Implementation of a fully digital histology course in the anatomical teaching curriculum during COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, many medical schools are forced to switch courses of the mandatory curriculum to online teaching formats. However, little information about feasibility and effectiveness is available yet about distance teaching in anatomy. The aim of this study was to evaluate the implementation of a histology course previously taught in a classroom setting into an online-only format based on video conference software. METHODS: Our course design included theoretical introductions, an online-adaptation of virtual microscopy used previously in the classroom, and active learning elements such as collaborative learning in breakout rooms, annotation assignments and multiple-choice questions. Two preclinical semester cohorts of around 400 second and third semester students were taught in histology in parallel courses, using the Zoom software platform. We analyzed data about student attendance during the course, summative quantitative and qualitative evaluation of the students and results of a written test required to pass the course. RESULTS: We observed that student attendance was high and stable during the 19 course days for both second and third semester, and only few students reported technical problems. There were no significant differences in examination results of second semester compared to the third semester, an unexpected result as the third semester already participated in the dissection course before. Similarly, no significant gender-related effects on the examination performance could be noted in both semesters. However, the age of students was negatively correlated with test scores in the second and third semester. Importantly, the overall evaluation of the digital version of the histology course was at least as positive as the in-person version over the past years. CONCLUSION: Together, we experienced that the implementation of a curricular histology course in an online-format is technically realizable, effective and well accepted among students. We also observed that availability and prior experience with digitized specimen in virtual microscopy facilitates transition into an online-only setting. Thus, our study supports the positive potential of distance learning for teaching anatomy during and after COVID-19 pandemic but also emphasizes the need for a synchronous learning environment with partially personnel-intensive small group settings to overcome passivity and inequality aspects, and to foster active learning elements.

Chemical anoxia activates ATP-sensitive and blocks Ca(2+)-dependent K(+) channels in rat dorsal vagal neurons in situ.

The contribution of subclasses of K(+) channels to the response of mammalian neurons to anoxia is not yet clear. We investigated the role of ATP-sensitive (K(ATP)) and Ca(2+)-activated K(+) currents (small conductance, SK, big conductance, BK) in mediating the effects of chemical anoxia by cyanide, as determined by electrophysiological analysis and fluorometric Ca(2+) measurements in dorsal vagal neurons of rat brainstem slices. The cyanide-evoked persistent outward current was abolished by the K(ATP) channel blocker tolbutamide, but not changed by the SK and BK channel blockers apamin or tetraethylammonium. The K(+) channel blockers also revealed that ongoing activation of K(ATP) and SK channels counteracts a tonic, spike-related rise in intracellular Ca(2+) ([Ca(2+)](i)) under normoxic conditions, but did not modify the rise of [Ca(2+)](i) associated with the cyanide-induced outward current. Cyanide depressed the SK channel-mediated afterhyperpolarizing current without changing the depolarization-induced [Ca(2+)](i) transient, but did not affect spike duration that is determined by BK channels. The afterhyperpolarizing current and the concomitant [Ca(2+)](i) rise were abolished by Ca(2+)-free superfusate that changed neither the cyanide-induced outward current nor the associated [Ca(2+)](i) increase. Intracellular BAPTA for Ca(2+) chelation blocked the afterhyperpolarizing current and the accompanying [Ca(2+)](i) increase, but had no effect on the cyanide-induced outward current although the associated [Ca(2+)](i) increase was noticeably attenuated. Reproducing the cyanide-evoked [Ca(2+)](i) transient with the Ca(2+) pump blocker cyclopiazonic acid did not evoke an outward current. Our results show that anoxia mediates a persistent hyperpolarization due to activation of K(ATP) channels, blocks SK channels and has no effect on BK channels, and that the anoxic rise of [Ca(2+)](i) does not interfere with the activity of these K(+) channels.

ATP-independent anoxic activation of ATP-sensitive K+ channels in dorsal vagal neurons of juvenile mice in situ.

