May). Laboratory and field data indicate that dormancy was broken by warm, moist temperatures (> or =50 degrees C) during summer. CONCLUSIONS: PY occurs infrequently in genera of Sapindaceae native to Australia. Seeds of Dodonaea and Distichostemon had PY, whereas those of the other seven genera did not. Seeds of these two genera and of Diplopeltis (a previous study) are the only three of the 20 native Australian genera of Sapindaceae for which germination has been studied that have PY; all three belong to subfamily Dodonaeoideae.

Procedural skills: what's taught in medical school, what ought to be?

BACKGROUND: Medical schools' instruction of skills is often found to be inadequate. In 1999, the American Association of Medical Colleges (AAMC) published a list of eight procedural skills that medical students are recommended to learn. This study aims to evaluate compliance with these guidelines and to examine the instruction of other skills to determine if the most important skills receive adequate instruction. METHODS: In 2004, surveys were sent to 138 educational representatives at North American (AAMC) medical schools and 1208 Canadian family physicians. The survey addressed the importance of selected skills. Findings were analyzed by chi2 testing. RESULTS: Of the eight skills recommended by the AAMC, only four were taught by all schools. All eight, except for suturing, and most of the other skills, were taught at a higher rate than they were practiced. Only digital block anesthesia was practiced more commonly than it was taught. CONCLUSION: Although guidelines exist for skills instruction in medical school, they are not followed completely. Furthermore, the guidelines may reflect an emphasis on skills that are more suited to specialist rather than general practice. This may come at the expense of the instruction of other more practical skills.

Ecophysiology of seed dormancy in the Australian endemic species Acanthocarpus preissii (Dasypogonaceae).

BACKGROUND AND AIMS: Seedlings of Acanthocarpus preissii are needed for coastal sand dune restoration in Western Australia. However, seeds of this Western Australian endemic have proven to be very difficult to germinate. The aims of this study were to define a dormancy-breaking protocol, identify time of suitable conditions for dormancy-break in the field and classify the type of seed dormancy in this species. METHODS: Viability, water-uptake (imbibition) and seed and embryo characteristics were assessed for seeds collected in 2003 and in 2004 from two locations. The effects of GA(3), smoke-water, GA(3) + smoke-water and warm stratification were tested on seed dormancy-break. In a field study, soil temperature and the moisture content of soil and buried seeds were monitored for 1 year. KEY RESULTS: Viability of fresh seeds was >90 %, and they had a fully developed, curved-linear embryo. Fresh seeds imbibed water readily, with mass increasing approx. 52 % in 4 d. Non-treated fresh seeds and those exposed to 1000 ppm GA(3), 1 : 10 (v/v) smoke-water/water or 1000 ppm GA(3) + 1 : 10 (v/v) smoke-water/water germinated <8 %. Fresh seeds germinated to >80 % when warm-stratified for at least 7 weeks at 18/33 degrees C and then moved to 7/18 degrees C, whereas seeds incubated continuously at 7/18 degrees C germinated to <20 %. CONCLUSIONS: Seeds of A. preisii have non-deep physiological dormancy that is released by a period of warm stratification. Autumn (March/April) is the most likely time for warm stratification of seeds of this species in the field. This is the first report of the requirement for warm stratification for dormancy release in seeds of an Australian species.

An in-vitro investigation of the antibacterial effect of nisin in root canals and canal wall radicular dentine.

