Primary Literature In Clinical Neuroscience for In-Person Or Remote Instruction

Structure and function relationships in the nervous system are a major component of neuroscience education. Readings and/or discussion of lesion studies in animal models are often used to demonstrate how brain injury/damage affects specific behaviors or cognitive processes. In contrast, primary literature in clinical neuroscience is less often used to teach brain structure and function relationships and this literature often describes remarkable stories of preserved brain function despite major brain injury/lesion. Here we describe a series of published articles in clinical neuroscience that we used in an undergraduate neuroscience course that challenge the simplistic views of brain localization of function and demonstrate the dynamic and plastic properties of the brain. Discussion of these primary articles can take place in-person or remote via video conferencing platforms.

IgE-Mediated Systemic Anaphylaxis And Its Association With Gene Polymorphisms Of ACE, Angiotensinogen And Chymase

BACKGROUND

The renin-angiotensin system (RAS) protects the circulation against sudden falls in systemic blood pressure via generation of angiotensin II (AII). Previously, we demonstrated that patients with anaphylaxis involving airway angioedema and cardiovascular collapse (AACVS) had significantly increased "I" gene polymorphisms of the angiotensin-converting-enzymes (ACE). This is associated with lower serum ACE and AII levels and was not seen in anaphylaxis without collapse nor atopics and healthy controls.

OBJECTIVES

To examine the angiotensinogen (AGT-M235T) and chymase gene (CMA-1 A1903G) polymorphisms in these original subjects.

METHOD

122 patients with IgE-mediated anaphylaxis, 119 healthy controls and 52 atopics had polymorphisms of the AGT gene and chymase gene examined by polymerase chain reactions and gel electrophoresis. Their previous ACE genotypes were included for the analysis.

RESULTS

AGT-MM genes (associated with low AGT levels) were significantly increased in anaphylaxis (Terr's classification). When combined with ACE, anaphylaxis showed increased MM/II gene pairing (p<0.0013) consistent with lower RAS activity. For chymase, there was increased pairing of MM/AG (p<0.005) and AG/II and AG/ID (p<0.0073) for anaphylaxis consistent with lower RAS activity. A tri-allelic ensemble of the 6 commonest gene combinations for the healthy controls and anaphylaxis confirmed this difference (p=0.0001); for anaphylaxis, genes were predominately MM/AG/II or ID, while healthy controls were DD/MT/AG or GG patterns.

CONCLUSION

Our gene polymorphisms show lower RAS activity for anaphylaxis especially AACVS. Animal models of anaphylaxis are focused on endothelial nitric oxide (eNO) which is shown to be the mediator of fatal shock and prevented by eNO-blockade. The interaction of AII and eNO controls the microcirculation in man. High serum AII levels reduce eNO activity, so higher RAS-activity could protect against shock. Our data shows low RAS activity in anaphylaxis especially AACVS, suggesting the influence of these genes on shock are via AII levels and its effects on eNO.

Front and Back Flipping for Neurobiology! Developing a Hybrid Upper-Division Lab Course

Flipped instruction using online enrichment is a popular way to enhance active learning in the laboratory setting. Graduate student teaching assistants at University of California, Irvine flipped an upper division undergraduate neurobiology and behavior lab using the new online software platform "Rocketmix." The following research study compares the impact of pre-lab online instruction (front flipping) and post-lab online instruction (back flipping) on student exam performance. We describe a novel method for unbiased categorization of exam questions by degree of difficulty. Multi-choice instruction encourages students to consider all distractors and discourages verbal cues and process of elimination techniques. Eighteen identical questions were evenly distributed across exam versions with multiple choice instruction (single answer) or a more challenging multi-choice instruction (more than one answer). Student performance on multiple choice questions were used to categorize the degree of difficulty of questions that were presented in multi-choice format. Our findings reveal that pre-lab instruction resulted in better student performance compared with post-lab instruction on questions of moderate difficulty. This effect was significant for both male and female students. Student survey data on the flipped lab format is provided, indicating that students appreciated the online instructional modules, finding them both informative and useful during lab exercises and exams.

Don't Believe the Gripe! Increasing Course Structure in a Large Non-majors Neuroscience Course

Active teaching is increasingly accepted as a better option for higher education STEM courses than traditional lecture-based instruction. However, concerns remain regarding student preferences and the impact of increased course structure on teaching evaluations. Undergraduates in a non-majors neuropharmacology course were enrolled in an enriched blended course format, providing online case-based learning opportunities in a large lecture hall setting. Students working in small assigned groups solved weekly case studies developed to teach basic neuropharmacology concepts. All case study assignments were peer reviewed and content was further reinforced with a weekly online quiz. A comparison of scores on equivalent midterm and final exam questions revealed that students enrolled in the High-Structure course scored better than students from the previous year that took a more traditional Low-Structure lecture-based course. Student performance increased significantly for exam questions that required Bloom's level understanding. When surveyed, students in the High-Structure course reported some regret for the lack of traditional lecture and revealed some disapproval towards the extra work required for active teaching and peer review. Yet, we saw no change in quantitative instructor evaluation between sections, challenging the idea that student resistance towards increased work lowers course evaluation scores. Future instructors using active learning strategies may benefit from revealing to students the value of increased course structure on performance outcomes compared with traditional lecture courses.

