The use of a mixed reality breast simulator with an innovative touch map feedback system to teach breast history-taking and examination skills

Abstract #2105

Introduction: Physical examination remains an important method of breast cancer detection. Unfortunately, many health care professionals express concerns about missing breast lesions and current methods of teaching this essential skill are limited. Through an interdisciplinary collaboration, we created an immersive virtual patient to teach health professions students history-taking and breast examination skills.
 Methods: Fifteen physician's assistant (PA) and 13 medical students (MS) interacted with a mixed reality human (MRH, a computer avatar with a mannequin-based breast simulator) with a breast complaint (Figure 1).
 
 Students spoke to and touched the MRH to take a history and examine a simulated breast with two masses of differing size and consistency. Subjects were surveyed regarding the usefulness of the virtual teaching tool and composed a patient note documenting pertinent history and physical examination findings. Students received feedback regarding the content of their patient note (number of 17 essential content items documented) and on the completeness of their breast examination (percentage area covered) using a color-coded touch map.
 Results: Student feedback related to the utility of this virtual educational tool was positive. Students only documented a mean of 7.8±2.7 (range=4-15) essential content items in the breast history. The completeness of the breast exam was a mean of 82% (range=62% to 97%) of total breast area examined (Figure 2, green=area examined, red=area missed).
 
 More clinically experienced students (MS 3 and 4, N=9) performed better than those with no clinical experience (MS 1 and PA 1, N=19) in both history-taking (58% vs. 40%, p<0.05) and completeness of exam (90% vs. 84%, p<0.05). Fifty percent of students were able to locate at least one mass but only 14% were able to correctly document the location of both lesions.
 Conclusions: The simulated experience differentiated performance among students with varying levels of clinical experience and identified a need for improved teaching and greater practice among all students. MRH scenarios provide a less anxious learning environment for students to practice breast history-taking and examination.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2105.

Inhibition of a Golgi complex lysophospholipid acyltransferase induces membrane tubule formation and retrograde trafficking

Recent studies have suggested that formation of Golgi membrane tubules involves the generation of membrane-associated lysophospholipids by a cytoplasmic Ca2+-independent phospholipase A2 (PLA2). Herein, we provide additional support for this idea by showing that inhibition of lysophospholipid reacylation by a novel Golgi-associated lysophosphatidylcholine acyltransferase (LPAT) induces the rapid tubulation of Golgi membranes, leading in their retrograde movement to the endoplasmic reticulum. Inhibition of the Golgi LPAT was achieved by 2,2-dimethyl-N-(2,4,6-trimethoxyphenyl)dodecanamide (CI-976), a previously characterized antagonist of acyl-CoA cholesterol acyltransferase. The effect of CI-976 was similar to that of brefeldin A, except that the coatomer subunit beta-COP remained on Golgi-derived membrane tubules. CI-976 also enhanced the cytosol-dependent formation of tubules from Golgi complexes in vitro and increased the levels of lysophosphatidylcholine in Golgi membranes. Moreover, preincubation of cells with PLA2 antagonists inhibited the ability of CI-976 to induce tubules. These results suggest that Golgi membrane tubule formation can result from increasing the content of lysophospholipids in membranes, either by stimulation of a PLA2 or by inhibition of an LPAT. These two opposing enzyme activities may help to coordinately regulate Golgi membrane shape and tubule formation.

Analysis of inhibitory action of modified U1 snRNAs on target gene expression: discrimination of two RNA targets differing by a 1 bp mismatch

The modified U1 snRNA gene can suppress expression of a target transgene. In the present study, its potential utility to inhibit a dominant negative/gain of function mutation is explored. Using a green fluorescent protein (GFP) target gene, inhibition was achieved in all cells transduced with U1antiGFP directed at multiple sites within GFP. Using a chloramphenicol acetyltransferase (CAT) target gene, inhibition was not increased by increasing the hybridization domain from 10 to 16 bp or when a site in an upstream exon or intron was targeted. To determine if a U1 anti-target design could discriminate between two transcripts that differ by a 1-2 bp mismatch, GFPtpz and GFPsaph were chosen as targets because they share sequence homology except for three regions where a 1, 2 or 3 bp mismatch exists. The results demonstrated that U1antiGFP correctly reduced its cognate GFP expression by >90% and therefore U1 anti-target constructs are able to discriminate a 1 or 2 bp mismatch in their target mRNA. Thus, these U1 anti-target constructs may be effective in a strategy of somatic gene therapy for a dominant negative/gain of function mutation due to the discreteness of its discrimination. It may complement other anti-target strategies to reduce the cellular load of a mutant transcript.