AIM: To determine whether nisin, a bacteriocin, would be effective at killing Enterococcus faecalis and Streptococcus gordonii cells in solution and within the root canal system. METHODOLOGY: Bacterial isolates of E. faecalis and S. gordonii were grown from glycerol stocks in closed tubes containing BHY broth at 37 degrees C. The minimum bactericidal concentration (MBC) of nisin for both bacterial species was determined by a microdilution method. Extracted human teeth were decoronated to produce roots of equal length with a single canal and divided into six groups of 10 roots. The canals were prepared to a master apical size 30 file using 0.04 taper Ni-Ti rotary instruments. Bacterial samples of each species were inoculated into three groups of prepared roots and incubated in closed tubes at 37 degrees C for 21 days. The root canals in each group were then medicated with water (control), calcium hydroxide powder mixed with sterile water [Ca(OH)2], or nisin and incubated for a further 7 days. Rotary Ni-Ti files were used to take radicular dentine samples from the walls of each canal which were then incubated in BHY broth for 24 h. Optical density (OD600) readings were taken as a measure of bacterial growth. RESULTS: The MBC of nisin for E. faecalis and S. gordonii was 70 and 20 mg mL(-1) respectively. Calcium hydroxide and nisin medication eradicated infection within the root canal while cells remained viable in the control group. Mean optical density (OD600) readings from canal wall dentine shavings infected with E. faecalis were 1.32 +/- 0.98, 0.73 +/- 0.27 and 0.69 +/- 0.38 for the control, Ca(OH)2 and nisin samples respectively. Corresponding mean readings for S. gordonii were 1.19 +/- 0.18, 0.73 +/- 0.15 and 0.60 +/- 0.29. The Ca(OH)2 and nisin group readings were significantly (P < 0.01) lower than the control for each species as tested by Student's t-test and Mann-Whitney U statistical analysis. Values for Ca(OH)2 and nisin were not significantly (P > 0.01) different. CONCLUSION: Nisin was effective at eradicating E. faecalis and S. gordonii cells in pure culture and was comparable with Ca(OH)2 in the elimination of these species from within the root canal system.

Mutations of the secondary cell wall.

It has not been possible to isolate a number of crucial enzymes involved in plant cell wall synthesis. Recent progress in identifying some of these steps has been overcome by the isolation of mutants defective in various aspects of cell wall synthesis and the use of these mutants to identify the corresponding genes. Secondary cell walls offer numerous advantages for genetic analysis of plant cell walls. It is possible to recover very severe mutants since the plants remain viable. In addition, although variation in secondary cell wall composition occurs between different species and between different cell types, the composition of the walls is relatively simple compared to primary cell walls. Despite these advantages, relatively few secondary cell wall mutations have been described to date. The only secondary cell wall mutations characterised to date, in which the basis of the abnormality is known, have defects in either the control of secondary cell wall deposition or secondary cell wall cellulose or lignin biosynthesis. These mutants have, however, provided essential information on secondary cell wall biosynthesis.

Cloning and characterization of irregular xylem4 (irx4): a severely lignin-deficient mutant of Arabidopsis.

A severe lignin mutant, irx4, has been identified in Arabidopsis thaliana as a result of its collapsed xylem phenotype. In contrast to previously described irx mutants, irx4 plants have 50% less lignin than wild-type plants, whilst the cellulose and hemicellulose content remained unchanged. These alterations in the composition of irx4 secondary cell walls had a dramatic effect on the morphology and architecture of the walls, which expand to fill most of the cell, and also on the physical properties of irx4 stems. Further analysis indicated that the irx4 mutation occurred in a cinnamoyl-CoA reductase (CCR) gene within a highly conserved intron splice site sequence of intron 2. As a result, CCR mRNA transcripts were incorrectly spliced. Transgenic plants expressing an IRX3 promoter-CCR cDNA construct were used to generate a series of plants with varying degrees of lignin content in order to assess the role of lignin content in determining the physical properties of Arabidopsis stems.

Effects of plant growth regulators on survival and recovery growth following cryopreservation.

Studies on the effects of plant growth regulators (PGRs) on survival, recovery and post-recovery growth of shoot apices following cryopreservation are limited. In this study, the effects of plant growth regulators in both the culture phase and the recovery phase of cryostorage were examined for the rare plant species, Anigozanthos viridis ssp terraspectans Hopper. Survival of shoot apices was not correlated to cytokinin or auxin treatments administered in culture media prior to cryostorage. In recovery media, the plant growth regulators, kinetin, zeatin (cytokinins), IAA, (auxin) and GA3 were examined for their effect following cryopreservation. It was found that the application of a combination of cytokinin and 0.5 microM GA3 from day zero was the most appropriate for obtaining vigorously growing plantlets following LN immersion. This combination proved to be more effective than basal medium, zeatin or kinetin treatments.

