ISSR markers endorsed genetically stable plants regeneration of neem (Azadirachta indica A. Juss.) through indirect organogenesis using different explants.

BACKGROUND: Various parts of neem (Azadirachta indica) have high demand in several industries. However, the inadequate supply of sources hampers the commercialization of different neem products. In this scenario, the current research was undertaken to produce genetically stable plants through indirect organogenesis. METHODS AND RESULTS: Several explants like shoot tips, internodal segments, and leaves, were cultivated on MS media with different growth regulators. Maximum callus formation was achieved using 1.5 mg/L NAA, 0.5 mg/L 2,4-D and 0.2 mg/L both for Kn and BAP in combination with shoot tip (93.67%). These calli showed an organogenic potentiality on MS medium having coconut water (15%) without growth regulators. This medium along with 0.5 mg/L Kn and 0.1 mg/L both for BAP and NAA yielded the maximum adventitious shoot production with shoot tip-derived callus (95.24%). These calli further produced the most buds per shoot (6.38) and highest average shoot length (5.46 cm) with 0.5 mg/L both for BAP and Kn and 0.1 mg/L NAA in combination after the fifth subculture. The 1/3 strength of MS media was found to be best along with 0.5 mg/L IBA and 0.1 mg/L Kn in combination to generate maximum root response (92.86%), roots per shoot (5.86) and longest average root length (3.84 cm). The mean plant survival after initial hardening was 83.33% which increased to 89.47% after secondary hardening. The lack of variation in ISSR markers among the regenerated trees is evidence of clonal fidelity between hardened plants. CONCLUSIONS: This protocol will accelerate the propagation of neem for utilization of its sources.

A standardized protocol for genetically stable artificial seed production of Ficus religiosa L. using ISSR fingerprinting.

Ficus religiosa LQuery. has several ornamental, medicinal, and economical applications. The in vivo propagation of this species has shown various limitations. Due to this reason, the present study efforts on genetically uniform artificial seed production from in vitro developed shoot tips of this species. The in vivo shoot tips were cultivated on Murashige and Skoog (MS) media containing different growth regulators. The maximum shoot response (93.67%) and the longest shoot length (3.85 cm) were exhibited with 0.5 mg L-1 6-furfuryl-amino purine (Kn), 0.2 mg L-1 benzyladenine (BA) and 0.1 mg L-1 2,4-dichlorophenoxyacetic acid (2,4-D) in combination. A treatment of 3% sodium alginate and 75 mM calcium chloride having a polymerization time of 15 min was exhibited to be superior for artificial seed production of these in vitro grown shoot tips. Artificial seed-derived micro shoots yielded the highest root response (94.44%) and roots per shoot (4.61) with 0.5 mg L-1 indole-3-butyric acid (IBA) and 0.1 mg L-1 BA in combination on ½-strength MS media. In comparison to 4 °C-kept artificial seeds, 24 °C-stored artificial seeds had superior germination potential across all storage times. The soil:organic manure (1:1) generated 90% of plantlet survival after 28 days of primary hardening than other mixtures tested. The secondary hardening displayed 92% of plant survival after 60 days. The banding patterns of ISSR analysis between the mother plant and hardened plants were discovered to be monomorphic. This methodology provides a promising and affordable approach to the large-scale plant production of this significant species.

Clonal fidelity investigation of micropropagated hardened plants of jackfruit tree (Artocarpus heterophyllus L.) with RAPD markers.

BACKGROUND: Artocarpus heterophyllus is an important tropical agroforestry species that bears multiple applications. However, the population of this species is reduced due to various anthropogenic activities. For this reason, in vitro approach is needed to propagate or conserve this species as in vivo propagation methods face various obstacles. In this respect, the present investigation was undertaken to produce genetically stable jackfruit trees through in vitro technology. In vivo grew shoot tips were harvested on Murashige and Skoog (MS) medium containing several plant growth regulators to achieve this. RESULTS: The 6-benzylaminopurine (BAP) at the concentration of 1.5 mg L-1, indole-3-butyric acid (IBA) at 0.5 mg L-1, and α-naphthaleneacetic acid (NAA) at 0.1 mg L-1 in combination on MS media yielded superior shoot response (94.44%), longest shoot length (4.02 cm), and the maximum number of shoots per explant (4.78). They were further multiplied by repeated subculturing on the same media composition and the third subculture resulted in a maximum number of shoots (5.92) with the largest shoot length (5.85 cm). Among the different media screened for rooting, the » MS media yielded 94.44% rooting response, the longest root length (3.78 cm), and the maximum number of roots per shoot (8.44) with 0.1 mg L-1 NAA, 0.5 mg L-1 IBA and 0.1 mg L-1 BAP in combination. Primary hardening showed 88.89% of plant survival under greenhouse conditions after 4 weeks of incubation having a sterilized mixture of garden soil and vermiculite mixture (1:1, w/w). It increased to 90.60% after the secondary hardening process in a vermiculite-soil mixture (2:1; w/w). No polymorphism was detected on random amplification of polymorphic DNA (RAPD) profiling between the mother plant and hardened plants, indicating high genetic stability among the clones. CONCLUSIONS: This is the first report of the genetic fidelity study of in vitro grown regenerants of A. heterophyllus. This study established a micropropagation protocol for genetically uniform in vitro regeneration of this species to supply plant resources to various industries or conservation of elite germplasm.

