Sleep deprivation alters neutrophil functions and levels of Th1-related chemokines and CD4+ T cells in the blood.

PURPOSE: The state of knowledge about the effect of sleep deprivation on the immune system is scarce and conflicting. It would therefore be useful to investigate the consequences of sleep deprivation on the immune system. We have studied the effect of sleep deprivation on the changes in neutrophil functions, and the ex vivo proliferative pattern of CD4+ T lymphocytes in relationship with blood cytokine and chemokine levels due to the crucial role of these cells in mounting potent immune responses. METHODS: Healthy volunteers were followed for 3 weeks. They had normal sleep in weeks 1 and 3 and they were sleep-deprived on week 2, sleeping < 6 h per 24 h, a pattern similar to sleep behaviors of many chronically sleep-deprived individuals. We assessed the levels of Th1/Th2 and inflammatory cytokines and chemokines, CD4+ T cells, and the NADPH oxidase activation and phagocytic functions in neutrophils. RESULTS: Our results suggest that sleep deprivation leads to a decreased neutrophil capacity to phagocytose bacteria and activate NADPH oxidase (p < 0.05). Sleep deprivation was associated with a potential increase in CXCL9 levels and decrease in CXCL10/CXCL9 and CCL5/CXCL9 ratios (p < 0.05). Furthermore, our results suggest that the decrease in CD4+ T cell due to sleep deprivation was not associated with changes in their proliferation as observed by Ki67 levels, but rather, it correlated with changes in CXCL10/CXCL9 ratio (p < 0.05). CONCLUSIONS: Sleep deprivation may lead to a decreased phagocytosis and NADPH oxidase activity in neutrophils and a decrease in the levels of CD4+ T cells which is related to changes in the Th1-related chemokine balance.

Is the myonuclear domain ceiling hypothesis dead?

Muscle fibres are multinuclear cells, and the cytoplasmic territory where a single myonucleus controls transcriptional activity is called the myonuclear domain (MND). MND size shows flexibility during muscle hypertrophy. The MND ceiling hypothesis states that hypertrophy results in the expansion of MND size to an upper limit or MND ceiling, beyond which additional myonuclei via activation of satellite cells are required to support further growth. However, the debate about the MND ceiling hypothesis is far from settled, and various studies show conflicting results about the existence or otherwise of MND ceiling in hypertrophy. The aim of this review is to summarise the literature about the MND ceiling in various settings of hypertrophy and discuss the possible factors contributing to a discrepancy in the literature. We conclude by describing the physiological and clinical significance of the MND ceiling limit in the muscle adaptation process in various physiological and pathological conditions.

XIST in Brain Cancer.

Long non-coding RNAs (lncRNAs) make up the majority of the human genome. They are a group of small RNA molecules that do not code for any proteins but play a primary role in regulating a variety of physiological and pathological processes. X-inactive specific transcript (XIST), one of the first lncRNAs to be discovered, is chiefly responsible for X chromosome inactivation: an evolutionary process of dosage compensation between the sex chromosomes of males and females. Recent studies show that XIST plays a pathophysiological role in the development and prognosis of brain tumors, a heterogeneous group of neoplasms that cause significant morbidity and mortality. In this review, we explore recent advancements in the role of XIST in migration, proliferation, angiogenesis, chemoresistance, and evasion of apoptosis in different types of brain tumors, with particular emphasis on gliomas.

Students' Perceived Benefits of Integrating a BSc in Health Sciences within a Medical Degree at Sultan Qaboos University.

OBJECTIVES: After completing the pre-clinical phase of a Doctor of Medicine (MD) curriculum, undergraduate medical students may choose to add a Bachelor of Science (BSc) degree in health sciences to their MD degree. Limited data exists on the motives behind students' decisions to undertake such intercalated degrees. Hence, this study aimed to identify the factors that influence students in making this choice. METHODS: Undergraduate students who chose the research-based academic track of the intercalated phase of the BSc programme at the College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, between 2014-2018 were enrolled. A standardised and validated self-explanatory questionnaire examining motivations to join the intercalated phase was administered to all students in the first week of enrolment. RESULTS: Over a five-year period, out of 557 eligible students, 18 (3%) were enrolled in the intercalated phase and all completed the questionnaire. The mean age was 22 ± 1.5 years and the majority (83%) were female. Out of the 18 students, 10 (55%) had taken the university's foundation programme. A total of 45% of students chose to intercalate out of their own interest, regardless of career ambitions. The main reasons to intercalate were an opportunity to enhance research experience, alignment with long-term career goals and a chance to publish in indexed journals. CONCLUSION: Despite the benefits of obtaining an additional degree, a relatively small proportion of MD students were attracted to the intercalated phase. A better presentation of the BSc degree is needed to help students make a more informed decision.