The role of ATP in anoxic activation of ATP-sensitive K+ (KATP) channels was studied in dorsal vagal neurons of mouse brainstem slices. In the whole-cell configuration, cyanide-induced chemical anoxia evoked within 10 s a 300-pA outward current that gave rise to a hyperpolarization of 24 mV. These responses were mimicked by nitrogen-aerated saline, rotenone or diazoxide and abolished by tolbutamide. The cyanide-induced hyperpolarization was due to activation of 70 pS K(ATP) channels that were half-maximally blocked by 5 microM internal ATP. Dialyzing the cells with either 1, 20 or 0 mM ATP did not, however, affect the time to onset, the kinetics or the magnitude of the cyanide-induced hyperpolarization. Impairment of ATP consumption by ouabain, vanadate or reduced temperature had no effect either. Thus, anoxia-induced activation of these KATP channels cannot be explained by a fall of cellular ATP or a concomitant rise of ADP. Anoxia-related changes of the actin cytoskeleton or the composition of the plasma membrane are also not likely to be involved, as cytochalasin D did not affect the cyanide-evoked hyperpolarization and phosphatidylinositol 4,5-bisphosphate failed to decrease the ATP sensitivity of single KATP channels. Finally, because of a lack of effects of reduced/oxidized glutathione and the oxidase blocker diphenyliodonium on the cyanide-induced hyperpolarization, cellular redox state does not appear to be involved. Our results indicate that despite a high sensitivity to ATP in excised patches, anoxic activation of KATP channels is independent of cellular ATP. Rather the ATP block seems to be removed as a consequence of impaired mitochondrial function.

Developmental downregulation of ATP-sensitive potassium conductance in astrocytes in situ.

In many neural and non-neural cells, ATP-sensitive potassium (K(ATP)) channels couple the membrane potential to energy metabolism. We investigated the activation of K(ATP) currents in astrocytes of different brain regions (hippocampus, cerebellum, dorsal vagal nucleus) by recording whole-cell currents with the patch-clamp technique in acute rat brain slices. Pharmacological tools, hypoglycemia and specific compounds in the pipette solution (cAMP, UDP), were used to modulate putative K(ATP) currents. The highest rate of K(ATP) specific currents was observed with a pipette solution containing cAMP and external stimulation with diazoxide (0.3 mM). The diazoxide-activated current had a reversal potential negative to -80 mV and was inhibited by tolbutamide (0.2 mM). We found that not all cells activated a K(ATP) current, and that the portion of cells with functional K(ATP) channel expression was developmentally downregulated. Whereas diazoxide activated K(ATP) currents in 57% of the astrocytes in rats aged 8-11 days (n = 21), the rate decreased to 38% at 12-15 days (n = 29) and to 8% at 16-19 days (n = 12). No significant difference was observed for the three brain regions. In recordings without cAMP in the internal solution, only 21% (12-15 days; n = 19) or none (16-19 days; n = 7), respectively, showed a potassium current upon diazoxide application. This metabolically regulated potassium conductance may be of importance, particularly in immature astrocytes with a complex current pattern, which have a relatively high input resistance: K(ATP) currents activated by energy depletion may hyperpolarize the cells, or stabilize a negative resting potential during depolarizing stimuli mediated, e.g., by glutamate receptors and/or uptake carriers.

Anticonvulsant A(1) receptor-mediated adenosine action on neuronal networks in the brainstem-spinal cord of newborn rats.

Membrane potential of ventral respiratory group neurons as well as inspiratory-related cranial (hypoglossal) and spinal (C(1)-Th(4)) nerve activities were analysed in brainstem-spinal cord preparations from neonatal rats. Block of Cl(-)-mediated inhibition with bicuculline (plus strychnine) affected neither rhythmic depolarizations nor spike discharge in 23 of 30 ventral respiratory group cells. In the other seven neurons, block of inhibitory postsynaptic potentials evoked pronounced depolarizations and spike discharge that was synchronous with seizure-like spinal nerve activity. Respiratory hypoglossal nerve activity persisted after transection at the spinomedullary junction, whereas spinal rhythm was blocked. After transection, the moderate bicuculline-evoked seizure-like perturbation of hypoglossal nerve activity was abolished and rhythmic ventral respiratory group neuron activity was not disturbed, whereas epileptiform discharge persisted in spinal nerves. The seizure-like nerve activity and depolarization of the minor subpopulation of perturbed ventral respiratory group neurons were reversed by either adenosine or the A(1) adenosine receptor agonist 2-chloro-N(6)-cyclopentyladenosine. The A(2) receptor agonist CGS 21860 had no effect. In control preparations, inspiratory nerve activity and membrane potential fluctuations (29 of 35 cells) were not changed by adenosine, 2-chloro-N(6)-cyclopentyladenosine or CGS 21860. In the other six cells, adenosine evoked a hyperpolarization (<10 mV) with no major change in input resistance. The anticonvulsant effects of adenosine and 2-chloro-N(6)-cyclopentyladenosine were antagonized by the A(1) adenosine receptor blocker 8-cyclopentyl-1,3-dipropylxanthine. After pre-incubation with 8-cyclopentyl-1,3-dipropylxanthine, bicuculline also evoked seizure-like discharge in the hypoglossal nerve. The results indicate that seizure-like spinal motor output of the respiratory network upon block of Cl(-)-mediated inhibition is caused by disinhibition of spinal neuronal networks with afferent connections to the ventral respiratory group. Presynaptic A(1) adenosine receptors exert an anticonvulsant action on the disinhibited spinal motor network, but have no depressing effect per se on the isolated medullary respiratory network.