The art and science of selecting appropriate dressings for acute open wounds in general practice.

BACKGROUND: Acute open wounds constitute a significant part of general practice. With an expanding global market of dressing products, selection of wound dressings remains an area of concern among doctors entering general practice. OBJECTIVE: The aim of this article is to describe a practical guide for choosing appropriate dressings when treating acute open wounds in general practice. DISCUSSION: Although dressing is an essential element of standard wound care, it is important to remember that dressing alone does not heal the wound. Judicious selection of dressings based on wound characteristics, physical properties of dressings and their costs, shelf life and availability are important for delivering appropriate care towards timely healing of acute wounds.

Sex-related Differences of Excoecaria agallocha L. with a View to Defence and Growth.

Excoecaria agallocha is a dioecious mangrove species, reported to have various medicinal properties. This study compares the gender-related biological activities between the sexes of E. agallocha in accordance with morpho-biochemical parameters which indicate their fitness over various environmental stresses as well as some information about the investment of their resources over defence and growth. For this investigation, mature sun leaves of E. agallocha were collected from each sex from three different ecological regions like Bokkhali, Jharkhali, and Kolkata, West Bengal. The comparative study found that leaf of female plants yielded more compounds than males and also resulted in higher anti-bacterial, reducing power, total antioxidant, and lipid peroxidation activities. Female leaves also showed higher concentrations of biochemical constituents like chlorophyll a, chlorophyll b, total carotenoids, total phenolic compounds and total protein content than male leaves. However, leaf area of all-male leaves in all sites was found to be greater than female leaves. The differences in growth rate and secondary metabolite content-based defences between sexes suggest that females invest resources in defences or resistance (Relative electrolytic leakages and TBARS content), whereas male invests their resources in growth (Leaf area) or tolerance. The present study strongly suggests that the female plant's yields are more beneficial in terms of medicinal properties as compared to the male plant.

Inguinal hernia repair: a global perspective.

BACKGROUND: Inguinal hernia repair is one of the most common operations performed worldwide with most of the burden of these occurring in low- or middle-income countries (LMICs). There has been much research investigating the most effective method of hernia repair in resource-rich countries, however very little has been done to determine the most cost-beneficial method of hernia repair in LMICs. METHODS: A systematic review of the English literature through PubMed and Scopus was conducted according to the PRISMA statement. RESULTS: Twenty-eight studies met the inclusion criteria of which 17 were randomised controlled trials and 11 were systematic reviews. Three areas of investigation were established from the literature search, namely operative method and type of mesh used (where applicable). Open-mesh procedures were shown to be less costly and have shorter operative times than laparoscopic methods. People who underwent laparoscopic hernia repair regularly returned to normal activities earlier than those who had open-mesh procedures. However, there was no other difference in complication rates between these two methods. Recent investigations have revealed that sterilised synthetic mosquito net was similar to hernia-specific meshes whilst significantly reducing cost. CONCLUSION: We postulate that the most cost-beneficial method of hernia repair for implementation in LMICs is using open-mesh procedures with sterilised mosquito net under local anaesthetic. Further cost-benefit research is required in this area.

Assessment of genetic divergence through cluster analysis of chilli varieties.