Altered blood cytokines, CD4 T cells, NK and neutrophils in patients with obstructive sleep apnea.

BACKGROUND: There are contradictory reports on the effects of obstructive sleep apnea (OSA) on the immune system. In order to clarify the effect of OSA on the different components of the immune system, we studied the association of OSA with changes in cytokine and chemokine levels, proliferative patterns of CD4 and CD8 T lymphocytes as well as NK cells ex vivo and neutrophil functions. METHODS: We investigated the association of OSA with potential alterations in 14 Th1/Th2 and inflammatory cytokines and chemokines, CD4 and CD8 T cells, NK cells, and the NADPH oxidase activation and phagocytic functions in neutrophils. RESULTS: Our results suggest that the increase in CD4 T cell frequency in OSA is associated with an increased expression of the nuclear protein Ki67 (p<0.05; power>0.8), and is correlated with the levels of IL-1ß (p<0.05; power>0.8). The levels of IL-1ß as well as IL-6 showed a potential increase, while the levels of IFN-γ (p<0.05; power>0.8) and the ratio IFN-γ/IL-4 in the blood were possibly decreased in OSA. Additionally, we observed a potential increase in the expression of Ki67 in CD8hi and CD8lo NK cells (p<0.05; power>0.8). Our results also suggest that neutrophils have a decreased capacity to phagocytose bacteria and activate NADPH oxidase in OSA patients (p<0.05; power>0.8). CONCLUSION: OSA may be associated with inflammatory and pro-Th2 immune responses, an increased proliferative potential of NK and CD4 T cells and a decreased capacity of neutrophils to phagocytose bacteria and produce ROS.

Immunoreactivity of ubiquitin in human prostate gland.

BACKGROUND: Ubiquitin is a low molecular weight protein which has been detected in a variety of normal and cancerous tissues. It is involved in many regulatory processes including protein proteolysis. It has been implicated in tumor pathogenesis. The role of ubiquitin in human prostate gland is investigated in this study. METHODS: In this study, we utilized immunohistochemistry technique to localize ubiquitin in human prostate gland and correlate it with different pathological conditions of the prostate. RESULTS: Ubiquitin was localized in normal, benign prostatic hyperplasia (BPH) and prostatic adenocarcinoma with variations in the distribution and intensity. In BPH, ubiquitin immunoreactivity was localized mainly in the nuclei while in the adenocarcinoma was localized mainly in the cytoplasm. CONCLUSION: The presence of ubiquitin mainly in the nuclei and in the cytoplasm of BPH and prostatic adenocarcinoma, respectively, may suggest a role of ubiquitin in the development of the above mentioned conditions. Ubiquitin could be used as a potential marker for the diagnosis and prognosis of pathological conditions of the prostate.

In-vitro antimicrobial activity of Lawsonia inermis Linn (henna). A pilot study on the Omani henna.

OBJECTIVE: To investigate the antimicrobial activity of henna's fresh and dry leaves and seeds obtained from Oman. METHODS: This study was carried out at the College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman during the period January-June, 2004. Crude extracts of fresh and dry leaves and seeds were investigated for their antimicrobial activity against 3 standard bacterial strains namely: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Eleven different bacterial strains were obtained from patients attending the Sultan Qaboos University Hospital, Muscat, Sultanate of Oman. In addition, one Candida albicans (C. albicans) species was used for testing the antifungal activity of the Omani henna sample. RESULTS: All fresh and dry leaves and seeds of the Omani henna demonstrated antibacterial activity against all 3 standard strains and the 11 patients' isolated strains. Henna dry leaves demonstrated the best in-vitro antimicrobial activity and in particular against Shigella sonnei. However, henna fresh and dry seeds failed to show any activity against C. albicans. CONCLUSION: Omani henna does possess, in-vitro antibacterial activity against a wide spectrum of bacterial strains and C. albicans.

Teaching of an integrated human nervous system course in the Sultanate of Oman.

The College of Medicine at Sultan Qaboos University, Muscat, Oman has opted for the credit system that makes the designing of an integrated, multidisciplinary course a challenging proposition. The human nervous system course is no exception to that. The aim of the course is to guide students to understand the structure and function of the brain and to learn about the disorders afflicting it. There are 4 major problems encountered in this course. First, due to the relative weighting of different subjects in the course, the students tend to ignore the topics that have less credit hours and contribute fewer marks to the total marks. Secondly, students make minimal effort to analyze and synthesize information. Thirdly, poor knowledge of the English language hampers comprehension. Finally, it is felt that in its present form the course is too long. We are trying to evolve a version of hybrid problem-based learning that suits our local needs and resources.