The gapped xylem mutant identifies a common regulatory step in secondary cell wall deposition.

The phenotype of the novel gapped xylem (gpx) mutant is described. gpx plants exhibit gaps in the xylem in positions where xylem elements would normally be located. These gaps are not part of the transpiration stream and result in gpx plants having fewer functional xylem elements. The gaps are due to the absence of a secondary cell wall in developing xylem elements, resulting in complete degradation of these elements during cell death, and illustrate the importance of the secondary cell wall in retaining a functional xylem element following programmed cell death. Consequently the gpx phenotype suggests that the processes of secondary cell wall formation and cell death are independently regulated in developing xylem. gpx plants also exhibit a highly irregular pattern of secondary cell wall thickening in interfascicular cells, with some cells apparently undergoing little or no secondary cell wall deposition. Secondary cell wall deposition in plants involves the co-ordinate regulation of several complex metabolic pathways. The gpx mutant identifies a key step involved in regulating the deposition of secondary cell wall material in both xylem and interfascicular cells, and suggests that a common regulatory step controls secondary cell wall formation in these diverse cell types. The gpx mutant offers a unique opportunity to elucidate the mechanism by which the complex processes involved in secondary cell wall formation are co-ordinately regulated.

Multiple cellulose synthase catalytic subunits are required for cellulose synthesis in Arabidopsis.

The irregular xylem 1 (irx1) mutant of Arabidopsis has a severe deficiency in the deposition of cellulose in secondary cell walls, which results in collapsed xylem cells. This mutation has been mapped to a 140-kb region of chromosome 4. A cellulose synthase catalytic subunit was found to be located in this region, and genomic clones containing this gene complemented the irx1 mutation. IRX1 shows homology to a previously described cellulose synthase (IRX3). Analysis of the irx1 and irx3 mutant phenotypes demonstrates that both IRX1 and IRX3 are essential for the production of cellulose in the same cell. Thus, IRX1 and IRX3 define distinct classes of catalytic subunits that are both essential for cellulose synthesis in plants. This finding is supported by coprecipitation of IRX1 with IRX3, suggesting that IRX1 and IRX3 are part of the same complex.

Cryopreservation of the australian species Macropidia fuliginosa (Haemodoraceae) by vitrification.

Somatic embryos were used to develop a cryopreservation protocol for Macropidia fuliginosa, a commercially-important species endemic to the south-west of Western Australia. Somatic embryos were allowed to develop from embryogenic callus for three weeks on an kinetin medium prior to processing. These were transferred and cultured on a agar solidified basal medium supplemented with 0 to 0.6 M sorbitol for 2 d prior to incubation in Plant Vitrification Solution Two (PVS2). Following this, embryos were then washed in 1 M sucrose solution (treated controls) or cooled in liquid nitrogen (LN). Cooled embryos were then warmed and washed in sucrose solution. Highest survival for cooled treatments (67.3%) was achieved by preculture with 0.4 M sorbitol, then incubation in PVS2. Further experimentation varying pre-culture duration (2 or 3 d) and incubation on either glycerol (0.8 M) or sorbitol (0.4 M) indicated that very high survival (90.6%) of embryos was achievable by adopting a 2 d preculture period on 0.8 M glycerol. The phenotype and growth rates of plants obtained using this protocol were similar to those of parent plants. This optimised procedure was then applied to tissue culture-derived shoot apices of the same clone also resulting in a high survival rate (84.4%).

The irregular xylem3 locus of Arabidopsis encodes a cellulose synthase required for secondary cell wall synthesis.