Our study on genetic diversity was conducted with six chilli genotypes with inter- and intra-specific cross varieties of the three most popular chilli species (Capsicum annuum L., Capsicum chinense Jacq., and Capsicum frutescens L.). Twelve quantitative characters, viz. plant height (cm), primary branches, secondary branches, number of flowers, number of fruits/plant; dry fruit weight (g), fruit length (cm), fruit diameter (cm), pedicel length (cm), pericarp thickness (mm), seeds/fruit, and seed weight (g), were taken into consideration. The analysis of variance revealed considerable variability among the genotypes for the character studied. Cluster analysis was used for grouping of parental and hybrid chilli genotypes under the study grouped into five clusters. Cluster I had the maximum (12) and clusters IVand V had the minimum number (1) of genotypes. The inter-cluster D2 values ranged between 40.404 and 127.530. The minimum inter-cluster distance was between clusters III and IV (40.404). The maximum inter-cluster distance was observed between clusters II and V (127.53). Diversity pattern and other horticultural performance among the genotypes of new varieties were generated due to the cross between Local Line Mahadev Pramanick and Sukhia bullet and also the cross between Local Line Mahadev Pramanick and Habanero orange (cluster II) as well as single parental variety i.e. Habanero orange. These genotypes were identified as promising varieties with respect to various characters may be taken into consideration as better parents for an efficient hybridization programme of chilli.

A pragmatic approach to effective anatomy teaching and learning to medical students: a ten-year experience using evidence-based principles.

This article was migrated. The article was marked as recommended. Teaching and learning of anatomy for medical students have been extensively studied. However, we believe that a 'gold-standard' of an anatomy teaching and learning model is difficult to establish as every educational institution faces unique. For the past ten years at the University of Notre Dame Australia, School of Medicine Sydney, the anatomy faculty has implemented evidence-based teaching strategies adopted from medical schools around the world and supported by timely student feedback to deliver cost-effective and sustainable anatomy learning. Student evaluations of this program have been positive and associated with improved summative anatomy results. This article describes ten principles pursued by our faculty, which we hope will help others in restructuring or enhancing their anatomy teaching and learning program.

Enhancing pathology learning for medical students - via blended learning by clinicians.

This article was migrated. The article was marked as recommended. Objectives: Assessing the feasibility and benefits of supplementary pathology teaching by a clinician to improve students' understanding of the pathological process and its relationship with clinical symptoms and signs during their clinical rotations. Design, Setting, and Participants: The Bachelor of Medicine and Bachelor of Surgery (MBBS) Course in the University of Tasmania is a 5-year undergraduate program and all disciplines of pathology are taught in years 1, 2 (pre-clinical) and 3 (clinical transition), by pathologists. Over a twelve-year period, with the application of technology, pedagogy, and content knowledge framework, a blended pathology learning program developed and delivered by a surgeon to supplement the existing pathology curriculum. Participants were medical students in year three of the MBBS course during their nine-week surgical rotations. Intervention: Images of pathology specimens were presented online for the students to identify the organ, pathology and associate this with clinical features to arrive at a clinical diagnosis using online team discussions followed by face-to-face sessions to further explore students' responses. Main outcome measures: The survey used both quantitative and qualitative measures to assess students' knowledge gain in pathology, their perceptions about critical thinking and clinical reasoning skills, and satisfaction. Results:The results indicate that most students', especially the weaker students, improved on their pathology knowledge over the period of the course, which helped in their development of skills in diagnosing and managing diseases with a high level of satisfaction of all students. Conclusion: This study provides supportive evidence that overall students' pathology knowledge improved through delivery using blended learning and importantly weaker students benefitted considerably. Also, the results suggest that when students view pathology specimens online, engage in scholarly debate about them, and participate in face-to-face sessions to consolidate their learning, they gain strong inductive medical reasoning skills.

Evaluating a low-fidelity inguinal canal model.

PURPOSE: The inguinal canal anatomy is of paramount clinical significance due to the common occurrence of direct and indirect inguinal hernias. However, the inguinal canal is often an area of great difficulty for medical students to understand. The aim of this study was to evaluate the use of a low-cost, low-fidelity inguinal canal model as a teaching and learning aid. METHODS: A low-fidelity inguinal canal model was introduced as a learning aid in an anatomy tutorial on the inguinal region. Students were randomised into intervention (n = 66) and control (n = 40) groups. Following the tutorial, all students completed a multiple-choice question quiz on the inguinal canal. The intervention group also completed a questionnaire evaluating the positive and negative aspects of the model. RESULTS: Students taught with the inguinal canal model achieved higher scores (mean: 88.31% vs 81.7%, p = 0.087). Positive aspects of the model as described by the students included its simplicity and ability to improve their three-dimensional understanding of the inguinal canal. Students requested more hands-on time with the model during the tutorial. CONCLUSION: The present study supports current literature in that low-fidelity anatomy models are a useful adjunct to aid students' learning of complex anatomical concepts. Students may benefit from creating their own inguinal canal model to retain as a personal study tool.