Anatomy practical examinations: how does student performance on computerized evaluation compare with the traditional format?

Practical examinations in anatomy are usually conducted on specimens in the anatomy laboratory (referred to here as the "traditional" method). Recently, we have started to administer similar examinations online using the quiz facility in Moodle™. In this study, we compare student scores between two assessment environments viz. online and traditional environments. We hypothesized that regardless of the examination medium (traditional or online) overall student performance would not be significantly different. For the online medium, radiological images, prosected specimens, and short video clips demonstrating muscle action were first acquired from resources used for teaching during anatomy practical classes. These were optimized for online viewing and then uploaded onto Moodle learning management software. With regards to the traditional format, actual specimens were usually laid out in a circular stream. Identification tags were then attached to specific spots on the specimens and questions asked regarding those identified spots. A cohort of students taking practical examinations in six courses was studied. The courses were divided into three pairs with each pair credit-weight matched. Each pair consisted of a course where the practical examination was conducted online and the other in the traditional format. There was no significant difference in the mean scores within each course pair. In addition, a significant positive correlation between score in traditional and online formats was found. We conclude that mean grades in anatomy practical examination conducted either online or in the traditional format were comparable. These findings should reassure teachers intending to use either format for their practical examinations.

"Between a Rock and a Hard Place": The discordant views among medical teachers about anatomy content in the undergraduate medical curriculum.

The last two decades of medical education have been marked by a persistent push towards curricular reform. Anatomy as a discipline, the unshakable foundation of medical teaching for hundreds of years, has been at the centre of this development. Although it is widely agreed that for doctors to be competent, they need an adequate knowledge of anatomy underpinning medicine, there is much less agreement over the quantity required, and who should decide and define it. Many clinicians feel medical students are being under-trained in this basic medical science before reaching the clinical stages. Professional accreditation boards advocate the reduction of factual information in undergraduate medical courses. Anatomists complain of a progressive erosion of the time allocated to the subject. Caught in the midst of this controversy is the student of anatomy who is left bewildered and confused about what is required from him to become a safe and competent health professional. The way forward might, first, be for medical schools to facilitate discussions between students, anatomy professors, and clinicians to bring these divergent perspectives into alignment. Second, the anatomists need to re-invent themselves in two principal frameworks: first, to present the subject in the context within which it will be utilised by the student, and second to employ the overwhelming learning tool of today, i.e. technology, in their teaching and assessment of the subject.

Perceptions and Attitudes of Medical Students towards Two Methods of Assessing Practical Anatomy Knowledge.

OBJECTIVES: Traditionally, summative practical examination in anatomy takes the form of 'spotters' consisting of a stream of prosections, radiological images and dissections with pins indicating specific structures. Recently, we have started to administer similar examinations online using the quiz facility in Moodle™ (a free, open-source web application for producing modular internet-based courses) in addition to the traditional format. This paper reports on an investigation into students' perceptions of each assessment environment. METHODS: Over a 3-year period, practical assessment in anatomy was conducted either in traditional format or online via learning management software called Moodle™. All students exposed to the two examination formats at the College of Medicine & Health Sciences, Sultan Qaboos University, Oman, were divided into two categories: junior (Year 3) and senior (Year 4). An evaluation of their perception of both examination formats was conducted using a self-administered questionnaire consisting of restricted and free response items. RESULTS: More than half of all students expressed a clear preference for the online environment and believed it was more exam-friendly. This preference was higher amongst senior students. Compared to females, male students preferred the online environment. Senior students were less likely to study on cadavers when the examination was conducted online. Specimen quality, ability to manage time, and seating arrangements were major advantages identified by students who preferred the online format. CONCLUSION: Computer-based practical examinations in anatomy appeared to be generally popular with our students. The students adopted a different approach to study when the exam was conducted online as compared to the traditional 'steeplechase' format.

Anatomy "steeplechase" online: necessity sometimes is the catalyst for innovation.

In most medical schools, summative practical examination in Anatomy usually takes the format of a "steeplechase" ("spotters" or "bell ringers") conducted in the gross anatomy laboratory using cadaveric material and prosected specimens. Recently, we have started to administer similar examinations online using the quiz facility in WebCT™ and Moodle™. This article chronicles how we conceived and developed this method within the peculiar nature of our medical school setting. Over a five year period, practical summative examinations were organized as "steeplechase" online. The online examinations were administered using WebCT™ and later Moodle™ learning management software. Assessment "objects" were created from the materials available for anatomy teaching. These were digital images of cadaveric materials, radiological, and prosected specimens. In addition, short video clips of 30 seconds duration demonstrating muscle action were produced. These objects were optimized for online viewing and then uploaded onto the learning management software. A bank of questions (multiple choice or short answer type) was then created and linked to the assessment objects. These were used in place of the steeplechase in the computer laboratory. This method serves a crucial purpose in places like ours where continuous availability of human cadavers is impossible. Although time consuming initially, once questions are setup online, future retrieval, and administration becomes convenient especially where there are large batches of students. In addition, the online environment offers distinct advantages with regards to image quality, psychometric analysis of the examination and reduction of staff preparation time compared to traditional "steeplechase."