Kir2.4: a novel K+ inward rectifier channel associated with motoneurons of cranial nerve nuclei.

Members of the Kir2 subfamily of inwardly rectifying K+ channels characterized by their strong current rectification are widely expressed both in the periphery and in the CNS in mammals. We have cloned from rat brain a fourth subfamily member, designated Kir2.4 (IRK4), which shares 53-63% similarity to Kir2.1, Kir2.2, or Kir2.3 on the amino acid level. In situ hybridization analysis identifies Kir2.4 as the most restricted of all Kir subunits in the brain. Kir2. 4 transcripts are expressed predominantly in motoneurons of cranial nerve motor nuclei within the general somatic and special visceral motor cell column and thus are uniquely related to a functional system. Heterologous expression of Kir2.4 in Xenopus oocytes and mammalian cells gives rise to low-conductance channels (15 pS), with an affinity to the channel blockers Ba2+ (Ki = 390 microM) and Cs+ (Ki = 8.06 mM) 30-50-fold lower than in other Kir channels. Low Ba2+ sensitivity allows dissection of Kir2.4 currents from other Kir conductances in hypoglossal motoneurons (HMs) in rat brainstem slices. The finding that Ba2+-mediated block of Kir2.4 in HMs evokes tonic activity and increases the frequency of induced spike discharge indicates that Kir2.4 channels are of major importance in controlling excitability of motoneurons in situ.

KATP channel formation by the sulphonylurea receptors SUR1 with Kir6.2 subunits in rat dorsal vagal neurons in situ.

1. Functional and molecular properties of ATP-sensitive K+ (KATP) channels were studied in dorsal vagal neurons (DVNs) of rat brainstem slices using patch-clamp and single-cell antisense RNA amplification-polymerase chain reaction (PCR) techniques. 2. In the cell-attached configuration, 1 mM cyanide resulted in block of spontaneous firing and concomitant opening of single channels with a mean single open time of 2-3 ms and a burst duration of up to several hundred milliseconds. Inhibition of such single-channel activity with 200 microM tolbutamide led to the reappearance of spontaneous discharge. 3. Whole-cell recordings during anoxia revealed a hyperpolarization of the DVNs. Harvesting of cytoplasm, antisense RNA amplification and subsequent PCR showed coexpression for single DVNs of mRNA for the sulphonylurea receptor SUR1 isoform and for the inwardly rectifying K+ channel subunit Kir6.2, but not for the SUR2 or Kir6.1 isoforms of these channel/receptor subclasses. 4. Upon anoxia, a stable depolarization by less than 10 mV was observed in non-excitable cells in the dorsal vagal nucleus. These cells, which expressed glial fibrillary acidic protein (GFAP), showed a high level of mRNA for Kir6.2, a weak signal for SUR1, whereas SUR2 or Kir6.1 were not detected. 5. The results suggest that functional KATP channels in DVNs are constituted by the formation of Kir6.2 subunits with SUR1 receptors.

Synaptic inhibition in the isolated respiratory network of neonatal rats.

Gramicidin-perforated patch-clamp recording revealed phasic Cl(-)-mediated hyperpolarizations in respiratory neurons of the brainstem-spinal cord preparation from newborn rats. The in vitro respiratory rhythm persisted after block of gamma-aminobutyric acid (GABA), i.e. GABAA, receptor-mediated inhibitory postsynaptic potentials (IPSPs) with bicuculline and/or glycinergic IPSPs with strychnine. In one class of expiratory neurons, bicuculline unmasked inspiration-related excitatory postsynaptic potentials (EPSPs), leading to spike discharge. Bicuculline also blocked hyperpolarizations and respiratory arrest due to bath-applied muscimol, whereas strychnine antagonized similar responses to glycine. The reversal potential of respiration-related IPSPs and responses to GABA, muscimol or glycine was not affected by CO2/HCO3(-)-free solutions, but shifted from about -65 mV to values more positive than -20 mV upon dialysis of the cells with 144 instead of 4 mM Cl-. Impairment of GABA uptake with nipecotic acid or glycine uptake with sarcosine evoked a bicuculline- or strychnine-sensitive decrease of respiratory frequency which could lead to respiratory arrest. Also, the GABAB receptor agonist baclofen led to reversible suppression of respiratory rhythm. This in vitro apnoea was accompanied by a K+ channel-mediated hyperpolarization (reversal potential -88 mV) of tonic cells, whereas membrane potential of neighbouring respiratory neurons remained almost unaffected. Both baclofen-induced hyperpolarization and respiratory depression were antagonised by 2-OH-saclofen, which did not affect respiration-related IPSPs per se. The results show that synaptic inhibition is not essential for rhythmogenesis in the isolated neonatal respiratory network, although (endogenous) GABA and glycine have a strong modulatory action. Hyperpolarizing IPSPs mediated by GABAA and glycine receptors provide a characteristic pattern of membrane potential oscillations in respiratory neurons, whereas GABAB receptors rather appear to be a feature of non-respiratory neurons, possibly providing excitatory drive to the network.