Infiltrating the Curriculum: Integrating Medical History with Existing Surgical Pathology Tutorials.

This article was migrated. The article was marked as recommended. Objective: To assess medical students' perspective on medical history embedded into a pre-existing learning module. Design, Setting, and Participants: This study was performed in 2018 at the University of Tasmania; participants were medical students in year three of the Bachelor of Medicine Bachelor of Surgery course. This was a cross-sectional study which used a mixed-method survey before and after a lecture series to assess medical students' perspectives on history of medicine. Intervention: Historical perspectives were incorporated into existing surgical pathology tutorials. Main outcome measures: Students completed a survey on medical history before and after the lecture series. The survey used both qualitative and quantitative measures to assess students' perception of the utility of medical history and how it was taught in this project. Results: In the initialquestionnaire, students indicated they believed medical history would help make them better doctors and enhance their learning of pathology. In the final questionnaire, students agreed that learning medical history was important in becoming a doctor. Students enjoyed the content and found the integration of history and pathology beneficial to learning. Conclusion: This study demonstrates one method by which to increase medial history teaching without major alterations to an existing medical curriculum.

Management of post-surgical wounds in general practice.

BACKGROUND: The availability of complex wound dressings following progressive innovations, increasing demand for hospital beds and the early discharge of post-operative patients have shifted the sharing of care of such patients from hospital specialists to general practitioners (GPs). Although several published guidelines on the management of chronic wounds exist, there is a lack of similar material addressing the assessment and management of post-surgical wounds. OBJECTIVE: The aim of this article is to provide a practical guideline for identifying early complications of post-surgical wounds and managing patients with complex wound dressing systems such as vacuum-assisted closure. DISCUSSION: Early detection of wound complications is crucial to improving patients' quality of life and reducing hospital readmission. GP competency in the proper application of complex dressings is one component that can improve these factors. Effective communication, including documentation, between hospitals, community nurses and GPs ensures smooth management of wound care for patients.

Barriers and enablers to patient recruitment for randomised controlled trials on treatment of chronic wounds: A systematic review.

Randomised controlled trials represent the gold standard in intervention efficacy evaluation. However, suboptimal recruitment affects completion and the power of a therapeutic trial in detecting treatment differences. We conducted a systematic review to examine the barriers and enablers to patient recruitment for randomised controlled trials on chronic wound treatment. Review registration was under PROSPERO 2017:CRD42017062438. We conducted a systematic search of Ovid MEDLINE, EBSCOhost CINAHL, Ovid Cochrane Library, Ovid EMBASE, and Ovid PsycINFO databases in June 2017 for chronic wound treatment randomised controlled trials. Twenty-seven randomised controlled trials or qualitative studies met the inclusion criteria. Among the 24 randomised controlled trials, 21 were assessed as low quality in relation to recruitment, and 3 were assessed as high quality. All 27 studies reported barriers to recruitment in chronic wound randomised controlled trials. The reported barriers to recruitment were: study-related, patient-related, clinician-related, health system-related, and/or operational-related. No study reported recruitment enablers. To enhance randomised controlled trial recruitment, we propose the need for improved integration of research and clinical practice. To alleviate the problems arising from inadequate reporting of randomised controlled trials, the Consolidated Standards of Reporting Trials Statement could include an additional item on recruitment barriers. This approach will allow for increased awareness of the potential barriers to recruitment for Randomised controlled trials (RCTs) in both wound management and other health care research.

Anatomical variations of the renal arterial vasculature: An Australian perspective.

INTRODUCTION: Variations of the renal arteries have been studied and published across various population groups, but similar information for the ethnically diverse nation of Australia is lacking. This study describes the pattern of renal artery anomalies in a section of the Australian population based on computed tomography (CT) angiograms of the abdomen and cadaveric dissection. METHODS: The renal arterial vasculature of 594 kidneys from 300 subjects (28 cadavers, 272 CT) was studied. The number and pattern of renal arteries were categorised on the basis of laterality, point of origin and termination in the kidney (superior pole, hilum and inferior pole), symmetry and sex. RESULTS: Multiple renal arteries were discovered in 22% of subjects and 12.12% of kidneys. The most common pattern observed was the presence of one variant renal artery (93.1%), compared to the finding of two (5.6%) and three (1.4%) multiple arteries. The aorta was the most frequent site of origin for anomalous vessels, while the hilum was the predominant point of entry. No significant difference was established between left- and right-sided kidneys (13.8% vs. 12.5%; P = 0.627); however, unilateral distribution was more common than bilateral additional renal arteries (16.7% vs. 3.4%; P < 0.01), and variations among males were more than females (27.2% vs. 15.2%; P < 0.05). A higher rate of multiple renal arteries was noted in cadaveric dissections compared to CT images (46.4% vs. 19.5%; P < 0.01). CONCLUSION: These findings provide application of an evidence-based teaching tool that facilitates education regarding renal arterial variations in Australia.

Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial.

BACKGROUND: Venous leg ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of ulcers remain unhealed after 2 years, and ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the inflammatory processes present in venous ulcers is a possible strategy. Limited evidence suggests that a daily dose of aspirin may be an effective adjunct to aid ulcer healing and reduce recurrence. The Aspirin in Venous Leg Ulcer study (ASPiVLU) will investigate whether 300-mg oral doses of aspirin improve time to healing. METHODS/DESIGN: This randomised, double-blinded, multicentre, placebo-controlled, clinical trial will recruit participants with venous leg ulcers from community settings and hospital outpatient wound clinics across Australia. Two hundred sixty-eight participants with venous leg ulcers will be randomised to receive either aspirin or placebo, in addition to compression therapy, for 24 weeks. The primary outcome is time to healing within 12 weeks. Secondary outcomes are ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks. DISCUSSION: The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous leg ulcers. Study completion is anticipated to occur in December 2018. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12614000293662.

Medical student preferences for self-directed study resources in gross anatomy.

Gross anatomy instruction in medical curricula involve a range of resources and activities including dissection, prosected specimens, anatomical models, radiological images, surface anatomy, textbooks, atlases, and computer-assisted learning (CAL). These resources and activities are underpinned by the expectation that students will actively engage in self-directed study (SDS) to enhance their knowledge and understanding of anatomy. To gain insight into preclinical versus clinical medical students' preferences for SDS resources for learning gross anatomy, and whether these vary on demographic characteristics and attitudes toward anatomy, students were surveyed at two Australian medical schools, one undergraduate-entry and the other graduate-entry. Lecture/tutorial/practical notes were ranked first by 33% of 156 respondents (mean rank ± SD, 2.48 ± 1.38), textbooks by 26% (2.62 ± 1.35), atlases 20% (2.80 ± 1.44), videos 10% (4.34 ± 1.68), software 5% (4.78 ± 1.50), and websites 4% (4.24 ± 1.34). Among CAL resources, Wikipedia was ranked highest. The most important factor in selecting CAL resources was cost (ranked first by 46%), followed by self-assessment, ease of use, alignment with curriculum, and excellent graphics (each 6-9%). Compared with preclinical students, clinical students ranked software and Acland's Video Atlas of Human Anatomy higher and felt radiological images were more important in selecting CAL resources. Along with other studies reporting on the quality, features, and impact on learning of CAL resources, the diversity of students' preferences and opinions on usefulness and ease of use reported here can help guide faculty in selecting and recommending a range of CAL and other resources to their students to support their self-directed study.

Interns' Day in Surgery: improving intern performance through a simulation-based course for final year medical students.

BACKGROUND: The transition from final year medical student into the first year of clinical practice is known to be associated with anxiety and stress that ultimately affects job performance. Studies have shown that much of this stress and anxiety results from a junior doctor's lack of confidence in performing a number of basic tasks. We investigated if implementation of a half-day simulation-based course in the final year medical students results in increased confidence in performing these tasks. METHODS: Final year medical students of the University of Tasmania's School of Medicine posted at the Royal Hobart Hospital participated in a half-day simulation course, comprised of multiple simulation stations, which required students to perform the basic tasks a competent surgical intern would be expected to complete. Students completed a survey which investigated their confidence with each task before and after the course. RESULTS: Overall, the majority of students thought that the Interns' Day in Surgery course was useful. The most significant improvements perceived were in case presentation (57.5% to 94.6%; P = 0.02) and communication with patients and other professional colleagues (55.5% to 75.5%; P = 0.01). A follow-up survey of doctors who attended this course reinforced its benefits. CONCLUSION: Simulation-based courses in clinical practice provide good learning opportunities for final year medical students within the curriculum. This study confirms significant gains in all skills categories practised during the course with perceived benefits subsequently identified by interns. This should lead to a less stressful and more successful transition from student to doctor and ultimately, better patient care.

Management of venous leg ulcers in general practice - a practical guideline.

BACKGROUND: Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. OBJECTIVE: To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. CONCLUSION: Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. DISCUSSION: Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.