The irregular xylem3 (irx3) mutant of Arabidopsis has a severe deficiency in secondary cell wall cellulose deposition that leads to collapsed xylem cells. The irx3 mutation has been mapped to the top arm of chromosome V near the marker nga106. Expressed sequence tag clone 75G11, which exhibits sequence similarity to cellulose synthase, was found to be tightly linked to irx3, and genomic clones containing the gene corresponding to clone 75G11 complemented the irx3 mutation. Thus, the IRX3 gene encodes a cellulose synthase component that is specifically required for the synthesis of cellulose in the secondary cell wall. The irx3 mutant allele contains a stop codon that truncates the gene product by 168 amino acids, suggesting that this allele is null. Furthermore, in contrast to radial swelling1 (rsw1) plants, irx3 plants show no increase in the accumulation of beta-1,4-linked glucose in the noncrystalline cell wall fraction. IRX3 and RSW1 fall into a distinct subgroup (Csa) of Arabidopsis genes showing homology to bacterial cellulose synthases.

Psychological aspects of cleft lip and palate.

In addition to the influences of family dynamics, educational and vocational factors on the social development and rehabilitation of CLP patients, psychological problems, such as lowered self-esteem and difficulties during social interaction, are also experienced by CLP individuals. As only 20 per cent of cleft teams world-wide carry out a psychological assessment for their patients, it is likely that the prevalence of psychological problems is higher than the literature suggests. To maximize the chances of a positive outcome in the care of cleft affected individuals, CLP patients who are concerned about their appearance or who experience psychosocial problems need to be identified by cleft teams. Interventions, such as counselling or social interaction skills training, should be offered in order that the patient's self-esteem and social self-confidence can be increased. Current research surrounding patient and parent satisfaction with cleft care suffers from several areas of methodological weakness.

Tipranavir (PNU-140690): a potent, orally bioavailable nonpeptidic HIV protease inhibitor of the 5,6-dihydro-4-hydroxy-2-pyrone sulfonamide class.

A broad screening program previously identified phenprocoumon (1) as a small molecule template for inhibition of HIV protease. Subsequent modification of this lead through iterative cycles of structure-based design led to the activity enhancements of pyrone and dihydropyrone ring systems (II and V) and amide-based substitution (III). Incorporation of sulfonamide substitution within the dihydropyrone template provided a series of highly potent HIV protease inhibitors, with structure-activity relationships described in this paper. Crystallographic studies provided further information on important binding interactions responsible for high enzymatic binding. These studies culminated in compound VI, which inhibits HIV protease with a Ki value of 8 pM and shows an IC90 value of 100 nM in antiviral cell culture. Clinical trials of this compound (PNU-140690, Tipranavir) for treatment of HIV infection are currently underway.

Autotransplantation of teeth: is there a role?

Autotransplantation of teeth, if carried out successfully, ensures that alveolar bone volume is maintained due to physiological stimulation of the periodontal ligament. Autotransplantation has been carried out for many years, but with varying success rates. As a result, it is seldom regarded as an appropriate treatment option for patients with missing teeth especially with the continued development of osseo-integrated implants. Since placement of osseo-integrated implants in growing alveolar bone is contra-indicated, transplantation of available teeth remains a suitable choice for replacing missing units in the young patient. The role of autotransplantation of teeth in several clinical situations, the clinical techniques involved and factors influencing success of the transplant are discussed. The aim of this paper is to underline the evidence based principles for successful autotransplantation and present the technique as a viable treatment option in present day orthodontic practice.

Non-peptidic HIV protease inhibitors: C2-symmetry-based design of bis-sulfonamide dihydropyrones.

Potent, non-peptidic, dihydropyrone sulfonamide HIV protease inhibitors have been previously described. Crystallographic analysis of dihydropyrone sulfonamide inhibitor/HIV protease complexes suggested incorporation of a second, C2 symmetry-related sulfonamide group. Selected bis-sulfonamide dihydropyrone analogues display high HIV protease inhibitory activity.