ATP-induced membrane currents in ameboid microglia acutely isolated from mouse brain slices.

Microglial cells were harvested from the surface of corpus callosum slices acutely isolated from the brain of neonatal (five- to seven-day-old) mice. Transmembrane ionic currents were measured employing a standard whole-cell voltage-clamp technique. The extracellular application of 1 mM ATP triggered the generation of a complex membrane current comprising three components: (i) an initial fast inward current which had a reversal potential at about -20 to -15 mV; (ii) this initial component was followed by a steady-state inward current with reversal potential about -50 to -40 mV; and (iii) a delayed inward current with a reversal potential close to 0 mV. The first two components (fast and steady-state) had an activation threshold at 10 microM ATP, and 100 microM ATP evoked an almost maximal response. In contrast, the third component of ATP-induced inward membrane current could be observed only while 1 mM ATP was applied. The increase in concentration of tetra-anionic form of ATP (ATP4-) by removal of divalent cations from the bath solution substantially lowered the activation threshold for the delayed component of ATP-induced membrane current; conversely, lowering the ATP4- concentration (by replacing Ca2+ with Mg2+) resulted in its disappearance. These results suggest that ATP4- acts as a true agonist for the activation of the delayed ATP-induced membrane current. We conclude that microglial cells express several purinoreceptor subtypes. The activation of these receptors might play a role in intracellular signal transduction in brain microglia.

Membrane potentials and microenvironment of rat dorsal vagal cells in vitro during energy depletion.

1. Brainstem slices were taken from mature rats. In the dorsal vagal nucleus (DVNX), membrane potentials (Em) of neurons (DVNs) and glia, as well as extracellular oxygen, K+ and pH (Po2, aKo, pHo), were analysed during metabolic disturbances. 2. Postsynaptic potentials of DVNs, elicited by repetitive electrical stimulation of the solitary tract (TS), led to a secondary glial depolarization of up to 25 mV, a fall in Po2 of up to 150 mmHg, a rise in extracellular aKo of up to 9 mM, and a fall in pHo of about 0.2 pH units. 3. Hypoxic superfusates produced tissue anoxia, leading to an aKo increase of less than 2 mM and a pHo fall of 0.24 +/- 0.04 pH units (mean +/- S.D.). Glucose-free solution evoked, after a delay of more than 8 min, a slow rise in aKo of 1.9 +/- 0.8 mM, accompanied by a mean increase in pHo of 0.24 +/- 0.13 pH units. After pre-incubation in glucose-free solution, anoxia elevated aKo by up to 15 mM, whereas the anoxia-induced pHo decrease was completely blocked. 4. In 45 of 118 DVNs, anoxia elicited a persistent hyperpolarization of 15.6 +/- 5.0 mV. In the remaining DVNs, anoxic exposure either did not produce a change in Em (37%) or led to a depolarization of less than 10 mV (25%). A stable depolarization of 9 +/- 3.8 mV was detected in glial cells during anoxia. Similar responses were revealed in oxygenated glucose-free solution after a delay of 12-60 min. 5. The metabolism-related hyperpolarizations were blocked by 100-500 microM tolbutamide or 20-100 microM glibenclamide, leading to recovery of spontaneous (0.5-6 Hz) spike discharge. In these cells, 400-500 microM diazoxide evoked hyperpolarizations and blockade of spontaneous activity. 6. In DVNs and glial cells, a progressive depolarization of up to 40 mV in amplitude developed during anoxic exposure after pre-incubation in glucose-free solution. 7. The results show that oxygen or glucose depletion does not impair the viability of DVNX cells. The contribution of neuronal ATP-sensitive K+ (KATP) channels to this tolerance is discussed.

Phagocytozing ameboid microglial cells studied in a mouse corpus callosum slice preparation.

