Robotic assisted surgery in gynecology: current insights and future perspectives

To focus on the recent adoption, patents, experience, and future of Robotic assisted surgery (RAS) applications in gynecologic surgery, a computer aided and manual search for clinical and systematic reviews, randomized controlled trials, prospective observational studies, retrospective studies and case reports published between 1970 and January of 2011 has been performed. The use of RAS in gynecologic patients includes hysterectomy, myomectomy, tubal reanastomoses, radical hysterectomy, lymph node dissection, and sacrocolpopexies. Although individual studies vary, gynecological RAS is often associated with longer operating room time but similar clinical outcomes, decreased blood loss, and shorter hospital stay. RAS procedures on women have, however, their own limitations: the patented equipment is very large, bulky, and expensive, the staff must be trained specifically on draping and docking the instruments, the lack of surgical haptic feedback, a limited vaginal access, a limited specific instrumentation, and the need for larger port incisions requiring fascial closure. The RAS significantly facilitates gynecologic surgery, even if well-designed, prospective studies are needed to fully assess the value of this equipments in particular studies with well-defined clinical and long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life. The future of robotic surgery in gynecology may be bright, but currently, caution is advisable and clinically meaningful long-term outcomes are needed. These recent patents, however, has exciting potential for future applications, especially in long-distance telesurgery and might change the paradigm of gynecologic surgery in the future.     

Thapsigargin down-regulates protein levels of GRP78/BiP in INS-1E cells

Pancreatic β-cells have a well-developed endoplasmic reticulum (ER) and express large amounts of chaperones and protein disulfide isomerases (PDI) to meet the high demand for synthesis of proteins. We have observed an unexpected decrease in chaperone protein level in the β-cell model INS-1E after exposure to the ER stress inducing agent thapsigargin. As these cells are a commonly used model for primary β-cells and has been shown to be vulnerable to ER stress, we hypothesize these cells are incapable of mounting a chaperone defense upon activation of ER stress. To investigate the chaperone expression during an ER stress response, induced by thapsigargin in INS-1E cells, we used quantitative mass spectrometry based proteomics. The results displayed a decrease of GRP78/BiP, PDIA3 and PDIA6. Decrease of GRP78/BiP was verified by Western blot and occurred in parallel with enhanced levels of p-eIF2α and CHOP. In contrast to INS-1E cells, GRP78/BiP was not decreased in MIN6 cell or rat and mouse islets after thapsigargin exposure. Investigation of the decreased protein levels of GRP78/BiP indicates that this is not a consequence of reduced mRNA expression. Rather the reduction results from the combined effect of reduced protein synthesis and enhanced proteosomal degradation and possibly also degradation via autophagy. Induction of ER stress with thapsigargin leads to lower protein levels of GRP78/BiP, PDIA3 and PDIA6 in INS-1E cells which may contribute to the susceptibility of ER stress in this β-cell model.     

Applying voting rules to panel-based decision making in LCA

Background, aim, and scope  Cross-category weighting is one possible way to facilitate internal decision making when dealing with ambiguous impact assessment results, with simple additive weighting being a commonly used method. Yet, the question as to whether the methods applied today can, in fact, identify the most “environmentally friendly” alternative from a group perspective remains unanswered. The aim of this paper is to propose a new method for group decision making that ensures the effective identification of the most preferable alternative. Materials and methods  Common approaches to deduce a single set of weighting factors for application in a group decision situation (e.g., arithmetic mean, consensus) are discussed based on simple mathematics, empirical data, and thought experiments. After proposing an extended definition for “effectiveness” in group decision making, the paper recommends the use of social choice theory whose main focus is to identify the most preferable alternative based on individuals’ rankings of alternatives. The procedure is further supplemented by a Monte Carlo analysis to facilitate the assessment of the result’s robustness. Results  The general feasibility of the method is demonstrated. It generates a complete ranking of alternatives, which does not contain cardinal single scores. In terms of effectiveness, the mathematical structure of the procedure ensures the eligibility for compromise of the group decision proposal. The sensitivity analysis supports the decision makers in understanding the robustness of the proposed group ranking. Discussion  The method is based upon an extended definition of effectiveness which acknowledges the eligibility for compromise as the core requirement in group decision contexts. It is shown that multi-attribute decision-making (MADM) methods in use in life cycle assessment (LCA) today do not necessarily meet this requirement because of their mathematical structure. Further research should focus on empirical proof that the generated group results are indeed more eligible for compromise than results generated by current methods that utilize an averaged group weighting set. This is closely related to the question considering under which mathematical constraints it is even possible to generate an essentially different result. Conclusions  The paper describes a new multi-attribute group decision support system (MGDSS) for the identification of the most preferable alternative(s) for use in panel-based LCA studies. The main novelty is that it refrains from deducing a single set of weighting factors which is supposed to represent the panel as a whole. Instead, it applies voting rules that stem from social choice theory. Because of its mathematical structure, the procedure is deemed superior to common approaches in terms of its effectiveness. Recommendations and perspectives  The described method may be recommended for use in internal, panel-based LCA studies. In addition, the basic approach of the method—the combination of MADM methods with social choice theory—can be recommended for use in all those situations where multi-attribute decisions are to be made in a group context.     