Drugs & the Brain: Case-based Instruction for an Undergraduate Neuropharmacology Course

In order to transform a traditional large non-majors general education (GE) neurobiology lecture (Drugs & the Brain) into an active learning course, we developed a series of directed mini-cases targeting major drug classes. Humorous and captivating case-based situations were used to better engage and motivate students to solve problems related to neuropharmacology and physiology. Here we provide directed cases, questions and learning outcomes for our opiates mini-cases. In addition, we describe how case studies were incorporated into our course and assessed using peer review and online quizzing. An in-depth analysis of the overall course transformation on student exam performance, opinions and instructor evaluations can be found in the JUNE article Don't Believe the Gripe! Increasing Course Structure in a Large Non-majors Neuroscience Course.

The foliar trichomes of Hypoestes aristata (Vahl) Sol. ex Roem. & Schult var aristata (Acanthaceae) a widespread medicinal plant species in tropical sub-Saharan Africa: with comments on its possible phylogenetic significance

The micromorphology of foliar trichomes of Hypoestes aristata var. aristata was studied using stereo, light and scanning microscopy (SEM). This genus belongs to the advanced angiosperm family Acanthaceae, for which few micromorphological leaf studies exist. Results revealed both glandular and non-glandular trichomes, the latter being more abundant on leaf veins, particularly on the abaxial surface of very young leaves. With leaf maturity, the density of non-glandular trichomes decreased. Glandular trichomes were rare and of two types: long-stalked capitate and globose-like peltate trichomes. Capitate trichomes were observed only on the abaxial leaf surface, while peltate trichomes were distributed on both adaxial and abaxial leaf surfaces.

Age-related gene-specific changes of A-to-I mRNA editing in the human brain

A-to-I editing is an adenosine-to-inosine modification of mRNA particularly widespread in the human brain, where it affects thousands of genes. A growing body of evidence suggests that A-to-I RNA editing is necessary for normal development and maintenance in mammals and that its deficiencies contribute to a number of pathological states. In this study, we examined whether mRNA editing levels of two mRNA species, CYFIP2 and GABRA3, change with aging. CYFIP2 has been implicated in synaptic maintenance, while GABRA3 is a GABA receptor subunit, a part of the major inhibitory neurotransmitter system in the CNS. The levels of mRNA editing were assessed in cortex samples of 20 subjects 22-102 years old. The data show an age-dependent statistically significant decrease in editing in CYFIP2. GABRA3 editing remained much more stable with age, implying that age-related decline of RNA editing is gene-specific. This is the first report of age-dependent decline in A-to-I editing. Further examination of these and other vulnerable genes may reveal specific RNA editing mechanisms that contribute to the aging phenotype.

Single molecule PCR in mtDNA mutational analysis: Genuine mutations vs. damage bypass-derived artifacts

The area of somatic mtDNA mutation measurement is in a crisis because the methods used to quantify mtDNA mutations produce results varying by multiple orders of magnitude. The reason for these discrepancies is not clear, but given that most methods involve PCR, the prime suspect is PCR artifacts (e.g. spontaneous errors by the DNA polymerases used). In addition to simple misincorporation, another important source of artificial mutations is the conversion of chemically modified (e.g. damaged) nucleotides into mutations when bypassed by a thermostable DNA polymerase. These latter mutations are particularly difficult to account for because appropriate controls are not available. Here, we argue that single molecule PCR (smPCR) is uniquely positioned to account for these bypass-related artificial mutations and discuss the methodology involved in employing this technique.