The State of Human Anatomy Teaching in the Medical Schools of Gulf Cooperation Council Countries: Present and future perspectives.

Available literature on medical education charts an emerging trend in the field of anatomy. In the past decade, assisted by innovations in informatics and the paradigm shift in medical education, the hands-on experience of cadaver dissection has progressively become a relic of the past. Within the context of the situation in Gulf Cooperation Council countries, this paper compares the traditional teaching approach with the modern one that tends to emphasise technical gadgetry, virtual reality and plastic models rather than hands-on-experience to impart knowledge and skill. However, cadaver-based learning is an important building block for the future physician and surgeon since clinical astuteness is likely to rely on skills gained from hands-on experience rather than the tendency to learning through virtual reality found in modern curricula.

Variations in the superficial palmar arch of the hand.

Variations in the pattern of the hand blood supply are frequently encountered. Awareness and identification of such variations is crucial during hand surgery. Thirty formaline fixed hands of male and female cadavers were dissected. All arteries contributing to the superficial palmar arch (SPA) of the hand were verified. In addition to the frequently encountered types of SPA, three very rare cases were described. In the first case, the superficial branch of the radial artery passed superficial to the thenar muscles with a diameter larger than that of the ulnar artery. In addition to the common palmar digital artery to the second web space, it gave the princeps pollicis and radialis indicis arteries. In the second case, the SPA was formed by the ulnar artery and was completed by a small branch from the deep branch of the radial artery. The palmar digital artery to the ulnar side of the fifth finger and the common palmar digital artery to the fourth web space arose from a common trunk. In the third case, incomplete SPA was formed by the median artery which only gave the princeps pollicis and radialis indicis arteries, while the ulnar artery supplied the rest of the hand except the ulnar side of the third finger and the second web space which were supplied by the deep palmar arch. Therefore, sound knowledge of the pattern of the blood supply of the hand by various techniques is crucial to avoid possible complications during hand surgery.

Bilateral Absence of the Arcuate Artery on the Dorsum of the Foot: With anomalous origin of dorsal metatarsal arteries.

Bilateral absence of the arcuate artery was observed during routine dissection of the lower limbs of a 60-year-old male cadaver. Running distally on the dorsal aspect of both feet and opposite the tarso-metatarsal joint, the dorsalis pedis artery diverged 2cm lateral to the tendon of the extensor hallucis longus. The 2nd dorsal metatarsal artery was found originating from the dorsalis pedis artery opposite the intermediate cuneiform bone. The 3rd and 4th dorsal metatarsal arteries originated from the lateral tarsal artery. Although absence of the arcuate artery has been previously described, the arterial variant described here is thought to be distinct from those previously reported. The variant 2(nd) dorsal metatarsal artery was found to originate from the dorsalis pedis artery. Knowledge of anatomical variations of arteries supplying the feet and toes has important clinical significance in reconstructive surgery and in determining associated pathology.

Clinical and molecular analysis of Grebe acromesomelic dysplasia in an Omani family.

Grebe syndrome is a rare autosomal recessive acromesomelic dysplasia. The syndrome was studied clinically, radiographically, and genetically in an Omani family with four affected children. The affected persons had normal axial skeletons, severely shortened, and deformed limbs with severity increasing in a proximo-distal gradient, and subluxated joints. The humeri and femora were hypoplastic with distal malformations. The radii/ulnae were shortened and deformed whereas carpal bones were invariably rudimentary or absent. The tibiae appeared rudimentary; fibulae were absent in two children, and some tarsal and metatarsal bones were absent. The proximal and middle phalanges were absent while the distal phalanges were present. The father and mother had short first metacarpal and middle phalynx of the fifth finger and hallux valgus respectively. Transition A1137G and deletion delG1144 mutations in the gene encoding the cartilage-derived morphogenetic protein-1 (CDMP-1) were identified in this family. The A1137G is a silent mutation coding for lysine, whereas the delG1144 predicts a frameshift mutation resulting in a presumable loss of the CDMP-1 biologically active carboxy-terminal domain. The affected siblings were homozygous for the delG1144 mutation while parents were heterozygous.