Functional variability of the Lr34 durable resistance gene in transgenic wheat

Breeding for durable disease resistance is challenging, yet essential to improve crops for sustainable agriculture. The wheat Lr34 gene is one of the few cloned, durable resistance genes in plants. It encodes an ATP binding cassette transporter and has been a source of resistance against biotrophic pathogens, such as leaf rust (Puccinina triticina), for over 100 years. As endogenous Lr34 confers quantitative resistance, we wanted to determine the effects of transgenic Lr34 with specific reference to how expression levels affect resistance. Transgenic Lr34 wheat lines were made in two different, susceptible genetic backgrounds. We found that the introduction of the Lr34 resistance allele was sufficient to provide comparable levels of leaf rust resistance as the endogenous Lr34 gene. As with the endogenous gene, we observed resistance in seedlings after cold treatment and in flag leaves of adult plants, as well as Lr34‐associated leaf tip necrosis. The transgene‐based Lr34 resistance did not involve a hypersensitive response, altered callose deposition or up‐regulation of PR genes. Higher expression levels compared to endogenous Lr34 were observed in the transgenic lines both at seedling as well as adult stage and some improvement of resistance was seen in the flag leaf. Interestingly, in one genetic background the transgenic Lr34‐based resistance resulted in improved seedling resistance without cold treatment. These data indicate that functional variability in Lr34‐based resistance can be created using a transgenic approach.     

Mitochondrial Control Region and microsatellite analyses on harbour porpoise (Phocoena phocoena) unravel population differentiation in the Baltic Sea and adjacent waters

The population status of the harbour porpoise (Phocoena phocoena) in the Baltic area has been a continuous matter of debate. Here we present the by far most comprehensive genetic population structure assessment to date for this region, both with regard to geographic coverage and sample size: 497 porpoise samples from North Sea, Skagerrak, Kattegat, Belt Sea, and Inner Baltic Sea were sequenced at the mitochondrial Control Region and 305 of these specimens were typed at 15 polymorphic microsatellite loci. Samples were stratified according to sample type (stranding vs. by-caught), sex, and season (breeding vs. non-breeding season). Our data provide ample evidence for a population split between the Skagerrak and the Belt Sea, with a transition zone in the Kattegat area. Among other measures, this was particularly visible in significant frequency shifts of the most abundant mitochondrial haplotypes. A particular haplotype almost absent in the North Sea was the most abundant in Belt Sea and Inner Baltic Sea. Microsatellites yielded a similar pattern (i.e., turnover in occurrence of clusters identified by STRUCTURE). Moreover, a highly significant association between microsatellite assignment and unlinked mitochondrial haplotypes further indicates a split between North Sea and Baltic porpoises. For the Inner Baltic Sea, we consistently recovered a small, but significant separation from the Belt Sea population. Despite recent arguments that separation should exceed a predefined threshold before populations shall be managed separately, we argue in favour of precautionary acknowledging the Inner Baltic porpoises as a separate management unit, which should receive particular attention, as it is threatened by various factors, in particular local fishery measures.     

The genetic population structure of the ant Plagiolepis xene-implications for genetic vulnerability of obligate social parasites

Obligatory social parasites, such as ant species that need colonies of other ant species for reproduction, are rare and many of them are classified as vulnerable. This is especially the case with highly adapted permanent inquilines that are specialised on one or a few host species. Their rarity may be due to reduced dispersal abilities, as a result of reduced body size, altered wing morphology, and curtailed nuptial flight, eventually leading to inbreeding. Furthermore, the host populations may differ in their ability to resist the parasite, yet the conditions of successful parasite invasion are largely unknown. Here we investigated the population structure of the inquiline ant Plagiolepis xene and its host P. pygmaea, using microsatellite data. Genetic differentiation, inbreeding, the effective population size and nest kin structure were analysed. We found that populations of P. xene are established by a single or at most a few individuals, and that the populations were genetically highly differentiated. However, within individual host populations the parasite is able to maintain panmixia, although data on the host suggests that the local distribution of the parasite also follows patterns of substructuring in the host population. Altogether our results suggest that inquiline parasite populations are genetically highly vulnerable.     

Identification of candidate risk gene variations by whole-genome sequence analysis of four rat strains commonly used in inflammation research

Background

The DA rat strain is particularly susceptible to the induction of a number of chronic inflammatory diseases, such as models for rheumatoid arthritis and multiple sclerosis. Here we sequenced the genomes of two DA sub-strains and two disease resistant strains, E3 and PVG, previously used together with DA strains in genetically segregating crosses.

Results

The data uncovers genomic variations, such as single nucleotide variations (SNVs) and copy number variations that underlie phenotypic differences between the strains. Comparisons of regional differences between the two DA sub-strains identified 8 genomic regions that discriminate between the strains that together cover 38 Mbp and harbor 302 genes. We analyzed 10 fine-mapped quantitative trait loci and our data implicate strong candidates for genetic variations that mediate their effects. For example we could identify a single SNV candidate in a regulatory region of the gene Il21r, which has been associated to differential expression in both rats and human MS patients. In the APLEC complex we identified two SNVs in a highly conserved region, which could affect the regulation of all APLEC encoded genes and explain the polygenic differential expression seen in the complex. Furthermore, the non-synonymous SNV modifying aa153 of the Ncf1 protein was confirmed as the sole causative factor.

Conclusion

This complete map of genetic differences between the most commonly used rat strains in inflammation research constitutes an important reference in understanding how genetic variations contribute to the traits of importance for inflammatory diseases.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2164-15-391) contains supplementary material, which is available to authorized users.     

Vergleichende Untersuchungen über die Wirkung verschiedener Wuchsstoffe auf das Wachstum einiger Pilze

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