Enhancing cognition after stress with gene therapy

Hippocampal function is essential for the acquisition, consolidation, and retrieval of spatial memory. High circulating levels of glucocorticoids (GCs), the adrenal steroid hormones secreted during stress, have been shown to impair both acquisition and retrieval and can either impair or enhance consolidation, depending on experimental conditions. In contrast, estrogen can enhance spatial memory performance and can block the deleterious effects of GCs on such performance. We therefore constructed a chimeric gene ("ER/GR") containing the hormone-binding domain of the GC receptor and the DNA binding domain of the estrogen receptor; as a result, ER/GR transduces deleterious GC signals into beneficial estrogenic ones. We show here that acute immobilization stress, before acquisition and retrieval phases, increases latencies for male rats in a hidden platform version of the Morris water maze. This impairment is blocked by hippocampal expression of the ER/GR transgene. ER/GR expression also blocks decreases in platform crossings caused by acute stress, either after acquisition or before retrieval. Three days of stress before acquisition produces an estrogen-like enhancement of performance in ER/GR-treated rats. Moreover, ER/GR blocks the suppressive effects of GCs on expression of brain-derived neurotrophic factor (BDNF), a growth factor central to hippocampal-dependent cognition and plasticity, instead producing an estrogenic increase in BDNF expression. Thus, ER/GR expression enhances spatial memory performance and blocks the impairing effects of GCs on such performance.

The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department

OBJECTIVE

A study has been conducted to identify the benefits to the accident and emergency (A&E) department of a hospital wide Picture Archiving and Communications System (PACS).

METHODS

The study was conducted in two parts: firstly while the hospital was using conventional radiographic films, and secondly when the PACS was in operation. For each part of the study, the diagnoses of radiographic images made by A&E clinicians were compared with those made by radiologists. This resulted in the estimation of the incidence of false negative findings by the A&E staff. The management of patients with such findings was studied to identify those for whom a change of treatment was required. Such data for the two periods, when film and when PACS was used, were compared.

RESULTS

It was found that the overall rate of misdiagnoses across all A&E patients who had radiography was low in both periods and there was a significant reduction when PACS was used (1.5% for film and 0.7% for PACS, 95% CI for difference between proportions: -0.014 to -0.0034), but the rate of serious misdiagnoses involving patient recall did not change significantly (95% CI for difference between proportions: -0.0059 to +0.0001).

CONCLUSIONS

When PACS was used the diagnostic performance by A&E staff improved by reducing false negative interpretations but the rate of serious misdiagnosis did not change.

The case for early intervention with pre-school dysfluent children

This paper aims to provide support for the hypothesis that early intervention with young dysfluent children is more successful over a shorter period of time than if speech and language therapy is delayed. The case histories of children between the ages of 3;06 and 5;11 years and 8;00 and 10;11 years who attended the Michael Palin Centre in a one year period were analysed. Those children whose histories included four or more risk factors were included in the study. The amount and duration of speech and language therapy along with the outcome was measured. Outcome was measured by the presence of stammering and parental and child concern. Preliminary findings indicate that the hypothesis will be supported. Full statistical analysis will be presented at the conference. Implications of the findings for service delivery will be discussed.

Duration of vaginal bleeding and trisomy at prenatal diagnosis

In the case-control study of 118 women with autosomal trisomy identified at prenatal diagnosis and their 442 karyotypically normal matched controls, we found that there was no overall association between risk of trisomy and the presence of vaginal bleeding during pregnancy. However, a lengthy duration of bleeding appears to predict increased risk of trisomy.

Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange

By studying the clearance of autologous labeled antibody-coated or heat-damaged erythrocytes, we showed that reversible blockade of the splenic component of reticuloendothelial function existed in 14 of 15 patients referred for treatment of nephritis or vasculitis. In 10 patients treated by plasma exchange--alone in three and combined with steroids and cytotoxic drugs in six--reversal of splenic blockade followed in nine, and in the three patients treated solely by plasma exchange this reversal was demonstrated to occur within 48 hours of the procedure. Only gradual reversal of splenic blockade was found in three of five patients treated by steroids with or without cytotoxic drugs; no change in splenic function was observed in two. When circulating immune complexes were detected by a C1q-binding assay, there was, in serial studies, an approximate inverse correlation between splenic function and the level of C1q-binding material, though hyposplenism was also a feature of patients in whom the C1q-binding assay was negative.

Splenic red cell pooling: a diagnostic feature in polycythaemia

Total red cell volumes and splenic red cell pools were measured in 31 patients with polycythaemia. 22 had polycythaemia vera (PV), 12 of whom had clinically detectable splenomegaly, and nine patients had secondary polycythaemia (PS). The mean red cell pool was 192.8 ml (SD 126.6) in PV (all cases), and 130.9 ml (SD 28.4 ml) in PV without splenomegaly; it was 61.1 ml (SD 8.3 ml) in PS. When expressed relative to spleen size (in cm), differences were even more striking: PV (all cases)--mean 13.7 ml/cm (SD 4.3); PV without splenomegaly--mean 12.7 ml/cm (SD 2.2); PS--mean 6.6 ml/cm (SD 1.2). Measurement of splenic red cell pool thus appears to be a valuable diagnostic tool for distinguishing between PV and PS. The findings point to the presence in PV of a splenic structural abnormality which is not simply an effect of the increased circulating red cell mass.