Highly motile brain macrophages/microglial cells were observed in the cingulum and supraventricular corpus callosum, an area termed by del Rio-Hortega the "fountain of microglia." This is the first study that uses time lapse video microscopy in acute cortical brain slices to analyze directly the motile and phagocytic behaviour of these cells. The cells migrated within minutes to the slice surface and actively screened their surrounding with velum-like processes. Dead/damaged cells on the slice surface were contacted by the processes and phagozytozed within minutes. A method to add red blood cells in a defined density was used to observe the phagocytosis.

Membrane properties of ameboid microglial cells in the corpus callosum slice from early postnatal mice.

Microglial cells in culture are distinct from neurons, macroglial cells, and macrophages of tissues other than brain with respect to their membrane current pattern. To assess these cells in the intact tissue, we have applied the patch-clamp technique to study membrane currents in microglial cells from acute, whole brain slices of 6-9-d-old mice in an area of microglial cell invasion, the cingulum. As strategies to identify microglial cells prior to or after recording, we used binding and incorporation of Dil-acetylated low-density lipoproteins, binding of fluorescein isothiocyanate-coupled IgG via microglial Fc-receptors, and ultrastructural characterization. As observed previously for cultured microglial cells, depolarizing voltage steps activate only minute if any membrane currents, while hyperpolarizing voltage steps induced large inward currents. These currents exhibited properties of the inwardly rectifying K+ channel in that the reversal potential depended on the transmembrane K+ gradient, inactivation time constants decreased with hyperpolarization, and the current was blocked by tetraethylammonium (50 mM). This study represents the first attempt to assess microglial cells in situ using electrophysiological methods. It opens the possibility to address questions related to the function of microglial cells in the intact CNS.

Microenvironment of respiratory neurons in the in vitro brainstem-spinal cord of neonatal rats.

1. O2-, K(+)- and pH-sensitive microelectrodes were used to measure extracellular oxygen pressure (PO2), K+ activity (aKo) and pH (pHo) in ventral regions of the medulla oblongata containing respiratory neurons in the in vitro brainstem-spinal cord preparation from 0 to 4-day-old rats. 2. The location of respiratory neurons was mapped by extracellular recordings with conventional microelectrodes, or with the reference barrel of ion-sensitive microelectrodes. The major populations of respiratory neurons were distributed in the ventrolateral reticular formation near the nucleus ambiguus at depths of 300-600 microns. In this area, aKo baseline increased from 3.2 to 3.8 mM whereas steady-state values of PO2 and pHo fell from 120 to 7 mmHg and from 6.9 to 6.7, respectively. 3. During rhythmic inspiratory discharges recorded with suction electrodes from ventral roots of spinal (C3-C5) and cranial (IX, X, XII) nerves, aKo transiently increased by up to 100 microM, and PO2 fell maximally by 0.4 mmHg. During episodes of non-rhythmic neuronal discharge, aKo increased by as much as 0.4 mM and PO2 decreased by about 10 mmHg. In contrast, no variations in pHo could be detected during such activities. 4. Activation of medullary neurons by tetanic electrical stimulation of axonal tracts in the ventrolateral column of the spinal cord at the level of the phrenic motoneuron pool produced aKo elevations of up to 5 mM, decreases of PO2 by up to 50 mmHg, and pHo increases by a maximum of 0.07 pH units. These aKo and PO2 transients were reduced by more than 80% during blockade of synaptic transmission with 5 mM manganese (Mn2+) and completely blocked by 1 microM tetrodotoxin (TTX). 5. The tissue PO2 gradient as well as activity-related decreases of PO2 were completely abolished after block of oxidative cellular metabolism by addition of 2-10 mM cyanide (CN-) to the bathing solution. 6. Inhibition of the Na(+)-K+ pump by addition of 3-50 microM ouabain (3-10 min) caused a reversible increase of aKo by 0.8-3 mM, a delayed recovery of stimulus-induced aKo elevations, and produced a disturbance of the respiratory rhythm. 7. The sensitivity of the respiratory network to oxygen depletion was tested by superfusing the neuraxis with hypoxic solutions gassed with N2 instead of O2 (5-20 min).(ABSTRACT TRUNCATED AT 400 WORDS)

Structured experiential learning exercises: a facilitation to more effective learning in clinical settings.

Structured experiential exercises can help to make students more aware of the learning skills required in each of the four phases of experiential learning. These exercises should be structured to increase the trust and communication between the clinical nursing instructor and the students, as well as to assist the students to understand better their own and others' values and group processes. We believe that exercises that fulfill these objectives enable the students to adjust better to the learning styles required in a clinical course. Moreover, students who obtain increased awareness of their own values and those of others may become more effective members of the nursing profession.